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• AS BUILT SANITARY SYSTEM REPORT
'VAR M R rl /C_ S , TOWNSHIP q d ,*n SEC.23 T N. RZW
0. ADDRESS 'Q3 ti , ST. CROIX COUNTY, WISCONSIN. ,
MIVISION , LOT LOT SIZE '
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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'TIC TANKS) I d�� MFGR. �'_L S .[.-i2- CONC TE!/ STEEL
NO. of rings on cover Depth DRY WELL
";NCHESNQ� of width length area
no. Of line h widt length_ �p area
_ depth to top of pipe"
.0 1A ,•/
RAT �'.f ._ AREA REQUIRED- (r D AREA AS BUILT G lS
ciaimgr. ;The inspection ,of this system by St. Croix County does not imply complete %
-plian e,wit.h. State Administrative Codes. There are other areas that it is not possible
inspedt. at this point of construction. St.., Croix County assumes no liability for
tem o rdtidn: However, .if failure is noted the County will make every effort to
.-ermin .-c us.e of failure.
'A$ES. A%D OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
ECT '�..�
SO
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; TEi D I ( �. PLUMBER ON JOB r"f
'NUMBER a 7
1 s
REPORT OF INSPECTION - INDIVIDUAL SLWAGE SVSTLM
San-i.tahy Penm.i.t .2 'ey
. _
State Septic
TAME Towne.h.ip St. CtoiX Cuunrty
uc .ion ��� �$ Secti.onaa_Lot M Subdi,vi4ion
A PTIC. TANK
Size, gattond Numben of eompan.tmen.ta
,catanee 64om:. Week. Bui.edi.ng / 4 12% atope
Hi,ghwaten
LIMPING CHAMBER
Size gattona _ Pump M en Mudee Numben
OLDING TANK
Size gae.Qonaha Nu 6 ompantmente
Pumpe't tem
l4atanee 6nom: Wett Bui.edi.ng` !_12% aeope__
Hi.ghwaten
8SORPTPON SITE
Bed Tae.neh
iatance Prom: , Wet , a Bui,edi.ng 7 12% eeope __,_
H.ighwaten
HSORPTION SITE DIMENSIONS
Width o 6 tKeneh 6t Requ.i red aaea_ G S --- - _-6x
Length u6 each tine 30 6t Depth oA Koch betow tole 4 <n
Numben o6 .t.inee 3 Depth u6 noch (jven fife Z- in
Tot.ak tength u6 ei.nee V 6t Depth u6 t.iee bexuw grade �-8 .i.n
Di,6tanc.e between ei.nee G 6t Seope u6 t4e.nch�'` tin . Pen 100 6t
1U4,A, uL6u�� ti,un a)tect ,
N 6z Type u 6 Coven Papers o e tn.a
IT DIMENSIONS-
Numbt)n a j- pi:tb a e around p.ita yea-___-! rtu
Outeidg di.ameten
totae abeoKpti.on aaea 6t I':
ktta nequi 4ed 6,t
NSPE TITLE
I)PROVED DATE / 19 8
1 JECTED DATE 198
A ASON FOR REJECTION
EH 11' 5 Rev.9/78
REPORT ON SOIL BORINGS AND E 60 ;Tt S "+
WISCONSIN DEPARTMENT OF HEAL H.'�1ND SO6I�0LLT. 0 /ICES
P.O. BOX 309,MADISON,W NSI" X980
FF
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LOCATION %,��_/4,Section •3 ,T�N,R/—ftur)W,Towns ip �1yr icipality S
Lot No. ,Block No. rt I fr i C C
u me IVISIon a Z 5-q'
Owner's/Buyers Name: 1 E S
Mailing Address: 65'34-
TYPE OF OCCUPANCY: Residence No.of Bedrooms ' COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS II I I(S, a50 PERCOLATION TESTS rl 8 d
SOIL MAP SHEET `�� NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-1 eQ 54
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,
TEXTURE,MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B– 1 84- &AZE > 1. 15 ZG' an S 5'7
B— Z 7-0 MOAIE7
B- (1 a 9 L S c G 5L /o• go 5 C'A
B– 4, & 4 N. X84 P5L LT-54- t IZ L 4' e
B- ,c G
B- Co Z Z -S L 8' 13 [ 1� G L r-G• S C
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the blan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 41C SO,. F7' R Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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I,the undersigend,hereby certify at t e soil tests reported on this form were made by me in accord with the procedures and methods
specified in the Wisconsin Administ tive de,and that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (print,)mT---S T:=--- T� j ( H '/--Certification No. S°
Address 'c/ � W LL.S.
