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HomeMy WebLinkAbout014-1031-40-000 \ ` \ � § / § $� f § = m $ ��2, > Q5 ]§ [o0 C`j 0 2� E\f \§/M. 2 »= E®£& @ . °( / � e®E0) » c 9- 966–m 15 6E– § ° � `C 7 � J E2� m $ &rkC, ; $%§$ e77�J § ® ci \�#kJf ; A? mE 0- k-2}kƒ \ 6o= lo8o =2asmo: % 2t °88 §� c ` aCL 0 § 6 - �#2�–< 4)0 ƒ k �2 )�t7770 ■ aEm tea»-E -% 7F— E $A§EE£ E 2 § 2 « \ \ E k ® m : o z 7 i a_ � \ )\ \ 2 k 2 X – § K 7 I E � & \ �. N [ �� VT.) f ) Ur ' ) ) i E 3 . , } / z n " cn \ / k , � s ƒ / aE = e) 2 § D ) < t m t « z � > ' o e e E o 3 •� $ � $ 2 2 2 � CL « « B C,') ^ m u m $ $ z _< ° S S E E 0 : � B * _ 0 0 0 0 0 0 � § m ° E 2 S / \ % / 0 0 ] Q 0 a C CL CO § k § o £ $ ] % 7 < z m R 2 0 I k s . \ 0 m k § ) e . q c 2 2 Cl) o c a 0 0 0 0 0 0 f e y . § 2 c = Q Q Q e . _ • o a a » R R & w 2 § ) ¢ \ / m _ \ $ ) 2 d S / k 5 % / § - \ \ / M \ o z \ / F- E 2 / � ® � L . k E ) ) k © § / J a 2 3 ) v DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 State Plan I.D.Number: NW4jSW4,S14,T29N-R15W CONVENTIONAL ❑ALTERNATIVE (If assignee) Town of Springfield ❑Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ron Brettingen R.R. Wilson, WI 54027 L"' "C�jl " BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 7ST REF.PT.ELEV.: Name of Plumber. MP/MPRSW No.: County: Sanitary Permit Number: Joseph J. Menter 5658 St. Croix 92506 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING DEDLABEL PROVIDED OVER DYES ❑NO DYES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:IVENT NLET FRESH ALARM' FEET FROM DYES ONO [:]YES ONO DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MAN UFACTURER. PROVIDED:LABEL PROVIDED:OVER ❑YES ONO ❑YES ONO OYES ONO LOCKING GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT LE FRESH LINE AIR INLET: (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF JDISTR.PIPE SPACING COVER N DIA st PITS LIQUID - f`�/!^(�as� TREN9 S. MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL'. BUILDING'. V NT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET ELEV.END: PIPES: FEET FROM LINE'. AIR INLET. NEAREST--► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 0 N PERMANENT MARKERS, OBSERVATION WELLS OIL COVER ITEXTURE El YES ONO DYES ONO DEPTH OVER TRENCH/B7EDGES DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED CENTER: '. OYES ❑NO ❑YES ❑NO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. I N O.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.: DIA, ELEV.: PIPES ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS' DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES — NO DYES : NO NEARES -T 72,5 X48 Sketch System on Re ain in county file for audit. Reverse Side. SIGNATURE'. TITLE Zoning Administrator DILHR SBD 6710(R.01/82) II Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 92506 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Brettin en, Ronald Springfield, Town of 034-1031-40-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: !( ) 14.29.15.2198 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic !�� j, fJ(`J Benchmark 1 7 Dosing Alt. BM Aeration Bldg.Sewer k'w J'" '- Holding St/Ht Inlet O TANK SETBACK INFORMATION St/Ht Outlet 39 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom l Dosing eader/ an. -ys� 17.1 Aeration Dist. Pie Z ,�7 '•O 2. !o Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM !