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HomeMy WebLinkAbout038-1035-60-000 z, cc m E ow r- 4) 0 f\k ; @ C 0 CD ■ 0 0 -0 4) -0 C'4 0 M-0 C C q CD 0) r-— m j co 0.0 Q E CD CY) 0 CD m o co 4) ca> r- I 2 Z N E E t LL c o 0), 0 C.8 0 0 U) &§).0 0 0 C.0 Cl) z co E CD 0 00 ce) IL m 0 z :!t c CO) i IM a m (D :3 CL 4) 0 (D z z C-4 c LO i 0 E r- cc .0 tm i E I 0- CL M (D m 0 C3 (L 0) I 52 U) U) w E ■ E FL m 0 0 0 0 EL E co co U) co 00 0� $U) j z z Q Q 0 . Im 0) (D > m w >T U) 04 c 04 c r- d 1: :F; 0 6 co-) 40. Z ( 7 2 : �2 C-4 CL 0* b cl So E ca tm 4 m co 1 fA cc z EL L: 0. � � � $ � � % � 0 CL -3 " a, E 'E o m 02 IL a o US 0 Parcel #: 038-1034-40-000 12/15/2006 10:47 AM PAGE 1 OF 1 Alt.Parcel#: 08.31.18.153C 038-TOWN OF STAR 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 O-TTR DEVELOPMENT LLC TTR DEVELOPMENT LLC 775 PRAIRIE CENTER DR STE 160 EDEN PRAIRIE MN 55344 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB&MANAGE SP 1700 WITC Legal Description: Acres: 5.060 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 8W 5.060A IN E 1/2 SW 1/4 Block/Condo Bldg: COM S 1/4 COR, E 32.35FT, N 588.65FT TO POB N 89 DEG W 50 FT, N 24 DEG W 940.61 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT, N 52 DEG E 208.55 FT S 47 DEG E 08-31 N-1 8W 377.05 FT S TO POB Notes: Parcel History: Date Doc# Vol/Page Type 06/16/2005 797862 2824/370 QC 12/15/2003 749042 2473/604 WD 07/23/1997 787/442 2006 SUMMARY Bill M Fair Market Value: Assessed with: 174842 29,900 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.060 26,400 0 26,400 NO Totals for 2006: General Property 5.060 26,400 0 26,400 Woodland 0.000 0 0 Totals for 2005: General Property 5.060 26,400 0 26,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I� J1 �. tilt, ca JV l . �t 11 � i 1 cry CY796 Lp - nn' t Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER </>,� 1��f/ TOWNSHIP S-& d"I-a SEC. _� T _W ADDRESS , 171 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING THIN 100 FEET OF SYSTEM o v y3' INDICATE NO TH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 9 P //��.�J' Proposed slope at site: ,3 SEPTIC TANK: Manufacturer:;�, Liquid Capacity: / Number of rings used: —42-- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Rear, O -'` ��� feet From nearest property line Front,0 Side 10 Rear,0 _Y,10 feet f , Number of feet from:. well 2 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER / Manufacturer: � Liquid Capacity: Pump Model: A))00.1 Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: ti�sc Alarm Switch Type: L�/ Number of feet from nearest property line: Front, O Side, Rear, Ft. Y r a; Number of feet from well: �S Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenth: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Pt . Number of feet from well: 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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: - _ Plumber on job: J J 04L2cs i License Number: -A 3/84:mj "All Fr H _ x LIDW and MARLENE E. LIN_N, husband and 81r —Pint nth, Grantors, ' 'mss aid warrants to $EITH C. VOGEL, a jq J ng 1 e man: doy 6ran�e. of £ Soilowing de scribed real estate in—St. Croix _County, . fists of Wisconsin: $,A NOW of land of 5.001 acs located in the -%h and 09.eection 8-31-18, being further described as follows: at the A egsaer of Section 8; them S88 040' Tax Key No. the 0 line of said Section a distance of 32.35 feet; thence N0e4T�' to the point of beginning; thence onntiming N0007'32"W 485.64 feet; 446.76:9eet to the beginning of a meander line; theme S2 019132"E alalq ,13tie 15.69 feet; thence S5304313209 along said mm-tader line 334.31 ' 761.31 feet to the point of beginning, includirug land from ---SAW iaioe. 