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HomeMy WebLinkAbout022-1080-50-001 C o (D ° a 0 °Fn � Y O O _N N N U N _ N ry C cp v > O U Co f0 O C Co °0 3 o _ Q) '3 r U n m x 3 I Z y CC III LL C L O ! a Q N N M Z E o v z a 4)° co Z o I O Z d I! c o aUi Z 'd' o = I N H r !i m E z N m �V N o U) O o 2 Q w Z I- Z o N Z N N LO y d CO O O ° N G G d E M N N Q p !. O N N N _> E w Z > Z o 0 v F. 0 0 �_ 3 31 � d IL v; N LL O O N fA � U y rn rn � ! � rn o I J 3 a c O O O ~ ( Y N C C U IL 0 0 o U) M U U C N N L Oi a C h 00 _ O) p CO o c o C C ° ICI N N C= 00 Z Z C Co T m o N W o E E C N r V it a m T CL 2 0 in 0 G r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER f art ns TOWNSHIP �ih y�c � I, SEC. � T 2�N-R W ADDRESS C��y'��r <ff ST. CROIX COUNTY, WISCONSIN SUBDIVISION r`t'es LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I IG _ d qz- �0?G� k 71/ INDICAT NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: �� SEPTIC TANK: Manufacturer: f J,�ej/i 5 �' 0' Liquid Capacity: lb�U Number of rings used: 0 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: r Number of feet from nearest Road: Front,Q Side Rear, O , DQ+ feet J0 From nearest property line ' Front.0 Side,0 Rear,(D feet Number of feet from: well 7� , , building: ,: 0 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 111,1 Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: C Width: S Length: Number of Lines: Z Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ®Rear,0 It Number of feet from well: /d0 t Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: � Number of pits: Diameter. Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: C,-Tacity: Number of rings used: Elevation nr bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of f(,r,t from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Y Dated: Plumber on job: License Number: `y///1 J 32 3/84:mj I DEPAATMENT OF INDUSTRY, INSPECTION REPORT FOR \tUf SAFETY&BUILDING ` LABOR HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION ' MADISON,WI 53707 State Plan I.D.Number: 'NW,NW, 28 , 28 , 18W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Kinnickinnic ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Lot AME *AoAdd ADDRESS OF PERMIT HOLDER: INSPECTION ATE: Rick Dennis Liberty Rd,River Falls ,WI 54022 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Rog er Timm 3224 St . Croix 128638 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER \ PROVIDED: PROVIDED: �J 70, I 9 U YES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH / ALARM: FEET FROM �/� LIN : s� r} 8<D AIR INLET: ❑YES O�NO Cz- ❑YES 0 NEAREST---► W d !� `�(J DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST— 11111 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: 1 MATERIAL PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR.8AREST MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: tt�� PIPES: LINE: 1 AI I T:FEET J e &l� l O10 b�U �8 } MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW [DYES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO [DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS [--]YES ❑NO ❑YES ❑NO BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: FEET FROM LINE: / ❑YES [:1 NO ❑YES ❑NO NEAREST �U 46 C1 X'. -7 Sketch System on Retain in county file for audit. Reverse Side. SIGNATUR TITLE: SBD-6710(R.06/88) �+ Zonin Administ Thomas C. Nelson I �. SANITARY PERMIT APPLICATION JYt 7 In accord with ILHR 