Name of installer if known
Copy A—Local Authority CST Signature
State and County State Permit #
PLB
99 j
6 7 Permit Application County Perm' # 7
m
for Private Domestic Sewage Systems County � :: A
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Jim Hiers 834 N. Hazel, St. Paul. Minn 55119
B. LOCATION: SE % SE %, Section 2, T 29 N, R 19 E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Hudson
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance
Single family X Duplex No. of Bedrooms 3 No. of Persons 4
D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify)
New Installation X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate n Total Absorb Area sq.ft.
New X Replacement Alternate (Specify)
Seepage Trench: No.of Lineal Ft. Width Depth Tile depth (top) No.of Trenches
Seepage.Bed: x Length 351 Width 18' Depth_1" Tile depth (top) 320 No.of Lines 3
Seepage Pit: Inside diameter Liquid Depth No.of Seepage Pits
Percent slope of land— 8% Distance from critical slope- 25%
WATER SUPPLY: Private IN Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME James E. Ruseh C.S.T. # 55-568 and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# .5184 Phone # 698-2407
Plumber's Address BOX 4, Woodville,
s
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Please xef er -to attached dr4wi s
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY p
Date of Application l� 9�d Fees Paid: State /y. County J. Date
I e� ' ✓ �U
Permit Issued/Rejected (date) f�_ 9—Q Q Issuing Agent Name
Inspection Yes_y No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
•... 1 d _.'' �� F
l � ►QED JA
D �AN 25 1978 JAA. - d
Mf)� MMES O,C
I R�prster ONNEI[ is
aA Gorx f°°•d,
c ST.CROIX COUNTY
3 4 6° 2 SURVEYOR'S RECORD' z
ST. CROIX COUNTY CERTIFIED SURVEY MAP NUMBER 5�1
P/7RT OF TKE SE 114 OF THE SE- 114 OF
SEC T l 0 Al 2 3, TOWNSHIP 2 9 AIO/2T14, R AIVGE /9
WEST, TOVV/ll OF HUDSOA1, COUNTY OF ST
C20/ x, 5TF777EE OF WISCONSIN
,,�e��'M►eeeeoeopeee�, 2
••''`" ��,,s o ,��° APPROVED
� F• � RT T. 'Q��1 I
S i RICNEY
S 29
AN 181978 E C0/zA1Er2
• 14
WEBSTER,
WIS' 0: St. CROIX COUNTY SECr/oN 2.3-24 19
� ^.., .. so COMPdEMMENSIVE PARKS PLANNING
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AND ZONING COMMITTEE Q
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= BERNTSEAI MON.) FD.
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OF THIS
W�1NCR SUBDIVISION O /"x 24" I.P. SFr, /.68#�L.F. Q
p,PPROVAt w1-AN AFP,,GVAL FOR � Rl
DOES JI THE BRS/S FOR THE BFf1RIAIGS IAI THIS 9VCVEY
ES OR SEPTIC SYaTEN►. /S TRUE NOR7'H BRSEO 0A1 R PoLHRUS
BUII.DING SH62.20. OBSA-R 1II77-IOAI MFTDE AIGIJ5'7-8,/97'6 LOM- T/NE. '
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PAGE /OF 2.
Volume 2 Page 541