`,�LL Lj Model Number ao�7vr�1 o.o 'L TDH Lift Friction Los em Head TDH Ft T•V Forcemain Length Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width _ Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS LJ• SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L CHI Manufacturer: INFORMATION CHA OR Typ�eg Of System: Ll I Model Number: C.o n `o-nj D IBUTION SYSTEM Header anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil E �Yees N No 9 Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#11: 4 /23 /O�O l S Inspection#2: Location: 925 Rustic Road 3 Glenwood City,WI 54013(NW 1/4 SW 1/4 14 T29N RI 5W) NA Lot - Parcel No: 14.29.15.219B 1.)Alt BM Description= d I 2.)Bldg sewer length=-- r�l�WGL -amount of cover= Plan revision Required? ❑ Yes Fal No Use other side for additional information. — - - - Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) IN -, io rO r UN - � 6's Ql� zo m � y � 1 a 0 � r �O C;zb / N UN 0. I Ln y s . I �G .m 4V pZ. ® C' ` 0 a 0 @ w e4 Parcel #: 034-1031-40-000 01/25/2006 03:51 PM PAGE IOF1 Alt. Parcel#: 14.29.15.219B 034-TOWN OF SPRINGFIELD Current X'', ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner MICHAEL J&BONITA J ANDERSON O-ANDERSON, MICHAEL J &BONITA J 925 RUSTIC RD 3 GLENWOOD CITY WI 54013 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description "925 RUSTIC RD 3 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acre : 21.000 Plat: 3743-CSM 13/3743 SEC 14 T29N R15 NW SW/SW SW BEIN LOT 2 Block/Condo Bldg: LOT 2 CSM 13/3743 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-1.5W SW SW Notes: Parcel History: Date Doc# Vol/Page Type 09/20/2001 657064 1722/78 WD 05/31/2001 646948 1649/631 WD 05/31/2001 646947 16491630 QC 10/18/1999 612195 1463/547 WD more 2005 SUMMARY Bill M Fair Market Value: Assessed with n 82075 259,800 Valuations: /0� ast Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,950 193,650 206,600 NO UNDEVELOPED G5 16.710 13,700 0 13,700 NO PRODUCTIVE FORST LANDS G6 2.290 4,100 0 4,100 NO Totals for 2005: General Property 21.000 30,750 193,650 224,400 Woodland 0.000 0 0 I Totals for 2004: General Property 21.000 30,750 193,650 224,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 wlsconsln APPLICATION FOR SANITARY PERMIT DILHR �v COUNTY - DEPRRTmEnTOF ��« ��) UNIFORM SANITARY PERMIT# � I RI.USTIII LRBOR 6 MUIRn REL.TIOnS /1)�� —Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT P OPERTY OWN MAILING-ADDRESS NGDDRESS , C)K) 6 r�� >'�t 11 /� . W, /s PROPERTY LOCATION CITY: AJ AJ1/4J1V1/4, S 1Y , ToZ , N, R /< go("r) W OWNO F. l�/'/�/lJ 7"�'G�L J, LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME ST ROAD, LAKE O LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 91 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: 14 New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity /Q®O Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: At d W eST P r t-C 4S°r-, IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): (06 Qq d "/qo X.Private ❑ Joint ❑ Public I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): nature: h>on/e S Number: M O S e P l- 3- A kQ^ Tt c- Plumber's Address: Na a of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �m M /LSO A ❑ Owner Given Initial I 1 �4 Approved Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ' To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your buiiding plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. I Ar State of Wisconsin \ Dep ; Industry, Labor and Duman Relations 4uly U, 19 \� VG '� SAFETY&BUILDINGS DIVISION awe" of Pluwinq 201 E. Wash i gt Avast c� g` P.O. Box 7969 Ma+riisoh# K 53707 Red ( Cedar Plumbing Meatiag 1120 North Broadway ie, MI 54751 I Plan Identification n ND. 86-03629-i Re; Pon 5rettea+, - Propwrty ►eeater Mitering idt, ,14,29*l5* Town of $pri field „ St. Croix ater as niter1114g data sUll1witted in acted with section ILMR 83.09 (7) (a)* hi is Administrative Code, has heea revieweId, Approval is heray grantad to allow the installation of a conventional system, This approval is for tAe to gromawater only and Own not include review of the desilm and size of ttm system. All other criteria is chapter ILMR 83, Otis. Adm. Code* mat he amt prior to issuance of the sanitary permit by the 10ca1 aahority. No installation can begin Wom issuance of that pa 'it This letter in no way relinquishes the use of soil mottling to determine the depth to high ymmukater on any other parcel or any other portion of the parcel than that descrtbed herein. In granting this appmval, the Division of Safety and buildings does not hold itself liable for any examination oversight, canstruction or any asmge that my molt in or air installation and reserves the rigs to oNer changes or additions $ ld conditions arise iog this necessary. This approval shall remain valid dories the site is altered to such a way that the depth to groundwater mould change,, or unless mater is ever present within the critical depth for system operation for at least seven cvese utive days DILHA-SBD-6423 (N.04/81) I State of Wisconsin ` Department of Industry, Labor and Human Relations Plumbing & iftatiag SAFETY&BUILDINGS DIVISION July 1,s l page 2 In the anent that this ral creates liquid waste problem at level or it any der ation*l or maintenar4e problen occur, tho provisions nemsary to resolve tie problems wall be commenced Upon M610 of approval by this department. 5inwely, . Edwd M. o CUSS Soil Scientist Section of Private swap 90:6616t ct !wary Jansky, Private a Consultant - District C►, Chippewa Falls ld C. Sarbery tat Administrator - St. Croix qty DILHR-SBD-6423(N.04/81) tn H 9 r STC - 105 a H ~' SEPTIC TANK MAINTENANC E AGREEMENT o St . Croix County z d 9 H OWNER/BUYER �? 0K.-CL c� \L VL- Ie)l� ROUTE/BOX NUMBERS ,"�� _Fire Number w /'ar } CITY/STATE (j Ieh /,,,7& 1 �r L l c�1 I. IP ¢ b ( 3 PROPERTY LOCATION : AV ICU 14, J UJ Section , T pZ!7 N , R _W, Town of 3 110,41, /V°� rr`a- I St . Croix County , Subdivision Lot number • I 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 i the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system . St . Croix . County residents m_ y 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 . Ho F, I/WE, the undersigned,, have read the above requirements and agree tA to maintain the private sewage disposal system in accordance with x r+ the standards set forth , herein, as set by the Wisconsin Depart- ►d 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 . SIGN DA'rE St . Croix County Zoning Office P. O. Box 9S- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . THE Aed Cedar Plumbing & Heating VWLUMBERYA HOME CENTER 1120 N. Broadway MENOMONIE, WISCONSIN 54751 Phone: 715-235-7341 July 2, 1985 St. Croix County Zoning Administrator Hammond, 'III 54©15 Attn: Tom Nelson Dear Tom: Enclosed is a copy of the Soil Monitoring Report as I submitted to the State. Yours very truly, RED CEDAR PL M3ING & HEATING Joe Manter JM:rb Enc. 