HomeMy WebLinkAbout038-1099-50-000 A/4
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 1�jr� M /! _ TOWNSHIP _ SEC. TLN-RW
ADDRESS /it ST. CROIX COUNTY, WISCONSIN
L
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
U7ci�
+ lx�
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Vld�,a
Elevation of vertical reference point: (Z,P)� Proposed slope at site:
SEPTIC TANK: Manufacturer: 60 S Liquid Capacity: ) -'N30 � ,
Number of rings used: Tank manhole cover elevation:
� a
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front Side 0 Rear, O feet
From nearest property line Front, Side 10 Rear,O feet
Number of feet from: well 106'4" , building:
(Include this information of t e above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
/rmManufacturer: Pump/Siphon Manufacturer: Pump Size
inlet: Bottom of tank elevation:
h elevation: Gallons per cycle:
urer: Alarm Switch Type:
from nearest property line: Front, O Side, O Rear, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
i
Width: _ Lenjth: ��. Number of Lines: la, Area Built:
Fill depth to top of pipe: Z 3�
Number of feet from nearest property line: Front, O Side, (2rRear,0 Pt ? �
Number of feet from well: J�` 4'
Number of feet from building: (p
(Include distances on p of plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Bui
Has either 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 ri s used: Elevation of bottom of tank:
Elevation of inlet:
Numbe 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:
License Number -Sj
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7J69 BUREAU OF PLUMBING
MADISON,WI 53707 �y
SW4, St4;S24,T31N—R18W nCONVENTIONAL 1:1 ALTERNATIVE State Plan LD,Number:
Town of Star Prairie ❑Holding Tank ❑ In-Ground Pressure ❑Mound (If assigned)
Co, Rd. CC
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DA E:
Virgil Timm Route 3, New Richmond, WI 54017 ,�/ .�� 113d
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT,ELEV..
Name of Plumber: JMPIMPRSW No Cnumy Samtary Permit Number:
Gary L. Steel 3254 St. Croix 106084
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEy' TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
P OV DED. PROVIDED:
7 (7,5� YES L1 O DYES NO
BEDDING. VENT DI VENT ATl HIGH WATER NUMBER OF <.ROAD. PROPERTY WELL BUILDING:IVENYTO FRESH
ALARM LIN AIR
FEET FRO ?�
1:1 YES � O EYES O INEARESTt=� J
DOSING CH MBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PIIMP MODE I. IPIIMP,SIPHIIN MANUI ACTIIHEI2 WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
1:1 YES ONO ❑YES ❑NO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF I PHOPEHTV WELL BUILDING JVENTTOFRESH
(DIFFERENCE BETWEEN FEET FRAM LINE AIR INLET
PUMP ON AND OFF) 1:1 YES ❑NO NEAREST'! ON
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I F N(,T H IIIIA1,11 TER IIIATI HIAL AND MAHKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAINE
CONVENTIONAL SYS7 EM:
_WIDTH LENGTH NO OF DISTN PIPE SPnCINC� COVER JINSIIA DIA -PITS LIQUID
BED/TRENCH THEN Es M RIAt PIT DEPTH.
DIMENSIONS 7
GRAVEL DEPTH FILL DEPTH DISTH PIPE UISTH PIPE DISTR PIPE MATERIAL NO IS NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES / ABO7VE EH ELEV INLfjV ENU PIPES FEET FROM r LINE�f C7 / AIR�«Ny ET
�( � - �J�8� /,S�I 2. 7 Z `� L_ NEAREST-----�► ° O � (i(�
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.
❑YES ONO
SOIL COVER TEXTURE 1111111AIII NT MAHKE HS QHSEH VATION WELLS
_
1:1 YES ❑NO _❑YES NO
DEPTH OVER TRENCH BED DEPTH OVEH TRENCH BED DEPTH OE TIIPSOIL ['"D,E]ED S MULCHED
CENTER EDGES
YES. 1:1 NO YES ONO ❑YES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO OF LATERAL SPACING IGHAVIL DEPTH BELOW PIPI FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
- MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL N11 DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
is ELEV.. ELEV. DIA. ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ❑NO ❑YES 1:1 NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:
L1 YES El NO 1:1 YES ❑NO N
4, ) .
- _ X
4 c
Sketch System on X12 R file for audit.
Reverse Side.
