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HomeMy WebLinkAbout032-1017-20-000 § / C) \ } o q K 0 2 7 � � k $ % § ƒ 0 k 2m � t(L § 5E6 U. / $0 720 ! Cl) CD z B j \ \ z z / 22 § z a co § � \ \ $ 2 7 / E 2 2 e m \ 2 j -� ) \ } 0 kD } c k .. k E 2 R .2 A £ 3 £ ' CL § / E o o 2 m e § R }k k EL \ 7G � -Wftb # k a 2 a CL § & : 0 2 j v 0 k m z 6 D 'D E � tk k j a § a) .2) ± § ¥ m A \ K co 04 ) EC'4 � k § S / \ § « k § § { % m a � = f � $ 2 2 ¥ � � CO / % 7 f k . m ) § f LO o ] % § M t CD o m : I a o z I e m — � _ � 'i% a k a § k v £ o U) 0 . PUMP CHAMBER � s Manufacturer: Liquid Capacity: 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, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: 1 Length: L Number of Lines: Area Built: Fill depth to top of pipe: �� Number of feet from nearest property line: Front, O Side, O Rear,O Ft . 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 6-16-87 Plumber on job: Zol License Number: /��� / 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER DAN MURPHY TOWNSHIP SOMERSET SEC. 6 T31 N-R 19 W ADDRESS 4501 Grand South ST. CROIX COUNTY, WISCONSIN Minneapolis, MN 55409 SUBDIVISION . LOT LOT SIZE 23 Acres PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Al X19, N/y' 011414 N `1 �b 1 • tc �a INDICATE NORTH ARROW / _ /1 BENCHMARK: Describe the vertical reference point used Tl",,,/ ( J d A � p/t���t.� (�/> C,A)kV ,f d.F Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: \ & c Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side e Rear, O f From nearest property line : Front,0 Side,O Rear,O feet Number of feet from: well building: (Include this information of the ibove plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING &r1A�IS0U,YUI 53707 NEB, SEA, S6,T31N—R19W 'CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: Town of Somerset (If assigned) ❑Holding Tank El In-Ground Pressure El mound � ' Delong Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DATE: Dan Murphy 4501 Grand South, Minneapolis, MST 55409 r _ , BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: qEF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Byron R. Bird 1309 St. Croix 95998 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV,. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER Id_ I P OV ED: PROVIDED YES 1:1 NO 10 YES NO BEDDING: IVENTL DIA.: VENT MAT L: JFIGH WATER IUM009-0� 1F ROAD: JPR WELL:f BUILDING:�VENTTOFRESH ALARM: FEET FROM I * LINE: AIR INLET: ❑YES O ]YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACTURER. IWDYES ARNING LABEL LOCKING COVER ROVIDED: PROVIDED ❑YES ❑NO ONO OYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF' IPROPERTV WELL. BUILDING.JVENTTOFREESH (DIFFERENCE BETWEEN FEET FR(IM LINE AIR INLET PUMP ON AND OFF) ❑YES ONO 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 FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: 606� .T H, WIDTH: LENGTH_. NO.OF DISTR.PIPE SPACING. COVER '.INSIDE CIA_. #PITS. LIQUID � /�-1{/ "� TRENCHES �l MATERIAL• P#T' DEPTH: �...• �.. GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. STR MII.'R qF PROPERTY WELL BUILDING: VENT TO FRESH BE LOW,P IPES ABOV COVER. ELEV.INLET.ELEV.END. PIPES. FEET FROM LINE: AIR INLET '1 n n NtAAES,T 1 JD 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES I ❑NO DYES I ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER EDGES: DYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: I � '.WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: TRENCHES: AEI a r.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: T_ ELE V.. ELEV.. DIA. ELEV.: PIPES i a HOLE SIZE HOLE SPACING. DRILLED CORRECTLY C E ATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED F PLANS. ❑YES ONO ❑YES 0 N COMMENT : MANENTMARKERS: OBSERVAT NWELLS: a�M015"Of PROPERTY WELL: BUILDING: a- f FRET FA�fis�krF LINE: ❑YES NO YE NO NEA4 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Adminis trator DILHR SBD 6710(R.01/82) F INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION 4 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-bz 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 Fornn- (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 licensed pumper whenever necessary, usually every.2 to 3 years; 6. if yo;J have questions concerning your private sewage syster,i, contact your local cod: 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 owners 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 repai r; 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 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 GrounOlAtate r included the creation of surcharges (tees) for a number of regulated