'I lei r r) uepar.rnent of Industry, ! , 1P. F Safety & Buildings Division UKOU�tiI,�'ar, ; _� Y K Labor and human Relations MOPSI TOR ING P.O. Box 7969 Bureau of I'lumbing Madison Wisconsin 53707 ���O�T Note: Shc depths in inches. hocation: Lo t4Nu.TBlock Nc�. �IU!� W'zS ! /T y N!R/.. ,E�r)W , OBSERVATION i)[:!''i'Ii 1 �2()M StIR1 CF TU WATER/N0,'.'- �_. 1 __` ._ Wl.LL ! WELL WELL WELL DATE To V�_7:1-, 14 7 WIW�' ,�J Al �J Al ' 71 C t,�t O - e s Name: _ / G 'S - c^f MaKinf Ad dresls �' Sze A.,� t! -—- / G� N e, A/ /U V S�S W c D W'VUMBER: I 1 f S Go ,7 7S A/ �i`J d N 4S , WELL AJ YO v DEPTH: 30 �` 6 91,�, SCw 5o A l�j �p ' PRO?OSED INDIVIDUAL '—' SUBDIVISION LOT Z/0 Q✓.G qQR ippnfall Data Obtained Frorn:Q u,-.,Vco. 3 ewers tic r �?� (0 $�,' ' q'/ ) :,..i• `�s� �J- �Ftwt(� r�[..}.v`f- ,��J✓r 5/1�/Y- G/t�'�"vl�+S•9'c �/ , r 4 , 1. i MONTHLY DATA 7'� �� /1� �0 �J�S A) j s�O A) '9 g I ; Sept Oct 'Nov R.e c Jan Feb Total � _..._. March A r' v"��ayf Total (Need 7.6") F � Provide daily rainfall data on a separate sheet for March, April and Nay. Write total rainfall for March. April and May in the above boxes. �O 8 F ; ARTIFICIAI. DRAINAGE , Check the site for artificial drainage. If the site is affected by Ruch drainage, submit complete details for the drainage system. Indiciate wh. will be responsible for maintenance of the drainage system. CHECK rNE: ' - No artificial drainage '—) Intormatlon regarding artificial drainag s9 affecting this site. L- affecting this site Is attached. Attach a SBD-6395(115) or sK0-6309 (i` a proposed subdivision), for soil information and estimated depth to high groundwater using mottlirg. soil 2 copies of the Groundwater Monitoring Repirt to t17e Bureau of Plumbing, 111111 _ P.O. Box 7969, Madison, Wi 53707 and submit 1 copy to the 'local authority. INDIVIDUAL I,OT Pi..,,N-Provide n diaor gut showing accuri.ite 19cations and surface elevations of ai? monitoring wells. S'-JBDTVTS10"i ,t.ta,,-h a sc j.ed map showing well locations and relative elevations, (1 in. = 100 fact preff-reed) . Alf - - - _ A if C4 - - - _ II I , x. I -,-- LP tJ I I, the unders.iJ, ll,, hereby certify _,flat the data recorded and location of tests reporte,:i on ,iii-; Eor^.t are c .err-ct to the best of my knowledge anti b I _- - -- -- rDzte n.a�, D:I.HR '3D �i4iL(.i. ;_iJ it:l — / � �`"_ "' " t t •_ 4 _ (� �1 cl C t Mar-/l 7 1 1-7 6(a-1k Mefi-nVC' eMtlUTS CI F rom ! NecunMoaJ;t 12 0 / 9L ,d . (�Z..,z f PL 4 xl ?'j NC (J PLie,Pl Motva 3 C i L 5 U 4 f 21 �y.!yy�� . _... }. E ,^ ��/ //� 'I J�,/,J ems•^' { j A V 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 . 0 (H63A9(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ Y: LOT NO.:BLK.NO.: SUBDIVISION NAME: COUNTY: T'C O s0R'S NAME: MAILING ADDRES Y re% o lJ " USE So J`S DATIES OBSERVATIONS MADE NO.BEDRMS.:1COMM ERCIAL DESCRIPTION: PROFI DESCRIPTIONS: R LATION TESTS: &esidence New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system J G� CQ V STI❑U • IMOUND:�� ❑� IN G� E: SYSTEM-IN-FILL TANK:RECO G�C� SYSTEM:(optional) If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the under s.H63.09(5)(b),indicate: 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.HI H E­ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) .