TITLE-
G.-.� � -- Zoning Administrator
DILHR SBD 6710 (R.01/82) J
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm.Code St. Croix
.a.:,�,.:..... �...o� STATE SANITARY PERMIT#
—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 ❑ NO
PROPERTY OWNER PROPERTY LOCATION
Virgil timan SW % SW '/a, S 24 T31 , N, R 18 for) W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
R.R.0 n/a n/a n/a
CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK
New Richmond, Wi. 54017 X15 246-4055 ° VILLAGE:Star Prarie Co. Rd. #CC OWN
II. TYPE OF BUILDING OR USE SERVED: - xx- O— /40
Number of Bedrooms if 1 or 2 Family 3 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.❑ 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. IX-1 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. ❑ Seepage Bed b?91 Seepage Trench c. ❑ seepage 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):
class 2 750 750 96.53 Feet [Private El Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. - Fiber- Exper.
INFORMATION Manufacturer's Name
Con Steel Plastic
New xisting Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdina Tank
Lift Pump Tank/Siphon Chamber ____ ❑ ❑ I Lj ❑
VII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber' nature:(N Sta s) IKWPRSW No.: Business Phone Number:
Gary L. Steel 3254 715 246-6200
Plumber's Address(Street,City,State,Zip C Name of Designer:
88 N. Shore Dr. New Richmond Wi. 54017
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
Gary L. Steel 2298
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
88 N. Shore Dr. , New Richmond Wia. 54017 715 246-6200
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater rate Issuing Agent Signature(No Stam s)
Approved ❑ Owner Given Initial r1 charge Fee
Adverse Determination I G��0 r ��� W h� "
X. COMMENTS/REASONS FOR DISAPPROVAL:
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;
Ill. 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, 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% 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 8t8r
included the creation of surcharges (fees) for a number of regulated practices which Wisco En'S
e
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re!8S4Ire
is used in your building is returned to the groundwater through your soil absorption o
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)
APPLICATION FOR SANITARY PERMIT
STC - 100
'iThis 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 Virgil F and Agnes C . Timm
Location of Property SW It S`'' k, Section 24 , T 31 N-R 1E W
Township Star Prairie
!failing Address Route 2, Box 46 , New Richmond , WI 54017
Address of Site Route 2 , Box 46 , New Richmond , WI 54017
Subdivision Name
. Lot Number
Previous Owner of Property Russell Joyce
Total glee of Parcel 1 1/3 acres
Date Parcel was Created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? Yes _X No
Volume �� and Page Number �j(�,fp 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 Nap, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
i Iwo) cvVAN that att statMenth on tit" 60AM OAC tAue to the but 06 my (ouA)
hncwtedge; that I (we) am (aAc) the owne k l 06 the pAopenty ducAi.bed in thiA
.in604mation 604m, by viAtue 06 a waAAan.t�9M'/cokded in the 066.ice 06 the
County RegiAteA 06 Deeds ah Document No. ; and that 1 (We) pne.aenLty
avn f e pAOpoeed e c to bon the eeluage dizpoe aye em (on I (we) have obtained an
eaAement, to Awn with the above ducA,i.bed pAopei ty, bon the eonetnuction o6 said
system, and the dame has been duty AeeoAded .in the 066tce o6 the County Reg.ie.teA o6
Deeds, ae Po emen t No. ) .
i
SIGNA 01? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
A a -
DATE SIGNED DATE SIGNED
1.\'<,r -.. . . ... , • • .. . -.
i N0.1200. ""Snout nerd--To HuxLnud nild wife us Joinl�frn•��.tr,. rueiueeeeyruOYln/nAAShtlrna,0a.
259499
04 bibenture, Made this 31st day of August ,r9 59,
between Rita Anne Beseau, formerly Rita Anne Joyce by Russell
Joyce, her attorney in fact
,+ part of the first part,and
'f Virgil Timm and Agnes Timm
husband and wife,as joint tenants, parties of the second part.