'l W wdth a 30 foot non-exclusive easewnt for ingress and egress descri g at the Sh corner of Section 8; thence S88 040150"E along the S 32.35 feet; thence N0007132"W 621.65 feet to the point of titM07132OW 236.00 feet; thence N89°43'32"W 30.00 feet; thence 80e1M � lidnae 889'43132"E 30.00 feet to the point of beginning, ant] its am the rights-of-tray identified as the S road ad do In that deed from Mnrtell-Cloutier to Robert C. Vogel and wills a15?33u "504". page 506, Doc. No. 319181 in the Register of Deeds ate: ' Tltwt lift, Yedwead property .y to 'ion: Subject to easements, reservations, restrictiam # y of record. October 79 Dvftd� 25th day of 19_. 4 + �+.�......�.� (SEAL) Lj-4 -;6,A Larr JVZinn (SEAL) 7� a • Marlene E. Linn AUTHENTICATION ACKNOWLEDGMENT ` Signatures authenticated this n/a gay of STATE OF M iNESOPA '! Am S C County. } :� n/a Personally ca bef me,two ?.. h n/a _ October, 1979 the above taasrs TITLE: XENWR STATE BAR OF WISCONSIN T-inn and Marlene R- Is (if not. !_ n/a -- ---- authorised by ;706.06, Wis. s+ats. Tbis instrusedt was drafted by i�l. tlU gg Attorney_ to me known to be the person M,. GILBERT, GWIN i MUDGE rn go' g instrtwent and acknowledged X �- ( 49situres may be,outheaticoted or acknowledged, Both • act ?ce"ary.,) ,. N 4 om date: MIZU t eitut f.,�Al't'rwR:tit►,111FISCOMPI, .rdsw Ira, 2-11971 tip ;:, ' 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 $QI%�S�j, ��T31, 18G1 UCONVENTIONAL ❑ALTERNATIVE (IlassganI,D.Number: Town o6 Stah RhaiAie ❑Holding Tank ❑In-Ground Pressure ❑Mound NAM OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: Keith Voge.� R 2 Box 171C New Richmond W1 54017 01-/9-66 8 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 Roweu 5G3 Ist. ctoix 112772 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY'. TANK INLET ELEV.. TANK OUTLET ELEV.. JWARN.NG LABEL LOCKING COVER PROVIDED: PROVIDED' DYES ❑NO ❑YES ONO BEDDING: VENT CIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: ILIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ENO ❑YES ❑NO [—]YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES NO 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 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA &PITS LIQUID BED/TRENCH TRENCHES MATERIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FHESH 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 OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOILCOVER TEXTURE PERMANENT MARKERS OBSEHVATIONWELLS ❑YES ❑NO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED 17OPSOIL SODDED ISEED10 MULCRED CENTER EDGES. DYES ❑NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV. ELEV. DIA. ELEV.. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO 1-1 YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING LINE FEET FROM P 1:1 YES ❑NO ❑YES ❑NO NEAREST 1.12 g 10 S.S� Sketch System on i2_ Retain in county file for udit. Reverse Side, SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administtclxton DILH 0 SANITARY PERMIT APPLICATION CouN _ In accord with ILHR 83.05,Wis.Adm.Code - .em� STATE SANITARY PE MIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUM ER 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 K NO PROPE Y OWNER PROPERTY LOCATION %a '/4, S T , N, R (or)o PRO PITY OWNER'S MAILING ADDRESS LOT NU BER BLOCK MBER SUBDIVISI NAME 1At Cl _tj Y,ST AT ZIP C E PHONE NUMBER 0 CITY NE E T ROAD,L E OR LANDMARK O VILLAGE 01 TAW II. TYPE OF BUILDING OR USE SERVED: - d — L 03(5--40L Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 0 New b.❑ Replacement c. ❑ Replacement of d.❑ 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. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 50 Seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED Square Feet): PROPOSED(Square Feet): Feet [9 Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks. Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank p ❑ Lift Pump Tank/Siphon Chamber 1.14 0 1 El ❑ EEJF� 1:1 VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation f the private sewage system shown on the attached plans. Plumber' ame(Pr' t): P ber's Sig atur .(N Stamps) MP/MPRSW No.: Business Phone Number: Plumb 's Address(Street,C' - State, ' Code): J- Name of De gner: vV All VIII. SOIL TEST INFORMATION Certified oil Test (CST)Nam CST## < - CST' ADDRESS(Street, ity,State ip Code) Phone Number: IX. COUNTY/DE1 ARTMENT USE ONLY ' ❑ Disapproved I Sanitary Permit Fee Groundwater Date y Issuing Agent Signature(No Stamps) / I a o Su�h e Fee rO� Approved ❑ Owner Given Initial v g� Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: . a SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber r 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 do 3'y6`4rs; 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 all septic, lifVsiphon 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% 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 a � included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried yeas re 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. 0 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) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 Location of Property -s� k , _ t Section _ q� , T_J/ W Township ���y ZZ;2;z�! � sr Nailing Address ?�LlV e-_ sus ols� Address of Site a i Subdivision Name Lot Number Previous Owner of Property ,-r J 4 Total Size of Parcel 0,:::1r Date Parcel was Created Lf 44 2 ZfZ_3 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 w ich 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 I We) centi.6y that aft Atatement�s on .thus onm ahe .thue to the but o6 my (ouA) hnowtedge; that I (we) am (One) .the owneA(s 06 the kopeAty dezoL bed in this C� .in6olmdtion 6o4m, by viAtue o6 a waAlmanty d e necokded in .the 0 Colut y Regi s.ten o6 Deeds ass Document No. , and X lwe) phee en t£c Own the phopoded site bon the sewage dispo em (on I (we) have obtained an ea.aer+ent, to nun with the above desehi.bed phopehty, bon the eonAtAuction o6 said sya.ten, and the same has been duty kecokded in the 066.iee 06 the County Re9iAten o6 Veeda, as Uo ant No. SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) gs) _ SIGNED DATE SIGNED z En H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z 0 a OWNER/BUYER rn ROUTE/BOX NUMBER Rd 1Llpo c J 91 Fire Number ,; G CITY/STATE /Vao �R16 �-rnole7ee L)l'4 ZIP 5-�eQ /-5- PROPERTY LOCATION: -Stcl 14, Section 7360T N , R W, Town of St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can 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. H 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- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'honing Of ice within 30 days of the three year expiration date . SIGNED DATE l 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 OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 'INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911)&Chapter 145.045) LOCATI N- ,/ SECTION: u/e/ (or LOT :BLK. O.: SUBDIVI ON NAME: C NTY•/R OWN S BUYER' NAME MAILI G ADDRESS: Ll�vaow 2 1 r.