Loading...
HomeMy WebLinkAbout012-1040-60-100 & o % 2 ) a o _ k \ / \ a ( E k2 i D a2 ƒ § f\ ƒ L f\ \ e u0 § $ / /I � ) k 0 C k L) 2 cE . 2 7 §� k � 7 3 \2� � E 2 ƒ k E \ ) \§ § n k n t � ƒ C. � � / b � \ " 0 z 0 § / % 2 / a$ co IL ■ � § � 0 & 2 2 \ t m J a § ® * 2 7 / E E / e = f n I m . N & 7 2 I § E ƒ .� § / { § / / § + ' . 0 k k k ) k .. k 2 � . > ~ L C - ■ 7 � _ ■ ) o \ h 2 b , k $CL m � o o a = k \ ! C j 5 E k k k I (L ) : •� 4 ' i 2 2 2 d 2 2 2 S o B » CD 0) ® co 2 0 ■ Q ) $ § / o z Wawa d ® 6 I k o ® a ' ® iz: as ¥ o ¥ o E o o 7 g 2 D g / k \ ƒ / } § k J ƒ f m / k / $ 0 E o ƒ § £ — C) a / § 0 0 k { / } % 6 q = / � 5 2 / $ ) 2 2 7 § $ o « 7 k \ k \ j k Cl) = § 7 / \ § k \ \ - o LU 2 - ) / I / I o z / \ , � � � , ¢ k IL k IL L .2 W a » 0 m E 2 k ` 0 & o u a ■ 0 U) u AU) Q Parcel #: 012-1040-60-100 09/06/2006 05:15 PM PAGE 1 OF 1 Alt. Parcel#: 17.30.17.264B 012-TOWN OF ERIN PRAIRIE 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 HERBERT J&LAURA J TRST REBHAN O-REBHAN, HERBERT J&LAURA J TRST 1640 CTY RD G NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1640 CTY RD G SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 17 T30N R17W PT S1/2 SE SW BEING LOT Block/Condo Bldg: 1 OF CSM 9/2634 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-17W Notes: Parcel History: NO STR CONTACED PENNEY 2/7/05 ENTERED Date Doc# Vol/Page Type 5/10/05 03/10/2005 789284 2762/522 WD 11/29/2004 780962 2703/190 WD 07/23/1997 1019/638 WD 07/23/1997 972/530 m02... 2006 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 11.000 1,800 0 1,800 NO 05 OTHER G7 9.000 54,000 248,200 302,200 NO Totals for 2006: General Property 20.000 55,800 248,200 304,000 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 55,700 248,200 303,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 110 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS _BUILT SANITARY SYSTgM ,REPORT OWNER A, �1^ TOWNSHIP /�2/.^« SEC. 7 T 36N-R 1 I W ADDRESS /P/?/ j��,� png/ST. CROIX COUNTY, WISCONSIN WcS' SUBDIVISION Jl/ LOT /v LOT SIZE PLAN VIEW Distances and dimensions to meet requirements'! I•ZIA 83 SHOW EVERYTHING WITHIN 106 FEET OF SYSTEM i w - u:rn, f" 0, on �Q i j0 to INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /vdA�l t'&,-2 Elevation of vertical reference point: /DO Proposed slope at site: 1/0,96— SEPTIC TANK: Manufacturer: GVerf ( •dM&g4Liquid Capacity: oti-o f j n �X S J Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side ,O Rear, O 00 t;� feet From nearest property line Front,0 Side ORear,O /6d feet Number of feet from: well �, building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) PUMP CHAMBER `" 1 y� L, �_ Manufacturer: Liquid Capacity: apacity. 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: r Width: /oZ Length: Number of Lines: Area Built: 9� Fill depth to top of pipe: oQ Number of feet from nearest property line: Front, O Side, Rear,O Ft ./UO Number of feet from well: Number of feet from building:' 9 (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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). 5 HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of 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" feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: 42 —�— � Plumber on job: d nn Oau—t— T License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR"&HUMAN RELATIONS DIVISION P.O.130X 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NW,-,N(U%,S 17,T30N-R I A0 (If assigned) Town o(I Eton PtLaiAie CONVENTIONAL El ALTERATIVE orillotil �, ��, ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: P,litton Peteuon Jn, Route 1, New Richmond, W1 54017 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: Catvin PoweAz Jt . 