UJitnt000b, That the said part of the first part, for an, in consideration of the sum of
j; .Two thousand and no/100 (: 2000.00) - - - - - - -
Dollars,
to
j in hand paid by the said parties of the second part, the receipt whereof is hereby
�I confessed and acknowledged, ha given, granted,bargained,sold,remised,released,aliened,conveyed
j and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and
!j confirm unto the said parties of the second part, as joint tenants, the following described real estate
situated in the County of St. Croix
Wisconsin,to-wit:
A part of the Southwest quarter cf the Southwest
nuarter (SW4SW4) of Section Twenty-four (24) , Town-
ship Thirty-one (31) North of Range Eighteen (18)
West, described as follows:
Commencing at the Southwest corner of said South-
west quarter of Southwest nuarter (SW4SW4) of Sec-
tion Twenty-four (24) ; thence North Two hundred
thirty-six (236) feet; thence South Eighty-nine
degrees twenty minutex (89. 201 ) East Two hundred
forty and eight tenths (240.8) feet; thence South
Two hundred thirty-six (236) feet; thence North
Eighty-nine- degrees Twenty minutes (89°201 ) West,
Two hundred forty and eight tenths (240.8) feet to
the place of beginning, containing; 1.3 acres. more
or less.
w i
Z013tt0r, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise
appertaining; and all the estate, right, title, interest, claim or demand whatsoever,of the said party
of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained
ii premises,and their-hereditaments and appurtenances.
ZCo babt anti to 1j01b, the said premises as above described with the hereditaments and appurtenances,
unto the said parties of the second part, as joint tenants.
Anb tgt 00b, Rita Anne Beseau, formerly Rita Anne Joyce, by Russell Joyce
her attorney in fact.
party of the fast part, for herself, her heirs, executors and administrators,
do covenant, grant, bargain and agree to and with the said parties of the second part,and to and
with the survivor of them, his or her heirs and assigns,that at the time of the ensealing and delivery of
these presents she is well seized of the premises above described,
i
L
"• BOOK PAGE ,
BOOK PAGE566 ^A �
' I
as of a good, sure, perfect absolute and indefeasible estate of inheritance in the law,in fee simple,and
that the same are free and clear from all incumbranccs whatever.
and that the above bargained premises, in the quiet and peaceable possession of the said parties of the
second part,as foint tenants,against all and every person or persons lawfully claiming the whole or any
part thereof she will forever WARRANT AND DEFEND.
{�{!' 7n WitnC00 iJ orttat, the said part y of the first ha s hereunto set his' hand and
I'� seal this 31st day of August
Rita Anne Beseau. formerly Aij*g#A) Joyce,
S'l'gned,,Sealed and Delivered in Presence of by R el JOyCe. the atto e 1 fact,
' �.. � _.....'�e'�'�"�C.,aq_4r.:*�. `'' ..,t:•��C...;-(Seal).
l
J epla Hughes _ _.... _ ... _(Seal)
• Eva G. L'ynoh_ •--....._...__........................._..._...._.............._.............._.____......_.(Seal)
_
%tatt of Wioconoin,
St. Croix County. ss.
On this the 31st day of August , 1959 ,before
me, Joseph W. Hughes , the undersigned officer, personally
appeared Russell Jo ce,gg�attorney yin fact forknown (or satisfactorily proven) to be the
person
Rita ll names ubscer,bed fo theewyltfin ps rai)m Anne i)d4a�kro®!edged that he executed
the same for the purposes therein contained.
Zn witness whereof 1 hereunto set my hand,and official seal.
Jose.-ph W. Hug es _
Notary Public, St. Croix County, Wisconsin.
My Commission expires June 9th , 19 63
(To be filled In It signed by s Notary Public) � 1:;(;,�-.
C11l
is ,' �i u•. • �..
W
INt.H.—Ch.BB wtw,stot..prodders that all Instrumentx to be recorded.hnl]have olatnlr printrd or trverrrtttee thereon the
ta.eM of the Rroaters,grantees,Menesaes and notary.)
