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HomeMy WebLinkAbout040-1098-50-000 �., O °� 0 w �o m cNO �A?- aNi D 0o L 3 = z N = v1 EM C L co � N CD d0r. W W.0 •U N C •- V C a E CD U `yE 0c v.E a @ m. �V C �NOa O C v,co 0 O rn E aci a� v Z O N V Z N U = E O� c vi � c a� LL C �`N N y LL C O O O m N@ C E O C 3 a�Z 3 U N O Q O E Q U3 O O z5t 0) Z b N E E O) Z +' O = C 00 w a m a m N F- Z c O a+ 7 O N a t 0 N F- r O � � ` C f6 O y N •_ N a N � •� . m t a o N N a _ Cq a c m O z m z O z m z o w N zI = I � cl N G O I LL C a Y C' r g ca 11 EL CN N Z • y d a a a a a Ai N CL °' 7 c N @ ° co N J 0) 0) Z rn Z M n M M C7 CD co CO � � ml N a A a> m A U) H �i c 75 Ai O ° y y. C U N C O O o°o LL ! C U C_ d d O � M N l y ) •E O C N OD M > = N f6 '� N f/1 W N CO O � m C m a) m C .O. N aCd.. 7 N ° 00 0 3c n m ID o v 3 c°n aNi m T! �_ r yy N O •O ~ O N U ��'', Q OMO M Z Al 2 Z Q O Z Z d a d a � c d � ` c .. rw � I 14 ?'? <r"y COnU Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j / i �, &1.4L TOWNSHIP / r SEC. T '200 N-R W ADDRESS /�D ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L""D INDICATE NORTH ARROW X0710•►t ED OF -IE.ryz_ SiO�.vlr BENCHMARK: Describe the vertical reference point used 8r F CAi 4W&'y- i Elevation of vertical reference point: /0 0 Q Proposed slope at site: 3' S 2p rs TIwCr ,P-,< WiES�.e e- 0 SEPTIC TANK: Manufacturer: Liquid Capacity: /3-5'0 " Number of rings used.- / Tank manhole cover elevation: 7 -7 c / / / / ' � Tank Inlet Elevation: �s�-S Tank Outlet Elevation: �D SERU/CL--- Number of feet from nearest Road: Front,@ Side 0 Rear, O 12-0 feet So . From nearest pr©perty line ' Front,@ Side,©Rear,O feet Number of feet from: well 5 D building: �D (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) .i iir+ I i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact r: Pump Size Elevation of inlet: Bot m of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from n rest property line: Front, O Side,O Rear,0 Ft. umber of feet from well: umber of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: /` Trench: Z ' 131-a=� R3 Width: Length: -S s Number of Lines: Area Built: Fill depth to top of pipe: /1 *X/M0-4, OF 4-2- " Number of feet from nearest ro ert S©, P P y line: Front, O Side, Rear,Opt . �O Number of feet from well: > $p Number of feet from building: 3� . (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Botto of seepage pit elevation: i Area Built: Has either a drop box O distribution box b used on any of the above soil absorbtion sytems? (C ck one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inle . Number of fe 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: � 0 U Inspector: Dated: Plumber on job: License Number: �c+TE S&i ij,;PI.Uf:;SNG CO. 3/84:m j 656 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. MINN.INSTALLER&DESIGNER LIC.NO 00663 C V\ %A Ui o � Q � GM CA ad c , N r C � b � t H �g m ~ W N T1 �ocmocn qZN N oZ �' �_ o c� NZ or � w r ao T m t �m I T .� :k 0 ` Q CIQI rye, V If 0 r w `h tq W 'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NB%,NA1,,S25,T28N-R19w [ CONVENTIONAL ❑ ALTERATIVE (If assigned) Tows. o4 Tno y ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound R H ADDRESS OF PERMIT HOLDER. INSPECTION DATE: A.B.C. Highway 35 Nonth, Riven FaM, W1 5402 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: Robeht Utbkicht 3307 St. cuix 119381 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST----110' 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: 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 FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH:NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: 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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO [DYES ❑NO DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO [:]YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS [--]YES ❑NO I ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES E]NO NEAREST—� Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Admi DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE P-LAN I.D.NUMBER 8%x 11 inches in size. f 4ff O Y 3 Z —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PRO ERTTY.OWNER PROPERTY LOCATION • /,� (i . �/L�/'V NF_'/,NW '/a, S L� T , N, R / E(or o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME /-/i6-K w I/- 3 S 0.0 . CITY,STATE ZIP CODE PHONE NUMBER �. CITY NEAREST ROAD, VILLAGE 54o Z2- yts ?2 ys TiPD a . II. TYPE OF BUILDING OR USE SERVED: LU,c/i1�j `+o , 5,1!E S Number of Bedrooms if 1 or 2 Family OR j6d Public(Specify): j ,/Jf'/'2D III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. Z 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 Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 0 seepage Bed b. ❑See a e Trench c. ❑See a e Pit 2. PEFfCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): E `Q 42-!IR 7 D( /Z 11, 60 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in g allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank x f 3 50 Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): I Plumber's Signature:(No Stamps 1ofP/MPRSW No.: Business Phone Number: AIJE - V/-/3,94:WT I 3 ?6-2 Plumber's Address(Street,City,State,Zip Code): Name of Designer: &SS° ® ",v en, ;�V - ffv�so.� �iS ,� GNU�Cr ip� VIII. SOIL TEST INFORMATION Certified Soil ter(CST) me CST# S- CST's DDRESS(Street,City,State,Zi Code) Phone Number: 0 AO ? .�i G•G�, /itllf CJl f �S'�O 2­7 7/5 ¢ZS- �. IX. COUNTY/DEPARTMENT USE ONLY Disapproved I San y Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) pproved ❑ Owner Given Initial /�/ rchar e�F/eee� Adverse Determinationu""'�v �"� 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; 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'/2 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 $ Br included the creation of surcharges (fees) for a number of regulated practices which Wisco n. a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rl:6a$,ir@ is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) • S CA E}UST- r35O G}1�-. SL-DS1 C Truk i o r►�erh�� w«3 ca•�,c�zcTt �Efarry �tSl-R1 � _..._.........� _. . . GAi T L - —_.�--- �U i-'!On,1 B bx _h LUG S our�er �L T� �T to tEi:Xt ST. D Et. qy.q' 7 fZAr,rFr� EXL T, or swo,rv6 a3 I s - ►- q-1 � � � �, 46! ... trr,Ro►v Plpc PI �c 4 s S'r-r tiN, eou►-�MZ-Y op 55,uam C�Y1SC t BJT B1Tv� ►rr.r u1u S r..� Ys' ) "IP �P J,���s F 20>`►mcGE Ro a o 5• T. H . z 2 3 t _ Nwl/ -F SE--T!7 -ZS CDI�i'^Y, WIS-r F:ST^ . IADEY PAGE 1 OF 4 TITLE SPEET PA GE 2 OF 4 PROJECT DATA PAGE 3 OF 4 PLOT PLAN PAGE 4 r'7 4 PLAN VIEW-CROSS SECTION PYIEPAPED 35 V`12 FTC LL S,W t Sy©Z.Z. colvs FP_�FAP,�D pv: .t ,r '•ti �� ARTHUR L WEGERER = b1EGFSE�:, i,'E3EP. AND ASSOCIATES r,WZ)RTH. BOX 74 421 N. MAIN STRUT -1 wrs_ RIVER FALLS, WISCONSIN. 54022 i .�� Sti.y.N.�r ��e�♦jdA'S I GI; a� --moo$ � 88-zz6 of Y 5 88 - 04932 -`-Yr1 S TZ �-�C O✓I J T U2�t tv��3t p wt LL S�z ua A L wt `--fA-,PO wvticN " S A t117 R>LJM UM of 15 �►.�� 1 Furvzo\z R LO G . C-rs).j jj�-Jiu S z o F7'. Ica o2 5 {� f\ S 1-)Jet G 1 3 S(2) C-,t L. 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X17.3'•- cisrtuG G2rti-Df= J,. 9b.I ' l ELC)6.t4 •- rJI.-)Site GR� Sy m Yg• 3' a - - a P N o L/ t Pmt Fofu+T _ Pv c =_ 6 O ,�` Cz ��r LJ''SO��Dt�h�l J �ts�1218uT7U►.a PIPES ..........._ T .— _ w SEPTIC 3' Y 8' 3' I E�.96,y'f Sy' �-9S•y�J LL..Q s-W 041 NS`\le-, s� . �2 �� - S �C � 10 . �V�1P� / C Z UL"'x)T Pi Pts GS w/f rPPRouL'D CAP i \� SCZLL L4 Z i vgP)X. ,c- o Cv O G OG O ° c� � C e C C` • L"PVc o14I)B3,n5Q P)PEs Cl Z)/- TU ZI�ZM 1,)aG2(GA-TE tyR,�T�b WIPE -,Mz Boy-To►� or-, Tee W w P)) S- 2 PrBov t_ N-)PES � � ��=�� �� �D^ ^ � ������ �m Wisconsin � Department of Industry, Labor and ��UOO@O ��8l2�OOS .~°~..^~ � . � SAFETY a BUILDINGS DIVISION office of Division Codes and Application � 201 East Washington Avenue P.O. Box 7960 � ^ Madiuon Wisconsin 53707 � � � � WE( ERER, WEBER & ASSOCIATES Owner: ARROW BUILDING CENTER ATT: WAYNE RUDESILL � P.O. BOX 74 HIGHWAY 85 NORTH RIVER FALLS, WI 54022 RIVER FALLS, WI 54022 � RE: Plan Number: Date Approved: November 15, 1988 Gallons Per Day: Date Received: November 3' 1988 Project Name: ARROW BUILDING CENTER Location: NE,NW^SEC.25^0, 19W Town ufTROY County: 8TCROI% Fees Received (Priority Review) : 188.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one met of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: — REPLACEMENT CONVENTIONAL � � Inquiries concerning this approval may be made by calling (608) 266-8230. � � � Sincerely, Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 7 cc: ARROW BUILDING CENTER ___Priwate Sewage Consultant ___County ___UW—SSWMP —Plumbing Consultant aeo�4uo (n.00�o ___Owner ___Plumber _—Environmental Health I,NDUST OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INflUSTRY, DIVISION 76,LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1)&Chapter 145) LOCATION: SECTION: WNSHIP UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: r,3e 1/ Nw V44 zs TAN/R 19E (or 't-7z.�-Y 1 Z — I CS 11-1 vow L4 \'9 9',9 COUNTY: NER' UYER'S NAME: MAILING ADDRESS: 1}l�� 3S IL1rJ�Z'[1al ST•c�zo1X �. w ZQ%�-0)NG C-iSQT R FA LL s w I 5 2,Z- USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: I ❑Residence N--N �1. Z Cu' ❑New WReplace I Ci _ z,-�_ - y _ g V RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:fYSTEM-IN-FILLIHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑U ®S ❑U ®S ❑U S ❑U ❑S .®U SIGN RATE: If Percolation Tests are NOT required D I If any portion of the tested area is in the N • �• under s. ILHR 83.09(5)(b),indicate: INN Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN£11f CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 -7.-7 q S.a t�o>v�. > �.� . 1•-�' '81sil TS;Z.3' QhSiI ; 3.`7' 3>1S Gti Z. 1 131Sll TS 0.613 11 Si I i ©.b' lay► S B- Z `l.6 q S,$' N_ coj%J a > -�.(�' L{ •I ' n ark J S w s.wr ri Gv- J Z, 1 ' 8I Si TS ' 1.9 ' %n L B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERI0132 PERIOD PERINCH P_ S S N-1 0 �O '7/(6 Z 9/ Z 3/ P_ 2 S 6 h10 I p s/6 1 �t116 15/8 P- -3 IV C, l O Z '/1 Z Z S P- P_ tJo p L CE !"Um qZ11COUEL 077LVO S Pt P_ �C--Iru I stt 6"b P ke-itoir 1=10Ajw AjG I o s vR wk 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. Q0wr m op- 7gej,_. AGE 9 l SYSTEM ELEVATION �.• �► 1 . 6 ;j E ; s , E sew OF- s> D�+U G�_ its T• _a_ �_ � �� s�r�►c��' OF `4 e= G � a } LoT t � g � r�� )T d _ . s z — - L Q<-I t��► 1 .s.1 r-E ,W r P3 Byo S' cot u i G1 of Std E E E I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with tt res and meth ds specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my k 1�elief, t' NAME(print): TESTS WERE COMPLETED ON: 'i)12T1•}v12 L_ 1A-) 4EF-6�_� 1.o- 4- t 8 ADDRESS: T"'A OU3 T--- 4 O k Z G CERTIFICATION NUMBER: PHONE NUMBER(optional): SLLSwaR— w) SVO ► S-) (--, 7tS_1/Z 5—o/65( CST SIG DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — J T, 2, E R J p, 8, v, I H H E L p I C� S A �0, I TO THE OWNER: This soil test reoor% is the iifs"SI = wl may request verification of this soil test ?n ate M c, Me pri v, sewage system and a �nernit 1C obtain a pert its The am,ary t: S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT �+ '• �s St . Croix County ' `•: `q' ca OWNER/BUYER ?.i�;: ; . ROUTE/BOX NUMBER � 3 5 Fire Number '' ' fo'''p♦ CITY/STATE - 'eA- ��l/S ZIP �� Z�- T+ ►? ,fir;.. - PROPERTY LOCATION Section:N� '�f T N �' : .:•:''A , W� . r. , 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 pelt Into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Crolx. County residents may be eligible to receive a grant for '•: a maximum of 60% of the cost of replacement of a falling 