practices which WiscorS€n=S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea0 is used in, your building is returned tc the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. .a The monies collected through these surcharges are cred ted to the groundwater fund adminis tered by the `department of Natural R,?sources. These funds are used for monitoring ground- t water, grciursdwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) L�ILHR SANITARY PERMIT APPLICATION COUNTY CROIX In accord with ILHR 83.05,Wis.Adm.Code 5 STATE SANITARY 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 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES X❑NO PROPERTY OWNER PROPERTY LOCATION Dan Murphy NE %a SE '/4, S6 T31 , N, R 19 E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 4501 Grand South - - - - - - CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NE, EST ROAD,LAKE LANDMARK Minneapolis, 55409 1(612 825-021 VILLAGE: Somerset r II. TYPE OF BUILDING OR USE SERVED: AM /R• — 1O _0?0_ Number of Bedrooms if 1 or 2 Family 4 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.❑ Replacement c. El Replacement of d.El 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. 51Conventional 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. [3 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): REQUIR82( Square Feet): PROPOSED 82(SSquare Feet): 00 91.81 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # Manufacturer's Name Prefab. Con- Steel Fiber- Plastic p INFORMATION New xisting Gallons Tanks A s Concrete structed glass App. Tanks I Tanks Septic Tank or Holding Tank X 1200 1 Weeks Conc. Pr. El Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb 's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Byron R. Bird 1309 715 268-8317 Plumber's Address(Street,City,State,Zip Cod Name of Designer: Rt. 1 — Box 228 — Amery, WI 54001 Byron R. Bird Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Irvin Stolp 1854 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 612 465-5482 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) E Approved ❑ Owner Given Initial / S harge Fee p /� Adverse Determination cc) X. COMMENTS/RE SONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber . 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 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 _ D,4 ti Location of Property L S It, Section b , T I N-R W Township U Hailing Address /p J, Address of Site Subdivision Name . Lot Number l U Previous Owner of property 17 �� 7f7�- Total Size of Parcel 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 r?6 / 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 1 (Wel ce U6y that atC statements on .thi,6 604m aAe tAue to the best 06 my (ouk) hnoweedge; that 1 (we) am fake) the owne&(s) o6 the pnopehty des cAibed in thiA .in6oAmation 6o4m, by v.iA.tue o6 a waAAanty deed heconded in the 066ice o6 the County Reg..4teA o6 Vee&as Vocument No. ; and that I (We) pnesent£y own the pnoposed site 6oh the sewage d.i�spos b ys em (on I (we) have obtained an eaAement, to nun with the above de6cA bed pnopenty, bon the eon tAue..ti.on o6 6a.i,d aya.tem, and the eame had been duty keeokded in the 066ice o6 the County Reg-ia.teA o6 Deeda, 4A Document No. a � SIGNATURE p OlfNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 6 DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED ^� IrEGISTERS'O�iCd 4�� 6 �1Pac� ST. CROU; CO., WIS., Pae'd. for I ec-jrd this 8th Charles D. DeLaittre and Barbara M. DeLaittre, husband day p¢June ,q,p, 19 87 and wife cif 9:45 A -Jamts O'Connell conveys and warrants to Daniel W. P. Murphy and Deborah L. t eWwb Staack, both single persons as ioint tenants 41,deputy RETURN TO the following described real estate In St. C:roi x County, State of Wisconsin: Tax Parcel No:-19-31-06-41010 Part of NW 1/2 of SW 1/4 of Section 5 and part of NE 1/4 of SE 1/4 of Section 6, All in 31-19 described as follows: Commencing at the NW Sorner of Section 5; thence S 5°36 ' 40" W along S 5 36 ' $0" W along the Section line 1165.52 feet; thence N 88 19105" E 1335.07 feet• thence S 04 017 ' 40" W 1287.63 feet; thence S 01637 ' 10" W 1287.69 feet; thence S 81°13' 35" W 825.0 feet to point of beginDing; thence S 88 13' 35" W 509 .96 fee8; thence S 89"211 W 1320.1 feet; thence N 0 01110" 1 660.0 feet; thence N 89 21' E 339.0 feet; thence N 59 35155" E 690 41 feet; thence S 64 10115" E 67.0 feet; thence S 61620' 50" E 53.0 feet; thence S 73°32' 30" E 151.04 ISeet; thence N 81 37110" E 90.31 feetb thence S 60 08150" E 94.91 feet; thence S 35 28 ' W 284 .35 feet; thence S 01 37110" W 300.0 feet; thence S 01°37 ' 10" W 340.0 feet to the point of beginning. TOGETHER WITH and SUBJECT TO a 66 foot road easement as' described in Vol. "517" , page 595 (No. 17) . This 13 not homestead property. S (Is) (Is not) Exception to Warranties: Subject to restrictions, covenants and easements of record, if any. Dated this 2nd day of June ,18.HZ_. C�C���j���'c���'^-� (SEAL) (SEAL) • Charles D peLaittrP iSl-ti�--'` -tIC (SEAL) (SEAL) • Barbara M. DeLaittre AUTHENTICATION ACKNOWLEDGMENT Slgnature(a) STATE OF%ffMMX I]I) MINNESOTA so. RAI+� __ County. authenticated this da__._ of 19__ Personally came before me this 2nd day of IP 111101d IN 0414 BEVERLY D.BCHNXI! June —. 