�aL-T.S. (o Z M04,9`r g)go Te-K a. B- 2 >756 (o` 8L r:S �c�° S'�L. C• Mir 4r2Z), C're,, cl. 4, B- 3 a. q/, I ,� � I ��5�• C/1 O .q t 2 0� 9 Ar Y CC Lo B-/-# .7 AU O 34.7S 14 ;A-5v 7� CG L B2-4 7 a, lsm ES D C- Tk,�• 4 BS fi 7 �. ,AS S' &.T.s I&- SL. CMo r h-t- 2Y;) �7' C TeY eZ, L. 7-2- C1 91 � Q PERCOLATION TESTS t31=7'.S jg S�ZM07, .T 2ct j f TEST DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P RI PER INCH P_ t NO 30 y ' ADO P R1 © o �8 S� 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 ¢uJ ........... G 7 I Ft b u" t d ] E ; _ r 9 F 1 SYe LL �, re— E ' N MI__ �._. _ _ _._. _ q t t _ - - A F ( 4 I �_._._--- _ J I_ _ _L ____ I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): —�' TESTS WERE COMPLETED ON: �, ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): I l 2.0 3�0 �-d w Ill Q,Jo M,0 7i5-gas-��V/ T S I GNATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. uiLHR-SBU-6395 (R.02/8A —OVER — L i INSTRUCTIONS FOR COMPLETING FORM 115 - SRI - 6395 To he a complete and accurate soil test,your report mast include: 1. Complete legal description; 2. The use section most 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; S. Complete the suitability rating boxes. A SITE 11.3 SUITABLE FOR A HOLDING TANK. ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE czse the abbreviations shown here for v+rriting 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; C. M=ake snare your benchmark and vertical elevation reference point are clearly shower,and are permanent; B. Complete all appropriate boxes as to dates, narrres,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. Siam the form and place your current address and your certification number; '12, Make lerihle 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 Gather Symbols st Stone. (over 10") BR Bedrock c:oh cobhle (3- 10") SS -- Sandstone g, Gravel ('under 3") LS Lirnestone *s — Sarid HGW Nigh Gromidvvater cs __ Coarse Sand Perc Percolation Rate . nied s - Medium acrd v°r;It f Fine Sand BI(Ig - Building Is — Loarny Sand Greater Than sl _.. Sandy Loa>,n < - Less Than LCSaTTI Bn Brown "sil Silt Loam BI - Black s Sift. G — Gray ci - Clay Loam Y -- Yellow scl Sanely Clay Loam R — Rest sicl -- Silty Clay Load mot — Mottles sc Sandy Clay wi With sic - Silty Clay fff few, fine,faint yr; - Clay cc — cornmon,coarse in - Peat MITI Many, medium nn Muck d — distinct p prominent HWL — High watrrr level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP - Vertical Reference Point TO THE OWNER: This snail test report is the first stop in se curing a sanitary permit. The county or the Department may request 'i.,.iiication eJ this 'Sol! test in the field pilot, to Kermit issuance. A cornplete set of plans for the private ,�c and a pemil lipplication rnust be sljhni lted to #tee e<ppiopria e local authority in order to 'c' 11 i,, "n err z_ T I I e 5 a I a I y p alit rnust he ohl,a,P,ed and pEote d prior to the start of ar,y construction- CO r � w SUR EVOR'$RECORD _1.3�„► N ♦ �sco',,,� APPROVED ST.CROIX COUNTY CERTIFIED SURVEY M Planning Zoning and Parks LYLE L. ELLIOTT". = VOLUME �3 PAGE 3743 ' SEP 3 0 1999 S-1300 = PART OF THE NW 1/4 OF THE SW 1/4 AND THE HU r D SON Ivy SW1/4 OF THE SW1/4, SECTION 14. T29N, R 15W 1(not recorded within 3U days o: OWN 0 SPRINGFIELD. ST. CROIX COUNTY WISCONSIN v F R I �o�d ♦� approval date approval shall be E ueie���♦♦♦♦ 1 . LYLE L. ELLIOTT. REGISTERED gLANDoId UNPLATTED LANDS SURVEYOR S- 1300. DO HEREBY