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HomeMy WebLinkAbout022-1054-30-000 0 CO) O ! 3 v n d `r1 o d f c d o C 3 3 n 3 M 3 N n CD 'O to Z -0 1 C (D ' O) 3 3 K z o o li o .c ~r . cn z o o _ S 3 N C j N N I~+ fD V 3 a CD 0 N -4 O. CD Z - * 0_c', ~ O r :3 w v A N O N N ~ _ 10 N N N CL w > 7 CD CD c7 ~ O ' O COO O O O CD n Q O w O OD Cn N G ~I C C1 O N O O l~ 7 N O O O .Ni C W _ !Y ' Of N W ~ ~ v ~ D m o- n (D '0 CD W CL O , 2 _c O c o o 3 00 00 ` j' w U7 N z O W J ;u o 0 co 3 a 0. O O O O O G< G NC A O cc c CC A -1 N N v C 3 N N N C N /v~ O O c T M " ;z 0 0 77 .0 C, CD N (V 0) ~ N N N ~ CL o Z O z z O D ' o m o tr. N CD cn (n CD Cn (D i FT OIQ C N CD W CO C1 N :-t -j co z 7 (6 Z M 4 O ~ O n ~ I J ~ K A Z rt a C) O Z -I M " co M CD 1 I z a 3 p ~ 00 CD A N CD CD > CD ? O y C1 CD 0 3 m a C 7 N O CD -O CD C O 3 N N (D a O '.I CD (D ay =3 -n . 'O CD , Q O 9 3 'I FY w v cD o v oZ C. i CD - - M ~ CD -o 90 3o v,~~ m cCOD c m am N ~ A: O A t N 0 0 Q I O CD C 6 CO cr 3 c N C CD 7 fi a CD O C1 CQ :E ti N SU j O 0 CD O O O O V A CD A m A CD J, 00 m O 0 p O ` ST. CROIX COUNTY WISCONSIN -----`t ZONING OFFICE M II e M R q 11 p ■~■.6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 - (715) 386-4680 April 6, 1995 Ann Krumwiede 933 Chapman Drive River Falls, WI 54022 Dear Ms. Krumwiede: The records on the replacement septic system installed on your property located at the NE 1/4 of the SW 1/4, Section 19, T28N- R18W, Town of Kinnickinnic, on 10-23-87 have been reviewed. It is my understanding that you will be removing the house that is on the property, and after the removal, constructing a new house on the same site. You have asked if you may reconnect the existing septic system to the new house. In order to do so, a reconnect permit must be obtained by your plumber. As the existing soil report indicates suitable soils in the system area, no additional boring or soil test is required. When the reconnect permit is issued by this office, the existing system may be connected to the new residence. Should you have any questions, please contact me. Sincerely, Mary Jenkins Assistant Zoning Administrator cc: Clerk, Town of Kinnickinnic Bill Schumaker File L PUMP CHAMBER /s X1,3 v Manufacturer: Liquid Capacity: ~73 Y5- Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, OSide, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: %k Width: S Len$th: Number of Lines: Y Area Built Fill depth to top of pipe: IF-`' Number of feet from nearest property line: Front, Side, O Rear,O Ft aA52Z2 Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: c~-7 Plumber on job: License Number: 3/84:mj 1 'i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Ze TOWNSHIP, ti N i{ , y c~; SEC. /~7 T ~.2F N-R % r W ADDRESS 2 ~3~Y 1 S 7 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT - LOT SIZE lc~n C.-2s PLAN VIEW Distances and dimensions to meet requirements of I•MR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ -i n ~ 7 i ,.1 i I. f -•-I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 1C C. Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: t 000 Number of rings used: ;z Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,OSide'o Rear, O Cry feet .From nearest property line Front 10 Side 10 Rear,O Z P'G ` feet Number of feet from: well,~C/ L , building: 3C1 " (Incljde this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE . DEPAR'T'MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS P.O. BOX & 7969 HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O. BO MADISON, WI 53707 NEB, SW%,S19,T28N-R18W Qd CONVENTIONAL ❑ALTERNATIVE sfar.Plan l.D.Number: if assigned) Town of Kinnickinnic ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECT IO D TE: Dan Krumwiede Route 2, Box 257, Riv,-r Eal I R WT 540Z 1U-,~3_`p7 /U. 3Ca . PT. ELEV.: CST REF . PT. ELEV BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF Name of Plumber MP/MPRSW No.. County: Samfary Pe-, Number: St. Croix 102775 William qvhitrnaker i 6189 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY'. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 1PROVIDED'. PROVIDED. DYES ONO DYES ONO BEDDING: VENT DIA_. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING IVENT TO FRESH ALARM ROM LINE. AIR INLET FEET F DYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING JVENTTOFRLSH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) PUMP DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER IMATIRIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH INDE NCHES DISTR PIPE SPACING MATERIAL: INSIDE CIA -PIiS LIQUID PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPE RTV WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END'. PIPES FEET FROM LINE AIR INLET NEAREST-10 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 NO SOIL COVER TEXTURE PERMANENT MARKERS OIiSEHVATION WE LLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING I 1- ELEV.' ELEV.. DIA.. ELEV.'. PIPES DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS DYES NO DYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING FEET FROM LINE DYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLE SIGNATURE. DILHR SBD 6710 (R. 01 /82) Zoning Administrator 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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; 111. 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; Vlll. 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'h 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 Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wisco in's e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) SANITARY PERMIT APPLICATION COUNT ~ILHR In accord with ILHR 83.05, Wis. Adm. Code - 'Pei / v "~.o° ~...o . STATE SANITARY PERMIT # /d a yrXS- -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 r? NO PROPERTY OWNER PROPERTY LOCATION F '/a SI A/4, S l T i N, R /Jr E (or PR PERTY OWNER' MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME T .ts a5 ? "'614t CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ❑ VILLAGE F. e <<k~ Ah ; jjj"rOW W OF-7 II. TYPE OF BUILDING OR USE SERVED: Aga" I. W. GO lo6 Number of Bedrooms if 1 or 2 Family 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. Conventional 15.0 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. 0 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): ljy.s f,7, F- 191,44 c`.rL ~j o / Ba S 9 _ Feet Z Private ❑ 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 Holding Tank-~ - ❑ Lift Pump Tank/Si hon 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): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: fit/,'// ` i Plumber's Address (Street, City, State, Zip Code : Name of Designer: III. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # 000- 7- Lt~ don! Lo, OST's ADDRESS (Street, Ci , State, Zip Code) Phow umber: r a l4 ' d y IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) urcharge Fee Approved ❑ Owner Given Initial [a%). C)~ 16- py Adverse Determination C-IT 0 , 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 -~~i^ rt m kL'I ode -S'j,-,c . of x1i c° a-- • 2 ~n o ~ lr s V gLjs 0 OP id) 9.6 G Ine r . t OMPLI Tir l i` k IF AL <in ; D- 12, ME F FC. I _ 1Q 501rd5 rx~ A?' TOTHE C---._R: This soil test report is the first step in securing a sanit E lent may request verification of this soil test in the field prior to p }r private sewage system and a permit application rnust be iii 11 aL, t - to obtain a permit. The sanitary permit must be obtaine=I and of any L.