--Z aC_ 7 JQ?tAw�,17ZC k,-u ZCZ,97AW JOC USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IA DESCRIPTION: I� PROFILEDESCRIPTIONS: OLA O TESTS: Residence W New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN_-GROUND-PRESSURE:ISE]S YSTEM-IN-FILLHOLDING TANK:RECOMMENDED��YSTEM: ptional) S El U_ X ❑U ]S ❑U U ❑S ®U If Percolation Tests are NOT require DESIGN ATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: 112 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ,, BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXT RE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- > Q—� r! [7�S��,�(O'�.� N cls�•��.?— e OAFS�/1�C.0 kl���A/$ J r/ B' B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE' TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IPGHeS AFTERSWELLING INTERVAL-MIN. PERIOD t PERIO02 P R PER INCH P_ i3 P 9 ' 7 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 - - - 3 t I l � 1 1 M 3 3 - - t , � F I J'i --------- EE € } i 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME rint TESTS WERE COMPLETED ON: A CERTIFICATION NUMBER: PHONE NUM 'PER loptional): "ZW 14)Z �—ZA 7 y CST GN TUR DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SRI - 6395 To be a complete and accurate soil test,your report must include: 1. Cornplete local description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or cormercial use planned; 4. Is this a new or r(,,talacement system; S, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE rise the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MADE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred, A separate sheet may be used if desired; £I. Make suee your benchrnar k and vertical elevation reference point are clearly shown,and are per€ilanent; °. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate 10. If the inforn'lat.ion as flood plain, elevation) does not apply, place N,A. in the appropriate box; -11, Sign the form and place your current address and your certification number, 12. Make legible copies and distribute as re(laim=d, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Soil Separates and Textures dither Symbols s — ,'mne lover 10") FAR — Bedrock coy, - Coo111e {3- 10") SS — Sandstone gr — Eravel {under 3") LS Lirrrestone "s — Sanca G' High Groundwater GS -- coarse- Sand Pcerc - Percolation Rate; moil s - iut 1=Sal I W — `"'Vo,,I! F1 rs .._ „r and Bldg — Bu Ic°r, l:; - Lumiiy Sand - {greater Than sl - Sanely Learn � - Less Than Learn B,a _.., faro"rage It Loam B! Black Silt Cy — ray �3C1 - Clay Loam Y Ycliorry sc:l Swirly f Ia,r, Loam R Red sio-1 -- Silty Clay 1 oarn mot - Movies ,c Sandy Clay 1„ti u — Silty Clay fIf -- few,fine,faint c __ C,<ay cc - conrmori, coarse pt - Prrat meet Many, r;lediomi to f0hick to -_ distinct p - prominent HVVL - High water level, Sib general soil textures surfaeU yvater for hiti.iid waste disposal BM — Bench Mark VRP Vertical Refwence Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit, The county or the Department may request verification of this soil tryst in the field prior to permit. issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a perrnit. The sanitary permit must be obtained and posted prior to the start of any construction. sm,'/a yy j,,/X- AG'P/fib 6.9.4 , 407 Iz X65 f 1760 ��CCe ��✓ t 3y5 o` , J'O({SC <, (� PAGE OF CrUSS .Jec � lur, p4 Urn �� s ��n Fresh Air Inlalt And Observollon Pipe IV CN �c•/rte�ly�/I� M 12*Apow n Approved Vent Cap Final , Grode 20-42v Above Pipe _4"Cost Iron To Final Grade Vent Pipe Marsh Hey Or Synthetic Covering Min 2"Aggregate Over Plpe OlUrlbetlon Pipe o 0 o 0 0 —Tee 6" e Beneath th pipe Aggregate B 10—ComplIfto Perforated Pipe Below Terminating At Botlom 01 system �ItJr.