83.05,Wis.Adm.Code COON STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than a�� 3 83z x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOC(TION li, N(O'/e IV 01%, S ZB T , N, R /9 E(or)W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# C11 STATE ZIP CODE PHONE NUMBEP SUBDIVISION NAME OR C//SM NUMBER ldfrrTIJ6 6q0 Z Z n Tom-- I. TYPE OF BUILDING: Check one CITY NEAREST ROAD I ( ) El Owned VILLAGE� �� I Y 4OWN OF: ❑ Public ®1 or 2 Fam. Dwelling—#of bedrooms� PARCEL TAX NUM ER(b�)ii 4ze III. BUILDING USE: (If building type is public,check all that apply) aO�a �ud 6—S-0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 El In-Ground 42 El Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 12.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 7_ _.r_= ]✓�C, , (mod U r V_•lJ Feet , Y Feet VII. TANK CAPACITY Site in allo Total #of Prefab. Fiber- Exper. s INFORMATION New n Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank JGISC� l t1 Clio Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/mE S1 -No.: Business Phone Number: Plumb is Address(Street,Ci State,Zip Code): , 3 .5�y6 2 7 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(ISu1rudes Groundwater a e ssue Issuing Agent Signature(No Sta s! Approved Owner Given Initial / � r0 Adverse De rmination / 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 f T _ 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 (SBD 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 served. Check only one and complete#of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. i GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 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 /t/ Location of Property i/ k AMA. Section 7 T f N - R W Township ��iid,�'fc_ Mailing Address Subdivision Name < Lot Number / Previous Owner of Property /1&,`n. Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resalg (spec house) ? Yes X. No Volume ^ ' and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION 1 (We) cehti.6y that att .6 tatement6 on this 6o4m ane tAue to the best 06 my (oun) knowi!edge; that 1 (we) am (a&e) the owne (.6) o6 the pnopenty dese i.bed in .this .in6o4mati.on 6o4m, by vi tue o6 a womanty deed neconded in the 066.ice o6 the County RegizteA o6 Deeds as Document No. -1 ; and that I (we) pnesentty own the proposed .6 to bon the sewage poe system (on 1 (we) have obtained an easement, to nun with the above des ch i.bed pnopwy, bon the } eonst.u.ctti.on o6 said system, and .the same has been duty neconded in the 066ice 06 ather- unty Reg.i.6 ten o6 Deeds, as Document No. ) . a' SIGNATUR OF OWNER SIGNATURE 0 -OWNER (IF APPLICABLE) DATE .SIGNED DATE SIGNED P - llC� imp t �111106 _ and Ccbataace ;area, husband» MW Stet se"Ats: .»........ .:...........»............ F� .... .... ., ............... ° M ChardA.. .. .. :.I�IT�.. 101Ial.Itl:jQ1t..CRL18<Cfil .................................. :.;.. ..£ ......... ... ............................. ...................... ....................... ............. . ......... ......... .. .. ............... ......... 4 g: 2_ .. ...... ....................... .......................................................... .................. ... ...»...»....w.. ................... .. Mts S�swiaM'tis�sibM stel salsw is .. ........ �.. eC4tS..... ......... . }' �« Lot l of-'"rtified Survey Maps, Volume S, Page 1487, Document Number 397707, . St. `Crain County Register.of Deeds, located in,the NW 1/4 of the MW 1/4 and '.' the SW 1/4;6f the NW::1/4 of Section 28, Township 28 Worth, Range 18 1"t, lbwn -of E'tnn' kinnic_, St.. Croix County. Wisconsin. ' r. !' ThisB:.ARt.. ploMel�. , 41 (is> ed y r iW to wereaatin: Easements, restrictions and rights of wry of reoi* TrsiOii this t .... ................. of ......... . Sept r. . }� ...... .. ds r � • •.V �» - (SEAL) .......:. _qr ........ .... .: . Her ....................................dd .............................................(SEAL) Constance Mae Cudd .... ,........ . .......... * AVM �11lZi3Alt0lr ACKNOWLEDOU1IN! ... .»... ------- STATE O! WISCONSIN .. .. .. Y............................................................. :. si' mss[.. . ................. 1l...... Psesaagy Sl1N before me ..z. ............. ».. Se�tet[tber: .............. l!$$ NM " +► .,.. »., ........ . Herbert a - cudd� co • tan4'll:: : !!A'Pii_1#1-OF WIMOMN x.ncr�6arG +. s&71elret-iy f; 'is.Eerllr.)....................... to aw l..................................w N as ....... i ' _, a TMt;11�1eT11Utlp11`'1M7�e QRA'T!e w atN - � '��'" 2.4 be art_lkttorne, at,Law M:.. ...1t1.. z.t.,....�►s= 11s� WX 1Q2,2 =t e"ry PawMe . c.e[ � r i 'w i R 11 tsrswisig�lt. X7 C 0061MCS is t t_�r' M iM aeo, r 4&A"M%M 40 s114U41.1.w UPON 4010.++a. y , H a r STC - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z 0 OWNER/BUYER Velj Al,e VIA-605 ROUTE/BOX NUMBER / feot IU A60W Fire Number CITY/STATE A ZIP lej PROPERTY LOCATION: /UW iL, A✓AI 14, Section, T N , R W, Town of �jN/Vi� t1m, / _ , St . Croix County , Subdivision 1151�Ve t 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 affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% 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 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 . 0 E I /WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth , herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE St . Croix County Zoning Office P .O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . DEPARTMENT QF I. / SAFE-ry & t ltitmr'•,' INDUSTHY,- f :v r.,:,L; REPORT ON SOIL BORINGS . AND 111`'I:"It LABOR AND ' ,� t PERCOLATION TESTS (115) '' �' "\'i t `"`' ' HUMAN RELATIONS , Cf MADISf7N lYl : . ,tt; (ILHR 83.090) & Chapter 145) - - --- - -N LOCATION: SECTION: TOWNSFIIP I.OT NO.:HI_K.NO: SUED VISION NAME' NU '/a ---�/ i S COUNTY: pWAr B,6BU ER'S A E: MAILIN ADDRESS: Cr r , t USE __ DATES OB ERVATIONS MADE iNO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE E DESC-RIPTIONS: PERCOLATION TESTS Residence XNew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system S -S CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL DING TANK: RECOMMENDED SYSTEM:(option al) M$ []U ©S ❑U ®S ❑U ❑S IMU S xU o? 7S' t/en s f` DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: M�n Floodplam, inricate Fl000plam eievauon: PROFILE DESCRIPTIONS BORING TOTAL- DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTHI NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV ON BACK.) N I " n l f Q 32 r. 1LZ 1 w c -3 RA Cl 3.LA M w p� // s M w n dit ;r 39 B- ^ ' job" ' n , 301' B. $ .,Y4 5 c1 Q • " / "A s 3 * * N t . n 9 ) s X Ia 7►., Q •,c PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. Pff-Ftj _PERIpD2 PE--R-1 D PER INCH 14) jer ass 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 vert cal 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. 6,0' O C2_ SYSTEM ELEVATION 93. 7$" SG �c /11= /001 , C Ste r way 1,4 1 Eft 111/bF_. B AM loo' Too.f 1"i;-oM j�•� jrfees it f 4 h area � �y , ore Holes 0 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 isconsirL 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: C 31 .� �e l ve r s ADDRESS: CERTIFICATION UMBER: PHONE NUMBER(optional): 7 7 7i _" •3032 CST SIC UR DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. JOB a ROHL & TIMM EXCAVATING z ar SHEET NO. � OF ` 310 Arch Street 3z 1 y HUDSON, WIS. 54016 CALCULATED BY ��� /�" DATE (715) 386-8664 3d -617 CHECKED BY DATE_ 8 SCALE c,�e G ..... 9� ,_ . /o.00 I.A. �Im.........��n- ° /' /iajt, jrI �Ct.a Gil f Q . ._ . ... PROW 2044 e Inc.,Groton,Man 01471. • JOB 2rn�S ROHL & TIMM EXCAVATING SHEET NO. Z OF Z 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY ` DATE (715) 386-8664 CHECKED BY DATE_ SCALE ... .... .. i ... .. r • a .. _ ........ . li ... .._ ... ...;,. :..._._ _. _.. :........ t-.. .... .......... ......... PRODUCT 2041 Inc.,Groton,M—01471. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, C DIVISION BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.09(1)&Chapter 145.045) L TION: SECTION: TOWNSHIP/ LOT NO NO.: SUBDIVISION NAME: �/44V/4 28 /Tze N/R/ho Ror / — !'EPrrFiEO Sp,?dBr �A,� COUNTY: OWNER'S NAME: MAILING ADDRESS: sr, c,poi,c .4/E.P -. /l�E,e FA-1 Ls Gyi, ,r4 o z z USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION1 (PROFILE DE R TIONS: PERCOLATION TESTS: Residence 3 *1,4 New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVINTIONAL:IMOUND:�+ IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING(TTA�NK:RECOMMENDED SYSTEM:(optional) �+ [-]U S ❑ VAS ❑U ❑ ®U ❑S 1L]I U CO�✓/�EN7/ONAG 8E0 ,�Q X 3,5� If Percolation Tests are NOT required ]DESIGN l RATE: If any portion of the tested area is in the r under s.H63.09(5)(b),indicate: L'Li9SS Floodplain,indicate Floodplain elevation: 41/ P PROFILE DESCRIPTIONS BO G TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NU ER DEPTH IN, ELEVATION OBSERVED EST.71GH EST TO BEDROCK,IF OBSERV D (SEE ABBRV.ON BACK.) B- / '7Z 90, /HONE 72 2' -a-� z a4& m� ar& 4� B-Z 1 '72 9/.4 NONE > 72 2 B-3 9,6 93, No A1,6 y,6 ,�- B- 8d 96 Sri- B_ PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- , O 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. o.PiG i vA Z SYSTEM ELEVATION .9GT6,�,yATE 98.5 SCALE �"- �D' - 3 .E 30 dP E� AIC Ae: n•!G l. c Tip a Al O P © � E tom. �o , i E � I 3d - -1 o_ E ,CoQiVE.L� 0f ._ ��. _ Dm� 3'dArV Z;AoE OF LOT / 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: 1-4" ✓. G',2E�o.P ° OG+DEiv Ei1/�/AJFE.P/Nc� Co, 71..2 V.0}- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 123 E. ELIV Ste- ,Pi;lAe wi jr =3s 8 7/14=4F Ps 96 3/ CST SIGC�RE: DISTRIBUTION: Original anri one copy to Local Auiho;ity, ?rosec Ly Owner an<i 5011 ,Tester. INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must include, Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial-project.;. ;. 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; ca= 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; S. 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 ser>arate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; f3. Cc,mplete 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; if. Sign the form and place your current address and your certification number; 12 i ake, legible Copies and distribute as re(auired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUT HORITY WITHIN 30 DAYS OF COMPLETION. � ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols s>t — stono fovrr 10") BR Bedrock cob Cot)hIe, (3- 10"1 SS -- Sandstone ar ._ Gravel ,Under 3") LS Liinestonc s — Sano HGVV High Grr�ui�<3�r Ater Sand Perc .. f colatioti fiat., Sand kt _ ;. .r=.11 Saran Bidq ` ral f rig s — I crarrty sand ter tiler Than s1 Samdy Lesi Man _.. l_rf mn Bn 3 H ,,..era a as BI -- B 1,,;k Gy — Gr1,y Cl m,, j ,,Qi, sic! r iory Cl av Loam mot IVI °i i1 Sk� ,ray , ; 3y IH-0 — illarae. r, a'Siti" �. x, ia3;( rni .£}i: teiYiilrE"`; zi':-f as i`t v `ti'RP -- V€ riicai i-oiir t i s TO THE OWNERA Ttiis s .,a test=epa,r is III airs£step Ira secllr)ir€i a sar'ita=ry (9k-?,n,it:. The county or the 1: epar rr3 nt rn ay repu(Ist v,i;lical:lwl i)`� rhis oi€ les, .r E.he f€;Id pv l l jo P7,,r:71( A corny it' >,I of ¢)I%;l <<; for the private .,.t.g. a 5t.e??? irnrl f j,BY:i`tlit c[pC)1rCatl`.Srl tY?�35, ,i; SEll.ta.taiFz3 to 4.I"w �apprul iiit.e local ad !t orit"y in orCfi2r 'to .- ,i,,,i!i .i povr'?it, The-,,anitary r)emlil rnwi t he=7r,8t,me—d 0,nd on ted piior to uh:., start of an i"G3ri�t?t1L;trf3n. i "ti,. ,r`.:,. l a r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, — _—__ ____ _ _ DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (ILHR 83.09(1) & Chapter 145) / s- Z41111 LOCATION: SECTION: TOWNSHIP LOT NO.:BLK.NQ.: SUBD VISION NAM :4 , �/ V4, 028 / N/R '� / —' I 7A ` t /4 e.s COUNTY: BUYER'S NA-ME: MAILING ADDRESS: o r —r0 *:k :* Datkiii Dennis 6.2,24. Eart fieao,% Ret.- Se-, c&14 AZ 83-25 USE DATES OB ERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence 3 ,ZNew ❑Replace / Q p — RATING:S=Site suitable for system U=Site unsuitable for system C.-5 � S 9 P CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOL G TANK: REC ENDED SYSTEM:(optional) y S ❑U ©S ❑U ®S ❑U ❑S XU ❑ o? treha—x DESIGN RATE: 1 If Percolation Tests are NOT re uired If an portion of the tested area is in the 11 under s. ILHR 83.09(5)(b),ind4ate: M/h / Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL 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.) to A ---—• � of 40 3A 3 N I 17" 32,, &n s • o 97 N / N w n N q A is a2 Lob" • r •i An Is" s tl / r • 1 / " 1" J BA h _ r l 19" Aa is .W * N 4 n w gi.B T 91' 9 0' I 1 » A w a If If I 4 3 * , 22 r ZA 1.2 .2 1+ n » PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES 1 NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- P , • 21 Zt 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 vert cal 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. W/ 9s-66, / `f SYSTEM ELEVATION IV�. 1117Y l o .S�c r.ver} _I" rIn .P /,00_" Togo ._1 uax_ / ,6 AA 7 a Aa fi TNT E , 0*- _14 _ HoJes _0 aJ n � . F �K r I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce urey and methoys spWfied in the isconsin,, Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge a kief. Ut ° ,,O C0F c N1!�G NAME (print)- TESTS WERE COM L O ON: 1 C ' ADDRESS: CERTIFI TION UMBER: PHONE NUMBER(optional): CST SI UR DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R, 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 SBD ' 63B5 To bmacomp|emandacuu/atcooi| test,Your `epurt must inoiuda: � 1. Complete |e�m\ dosmi[tinn� 2, The use section mustdvedyindnte whehorthisisemddenoouruommardu| project; 3' MAX\K0UKD number ofbodmnmsoroommorda! um: p|aoned� X |othk* new or ,op|mrommnt sysew 5� Comc�otetho,,uitvbi|itymtingbumm. AS(TEISSUIT&BLEPORAHQL0NGTANKONLYIFALL