1987 the above named Charles D. DeLaittre & Barbara M De aittre HENNEPINCOUIIYY Husband and_ ife and • ' My Commisaitm fexpkN(1Ri•* �' Daniel W. P. Murphy & Deborah L taack, TITLE:MEMBER STATE BAR OF WISCONSIN both.single people (If not, WAS to me known to be the person s who executed the authorized by E T0 Wig.State.) fore oing Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY First Security Title, Inc. ite ear ve. , Ste. 20B Beverly D. chultz Maplewood, MN 55109 #W-0092 Notary Public. Hennepin County,)WIfi.MN (Signatures may be authenticated or acknowledged. Both My Commission Is permanent. (If not, State expiration are not necessary.) August 5 date: g t9 92 ) Names of persons signing in any capacity Mould be typed or printed below IWr signatures. NTF 2200 WARRANTY DEED STATE BAR OF WI&CONa1N form No.2—IOU Nalco Forms.P.O.Box s0208,Green Say,WI 51907-0208 ' H L N • H 9 r ST C - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER y��� /'�'✓�/f���/� ROUTE/BOX NUMBER ��'/Otir Fire Number CITY/STATE SonnJ� ZIP PROPERTY LOCATION :N'�- Section 1 T N , R W, Town of St . Croix County , Subdivision Geri �� Lot number Cl 4 �0 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 f 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 H three year expiration . o E z I/WE, the undersigned , have read the above requirements and agree W to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning ffice within 0 days of the three year expiration date . SIGNED D 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 . 4 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 f 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; 1 MAXIMUM number of bedrooms or coms7lercial use planned; 4, Is this a new or re[)Ir)cernent system; 5. Complete the Suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASEL? ON SOIL CONDITIONS, 6 PLEASE usrr 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 s eparate sheer may be used if desired; 8 Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 5. C mplele all appropriate boxes as to dates,narnes,addresses, flood plain data, percolation test exemp- tion, if appropriate; 70. If thri Information (such as flood plain,elevation) does not apply, place N.A. in the appropriate box; 11, Sign the fol rn and place. your current address and your certification number, 12. Make leclihie conies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Sail Separates and Textures Other Symbols st - Stone (over 10") BR Bedrock cola -- Cobble (3- 10") SS - Sandstone gr -- Gravel (under 3") LS - Limestone s - Sarre! HGW - High Growidwater r;s Coarse Sand Perc, Percolation Rate m art s - Maad€um Sand tfri _. Well is - Fine Sand .Bldg Bcatlddltj s Loaf-ny Sand > -. Greater Than "sl Sandy Learn < _ Less Than - Loam Bn - Brov%m sit _ Silt Loam BI Black si - Silt Gy - Gray cl Clay Loarn Y -_ Yellow sci -- Sandy Clay Loam R Red sicl -- Silty Clay Loam not - Nlottles sc -- Sa'cfy Ciay ti%v __ with sic - Silty Clay fff - few,fine,faint Y u Clay c - common, coarse pi -- Pcat IT1III — Many, ryli diii,I ni -- Muck d distinct p - prominent I-!'iCttL - High water level, Six general soil textures surface water foa liIpsid vvaste disposal BM -- Bench Mark VRP -- Vertical Reference Pont , TO THE OWNER: This soil test report is the first step it)seccaring a sanitary rlr,rmit, The county or the Departrnrnt may request vernicralion of this soil test in the firlild prior to pert-nil issuance. A complete seat of ;sans for the private �a rage system and a permit application must be suti,rnittej to the appropriate local authority in order to obtain a permit. The sani tat permit n7rist roe obtained and prase er#prrtar to the of one c cpnstrract:icln. DEPARTMENT OF REPORT ON SOIL BORINGS A 6� AY/ BUILDINGS . INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS x115 �' qO. BOX 7969 HUMAN ft�LATIONS \ N,WI 53707 - , (H63.090)&Chapter 145.045) j LOCAT,IQ;:', SECTION: Y Q c OWNSHIPJ UNIICIPALITY: L�OyT NO.. NO.' V N N COU TY: O ER'S _UYE AME: MAILING ADDRESS: r 1/ � dci' F� 1g �l 4 , ZZ USE DATES OBSER IND.BEDRMS.: COMMERCIAL DESCRIP PROFILE DESCRIPTIONS PERCOLATION TESTS: � e �/ �j, New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONNVnVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) 2JS ❑U ❑S ©S ❑U I El 2U I El ®U I eAn If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the q under s.H63.09(5)(b),indicate: i Floodplain,indicate Floodplain elevation: Axl PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DtPG. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- - 7 B- TSO TAW 3f. AA/ c4' B-,5' 7 7" 9 ,8-' �e�� 7%.�1 BLT U,3' Ns[ 0.4' ,tA L. .e2' B 1 O's ! AN ' B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATE LEVEL-INCHES RATE MINUTES NUMBER I114:14 S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P- .Ry f U ✓� /(i-. A� P- 3,d ,4 'i �/ a 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 surfacee levation at all bor'ngs and the direction and percent of land slope. . T ION /- met 0",,f,s i [.0 - t 1` +�� _ ------- keoz 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• ��1 �� 2 Q ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 0 R 1 ? a CST TU E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test, your report most include: 1. Complete legal description; 2. The use section most 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 if desired; S. Make sure Your benchmark and vertical elevation reference point are clearly shown,art ]are permanent; 93 Complete all appropriate boxes as to dates,narnes,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 certification number; 12. 1vgake legible collies 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 -- Storm (over 10") BR — Bedrock Col) Cobble (3- 10") SS — Sandstone gr - Gravel (under 3") LS — Limestone *s -- Sand HGhV — High Groundwater Cs .... Coars;er Sand Perc — Percolation Rate "led s -- ;N&Aiurn Sand W - Vve!I Is — Fine Sand Bldg -- Building is - Loarny Sand > — Greater Than >I - Sandy Loam < Liuss Than `i — Loam Bn -_- Brown sif --- Silt Lorin BI .- Black si — S;11 G — Gray cl __. Clay Loam Y .__ Yellow sc.l Sandy Clay Loam R — f'ed slcl Silty Clay Loan mot Mottles ;c __ Sanely Clay W/ with ;ic Silty Clay fff - frty, fine, falrrt ,x.c _.. Clay, CC; -..- CO[Orn€ r), coarse pi -- Peat corn — Many, nee dic;rrr rn Muck d distinct I) — prominent FfWL — High vvater level, Six genera1 soil textures surface water for liefr id waste disposal BM — French Mark VRP _.. of tote<l R feren c P€hit TO THE OWNER: This sort test report is the first step in securing a sanitary permit. The county or the,Department may request ve lficatron of ttris soil test in the field prior to permit issuance. A complete scat Of pl;ws for the private v,,mY "ysteln and a hermit aplaiicatim) must be submitted tc'a the rrppyorkriate local arazhority in order to o;sft{rr ? p03-r;aii nit;s gn}tary pc-r,nit muss: be obtained and poster{ frri€rr to the siart of ar'ry=rc;nstrrjctir>rj. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTR'', 1 DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HOMAN PtELATIONS (H63.09(1) &Chapter 145.045) LOCATfON: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.:BILK.NO.: SUBDIVISION NAME: fTr ` r COUNTY: OWNER'S UYER'SINAME: MAILING ADDRESS: j USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM ER IAL DESCRIPTION: PROFI E DESCR PTIONS: P R LAT ON TESTS: Residence r : O'New ❑Replace I RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONAL IMOUN I: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) Is ❑u ❑s au as ❑u ❑sou ❑s ❑u r DESIGN RATE: If portion of the tested area is in the If Percolation Tests are NOT r equired an y p under s.H63.09(5)(b),indicat Floodplain,indicate Floodplain elevation: jtir PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEFFH-Htl, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) } B- PERCOLATION TESTS L DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 R PER INCH J 'X, f .3 - . .f 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 - : -- 77 _I I- TT _ f � I } i JN j f .. I E , � _,�►. ! x..m(_<. .I- 8-._..._.�- . .._°m.. ,,,... _-._...._._w.l. , .L':;�.. I..... .'t ..L. §#i r_..:.. 4 d .._..._.. _.,.... ,.__..1_.__....�.�...L.e.... 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• ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): iv CST 914T U E: a,--+ DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DI LHR-SBD-6395 (R.02/82) —OVER— - Buyer rune b, lyti i 5�1th Minneapolis, MN 55409 NE4, SE4, S 6, T 31, R 19 W Township of Somerset St. Croix County Wisconsin 4 - Bedroom VA/ A; 0 4�rsS RC r l� �. as C p C r saILL t ti ti