CERTIFY — — THAT TO THE BEST OF MY KNOWLEDGE AND EAST - WEST 1/4 LINE BELIEF THIS PLAT IS A TRUE AND CORRECT S 89628'32'E 5247.81 ' REPRESENTATION OF PART OF THE NWI/4 OF THE SWI/4. AND THE SWI/4 OF THE h 656.04' SWI/4 SECTION 14. T29N. R15W, TOWN OF 623.04' SPRINGFIELD ST. CROIX COUNTY. WISCONSIN. v 3 .00' BEGIINNIING AT THE WEST QUARTER CORNER SAID SEC. 14. THENCE S89028'32"E ALONG THE EAST-WEST QUARTER LINE 656•.04 FEET: THENCE S00 024' 14'E 2386.72 FEET: o v THENCE N89°37'35'W 658.71 FEET TO THE WEST LINE SEC. 14: : N in v THENCE N00020'21 'W ALONG THE WEST LINE o L 0 T 1 _w wcn LINE OF THE SWI/4 SAID SEC. 14 2388.41 FEET TO THE POINT OF o BEGINNING. SAID PARCEL CONTAINS 36.03 N : 3 654.529 SF. c� ACRES MORE OR LESS. AND SUBJECT TO A W oo ; N 15.03 AC. o, 33.00 FEET RIGHT-OF-WAY ALONG THE N WEST LINE OF SAID PARCEL AND SUBJECT o 621 .450 SF EXC. TO ANY OTHER EASEMENTS OR RESTRICTIONS d' co OF RECORD. o HWY. R-O-W Co . Z I 14.27 AC. N I CERTIFY THAT I HAVE FULLY COMPLIED WITH THE PROVISIONS OF SECTION 236.34 OF THE WISCONSIN REVISED STATUTES AND W a+ 100' BUILDING SET w THE ORDINANCE OF ST. CROIX COUNTY IN c\1 BACK d SURVEYING '� cv HIS SURVEY WAS MADE AT THE REQUEST OF TIM AND CINDY MAHONEY. 3 a S89°31 '03'W 657.09' 0 5 RUSTIC RD 3. GLENWOOD CITY. WIS. 3 aco:o' 33.0624.09' lqd v, 0".: o�/I✓I EACH PARCEL SHOWN 0 IS PLAT IS OUSE SUBJECT TO STATE. COUNTY. AND TOWNSHIP 0 o LAWS. RULES AND REGULATIONS ( i .e cnl WETLANDS. MINIMUM LOTS SIZE. ACCESS TO Z 0 PARCEL. ETC) BEFORE PURCHASING OR '01 I BARN J DEVELOPING ANY PARCEL CONTACT THE aST. CROIX COUNTY ZONING OFFICE AND THE J o APPROPRIATE TOWN BOARD FOR VIC w a � ° Z CL �� i J M l — z 40 3 N . - 1 V M : N I � LYL L. ELLIOTT. RLS 1300 m) DATE: AUGUST 20. 1999 Ln REVISED SEPTEMBER 27. 1999 L] 0 : z LOT "—� SCALE I ' - 300' a ro I 914833 SF. 0 100 300 600 t� I 21 .00 AC. E- 869099 SF EXC. HWY R-O-W BEARINGS REFERENCED TO THE WEST xI 19.95 AC. LINE SWI/4 SEC. 14 (ASSUMED N00020'21 'W) 1 � I LEGEND SET 3/4' X 24' IRON REROD. w 33.00' WT. 1 .50 LBS/FT. "' 625.71 ' o FOUND 3/4" IRON REROD N 89037'35"W 658.71 ' N coy o N90000'00'E 692.21 R.A. ® FOUND. 3" ID IRON PIPE y _ R.A. RECORDED AS LOT 1 GSM VOL . 9 N ET 2523 FOUND. PK NAIL ' THIS INSTRUMENT DRAFTED BY L. ELLIOTT Vol. 13 Page 3743 Vi 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 . Lrie, 7-7-/, /v a(2N Location of Property N W 14 14, Section _ , T47N-R W Township S f� r 1` to e, Mailing Address a u� l� � ,, ��f9Aa( Address of Site L) vd 1 j �eh Subdivision Name Lot Number Previous Owner of Property 1,av V. /✓(& �p� � x16 Pav 4- Mug.Gaxei- 14c. (9ee, Total Size of Parcel Date Parcel vas Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ X No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (toe) eenti6y that a t ztatemenU on tW 604m ane true to the best o6 my (owc) knowledge; that I (we) am (ahe) the owner(.6) o6 the pnopeh ty de a cAib ed in thi.6 .in6o4mation 6onm, by vi tue o6 a WaAAanty deed neconded in the 066ice o6 the County Regtiaten o6 Veed�sah Voeument No. p !,/O� ; and that I (We) pne6entey own the pnopoaed bite bon the .sewage di6pob .6y6 em (on I (we) have obtained an ea.a anent, to nun with the above d"cA bed pnopeh ty, bon the conatnuc Lion o6 said ayatem, and the same has been duty neconded in the 066.ice o6 the County Regi.6ten o6 Ueede, as Document No. ) . SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED