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HomeMy WebLinkAbout006-1001-20-000 C) 69 M C h 0. O le C n N M i C I .q h y � I c Z LL C O E Q U f9 co C N E °o v £ m a m z 0 0 o Z d c w o Z c E 'o N (D � N V1 U) �' C IL i P1� Lt .0 ° L) O m 0 ° a z I- z o N 2 W •• r N E N O � � J IL O. w w N C a l c'`) r n d U` O O O O o C C a L t N N E 75 Z ° I � H F H w Z N _ U) 0 0 0 Zo 0 0 •►NV aaa *� Q a o N W J U rn rn } Pftfti ;S ° ° E ` , y ..� N N I M m _ LL O W LO LO ° ° � w Q d y N o Our ° � Q o- o n o o _ D N N N Vl I ° ° L m3 o C co 00 z c c o N m m 0 ro L • y?,' °o o U i Y o H U) xt d a w • 'C� a d .V N y c r A vat 0U) 0 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER -I � , s • V I� TOWNSHI SEC. ( T �N-R _W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION �� LOT LOT SIZE y^( . 7 g pa-Ct/ o 13� PLAN VIEW Distac S 1n,,d dimensions to meet requirements of I•ZHR 83 Tt- SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �•i S� •O's 3 f� 4,(Z Q01 N INDICATE NORTH ARROI BENCHMARK Describe the vertical reference point used AIS12 , VIA—L- 0 Elevation of vertical reference point: 1.0 e f Proposed slope at site: SEPTIC TAVK: Manufacturer: �j�, Liquid Capacity: to© Number of rings used: (~j Tank manhole cover elevation: ) ` Tank Inlet Elevation: Tank Outlet Elevation: _R°� Number of feet from nearest Road: Front,oLSide o Rear, O _ �� O feet From nearest property line Front 10Side,QRear,0 feet Number of feet from: well I Do � � , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVF^SE S" ' ' 1 .j PUMP CHAMBER ,4 Manufacturer: Liquid Capacity: Sco -?q- Pump Model: Pump/Siphon Manufacturer: Pump Size . j Elevation of inlet: B L r�� t%' ottom of tank elevation: G o-3 Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: A16, K gq 1 , 4— Alarm Switch Type: Number of feet from nearest property line: Front, O Side, C%ear,0 Ft Number of feet from well:_� � Number of feet from building: Q • (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: e Width: �' � Length: Number of Lines: Z Area Built: 7�C)1!7' Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, (QtiR ear,0 Pt .3D Number of feet from well: -r � 1����d Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Nu er of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built- 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 o rings used: :-Elevation of bottom of tank: Elev ion of inlet: ber of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: , Number of feet from nearest road: Alar(n Manufacturer: / Inspector• Af Dated: _ / �e- Plumber on job:C' 4", License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING ' P.Q..BOX 7969 MADISON,WI 53707 ADISOW4,S1,T31N—R16W CONVENTIONAL E]ALTERNATIVE state Plan I.D.Number. Town of Cylon ❑Holding Tank ❑In-Ground Pressure ❑Mound 1. h Street NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard S. Kirk Route 1, Box 99, Deer Park, WI 54007 /)—/ 6— —7 /&r 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: Gary L. Steel i3254 St. Croix 102814 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY- TANK INLET LEY.. P7;EOV L LOCKING COVER PROVIDED // NO ❑YES NO BEDDING. VENT DI VENT MATL. HIGH WATER)O(/L/ NUMBER OF ROAD: BUILDING.IVE TO FRESH ALARM FEET FROM ? AIR IN`ET ❑YES O ES ❑NO NEAREST / �/Y DOSING CHA BER: MANUF CT RER BEDDING LIOU CAPACITY PUMP MODEL. PUMP/ZSIPHMANU� IRER WARNIN ABE L LOCKING COVER DED ��^ ❑YES NO tiJv ❑NO YYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH N� AIR INLET (DIFFERENCE BETWEEN FEET FROM LIDS lr!-'q � �0Y/� PUMP ON AND OFF) YES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at thk depth of plowing LENGTH DIAMETER MATERIAL AND M Kwc or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE C� ), the soil is dry enough to continue.) MAIN p<�U CONVENTIONAL SYSTEM: WIDTH LENGTH IND OF DISTR.PIPE SPACING tNRL INSIDE DIA st PliS LIQUID BED/TRENCH TREF1G s PIT DEPTH DIMENSIONS odC GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR PIPE DISTR PIPE MATERIAL: NUMBER OF PROPERT Y WELL BUILDING BELOW PIPES / ABOV fj< EL/EV.INLET ELjV ND FEET FROM LI"� A INLeT1r /�G NEAREST--►� �/J MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WE LLS El YES FIND DYES ❑NO DEPTH OVER TRENCH/BED JCEITH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. 1:1 YES ❑NO El YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING JGRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. - ELEV.. DIA.. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS —]YES LIFT CORRESPONDS TO APPROVED DYES ONO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS, NUMBER OF PROPERTY WELL. BUILDING FEET FROM LINE. DYES El NO DYES ❑NO NEAREST 0. Sketch System on am county file for audit. Reverse Side. $IGNATUR E. TITLE Zoning Administrator i DILHR SBD 6710(R.01/82) DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code St. Croix STATE SANITARY PERMIT# /oa8i� -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 Richard S. Kirk MW '/4 '/4, S T , N, R 16 (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.##l, Box 99 n/a n a CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK Deer Park, Wi. 54007 715 263-3115 3 VILLAGE: 11. TYPE OF BUILDING OR USE SERVED: e,� 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. 0 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. ❑ 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): class 2 750 750 96.55 Feet ®Private —]Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber X 800 1 Weeks ncte Q I ❑ ❑ 1 ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' nature:(No mp NNftMPRSW No.: Business Phone Number: Gary L. Steel 715 246-6200 Plumber's Address(Street,City,State,Zip e): Name of Designer: 988 N. Shore Dr. NNW New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# ary L. Steel CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. , New Richmond, Wi. 54017 71 5 )246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature No Stamps) ®Approved ❑ Owner Given Initial a urc^^h��arge Fee nn- Adverse Determination X. OMMENTS/REASONS FOR DISAPPROVAL: Ian nerd Lod ,63 /1)"j I J-6N k,,1.1 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 aermit issuing authority. Anew 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 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%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 Y 9 9 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 At9[ included the creation of surcharges (fees) for a number of regulated practices which Wisco Inr.S ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur.e_ is used in your building is returned to the groundwater through your soil absorption u 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) of the property being developed. Any inadequaoies 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 Il �C�na �� Gv�c� I (A 0 K Location of Property N W S1�} 14, Section , T N - R 16 W Township Lon Mailing Address f?nk J 1 l k V � j , Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel -1 Date Parcel was Created De C Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume „3 and Page Number -(O� as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ee4ti.6y that att 6tatemen A on th,ie 6oAm ane tAue to the but o6 my (oun) knowt .edge; that I (we) am (ane) the owneA W o6 the pnopeA,t y de c4ibed in .this .in6oAmati.on 6oAm, by vi tu.e o6 a waAAanty deed A eo,%4ed in the 066.ice o6 the County Reg.e 6 teA o6 Deeds as Document No. --� �' 4 ; and that I (we) pAed en tt.y own the pAopoe ed e.c to bon the b ewage diApoAat a ys.tem (oA 1 (we) have obtained an easement, to Aun with the above deb cAi bed pnopen ty, 6oA the cons.t4acti.on o6 said system, and the dame has been &j�yJ ec Ad)d in the 066.iee o6 the County Reg,i,d.teA o6 Deeds, as Document No. F, SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) V - S - g7 DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2 ,... WARRANTY DEED ' i � ".') r` n L THIS SPACE RESERVED FOR RECORDING OATO .3 � FACE --- ---------- I k,:Car 1 i_.A5 OFFICE Viola Kirk, aka Viola R. Kirk, a single woman s'r. co,oiX co., wi& Re-.A- for € ecold !'f1Es 19th -- -- -- - '4oy of Dec. ACD. 1980 conveys and warrants to Richard Kirk, aka Richard S. at_ 8: 0 A. _Kirk and Paula Kirk, aka Paula F. Kirk., ._husband and wife as joint tenants eor,►ir . RETURN TO the following described real estate in St. Croix County, State of Wisconsin: i Tax Key No. Part of the Northwest Quarter of the Southwest Quarter (NW4 of SW4) , Section One (1) , Township Thirty-one (31) North, Range Sixteen (16) West, described as follows: Commencing at the Northeast corner of Lot Two (2) of Certified Survey Map filed September 5, 1978, in Volume "3" , page 678 , as Document No. 351398 , being a part of said Northwest Quarter of Southwest Quarter (NW4 of SW;) ; thence North 881 16 ' East, 504 feet; thence due South, 152. 50 feet; thence South 88° 16 ' West, 504 feet; thence North to Point of Beginning. EX.L�Pr�r This iQ not homestead property. (is) (is not) Exception to warranties: 1 Dated this llth _ day of December 1980 . s'� .2 i -'1-1-L (SEAL) (SEAL) Viola Kirk, Aka Viola R. Kirk (SEAL) (SEAL) e AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this stay of STATE OF WISCONSIN 19 ss. St. Croix County. S Personally came before me, this 11-L114`' ''°°daya'Of December, 1980 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Viola Kirk, aka Viola R. Kirk (if not, --- — -----— — ----- authorized by §706.06, Wis. Stats.) _--- :' 'this instrument was drafted by Reinstra, Van Dyk & Needham, S.C. to me known to be the person— who execAl;d.the f&e= Attorneys at Law going in rument and acknow�dged he a'me'n ! Q New Richmond Wisconsin 54017 (Signatures may be authenticated or acknowledged. Both * Tany L. Glaser are not necessary.) Notary Public St. Croix County, Wis. My Commission is ermanent. (If not, state expiration date: 4-1p0-83 , 19 .) WARRANTY DEED—STATE BAR OF WISCONSIN, FORM NO. 2-1477 1 H H a STC - 105 r a SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z ty �OWNER/BUYER S G ROUTE/BOX NUMBER pt� e_ �c�}( /� Fire Number CITY/STATE ,S ZIP ✓ /Voo PROPERTY LOCATION: ;4, Section T " i N , R_A6_W, Town of C, V I-0 , 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 . I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE St . Croix County Zoning Office P . M. Box 9$• Hammond, WI 54015 715-796-2239 or 715-425-8363 S %,i date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK.No.: SUBDIVISION NAME: NW 1��W14 1 /T31 N/R16 Eor)W Cylon n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Richard S. Kirk R.R.#I, Box 99, Deer Park, Wi. 54007 USE DATES OBSERVATIONS MADE NO.BEDRMS.:1COMMERCIAL DESCRIPTION: I PROFI LE DESC IPTIONS: PERCOLATION TESTS: Residence 3 n/a ❑New �leplace I( 10-19-87 n/a RATING:S=Site suitable for system U=Site unsuitable for system ICONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTTA�A,,IN��K:RECOMMENDED SYSTEM:(optional) ®S ❑U INHS ❑U S ❑U ❑S�U ❑S ltT conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Class 2 Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS a e 7 OMB BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER IDEPTHAN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B-1 6.86 99.85 none >6.86 .67bl.1. 1.25bn.sil. 3.33bn.c.s.&gr. 1.67 bn.m.s B- 2 6.92 99.89 none >6.92 .67bl.1. 1.17bn.sil. 1.00bn.c.s.&gr. 4.08bn.m.s. B-3 7.08 100.05 none >7.08 .58bl.1. 1.17bn.sil. 2.50bn.c.s.&gr. 2.83bn.c.s. B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- P- see desigr 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 96.55 ill io , o °� 3 1 E [ i 1 I -4 I r 1 3 €` I I I i ' ., 3. , 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 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): ,088 N. Shore Dr. , New Richmond, Wi. 54017 2298 715-246 6200 CST SIGN 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 - SRCB - 6395 To be a complete and accurate soil test,your report must ine,lucfe; 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 comrnercias use planned; 4. Is this a never or replacement system; 5. 