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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-SAGER,TIMOTHY K&LORIENA J TIMOTHY K&LORIENA J SAGER 1605 140TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1605 140TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 12 T3ON R18W SW SW 3AC LOT 2 CSM Block/Condo Bldg: 7/1820 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 12-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 863/284 07/23/1997 781/530 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 45,000 167,500 212,500 NO Totals for 2007: General Property 3.000 45,000 167,500 212,500 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 45,000 167,500 212,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • I PUMP CHAMBER % c *-6, Manufacturer: „Li/quid Capacity: Pump Model: Pump/$iphon Manufacturer: Pump Size Elevation of inlet: / Bottom of tank elevation: Pump off switch eley5a ion: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of,-feet from nearest property line: Front, O Side, O Rear, Ft. / Number of feet from well: Number of feet from building: j (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: (Z)Width: rJ f Length: 2-5 Number of tines: A. Area Built: 7S-60 Fill depth to top of pipe: rx 5 Number of feet from nearest property line: Front, O Side, ®Rear,O Pt . Number of feet from well: 4n,' Number of feet from building: �C�C ( (Include distances on plot plan). SEEPAGE PIT Size: Num r of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a rop box() or distribution box O been used on any of the above soil absorbtion'sytems? (Check.one). HOLDING TANK Manufacturer: /S Capacity: Number of rings used: Elevation of bottom of tank: Elevation./Of inlet: Numb/7//of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: j Number of feet from nearest road: / Alarm Manufacturer: Inspector: if Dated: 7 may • Plumber on job: may. All Dated: License Number: v .s 3 S 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L L ikn . `" 1 ,t o f e str. TOWNSHIP Pi SEC. / Z T 3d N-R/e7 W ADDRESS iti T. CROIX COUNTY, WISCONSIN Ark) P,(A 171,0.4,,e) SUBDIVISION C t if< LOT Z LOT SIZE e96/ PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • • zz'" 49' 15o 37 � 410,. 7„.5r r r — A 6 � --d 5 ' 41 �1-1 INDICATE NORTH ARROW � 4 BENCHMARK: Describe the vertical reference point 'used4,...17/30, k1&;94ftea Elevation of vertical reference oint: p / 00 Proposed slope at site: D Z- SEPTIC TANK: Manufacturer: 1� € Ks Liquid Capacity• l Number of rings used: r Tank manhole cover elevation: 6 2- (PZ si. Tank Inlet Elevation: Q Tank Outlet Elevation: 10 ion Number of feet from nearest Roads Front,OSide,O Rear, O )44%, feet From nearest property line : Front,OSide,®Rear,Op' " feet Number of feet from well 4 1) t building; ` ;2 ' (Include this information of the above plot planY( 2 reference dimensions tot septic tank) SEE REVERSE SIDE • DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,Wt. 53707 SA, SW%,S12,T3–N–R18W CXCONVENTIONAL ❑ALTERNATIVE State Plan 1.D.Number. Holding Of assigned/ Town of Richmond g Tank ❑ In-Ground Pressure ❑Mound Lot 2 NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE Wm. C. Kucirek Route 1, New Richmond, WI 54017 $_S-_d 3-26 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 3254 St. Croix 99024 SEPTIC TANK/HOLDING TANK: MANUFACTURER: 1 ! LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER �W\ td el 1 r�.�-� O� q P OV DEO: PROVIDED. l" vV �O /. / 7 /O .7 YES LINO OYES AINO BEDDING: VENT DIA. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ' ( ALARM I S FEET FROM LIN lop/ 22. AIR INLET LIVES 174 NO C ❑YES 111 NO NEAREST "N- '+� DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ONO DYES ONO 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) OYES ONO 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: CEO/TRENCH WIDTH LENJ T NO OF 'DISTR PIPE SPACING COVER INSIDE DIA #PITS LIQUID r r TRENH ES: M ERIAL• PIT DEPTH DIMENSIONS ) GRAVEL DEPTH FILL DEPTH DISTR.PIP (DISTR.PIPE IDISTR.PIPE/MATERIAL. NO. STR NUMBER OF -PROPERTY WELL BUILDING: VEN//TD�,ITO FRESH BELOW PIPES / ABOVE COVER 103•6111 113" V / 2. , PIPES. NEAR FR `� LINE / t '2.O 6O AIRW o/ MOUND SYSTEM: 0[(� S J Mound site plowed perpendicular to slope .Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM • and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. El YES CI NO SOIL COVER'TEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER. EDGES. DYES ONO OYES ONO OYES C7 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: s.. `D/TRENCH= , TRENCHES: =•.DIME IONS _ MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL 'NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.: DIA.. ELEV. PIPES DIA.: =ELEVATION AND OIBTAIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY `COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY 'WELL: BUILDING FEET FROM. /4 OYES LINO OYES 0 N NEAREST: ',. M' t . � r I LI al t / i ___ /O ZtIS 1 / JO... -- _____K , ., ,��;� __ Sketch System on etaln in county file for audit. Reverse Side. ' s SIGNATURE: '" TITLE •DILHR SBD 6710(R.01/82) Zoning Administrator I 1 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; 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 81/2 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 i ter included the creation of surcharges (fees) for a number of regulated practices which wisco to can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried reasure e is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- "4,3 6F tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, its worth protecting. SBD-6398(R.03/86) (� SANITARY PERMIT APPLICATION COUNTY LJ DILHR In accord with ILHR 83.05,Wis.Adm.Code St. Croix .., ,,�,,"° STAT ANITARYPERMIT# -.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 �( I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ri YES t J NO PROPERTY OWNER PROPERTY LOCATION Wm. C. Kucirek SW '/a SW %, S 12 T30 , N, R18 It (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.#1 2 n/a T.Derrick Addn. CITY,STATE ZIP CODE PHONE NUMBER 0 CITY : NEAREST ROAD,LAKE OR LANDMARK New Richmond, Wi. 54017 ( n/a ) ® TIOLWLANOF Richmond 140th.st. II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR I I Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. Ix I New b.H 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## 96006 Date Issued 6-17-87 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. El 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. El 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. Cl Seepage Bed b. ®Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): class 2 750 750 98.33 Feet LPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank x 1000 1 Weeks concrete I ❑ ❑ l❑ I ❑ I ❑CI Lift Pump Tank/Siphon Chamber --- El VII. RESPONSIBILITY STATEMENT I,'the undersigned,assume responsibility for installati•n of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's a nature:(No St s) / /MPRSW No.: Business Phone Number: Gary L. Steel d V Q 3254 (715 )246-6200 Plumbers Address(Street,City,State,Zip Co.e): ( Name of Designer: 988 N. Shore Dr, New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. , New Richmond, Wi. 54017 (715 ) 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Surcharge Fee %7)(0.,,,,,)Approved ❑ Owner Given Initial cd ` co `7-c_3/-S7 y� 7 l� Adverse Determination / CJ (�i�J X. COMMENTS/REASONS FOR DISAPPROVAL: '} I)L . Xirotied b3 `TN-06-6-5 L) . Ale 4S d'v' SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 • To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new 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 for writing 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 it desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain, elevation) does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification 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 lover 10") BR — Bedrock cob --- Cobble (3- 10") SS — Sandstone yr — Gravel (under 3") LS — Limestone -- Sand HGW — High Groundwater cs Coarse Sand Perc — Percolation Rate inert s — Medium Sand W — Well fs -- Fine Sand Bldg — Building Is — Loamy Sand > -- Greater Than "sl Sandy Loam < — Less Than `I — Loam Bn — Brown 'sil — Silt