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. I/WE, the undersigned, have read the above requirements and"agree &A ; to maintain the private sewage disposal system in accordance with- H the standards set forth, herein, as set by the Wisconsin Depart- 84 went of Natural Resources . Certification form must be completed and returned to the St . Croix County Zonin Offipe within 30 days. of the three year expiration date. ,.Y) SI ED ;r DATE N St . Croix County Zoning Office DG► °•::'a P.O. Box 98i Hammond, WI 54015 " ' 1 715-796-2239 or 715-425-8363 Sign, date and return to above address . � I is u r 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. - -----------------------j---------------------------------------------------------- Owner of property ' F/`�� Location of property N� 1/9 �� 1/4, Section 2-5 , TI? N-R.-I—W Township. __ Mailing address 2S �d Address of site Subdivision name Lot number C.S� I �� S �Z� VAS- Previous owner of property C• �� �"'YX�I` Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X"—Yes No Is this property being developed for resale (spec house)? Yes o Volume �7 7 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. t 1 ------------------------------------------------------------------------------- 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 recorded in the Office of the County Register of Deeds as Document No. 3¢0 7,S 7 ; 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. ) . Si nature o 441 Signature of Co-Owner (I placable) y VatA of Si ture ,r Dat f Signature F� 0144 f X977- PORT AS BUILT SANITARY SYSTEM RE . C.emlU. OWNER ;:, '7. ..�-s-r >/ WN SHI P �1�!9-( SPEC. TN, R W P.O. DREaS 4,2g, CROIX COUN WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM • �AO P. M 9, ., SEPTIC- TANKS') MFGR. �;( . cZ e�t.�` CONCRETE /-- STEEL X-0.7—of rings on cover Depth DRY WELL TRENCHES No. of width length area BED no. of lines widt = — length - areal 17 _ depth to to f i.pe .AGGREGATE � ' PERK RATE AREA REQUIRED AREA AS BUILT / . DISCLAIMER: The inspection of this system by St, Croix County does not imply com plete compliance ate Administrative Codes_ There are other areas p liance with S t inspect at this point of construction. St Croix that it is not possible to p County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. . ,INSPECTOR DATED p 1 J� �/�� PLUMBER ON JOB LICENSE jT ,0 7 3 l t . III • � . REPORT OF ITISPECTION--INDIhDUAI SMAGE DISPOSAL SYSTEM Sanitary Permit /S State Septic , = 7 TOT•RISHIP St. i-.%- County Sr^.PTIC TA'77Z • X50 .,s.ze gallons. lumber of Compartments Distance From: Well 7 _ft. 12% or greater slope On. Building ft. Wetlands _ /U!�- f Ilighwater ft. DISPOSAL SYST-L2 `\ Tile Field or Seepage Pit(s) Distance From: taell 2 ft. . 12% .or greater slope /AL Building; _ft. Wetlands f:. FIFLn Highwater ft. Total length of lines X208 ft. Dumber o1 lines Length of each line ft. Distance between lines ft. Width of the 1.25 . trench ft. Total absorption area sq. ft. Depth of rock below tile in. Depth of rock over tile in. Cover over rock ,. LAI Depth of tile below grade 4in. Slope ,of . trench 0 in per 130 ft. Depth to Bedrock ft. Depth to (;round water g ft. Number of pits OutsPeeAmeter ft. Depth below inlet ft. Gravel around pi es no. :Total absorption area sq.-ft. S q uare feet t of seepage trench bottom area �- required wired Square feet of seepage nit area required ' • Inspected by: ,PT�,\1 F Title: 2 Approved Date p - 7 - 197 7 . Rejected Date 197 Z a 7 PIb. # 60 3/70+ PROJECT DETAIL DATA SHEET NAME OF BUSINESS 1t2ely t /A, G LOCATION S 'T.T{ CC2A 1X street or highway .fir or township county LEGAL DESCRIPTION L� !i; of L)&u w OWNER Mailing address gb8 K-.,, 4 T-11 JTILI,Wt�TE� , f'Ilu. ZIP55o8Z ARCHITECT OR ENGINEER 11..IT'rLL Ft= Q0G/A)e-e2/k&Add ress 19 at!':p E_t-tAlRE� 1Ul ZIP PLUMBER ,-p p L'o.�ss;,Z�,��,6iy Address ZIP 1 . Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building X Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant . . . . . . . . . Car spaces ( ) Restaurant . . . . . . . . . . . . . . . . . . Seating capacity (10 sq. ft./person) ( ) Dining hall . . . . . . . . . . . . . . . . . Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages . . Number of units : 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches . . . . . . . . . . . . . . . . . . . . Number of persons Kitchen Yes No ( ) Bar or cocktail lounge . . . . . . Seating capacity (10 sq. ft./person) ( ) Nursing or rest home . . . . . . . . Number of beds ( ) Mobile home park . . . . . . . . . . . . Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store . . . . . . . . . . . . . . . . Number of employees 9 ( ) Number of customers X10 sq. ft./person) _ S- Service station . . . . . . . . . . . . . Number of cars served (daily) ( ) School . . . . . . . . . . . . . . . . . . . . . . Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building . . Number of persons (total all shifts ( ) Apartments . . . . . . . . . . . . . . . . . . Number of bedrooms ( ) Other . . . . . . . . . . . . . . . . . . . . . . . Specify 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes No �e Dishwasher Yes No x Automatic clothes washer Yes No X Automatic potato peeler Yes Other . . . (Specify) No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned h��y'� �AL Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET itECE1'V COMPLETE OTHER SIDE A� 2 j1977 Seepage trench bottom area planned `"" _ width linear fees - depth Seepage bed area planned <' width ' linear feet depth Seepage pit planned outside diameter - depth below inlet — depth ----- 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 Approved: Address: S t Date: ZIP THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: /S- 122!7— INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY PERMIT REQUIREMENTS AND SHALL BE V01D IF REVISED WITHOUT THE WRITTEN.APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY EXAMINED and reported upon by the Section of Plumbing ord Fire Protection Systems, Bureau of Envirc.,nmeni::l F;calth, D:vi3ion of Health, Departmeni c; Hcrdlh any-' Sociol Services. JAAa,5 t.. Chinf Section cr 6'! + ,c„ e� t P e APPROVED by the r r ,s o� r;''h, Dept. of !-health and Scc'sc,! S^r ri ;s, _ to conditions ;et forth in the letter of approval. RA!N-i L. A;NlN i A< .;, --'h.D. Admi),1' atcr Verifcatian -- .......�:. ....................... ......... State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 '1t" 24# MADISON. WISCONSIN 53701 �{ lBrli IN REPLY PLEASE REFER TO: SECTION OF PLUMBING 0 AND FIRE PROTECTION SYSTEMS 181 IN. ' ft. l'c AGG .vl���J' r� an Identification No. IOW/ O�cF� G Dear Sir: Re: ,Are" 9"1"" 0WA" (OW) ftt"2 stem selow *"011004 !,M Of 1h K $25 IM 119W, ?*vwbI# of s St* Cmft Commy This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the yroiect. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review : ,' Fee required is $ i'`=� �� �l� 7 Ue Fee received is $ L,�� Plan accepted for review. Fee is being returned because of Overpayment Q underpayment. Providing one of the two categories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. I] No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. Additional information required. See attached P1_b. 100. The permit to start construction will not be issued unti ` ► ter requested information is received and accepted. QPlans being returned. See attached P1 00 [ QW Sincerely, v ; z A. Barg Chief JAS:f js State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 MADISON, WISCONSIN 53701 Septenb*r !r f 1 IN REPLY PLEASE REFER T0: SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS by Dit#tf„off Iftl1wring �" 201 N. Ig •I Plan Identification No. 83.vwr Falls, V1 54M Dear Sir: �� 1�1 Re: � Bt�.Mag �r ( 1►) �I $ � �EQ 1o�E Swap ftemsel i*A at " Sk M WIN JU99 IMMAMP of TM - St. x This is to acknowledge receipt of your plans and specifications ro—r the above- indicated project. When referring{ to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the vroiect. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section R 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ % Fee received is Plan accepted for review. Fee is being returned because of II Overpayment Q underpayment. Providing one of the two categories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. QPlans being returned. See attached Plb. 100. 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' z,y 'YA > ai +'tF?'n '.�7Ys ;{MW . . r", ;�',�,"4;f�', 2 I ,'r r •i r S ,^.f n Y; r S .sly y y'9'rx t + '11 t t. r" ��^ray 4 I C2 r :,t d x',' �4 f� .r s :;a 1•`s��Y. w. "� rr"t I1 - �:�} I'0 ' `<- - 4 s s'i a��.a't .�: T k t" Q k..y ','r p..— ; d k'M s.�1 r r a .!•` y:. t 1 sr.? A x * � A_- 5. gyp, K taK �t,r + +r :" se r. � Y F V . `t 3 fi , , .Y J h . <, 11 ir'I. - ,� " " 't ' c • t `2 _ �.11 � 'e � x- r I i ,� t toils, .�p r, " j 4 p * w " . . w .y � J 1 . 1. .� y �< € s i Ea � 4a x . r ? 7t J f , EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL.HEALTH P.O.BOX 309 MADISON,WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:N—k' '/4, h.�IbW/4,Section ZS TZ R UE (or) W,Township oF�ty 7mT tj> l Lot No. , Block No. County Subdivision Name Owner's Name: C0 Ul 1,AMIEM Ly;� Et`iZ Cc, � SCs $ Z Mailing Address: N - (A"M Sr �` y� -� P N TYPE OF OCCUPANCY: Residence No.of Bedrooms Other r-IlrAl L 120 S i f`AFS5 EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOILBORINGS A�G• 4 , i97") PERCOLATION TESTS ' S o i-971 SOILMAPSHEET SO TYPE V-1<<--Ljo-V- PERCOLATION TESTS DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE TEST NUM- DEPT INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 1 Ts , tail S1 1 , _ I N a�, TS, z-ca , C3h g1l , �`� Z� oo �r S Z 36 Ts %Z ; Vs r+ s i 1 , ► •, I,�o p '7/g -7/,, h s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B Z -7 2, `� 7 -7 2 23 ' i V ' Z3' I Z B- 17 'L it 7 -7 Z i ZS • ! --) at > ?4! -L3 1 y • Z,y B- 5 -7Z 16 ' 19 (� 7 2 I PLAN VIEW (Locate perco lat io n tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. 17-So a 113&M Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 02- .e s i 9• � . I Ian- f4 s p+ z 11J z. � � o �- ON t N type � i1rT %3 L1 P k\ -M 5 cf I lg I,tie is 'e certify that the soil tests reported on this form were made by me in accord with the procedures and meth o 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) R=Md�rL —Certification No. Address ��'� �° °l`S r•l U 12'l i- �N I� Syo/I Name of installer if known CST Signature ` ' COPY A—LOCAL AUTHORITY r,. .................365520 CERTIFIED SURVEY MAP CONSOLIDATED LUMBER COMPANY, INC. Par of the Northeast 1/4 of the Northwest 1/4 of Section 25, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. Indicates 1" iron pipe found. e40 fo 0 G L ALL BEARINGS REF. TO THE N.S. 1/4 LINE cD -SEC. 25, T28N, R19W, ASSUMED 'n S 1° 44' 41"W o 0 to o' 0 M – t0 ti N 3 3 3 M – V• 0 W - N .V' J ~ p V ti o O O to – O CO _ 2 N to 2 2 Z.1 S I°44'41 "W 700.00' — _ — — __C.T.H. U. rl, N.S: 1/4 LINE j r N~ 0=Z N to O 4J lL /s9 0E-U 0 W �0= L) }� Z W P W O <m �` U.O 0,O O 0 (o Z to 0: to W>' 0• / / LLJ O p / < Z o� h ° ,/ APPROVED / '' AU 1.9 1880 L; `0 / / S1.CROIX COUr'•i Y Q CDMPREt*N$IVE YAKS nAN:::.:G aD / AND ZCMIING COMWTI*' '9 S9S N a: 0) 0 / I ) ti - N w i ✓ J i 0 i Z inMh, dON 000 0 1 t0 i / Q N – a•LON 000 W O _ v 0 0— ONM M NM to N I . o O 1 / f) tO --Om0 —O) Z M t0 t0 N a) U)ti N � 0� 0 h N N -- -- N ° I -� o ���ntmmtrrntti// � I / ,`�\\\\\\ O ////////, O Q 0]U O W t1 C7 2 '7 Y JAMES L. `;* 1 ° = . _ MURPHY S 1042 a: / RIVER FALLS, O W I SC. .0LAI LANG ,S / //l/lllillllllllll\ / Vol. 11 Page 979 (SEE DESCRIPTION ON REVISE) Certified Survey Maps St. Croix County, Wisconsin