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 far vvriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; I y S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9, Complete ail appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain,elevation) does riot apply, place; N.A.in the appropriate box; 11. Sign the form and place your-current address and your crrtificatiorr number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone, fovea 10") BR - Bedrock cots - Cobble Q- 10") SS -- Sandstone gr - Gravel (under 3") LS - Limestone '1s - Sand HGW - High Grorrrrdvwater c Coarse Sand Pere - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loarny Sand > - Greater Than Isl - Sandy Loarn < Less Than 'I Loam Ern - Brown -*sil - Silt Loanr BI Black Si Silt Gy Gray "cl Clay Loam Y Yellow sc! - Sandy Clay Loarn R Red sicl -- Silty Clay Loam mot - Mottles sc - Sandy Clay wl vvith sic - Silty Clay fff few, fine, faint c - Clay CC - comrncarr, coarse pt -- Peat rrrrn Many, mediurn M Muck d - distinct: p - prorninent HILL - High wasti level, Six general soil textures surface water for liquid waste disposal BM Bench Mark VRP - Vertical Reference Point TO TIME OWNER: : This soil test report is the first step in securing a sanaary permit. The county or the Department may request sve,r?r;cation of this soil test in the field prior, to pert-nit issuanCe. A cornplete set of plans, for the private sewage system and a permit application most be submitted to the appropriate local awhority in order to obtain a permit, The sanitary I erred mr.rst be obtained and frosted prior to the st'.rt of any c"onstruction. i Richard S. Kirk NW',,SW% S 1 T31 N. R16W town of Cylon 3 L-sc tea,,P v.c. 4-,-e.z . Soo 5�, 1� pelt ,50+� 460+ Y2oC-rC Gary L. Steel 988 N. Shore Dr. New Richmond., Wi. 54017 MPRSW 3254 11-8-87 H ` 7a Ln H a ST C - 105 r r a , y SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z d a H OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION : Section , T 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 I[ the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents 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 three year expiration. 0 I/WE, the undersigned , have read the above requirements and agree Ln to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Fd ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . 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 . PAGE OF PUMP CHAMBER CROSS SECTI17tJ AKIG SPECIFICATIOUS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER Z5' FROM DOOR, " w(of """S WIIJDOW OR FRESH I2 Mlu. I AIR INTAKE GRADE I 4"MIN. IB"MIN. CONDUIT -- ---------- � l PROVIDE I INLET AIRTIGHT SEAL i i III V APPROVED JOINTS WPC 1. PIPEJOINT A W/C.I. PIPE EXTENDIMC, 3' I II ALARM EXTENDING 3' OWTO SOLID SOIL B ' i( ONTO SOLID SOIL i ON , c I 1 p Vii' ELEV. FT. PUMP--� --� OFF 0 CONCRETE BLOCK RISER EXIT PERMITTED OIJLH IF TAMK MANUFACTURER HAS SUCH APPROVAL SEPTIC f SPEGIFI•CATIOKIS DOSE TANKS MANUFACTURER: `�v ���`'' WtABER OF DOSES: PER DAy TANK SIZE: goo `G/ALLONS DOSE VOLUME ALARM MANUFACTURER: b�.4/,6✓ T INCLUDING BACKFLOW: GALLONS MODEL MUMBER: ",I,4 CAPACITIES: A= _INCHES OR ��Z GALLONS SWITCH TSPE: B= IMCHES OR GALLONS PUMP MANUFACTURER: (O� � C= INCHES OR ��'°� GALLONS MODEL NUMBER: L�F[� 5 D=1-:7- INCHES OR 2�f 7 GALLONS SWITCH TYPE: In E✓ N�cH-�-1 MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ANO DISTRIBUTION PIPE..... FEET + MINIMUM NETWORK SUPPLY PRESSURTE/. . . . . . . . . . . �� FEET- WeO FEET OF FORCE MAIN X F/oo FZFR S ICTIO►T FACTOR. �o FEET TOTAL 0yWAMIC. 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