Loam BI -- Black si — Silt Gy — Gray *cl — Clay Loam Y -- Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc -- Sandy Clay w/ — with sic — Silty Clay fff ---- few, fine, faint c Clay cc common, coarse • pt - Peat mm — Many, medium rn — Muck - d — distinct p — prominent HWL — High water level, r- Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP -- Vertical Reference Point • TO THE OWNER: 'Ths soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to able- n rr per els.The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON,WI 53707 (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSH I P6COMMIRit LITY: LOT NO.:BLK.NO. SUBDIVISION NAME: SW W/4SW1% 12 /130 N/RL8 E(or)W Richmond 2 n/a T. Derrick Addn. COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: St. Croix Wm. C. Kucirek R.R.#1, New Richmond, Wi.a 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a ©New ❑Replace 7-31-87 n/a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) ©S ❑U ©S DU © S DU DS EU OS ©UJ conventional If Percolation Tests are NOT required DESIGN RATE: If an class If any portion of the tested area is in the n/a under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: decimal' PROFILE DESCRIPTIONS page 28 JSB BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTIP L OBSERVED-1 EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) . B- 1 7.51 102.33 none >7.51 .67b1.1. 1.67bn.sil. 3.75bn.s.l. 1.42bn.c.s. B- 2 7.08 102.14 none >7.08 .67b1.1. 1.08bn.sil. 4. 58bn.s.l. .75bn.l.s. B- 3 6.76 101.93 none >6.76 .67b1.1. 1.17bn.sil. 4.92 bn.s.l. B-4 6.50 101.02 none >6.50 .75b1.1. 1.25bn.sil. 4.00bn.s.1. .50bn.l.s. B- 5 6.91 101.76 none >6.91 .58b1.1. .75bn. sil. 5.58bn.s.1. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- see design rate P- P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal.and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 98.33 1 ri 1--toill3._1_. 4 ; 1 1 ir. i 1 5 E I I t j -W� } µ w_ l ...If-4)2 114 ,-, , I 1 _ - .1-, 1--- : ! , 1 ; ! i 1j , r P ! le I I ; 1 i , I , } 1 lAi � 10` i U f t i f . 1 1 i i 1 1 -I-� i i , I i -4; ' "; ; 1 ; :,-,/ii 1' -14!) (. ...'' 41 -1,-16P-rril ; ; 7 171717 7 7771 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 7-31-87 ADDRESS: CERTIFICATION NUMBER: PHONE UMBE (optional): 988 N. Shore Dr. , New Richmond, Wi. 54017 2298 715-246-6200 CST SIGN RE: C-L 1 DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— ■ `� a.),IP . e, j�r c r iC E'/. acv%Sw Y.,‘ , /2 -1430A. R./9& Raa._,C,ivytovi. 4 , troll ° p L________ 9.)6. 6, opi.„.4" 3 . , ,,‘..4.9 t ! 5-of-i- 6. w , tio1 s4 *-� too 1 '/�1\ t‘o ' (J�� YV 1 4(= for 440' /1 (S ; ) Diids /9-1/ / tr- 11/4, a. )12 . (4 .10 1 - - - - - '.. 61: 1 A jam- — _ 1z 19 - 3 tq . 6-ts /(0( Th A . '*91 vki)k:1:\, ( . 0-01 - d' 0 v **- b .✓ �-v` y �vs - ,b,c: -R.7..9 ems' 6 , 1 St I ‘' I _s 3 ,51 y L S te. ( 14 ? ' {� � rnlJ� d! c c) ,. 7- 3I - '7 A ST. CROIX COUNTY , WISCONSIN t a � , ,, a ZONING OFFICE Vgt *i. , ; 0 796-2239(HAMMOND). . h � M, Y ....1 r 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 31, 1987 . Ms. Vicki Smith Bureau of Plumbing 201 E. Washington Avenue P.O. Box 7969 Madison, WI 53707 Dear Vicki: The permit that is enclosed #96006 is being replaced by Number 99024 as the contractor put the house where the septic system was going to be so the plumber had to redo the sanitary plans. If you should have any questions, please feel free to call me. Sincerely, i Li-1 - / rut v(/,-, ,.) l ( 1,-4,,j Roxann Croes Zoning Secretary Enclosures L l CC 0 c c L - c m m W s CD C' m ; m c a O ° q no_T a o E o Q c CD o 6o To 5 > c.2. 0 O H ro E< 0 c ca 0,E E W d d o ° '°m m c o a �3 I- c E a y ° o 0. ° o dm Q o d g' c y -f. " m A N m v _o H c co NO T Z 52 N c Y > _0w Q m rn$jj � = m d >. ° w m 3 v ao E - - ` y a d > 'It . ' � S. O CC t>o 2 p... C N '10-F- 6 = N C C ` W 11i H m o E 3 .