~-_,~_ INDUSTRY, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS N, _ DIVISION INDUSTRY LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: Ne 1/ sw1/ 19 /TzBH/RiaE (o \-c11_ ~l COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: 2uvTt Z E3QX JS-7 ST.Mjr~ 1.)C ~~N Ic~uM(.u ~pE ~ZvQER C, W S ozz USE DATES OBSERVATIONS MADE PER OLATION TESTS: NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PvResidence 3 N • t~ ❑ New Replace N O _ \-Z _ 67 1 0 3 - 87 RATING: S= Site suitable for system U= Site unsuita'b'le for system -cvi (optional) S' x b~ C ~TIDU. MOUND: ~~❑U IN-GROUNDP URE: SYSTEM-IN-FILLHDSG~TAN U . 3C-MemCEyt~ SYSTEM: If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IBS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 S.o' `16•S' 1~TNK3~, rnol Z• Z' o.q I 'TS i \.3' lk. ~n 'V X31; 1.6 L,awr &17 ` s B= pu/ bN't-8m S'MUQGUy -~:S I S Z S•6` 93.01 << n1o~ @ 3.6' 1•Z'VFR`'t D1z6h si ITs; z.o'3n_si l; o.S'~» '~S; B LT• IN S -Jhk 'ah STWCLV CEIV . S 1 8* S 3 S.3` ~i6.c!' II ? S.3' 1•Z"-Jz 1-1 Si1TS_)__1•o$,nsil;i.6'3nsl;o-S► B n e wht _ 14 5.. 5' wOT [d 2.01 I.3'UD~~hsilTs; o8~D1z8~_Si_~; 3-3'$rlsTtza~ec.Y B- cwt. I w m n, o. , wk1 s B- S 5.8' c1~ Y'_ PC.ftT(i _ 1•)` VbklbtSi175 VS'BhSiI;-Z_8_S); oy~~7Z. -(__S.F>'_ ~1 _'t _ 5•g'_ l.Z' b\-r- V1 si.1 Ts 1,Z'*SN' 7_9' $n St 6- bk^a~ s 1 w )7z'~ 1~ 1 " /IE ES of LS PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER D PERINCH P_ 1 Z 1~~IJ 3 l~ 1 1 IS/n. PP _ Z Z 1J0>L1 E 30 ' _718 71181 P- 3 Z tat( ~3/~ 6 3/ 'V0 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 bworiings and the direction and percent of land slope. O O{ y.s V q z•% ` ?RGE a3 1 C.l_.l N SYSTEM ELEVATION 1-1 1'~ 3 r- Ok= M'1.llr 514~.1tJi - ~LL~w i I~ URYWi~.t- M 0 . 3 . Ott s o~ E °~F~ A~~ • bs, 3 I, the undersigned, hereby certify that the soil tests reported on this form were made e i i 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 s o my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: . w -1 t o -13 - $-1 ADDRESS: \~GC1UT y t+UX. -L -z- L. CERTIFICATION NUMBER: PHONE NUMBER (optional): I-- w0P Aj syul s-A6 14 zs-o16y CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - i REPORT ON SOIL BORINGS AND 5,{VttY ~ . _pLU, r,i- N i.UF r\ IVISION I, US RY, PERCOLATION TI= STS (115) P o aox 7769 ~;.upR AND MADISON, WI 53707 ! -}I;',AN RFtAI IONS (ILHR 83.090) & Chapter 145) _ T NO. RLI 'JO.: SUBDIVISIOti hAt,fE - - ~1.6CATION: SECTION. TO:~'~SHIP' UrJICIPALITY~ - >>TAN RIaE(o~ cr ►jis - - - - - S NAME: MAILINGADDRESS uj -1 C`_)JNTY r 1JNER'S/ UYER' 2~v~-R ~L4~, wt -7-z- _ DATES OBSERVATIONS MADE USE - _ ---R--ILE - - S - - CA! - R 1R 1 S If' OF DFSCR PTION PERC ON TES T-0-7 EDPQ COMrtnE _ AL DESCRIPTION: O r ' v IaCE L yrF, d-nce Tel 1Z g~ - RATING. S° Sne suitable for system U° Site unsuitable for system - - I'rlr :l 10'JAL -MOUND IN-GRO:! JCIPRESSUTRE SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) U S CCU S [ U [I S -.AJU S' x o-) t DESIGN RATE. l' are N07 required 11' anv port,On o' the tested are is in the ; . ILH R _ Cy__-__, indicate: Flo in, ncircate Floudnla r elevation • A - PROFILE DESCRIPTIONS (?RINGIr70TAL ELEVATION DEPTH TO GROUNDWAIEP-I _CHARACTER OF SOIL WITH THICfrNESc COLOF TEXTURE, AND DEPTH Irp l 1~~R1•~cPTF'ttE.~ OBSERVED EST. HIGHEST ITO BEDROCK IF OBSERVED ISEE ABBRV ON BACK.- _ .BHT b► ins - --I 5 O' q i -e -11 `O.q -,b -T S V B- vJ/ bin 5`~ u+.l G t_'-/ ~ ~'1~-3'i'F•T "c } "f!r'J=S ~ _.J ~ p ) n511;c _ S Z (S 9 0 " MCI @ 3.6' ~D1-.6n S' TS - - - - - - - - ~ . 