1563 St. cuix 119392 SEPTIC TANK/HOLDING TANK: M UFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: /Lf q YES ❑NO ❑YES Z NO BEDDING: VENT DIA.: VENT MATL.: I HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO F ESH ALARM: FEET FROM LINE: AIR INLET: ❑YES Z NO ❑YES [71 NO NEAREST--- DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMB F POP RTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET F O E: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAR ST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENG H: V DI ME R: 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: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH TRENCHES: TERIAL: PIT DEPTH: DIMENSIONS 1 20 GRAVEL DEPTH FILL DEPTH DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF IPROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: !� *-%C� PIP IL I / �^� AIR INLET: lI + l i 00`7 NEAREST 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 ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑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: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO [--]YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST— 0 � 32 1� Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: i Zonino Admin6ttcatotc SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COUNTY 7 DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SAN I ARY P R IT# -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 0 NO PROPERTY OWNER PROPERTY LOCATION I �� 2 r, W '/a/VW %, S T,30, N, R r)W PROPERTY OWNE 'S MAILING ADD R LOT NUMBER BLOCK UMBER SUBDIVISION NAME /U It CITY,STAT ZIP CODE PHON NUMBER CI NEARE ROAD,LAKE OR LAND�IA id-C � S O/ / ��f ❑ VILLAGE II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.;Replacement c. ❑ Replacement of d.El Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.xConventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.Xseepage Bed b. ❑See a e Trench c. ❑seepage Pit 2. PER 0LATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): q I Ap, _1/� Feet Private [:]Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App [Tanks I Tanks structed Septic Tank or Holding Tank 0>71tJ I ❑ Lift Pump Tank/Siphon Chamber I I I ❑ El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name nt): P tuber's Sig ture: o Stamps) OAP/MPRSW No.: Business Phone Number: 01 Ut h-4-t 15 6-3 7/-5 Plumber's Address(Street,Cit ,State,Zip Code): V Name of Designer: RRI .1140 Gv�o D% VIII.'SCIIL TEST INFORMATION Certified it T ster(CST me CST# CST's AIX RESS(Street,City,S �C e) Phone Number: IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stam s) I lul Approved ❑ Owner Given Initial s( harge Fee Adverse Determination X. C MENTS/RE SONS FOR DISAPPROVAL: MAO-Cn SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION ` TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. -Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'f 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground tit included the creation of surcharges (fees) for a number of regulated practices which Wisco i "s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re, sure.: ° is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) i ^ APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/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 Tf/oh Location of property �1/4 �1/9, Section ��, T.�41 N-R��W Township h/h rae eJ-r/ -e Mailing address �/�� � �;i �2�n GIJ�SLe- Address of site ryr Subdivision name /j Lot number Previous owner of/ ro ert P P Y ��rn r 4 CIA- 51 Total size of parcel Date parcel was created 19 7�/ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes _No Volume -.5-03and Page Numbe r 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed r orded in the Office of the County Register of Deeds as Document No. _la D B '=5 5 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ) . Signature of Owner Sign tune of Co-Owner (If Ap icable) 0, 7. /`�o Date of Signature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ ER �i �,/.o 5 v ROUTE/BOX NUMBER Xg/ FIRE NO. CITY/STATE_ � G �rr !� �/ S G Zip PROPERTY LOCATION: 1/41/4, Section � , TAO N, R_/ W, Town of � ,r; r�r�iti� , St. Croix County, Subdivision , Lot No.� Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents NAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 r (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,. DIVISION +HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M ICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: N '/a 'a / /T.30N/R/ W Y'r�C,j r1�e It� I�- COUNTY: OW ER'S/BUYER'S NAME: MAILING ADDRESS: J USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER O AT ON TESTS: esidence 3 Jf/ ❑Neweplace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURES STEM-IN-FILLHOLDING TANK: REC MMENDEDSYSTEM:(optional) S ❑U S DU S ❑U S ❑U ❑S U Lam, e.1, t o„q,! If Percolation Tests are NOT DESIGN RATE:required rD Q I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: LFloodplain,indicate Floodplain elevation: NO_ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHW ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- viv B- vaVe 5 Bk V -5 —/�5 A, 15-r (7 /�5- 3, gn5 -5 OK B� b U 9.5' n, D-/, 3 BK 5/ /,�-3;3 Ems• /s 3.3 -� S B- B- � B- PERCOLATION TESTS TEST WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ i N© o --a a /a P- 13 go 30 3 P_ 3 P-_ P- P- _ I 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 g0� ° ,P i ry 1- s fill � r fir tN I i l i __..3_.. _...,. __ v_._.�..¢ _- »-. ....._..._ _. _�. _.. _ _. _.._........_.... 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( nt): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): agD(d_a � Gv�sG S 7/5 :�yb 5131 CST L7 T RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — e�-��s m y i� Two N 7 w AL A / . /voj v 44-r&-s\- 09' � � a � 0rtk /OTC V JD9 V l/ PAGE OF FU y S e Fr416h Air 11114116 And Observation Pipe --Approved Vent Cap Minimum 12"Abow Final Grade 20-42"Above Pipe _4"Cast Iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering Mtn 2"Aggregate Over Pips Distribution —Tee pipe 0 0 0 0 0 It 6"Aggreg te 0 Perloraled Pipe Belo. Beneath Ple o —Coupling Terminating At Bottom Of System Pau�v 5 e � 1''►��-I `�rc,c�< .�.•� _ SOIL FILL DISTRIBUTIOVI PIPE ��NTN APPROVED ETIC COVER ° —14ATERIM- OR 9'. OF STRAW ZMOFhG REGALE —�� c OR MARSH HAy OF��2 —ZI/2 AGGREGATE ELEV. OF 90 FEET DIS•r•RIRUTIrZ)M PIPE TU BE AT LEAST INCHES BELOW ORIGIAIAL GRADE AUU AT LEAST20 IIJCHES BUT 1.10 MORE THAI) y2 ILIC14ES BELOW FINAL GRADE MAXIMUM DEPTH OF EIACAVATiowi FRoM OK116INAL 6KAK WILL BE D INCHES P'UNIMUM grr-P" of EAMIATIOW M01A. OIKI6114AL GRAD€ WILL BE 46 INCHES SIGAlEO: LIGEWSE AJUMBER: /-/ 6 ' DATE : �O t 110 O/Z, 141W cj ,h 1,41 A�- y/ z- /n414, .0d «o Z��,g �� FILED JUN Z�f I / � ' 0&--iy 2 919930- JAMES O'CONNELL Jr Register of Deeds 501.515 sc Croix Co.,Wt CERTIFIED SURVEY MAP A parcel of land being the S'-t of the SE4 of the SW4 of Section 17, T30N, R17W, Town of Erin Prairie, St. Croix County, Wisconsin. �r Mg n -�L:� �6 _ Bearings are referenced to the o IJr`IIDLA T T ELF L,AIN[) south line of the SW} of Section 17, assumed to bear N89°14'42"W. WEST LINE OF THE SE 1/4 OF THE SW 1/4 z N00°08'21W 601,91' 666.92 CD a 70' 65' 4 O F O - C c n • � ro p = rt Z ro a _O �„ y to O� rri w IL z IV c0 O coo CC) T� '- co ° cn cD r- —I m v c1? z I c Im In o N 0 o I2 o co -n 1 ❑ 1 co 0o N IS = = I m = 11> .. co 000 cn � I I m 1—I rn li I ) : p N It1l Na .- n 1 = a _ o .a H I L, in W (� ICr N W - 1] = rt x rt M N S` �_- W m 1(- n n rn 1 DAR = N � A rn rn 1_1 Z I O s r v 2 I-----i O 1(J) s M o -r = x • rn m o � 55' 55' -^ ^^^ Ut �• �- _ a a t! O c(o L x c g e 615.97' c to r rt d CL 8 n 1 S00°16'34°E 670.98' rt• �! D 1 EAST LINE OF THE SW 1/4 OF SECTION 17 r„ co v m rt Cr W. p n -n U)L U P�!N I j j�r I n \ r`-` ' /' N zo r Ty w: V Z x" -m O ° V "' "T V01.9 Pg.2634 i I • AS BUILT SANITARY SYSTEM REPORT ADDRESS , TOWNSHIP SEC./-7 TjN, R_�7 W -- , ST. CROIX COUNTY, WISCONSIN. 1 DIVISION , LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i I 'TIC TANK(S) MFGR.�pp[,s1 _ CONCRETE STEEL Indicate North Arnow Sca.2e •/_ � NO. of rings on cover Depth DRY WELL -NCHES NO. of -- width length area no. of lines_ width length ' area - ode t to top of pipe_�.lr� • S UGATE -I , . • RATE ,/ AREA REQUIRED 'ice AREA AS BUILT,_`c�J.,� -,ciaimer: The inspection of this system by St. Croix County does not imply complete � 1�liance with State Administrative.- Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for :tem operation. However, if failure is noted the County will made every effort to ermine cause of failure. ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEa. '-INSPECTOR DATED �-� / PLU:iBER ON"JOB Je LICENSE NUIMER z REPORT OF -INSPECTION—INDIVIDUAL SEWAGE SYSTEM Am.i.t bz Sanix at e y P State Septic 7 � ,2 '✓ rJi '� L� G�/ S Cto ix County Z � �J rowna hip Locatiox jC }"JCGSecZion SEPTIC TANK Size�I�( _gattonz . Number ob Compattmentz D.iAtanee Ftom: Wet ���. 12% of gteateA ztope �._ it Bu.itd.ing it. Wettands I H ighwatet it, DISPOSAL SYSTEM D.iatanee From: Wett Ot St. 12% of gteatet 6tope ��. Bu.itd.ing ix. Wet.2anda Ft. N.ighwatet it. FIELD DIMENSIONS : Width oS tAench / 1— St. Depth ob Aock be.2aw t.ite s? .in.- - Length as each tine 7 it. Depth o6 tock oven Cite in. NumbeA o6 tines Depth o6 tite below gtade_�:_Jin. Totat Length o i ti n es it. Sto pe o6 tteneh in pen 100 it. D.iatance between tines (-� jt. Depth to bedtock it. Totat abs oAbtion aAea- �t2 Depth to gAOUndwateA '� it. 2 Requited area it T yp e o i Covet: Sticaw PIT DIMENSIONS: Number o6 pits � vet around pitzs yed no Outside diameteA Depth betow inlet it. ,...M. 2 Totat ab.sanb�.can aA a it A -= > AAea 'eq u i Led '`r it 2 rn INSPECTED f TITLE APPROVED e t ,DATE f c 19751. REJECTED , DATE 197 EH 115 Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION %,Section ,T N,R U V (or)W,Township or Municipality A&y AEU` Lot No. , Block No. County Subdivision ame Owner's/Buyers Name: Mailing Address: i6a"taglazo TYPE OF OCCUPANCY: Residence_ No.of Bedrooms �� COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW—REPLACEMENT. ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET _ Z NAME OF SOIL MAP UNIT—<64 -S_A,rZ)& Cdr 1104Ua PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— ! // I P— -7 ! li 11 P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B— r i' B- B— ? . _ R-,4. B— B— B— PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan a oc 19n and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. e , r t e f , s �� - E �E s # { E E E Zu .. e IL I 4-- _. —T b�A i F f I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. Name (print) �� Certification No. Address Name of installer if known Copy A—Local Authority CST Signature • � icy P L B �6 7_ � State and County State Permit # Permit Application Count Permi for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: /�/////�J �J �i ) may* !�.i B. OCATION: ��'/4_ '/4, Section IL, T_jaN, R� 4 (or) .W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance Single family _) Duplex No. of Bedrooms �� No. of Persons _, __ D. SEPTIC TANK CAPACITY A56 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate _Total Absorb Area sq.ft. New Replacement 1W Alternate (Specify) Seepage Trench: No.of Lineal Ft. Width Depth Tile depth (top) No.of Trenches Seepage Bed:�e Length 3 r Width— ' Depth ve Tile depth (top 1 " No.of Lines -42 Seepage Pit: Inside dia�meeter Liquid Depth No.of Seepage Pits Percent slope of land Lr• Distance from critical slope WATER SUPPLY: Private X Joint❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil T ter, NAME t ,^ C.S.T. # �5: .�_'! and other information obtained from r (owner/builder). _ Plumber's Signature ' MP/MPRSW# _j�� Phone # �/ .� Plumber's Address /' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. � . r�v� L.�G L E � E a y...A d..i ...:..A.�,-_ _°Y3w e m .�e.�...,. ...m�....., r _ .oa ,P.� .. __ _. m .e .<.. .a ._dF .� _ ,.... <�...e r w® e,� a i- i .,. ..� .,.. e ,_- d.e.�.,_ .�� _y_. e w_. _ «,en. e F. _.j, e._ ,na ..<.m ... m. a �, � ate, m�. « E , 7 ? i ! ' ¢ 7 �� � � t a��.�...� ._ ._„a..,,.. ..»»-__"a a 3 .�.o., r°_ ;...__ .._...� _.,� ..�,. ., e............ e _ a .M. w _ _e �. .. mM _a „� t t � 3 E i t e � E j � Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY r Date of Application ���., '�y Fees Paid: State.zV, L) Count Date Permit Issued/ (date) —��_ Issuing Agent Name �' Inspection Yes No State Valid# Date Recd 1. county (w ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78