• - o' E Cr al z; ~ y U C i0 V !! M =MN E c m , c . H cc "•°o o N d = E� °-m o w w of ' t L ` E ° 0 O F.. a, 0 >o >•a-0 u a `' _� >O N:°. Qa� oa, ,',3 >. - of ° ` c W .J = 7 N Q 0 c E L d 'p o W'a. C N 3 ° V ao m� N° c NNrna 3 �. m W o .ca) .c•' L c° 3 c c,E c c o > LU �— L � ° . L o _a H- W H m ~ m ~ � cam �� �v3 ~_� Q z Z o u ov a_a ` w y . v w 0 DC:= �' a V w z z U O U z (....) Lila � ° o W 11::::k Lje)C) N �� > z z o iimmi 1 k (-lc n cr . ca... Q z o x O o Z U) /N 2 1 o w I-- >um 1 Z Q = 1 to ....t1 _I Y E— --OO 11 0 Cg .... t)) __I 1.._ O 14 • = O 0 CC II= • 4 ..-- C..� w 1 1 rJ . m . CIS ... " w Ilimm D_ cc E eii....c u) 44C a- UJ Dc---sPc ....?...: OQ t-- OC J 2 C:13 i ao oC m O w co w Z .„D 0_ . CO c/� o v) 0111111 a . 3 o i . N O LL. 2 Q 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969, BUREAU OF PLUMBING MADISON,WI 53707 SW1,SW1,612,T3ON-R18W CNONVENTIONAL Li ALTERNATIVE State Plan I.D.Number: Town of Richmond ❑ (If assigned) ❑Holding Tank In-Ground Pressure ❑Mound Lot 42 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE Wm. C. Kucirek Route 1, New Richmond, WI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV of Plumber: MP/MPRSW No County Sanita_rypgrrgitJJumber: Gary L. Steel, 3254 St. Croix (�60U6 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED OYES ONO OYES ONO BEDDING VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VN TO FRESH ALARM: FEET FROM LINE: AIER IT NLET: OYES ONO ❑YES 0 N NEAREST A DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED PROVIDED: LIVES 0 N OYES ONO OYES ONO 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) OYES LINO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) FORCE_„.., SYSTEM: �y �¢.� e. WIDTH. LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.. #PITS. LIQUID %NOS ,+ 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 1 NEAREST'. r 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. OYES 0 N SOIL COVER(TEXTURE PERMANENT MARKERS OBSERVATION WELLS. El YES LINO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER: EDGES. Ell/ES ONO ❑YES ONO OYES 0 N PRESSURIZED DISTRIBUTION SYSTEM: °'WIDTH LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER TRENCHES_ AN SI S " gt 'MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELE V., ELEV.: DIA ELEV: PIPES: DIA.: [411411.00461: i HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED % PLANS OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: —OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET"FROM - LINE: OYES ONO OYES ONO NEAREST '` III Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE 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: I. Property owners name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 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 .ater- included the creation of surcharges (tees) for a number of regulated practices which Wisco 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 system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis Wil ®t +' ' '• tE ed by the Department of Natural Resources. These funds are used for monitoring ground water groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. s5D-6398{9.03,86) .IIuuuh11i SANITARY PERMIT APPLICATION COUNTY (-N e PO/ u In accord with ILHR 83.05,Wis.Adm. Code °......,....oll STATE ANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION (� I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE fl YES LJ` NO PROPERTY OWNER PROPERTY LOCATION Wm. C. Kucirek SW 1/ '/4, S12 1-3Q , N, R 18 k (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME New Richmond R.R.#1 2 n/a n/a CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK El VILLAGE :New Richmond, Wi. 54017 ( n/a) &I TOWN OF: Richmond 140th. St. II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. © New b. Replacement c. I I Replacement of d. 1 I 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. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Class 2 750 750 98.76 Feet l Private ❑Joint El Public VI. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Concrete glass App. Tanks Tanks strutted Septic Tank or Holding Tank x 1000 1 Weeks Concrete i , ❑❑ El El ❑ El 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): Plumber',./.nature:(N St.iy^.