9 ' L'T. gn ~ S'NX12 '8h STRcWG~ CE-of _ _ _S 1l 7e!rr-.rJ S I --a ' B- C 3 S.3 -ct -I1 I B n .5 kjhtz_e -PS S' G6 Sr It I>/1oT z•o' 5j ITS; o•$~~B~Si) 3-3'$►,S-rrD0&~Y - I I G~1. I r ~1/ /h P 2 M 07 o ff' Vj't, ~ -c s S 5 . g' cj C, f , r, r h+o~ C~ 1. 1 V VM $r, S i 1 TS ; S "B n S) I ; I B- I S. Li ' 'e,' I -----~-t-----~`----- i ~ _5 pur 1.Z' VD~~~►'i S1I TS; 1.2'~SnS11; Or LTn$I "61z't -n SI w/ I/-L I' }~~~cE~ ms=s- 1B - PERCOLATION TESTS RATE MINUTES TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAl ER LEVEL-INCHES rNUMBERI INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P 10 D -._?E RINCH - I P. 30 ' /i(, ~/g gig 15__ P- 3 Z cyJ= !t I 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• zontai 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. O L1 S r U 92•a ' t` AGE ~3 IJ 1 C_ \-,-I N o X3.61 SYSTEM ELEVATION - 1---- _ 1 wit 11 A 1~. - CC r -j , 3~ - ~ . t oo, o ot_1 Bu i ro F-I t s~Y w t' ^^y- Yt~P~I SIANJG. tul Off. - ~ u`~ tjvt~ N2 . 0f 19 C5 / t cA IA _ H r . 5 F v= - b 0 -.bC C^ALE 1 tr So the'. nns,r. lr,. Uned hr,eb, ,rrtit~ tnat tnt snil Irsts i,•I,oned on this iorm were rna:ic by mi, r:.*su^'..tv,ih the uiorrdures and viethods soucif,ed in ,uieirativr Coo(, and ilia! the data recorded and the Incauon of vie tests are cotrect to th< best of mt r.nuv;lydpt and belief. 11ESTS tVERE C01,APLElEDON- ' i• „a l +I ! - - - - -ER7IFICATIOr`Nt'." FER IPHCIN iC Li 7- , ~:~~•~1?•11 X11 Syt,l~ J - ~J ' Uia i Itltiv I ION O .a and one copy to Local Authority, Property O,vnei and Soil Tester. iz r. r n r. IR 101931 - OVER - H • x • cn a r STC-105 a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County x d a H OWNER/BUYER PGL.✓ --wad'_" M ROUTE/BOX NUMBER g 7' .2 V -5 7 Fire Number { yG ~ .CITY/STATE Z I P ~ ~7f r ~~/lc ~ - PROPERTY LOCATION:AZI! , S6✓ 1%, Section 4_, T 2F N, R l W. Town of V-41 :'C.k/AlA-' i`C , 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, if needed, by a licensed septic tank pumper. What you pdt 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 three year expiration. H 0 • E 1/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ~v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offi<pe within 30 days of the three year expiration date. SIGNED DATE l St. Croix County Zoning Office P.O. Box 98: Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign. date and return to above address. a F ~ I 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 peimit 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 ~QcL h /s~~r. ha L,i~ Location of Property Section 9 , T_gjN-R l~ W Township 1K`A1.y Nailing Address a0 z~ 57 Address of Site -g--r- -7 Subdivision Name Lot Number Previous Amer of Property C 1-5- 6e!QZet::7e,,- 7- Total Size of Parcel /G- ~Cr.+s• Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number ✓tL 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 Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I lWe) eehtti.6y that atf, etatemente on thl,s j ohm ahe true to .the beet o6 my (ouA) hnowtedge; that 1 (we) am (OA9) -the ownen(06 the pnopehty de~scAi•bed in this im4o"ati.on 6ohm, by vi tue 06 a wa Aan,ty deed keeo4ded in the 066ice 06 the County RegiAten o6 Veed~s ae Voeument No. 4,2 and that I (We) pneeentty own the p4opoeed 6 to bon the sewage di~spoe .bye em (on I (we) have obtained an easement, to nun with the above deacA bed pnopehty, bon the eonatnucti.on o6 6aid dyatem, and the dame has been duty kecotded in the 066ice o6 the County Reg•i.d.teh o6 Deeds, ae Docwnent No. L,k 7 r ) . SIGNA Olt OWNER SIGNAT 0 CO OWNER (IF APPLICABLE) DATE SIGNED 'DATE S ED