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SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
d
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OWNER/BUYER Virgil F . and Agnes C . Timm
ROUTE/BOX NUMBER Route 2 , Box 46 New Richmond Fire Number 2003
CITY/STATE New Richmond, WI ZIP 54017
PROPERTY LOCATION : SW 14, SW 14, Section 24 , T 31 N , R 18 W,
Town of Star Prairie , 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 , I
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
H
three year expiration . o
z
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein, as set by the Wisconsin Depart- �d
ment of Natural Resources . Certification form must b 130days d
and returned to the St . Croix County 'honing Office i;thin
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 OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
DIVISION
INDUSTRY,
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS (H63.090)&Chapter 145.045)
LOCATION' SECTION: TOWNSHIP/( K=Y: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SW '�4SW��4 24 /T31 N/R181(or)W Star Prarie n/a /a n/a
COUNTY: OWNER'S RYYAME: MAILING ADDRESS:
St. Croix Vie it Titan IR.R.#3, New Richhmond Wi. 54017
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS:IPERCOLATION TESTS:
Residence 3 n/a F1 New 4-1-88 n/a
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL IHEIS OLDING TANK:RECOMMENDED SYSTE (optional)
®S ❑U �s ❑U MS ❑U EI S�U ®U conventional
N RATE::
If Percolation Tests are NOT required DES If any portion of the tested area is in the n/a
under s.H63.09(5)(b),indicate: class 2 Floodplain indicate Floodplain elevation:
decimal' PROFILE DESCRIPTIONS page 12 SHA
BORING TOTAL_ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPT ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-1 16.83 100.03 none >6.83 1.08bl.1. 1.33bn.sil. 4.4.2bn.l.s.
B- 2 7,17 100.46 none >7.17 1.00bl.l. 1.25bn.sil. 1.42bn.s.l. 3.50bn.l.s.
B- 3 6.75 99.99 none >6.75 1.00bl.1. 1.67bn.sil. .83bn.s.1. 3.25bn.m.s.
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN.."-' ' PERIOD 7 PERIOD2 P R
P-
P- se design rate
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 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 96.53
_ _ ..
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4 q. .... _.., 1. .. _..m._..
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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:
Gary L. Steel 4-1-88
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
988 N. shore Dr. , New Richmond Wia. 54017 229A 7b5-246-6200
CST SIGN E:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
I
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
,
To be a complete and accurate soil test,your report must include:
1. Complete legal description;
2_ The use section mUSt clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or comraael-Ckd use planned;
4. Is this a nevv or replacement 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 use, the abbreviations shown here for v riting profile descriptions and completing the plot plan;
1, MAKE A LEGIBLE diagrarn accurately locating your test locations. Dravving to scale is preferred. A
separate sheet may be used if desired;
S, Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test.exemp-
tion, if appropriate;
10. If the inform<atiron (such as flood plain,elevation) does riot apply, place; N.A. in the appropt iate box;
11, Sian the form:and place your current address and your certification number;
12. Male Iesauribl.a canopies and distribute as rerluired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL.. TESTERS
Soil Separates and Textures Other Symbols
s - Store (over 10") BR Bedrock
cob - Cobble (3- 10") SS - Sandstone
gr -- Gravel (under 3") LS Limestone
`s - &3nd HGW - High Groundwater
cs - Coarse Sand Perc -. Percolation Rate
me(i s Sand `At II
I' __ Fine Smut Bldg __ Bi"'ild ng
is - Loamy Sane! Greater Than
"sal - SzIndy Loam < Luss Than
Loeant Bn _ Bro,,vrr
'siI Silt Loam BI Bi a k
si -- Sill: Gy - Gr<y
c - Clay Loam Y _. ye;1ovv
scl - &eidy Clay Loam R - Red
sicl - Silty Clay Loam mot Mottles
sc Sandy Clay wa' v;ritla
sic. Silty Clay fff i'.vv4 firer.:, faint
F
c Ciar cc; - ccornmon,coarse
pt Peat MIT) - Many, medicina
M MUCk d - distinct
P - prominent
HVV1, - High hater lave(,
Six rleneral soil lextctres surface viatel
for licictid wiste disposal BM Bench Mark
VRP - Vertical Reference Point
TO THE OWNER:
T E<,soil test report is the first step ;ra securhig a sanitary Permit, The county or the Departrnrani may request
VeIlllcat;cw' of ti#ss soil test in the field prior to permit issuance. A c_orrplette set of plans for the privatc
r ;,� 5ysi erra ,ria<9 6a pe nait applicatis'm must be subnlitted to the aPoopnaie local awho rty in ord er tt;f
U$?1,i lt's a l'ert ni E1:. l n(-7 saanIt-Iry pit t mtt mr1SI be o,IItarileJ anI,I p)t,,;1.°L4 to !he 5tc i`t of id€"'4y i Ca;aSe3"S.;e;t,C7Si,
Virgil Timm
SW4SW4 S24-T31N-R18W
Star Prarie, twonship
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t� m E Ens r4 l l
s,�•14 12. �3, 10
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4-1 37
Gary L. St(e�el
988 N. Shore Dr.
New Richmond, Wi. 54012.
MPRSW 3254