OTHER SY3TEK3S ARE RULED OUT BASED 0Q SOIL CONDITIONS; 6. PLEASE ue We wh evio,ionsoho�,,vn he,r for mritiny pmfQa de^nipnmns mnd oomoivting the plot plan; 7, MAKE A LEGIBLE dimOmm eoou/#e|y |aoating your us', |uo"'�tinns. Dra�ing to sm|o iu preferred, A separate ohemmaybc used ifdwxied; 8, fv8oke,ure your b:nrwmmrh and votico| e}evation refernnoe point arodenr�yohmmn'onda/a permanent; 8. Cn*p/nzo aU appruor�ato bm�w as to datos' nan.es'addm�m�' f|ond p|vm duru' »mron|n�ion test uxemp' ' rion. ifonprnp,iat'� ` ly |fvie inionratinn us4.1mx p|»in'e|nxaton)doe nm.apdy. place N4, in �heapp-opriam box; 11. Sign die form and p|amuyou,uu7wnv youronrdfiuminnnumber 12, legible and disuibmo as ALL SOIL, TESTSyNUST BE FILE[) WITH THE LOCAL.AUTNOR|TY WITHIN 30 DAYS OFCOMPLETION, ` ABBREVIATIONS FOR CERTIFIED SOIL TESTERS , ` ` Soil Separates and Textures Ulho Symbols m — Stmne (ove" lO^) 8R — Pvcirm1k, ` ooh — Cobb|a (3- 1U'') S8 — Sondrmnr � g, — Gravel (unve� 2r') LS — Limos tmm °� H� — 3und �VV — High 6 rouod',,,wW�, � cm — C"vna5mnd P*rc — Pe/co|a�ion R^m meds — KAediumDaod VV — Von| ` fs — FinoSnnd B|dg — Bui|ding in — Loamy Sand > — G/eatm' Thon SundvLoam ( — LnoTl`an Loan` Bn — 8nnmn °di — Si)t Luam B| — B|ack d — SUc Qv — G/uv ~d — OavLuam Y — YoUmm � m� �� �� R Fowl Sa � � dd — Si|ry [Joy Loam mm/ — Almuieo oc — SwndvQwy �� — x'0�h . cc — S@|ty C|ny hf — few, fve, fsint - °c — C|ay co — oommon'm` me P« — Poa, /nm — K8any' madium dkinct n — pmminonu HVVL — Highnwtor }me|' Six gnnem| saw texm/eo ` � � wurhoemmw; . fo, |iqmxjmmoad)opno | 8�-"I — 8anoh �m,k Refo'nloe Point ' ~ / ' ' ' � � ^ ' � TO THE OWNER: This soil test report is the fi"t step in secw5g a w0ary p"mrtZl-he.counly or the Depariment may request verification of this soil tat in the field prior to permir s�uanrc. A complete set of plans for the private sewage sys-tern and o permit application muq be aubmAud to the opp,op'iate |ucm| authority in order to � aWainu permit. Theooniun/y permit mug be obtained and pog,d v,!o,to the man of any construction. � r .�=.--•ems I 397 708 CERTIFIED SURVEY MAP LOCATED IN THE NW1 14 OF THE NW1 /4 AND THE SW1 /4 OF THE NW1 /4 OF SECTION 28, T28N, R18W, TOWN OF KINNICK1NNIC, ST. CROIX COUNTY, WISCONSIN NW CORNER � V-1 SECTION 28 _ /W T28N, R18W O o i • Ln FILED Ln � 4 NOV-121984 I U N P L_A T T E D L A' N D S — JAAES o.'CONNELL l Rogbfu of Deeds 9 2 9"E _ 1321 . 8 0' 6 �\ St. Golx Cornt� S 8 9°1 ' Wboonchn 1 ' --�- `� -- LOT 10T _4_ W I F, J / NI OA p °i ' v I zI t O POINT OF ZCI I BEGINNIN Q ¢I z LL LOT 2 � O J O N 88 047'20"E 570.07' I I v� Jai UJ I J IQ LOT 5 LU W I F-I — ._- "- — — �0 _ 5.04 Acres t i� 60 I-I f-I LU �I M. 219,471 S.F. t ^ o Q I O T I j� O O t W LOT z N In M J Q a I I I a- zt Z =1 I 1I /� > S88°47'20"W I 6 6 — — _ ._�.....a. ......../ 507.76' NORTH LINE OF W1 /4 CORNER LOT 3 w co y/SECTION 28 I!Tr?PwrGekT--4S;tED-SURVEY, T28N, R18W - - - - - - - - - - - - -._.- . - 'rna F.Q0RD�ED to VOL. 2,' PAGE 345 , 0) — — — — — — — — — — — — — cn LEGEND 0 1"x24" IRON PIPE, SET, WEIGHING 1 .68#/LINEAL FOOT. z • 1" IRON PIPE, FOUND. 0 1 1 /4" IRON PIPE, FOUND. w EXISTING FENCE.. m Iu NAPPROVED OWNER AND SUBDIVIDER NOV ( 84 STEVEN G. & GAIL L. CUDD 403 N. 4TH STREET 1 v ST. CROIX COUNTY RIVER FALLS, WISCONSIN •54022 COMP 2EHENSIVE PARKS PLANNING AND ZONING COMMITTEE This instrument drafted by SCALE IN FEET Michael Ogden 0' 2001 4 00' Volume 5 :'ui-e 1.!1