$) /1 •/MPRSW No.: Business Phone Number: I► teel �`',._,, i�`! = % 0 (715 )246-6200 Plumber's Address(Street,City,State,Zip Co7-": Name of Designer: 988 N. shore Dr. New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. New Richmond, Wi. ( 715 )246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) `I Approved El Owner Given Initial !1 �+ Fee Adverse Determination 1 C�c) CO a- ,rcharge Fee O0 (p-0-87 e6,1s/ ` ,'i. -o X. COMMENTS/BASONS FOR DISAPPRO AL: 4 lat, AK-e dve(..,-e_ok .1:-. OC-)ThCk3 e . fSi.e Ls o,-‘) SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber • APPLICATION FOR SANITARY PERMIT S T C - 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. Owner of Property WM. C. Kucirek Location of Property SW ;6 SW 1, Section 12 , T 30 N-R 18 w Township Richmond • Mailing Address R.R.#1 • New Richmond, Wi. 54017 Address of Site same • Subdivision Name nfa • • Lot Number 2 ' Previous Owner of Property Thomas Derrick Total Size of Parcel veig o2, 7`r��f1�2�cg i Date Parcel was Created 6-9-87 • Are all corners and lot lines identifiable? x Yes No • Is this property being developed for resale (spec house) ? Yes x No Volume 781 and Page Number 530 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 (we) eettgy that att statements on the 6otm ane time to the beat o6 my (ouA) Ftnowtedge; that I (we) am (ate) the owner(a) o6 the phopen ty due/abed in this in6otmation 6o4m, by v.ihtue o6 a wa tantgA0 recorded in the O66ice o6 the County Reg..atet o6 Veedaa4 Document No. ; and that I (We) pteaent2y own the proposed site Got the sewage d•iapo,sa2 system (on I (we) have obtained an easement, to tun with the above deacAibed ptope/ay, 604 the constAuetion o6 eaid system, and the same has been duty tecotded in the 066ice o6 the County Register o6 Deed&, a4 Document No. ) . SIGNATURE O1 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED • r . . . . DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA I STATE BAR OF WISCONSIN FORM 2-1982 REGISTERS OFRC:E 4216804 ST. CROIX CO., WIS. 781115E 530 Rec'd. for R-ftcord ttits 10th _. . . Thorrkas E. Derrick and Janice L. Derrick, husban day of June AD 1917 and wife, as marital property, with rights of CO, . 2:00 P. ,M surViVOrahiP 44.- e;• 0'Connell ,-,-'441Xia, WWI*1 000161.0 conveys and warrants to ..-Wiiiiam...C..._Kucirek..azd. ShirIey...A.....Kucirek.,...husband..and__Vile.,...as...1114r.i.t.41 a'1.FAI ' (-4-)clLge‘-9-‘-' I property,..361i_th__.rights...of...survivoiship Deputy I RETURN TO — - ----------------------- — . 'I the following described real estate in St. Croix County, I State of Wisconsin: I I Tax Parcel No: I i I I I Part of the Southwest Quarter of the Southwest Quarter (SW of SWI) , Section Twelve (12) , ill I Township Thirty (30) North, Range Eighteen (18) West, described as follows: Lot Two (2) 1 , of Certified Survey Map filed May 26, 1987, in Volume "7" of Certified Survey Maps, page 1820, as Document No. 426075. I I IBANStat $36 ww . FEE This is not homestead property. (is) (is not) • Exception to warranties: Dated this 9th day of June , 19 87 (SEAL) . _ I ..', (SEAL) s: homas E. Derrick , Ji, ice L. Derrick (SEAL) (SEAL) * * 1 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN I' 1 ss. .at.....C.roix County. hI, authenticated this day of , 19 Personally came before me this 9th day of I Jun2 , 19 87 the above named I I! Thomas E. Derrick and Janice L. II * Derrick 1 TITLE: MEMBER STATE BAR OF WISCONSIN I (If not, ..r . , .. I 1 _ authorized by $ 706.06, Wis. Stats.) - ',•..3 1 to me known to be the person s ---,who execpted-the foreg g instrumen die acknowledte the same.. - . ' .7-• ' . I THIS INSTRUMENT WAS DRAFTED BY .4111111/1 / "' .4 '-iX - Reinstra, Van Dyk & Needham, S.C. — 9 I • --- :' - -- • , Attorneys at raw * Ruth A. Joh son 4.--4----ril• , 1, Ne.w...Riahmand,...kliacgilg.ip 54017-0127 Notary Public St• Croix ..".: '''. Ciminty, Wis. 1 (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, tate expiration are not necessary.) date: 12/2.3/.9_0 , 19 ) I I *Names of persons signing in any capacity should be typed or printed below their signatures. I' STATE BAR WISCONSIN H.C.MillerColniolnY WO FORM No.OF 2— 1982 Stock No 13002 ' G ' to H 9 STC - 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x 9 H OWNER/BUYER Wm. C. Kucirek ROUTE/BOX NUMBER R.R.