� tort \ SOIL FILL 0ISTRIBUT101.1 PIPE A S4WP • PPR,OVED ETIC COVER ° l�MAT�RI^t OR V OF STRAW 2"OFA6G9E6ATE —�� c pR MARSH "Ay (e OF��2 —2.1/2 AGGREGATE ELEV. OF,1Q,(4 FEAT—r 4 DISTRI0!rJTIr.:)N PIPE TU BE AT LEAST 2/9 INCHES BELOW ORIGIUAL GRAOE A11U AT LEASTLO 11JCHES BUT AIO MORE THAI) q2. I►JCHES BELOW FINAL GP.ADE MAXIMUM DEPTH OF EXtAVATIOP FROM 0KIGWAL 6KApF. WILL BE _ IKJC14ES MINIMUM 9F-F" OF FACAVATION MOA 0�16114111L GR49E WILL BE INCHES SIGNED: LICEAISE AJUMBER: -f��� I DATE : �'�©';P� l 110 J PAGE OF ` ox'17/6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VCWT CAP 4°C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING > JUNCTION BOX MANHOLE COVER 25' FROM DOOR, 7 WINDOW OR FRESH 12"MIU' I AIR INTAKE GRADE I 11. I `1"MIN. I IB"MIU. CONDUIT �-- le"Mw. IAJL.EI' PROVIDE I ----- AIRTIGHT SCAL I III I APPROVED JOINT A I III ppR I I A 0 y ED JOINTS W/C.2. PIPE I III W/C.I. PIPE O1 3' I II EXTENDING 3' ALARM ONTO 501.10 SG;;. B I I ONTO SOLID SOIL I 1 I ON C • I I 1 PUMP-1 "J OFF D CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAWV. MANUFACTURER HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND / DOSE TANK MANUFACTURER: J wAel� �� _,41L,tS NUMBER OF DOSES: PER pAy TANK SIZE: -- a �� GALLOWS DOSE VOLUME ALARM MANUFACTURER: 4-1. ���� �t_, -!� INCLUV!�!`. ZAC!;FLOW: J GALLONS / r MODEL NUMBER: ,�/�� /A/ CAPACITIES: A= INCHES OP. GALLONS SWITCH TYPE: d B=_INCHES OR _C.Lc[L GALLONS PUMP MANUFACTURER: C=_INCHES OR � . GALLOWS MODEL NUMBER: 4 - 1,#45 D= _INCHES OR 157-1 GALLONS SWITCH TYPE: /'41 NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHAR`E RATE GPM INSTALLED ON SEPARATE CIRCUITS 1 ERTICAL DIFFERENCE BWcrw PUMP OFF AND DISTRIBUTIOAJ PIPE.. FEET 1 �I�jI♦ �MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . • -L'.� FEET ♦ FEET OF FORCE MAIN X _F�OoitFRICTIOU FACTOR.. FEET TOTAL DYNAMIC HEAD = 2,. FEET INTERNAL QIMEWSION OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: LICEMSE I.JUMBER: DATE: -117- • b a� c�� w "1 0 V . c � A y V W% a ✓..rl 'n o0 r r rr+'r rlrr♦ r�r W d "4 e-1 r•, L . �i V Gy � 0J a a� 6 Cl P4$4 w a0 o °$4 �.i L o d m to � to ZI U b of � N ►a .. • ...n' ... ♦2:N .. .�. '.N. w ri r.. ,..,....w..,,. +r.�'k.;+w+.Y+wN,+AiWiwis+ W iMX `S"' ""�?::a. 4 . Submersible Effluent Pumps Mod - ,. Subm 140 • AV/7/I 120 ✓VTnI /1/G"}l�os�,� �I� how 551/7 , tijs ti w 100 A 3• o u. 80 - u �75, T ¢, 7Q 0 60 •Hp A. t; WPM03,'/,N.P. .26 Y1fp03.'h H.P. R 100 120 0 4 Capacity-Gallons P*f Mlnute .+ 4 �i H.P. OtOw No. YoNt PION And APd WP0311E 11S 94 W�PW10311E -- 1750 b WP0312E 230 !m 47 16e W wPr+o5,1 a 115 W 1HOS12E 230 90 h WPN0532E2 - 31 1 WPMQS_23 0 "'-�WpH0112E 23 410 � 9Q WPH0732E 206/230 S, 30 2.1 WPH0734E 460 WPH10/2E 230 1� 11'6 3460 1a 1 WPH1032E 208/230 8.4 W41034E •60 3.2 WPH1512E 230 10 134 WPH1S32E 208/230 8'2_ ` WPH1534E -OU 48 11- 1A 8 WPHH1512E 230 10 192 WPHH1S32E 208/230 3® PHH1S �1 W34 �I� E 460 .8 ■ 1 SPECIFICATIONS ARE Sk I9CT TO CNJI!WGE WITHC'lUT N�1