#1 Fire Number CITY/STATE Nev. Richmond, Wi. ZIP 5 4017 PROPERTY LOCATION :SW 14, SW 14, Section12 , T 30 N , R 18 W, Town of Richmond , St . Croix County , Subdivision n/a , Lot number 2 • 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 put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . Ho I/WE, the undersigned,, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth , herein , as set by the Wisconsin Depart- w 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 . SIGNEDW4LktiL. DATE D (p/8/ 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 . y. INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new 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 for writing 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 he used if desired; 8. Make sura your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; Id. If the information such aas flood plain,elevation) does not apply, place N.A.in the appropriate box; 1 1. Sign the form and place your current address and your certification 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 Stone (acer 10") BR Bedrock cob Cob bile (3 - 10") SS - Sandstone gr -- Gravel (under 3") LS -- Limestone s -- Sand HGW -- High Groundwater as Coarse Sand Pew -- Po, niat on Rate med a . Medium Sand ■J ._ fsage Senn Bldg - Building Is - Loamy-Sand Greater Than el _ Sandy Loam < - Less Thar, - Silt Loan! R; Bleak n - Clay Loam .-- Y `r c .0>s! C1 — Sariby C`':v Loam B Red <tr:i Srlly° Clay Loam mot - Mottles Sandy Clay dJj (.i) -�. -- S�rrry Clay ffi �- few, fore, faint a.; _ Cl- -I Eg+r C,l;: --- common, C(1 iise- i_ - Peat mm -- ,Many, medium - Mock d distinct }a prominent ;AWL - High water level, Six general soil textures surface water for lir tnrf waste disposal EM Berton Mark VGA Vertical Reference Point TO THE OWNER: This soar test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance, A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to >t}t:9in a permit, 1 he canit'n`I 7 permit roust be obtained add posted prior to the start of any construction, t -- - • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, . DIVISION LA4OR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN ReLATIONS (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/NIXX@C} IXTY: 'LOT NO.:BLK.NO. SUBDIVISION NAME: SW .14-w-14 12 /T30 NAB I (or)W Richmond 2 n/a T. Derrick addn. COUNTY: OWN ER'SietiMEZSiOC&IDAE: MAILING ADDRESS: St. Croix Thomas Derrick R.R.#1, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a New ❑Replace 4-15-87 n/a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) s ❑U ®S ❑U as ❑U ❑s ©U ns CU 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 decimal t_ PROFILE DESCRIPTIONS ge 28 JSB BORING TOTAL .PTH TO GROUNDWATER-INCHES_CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTF Ind. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 6.58 101.28 none >6.58 .58b1.1. 1.00bn.sil. 5.00bn.s.l. B- 2 6.50 101.02 none >6.50 .75)11.1. .83bn.sil. 4.92bn. s.l. bu. B. 3 6.57 101.76 none >6.57 .92b1.1. 1.25bn.sil. .58bn.s.l. 1.67bn.l.s. 2.15s.l. B- 4 6.92 102.29 none >6.92 .67b1.1. .42bn.sil. 5.83bn.s.l. B- 5 7.00 102.47 none >7.00 .83b1.1. 1.00bn.sil. 5.17bn.s.l. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- sPe design rite 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 98.76 _w___ ? ) it ) l ; 1 - _ _-. _ ..._ ._ _4_ 1 _. k,24.):-.--4` ' ' ' ,,, ,, 1 py� �p E 9 t ; r I� t- ,„ 1 ,... ..; ^.1\i ; . : 5401 , , le I t r h it? ! t J 1w , \E ��d �L i , , { u,;,6'' ) b---' ' I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 4-15-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. New Richmond, Wi. 54017 2298 715-246-6200 CST SIGNAT : ://,,,,,:ii_____., / C DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — I L Wm. C. Kucirek SASW4 S.12-T3ON-R18W A4 , Richmond, Township , w gyvt)Et( 5cti \ 4----- itD ,0 ry2-SL �S 16005.4( if a° X161 -ely „_, c,.h 5G-of‘e II / 1• � �/ 2. 83 Lo NIN N o /N _ 5 Sr S Xlot-Oct 74 0 \ 3 / A Pt2i - X12 5" ` Gary L. Steel 988 N. shore Dr. New Richmond, Wi. 54017 MPRSW 3254