Loading...
HomeMy WebLinkAbout038-1156-80-000 a o I r 3 o I r. 0 °� p �» C 0 0 E w III � o.c N 0) 3'� OD Do d 0) o c w I cn o h r y m E E — m m N N °' ayi a U) v ° c v Z ° X Z rn c a� m m m LL c O N LL C .O y 3 ° w ° Y t U t.= N E Q U O CL N N ! Z 3 E E °° O = O z o E o z w a m a m N H Z C � I O Z C C y y N Z O C O C N H r O c E c E o a� 4' m C n d ! m a> n N O N O 0 o 0 •� �;IloaU) °c (L t v UO �1 O N Q O O N Q N z m z z m z o Z o � Z .. E .. d E L `> ° 12 6 Y s v = �I H d � o C C ! 3 0 o a a Z co U) E a� E z m 0 0 0 a s E 0 0 0 a 0 •N N a a a g n. a s It IL L O c N m } O o� Z p0)i z N r' (0 co CD o o ° r v c a� m c a N N m 01 N m .O- O U) 7 O 3 N C N N C ! �+ O O li LL O O) r © F" Z` U U N 61 3 0 0 O N N ,� C ! y N C C U a 0 0 0 l L O O N m V°1 J N Y 0 10 � N N N v f0 J C N LO Nr r N C ` m N C C N N d 7 N d N y o z y Y ° Z c o is rn l H 00 M (0 C LO r+ 7 E 7 7 E L •N � M N f6 (O O N M O C N O N f0 O 16 U � O 04 (n = n z N 2 H Y am 0 z (n " r;6% � � �. = E ! = E I v tw0 CL m .� d d d d c t A c 2� i0 (au , 0U) 0 � b (Q y PUMP CHAMBER 0' 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: Lenth: Number of Lines: Built /J Fill depth to top of pipe: 3Q Number of feet from nearest property line: Front, O Side, O Rear,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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: J / Dated: -� Plumber on job: License Number: i 3/84:mj i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L4 - TOWNSHIP SEC. T t�N-R j ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ,c LOT SIZE JV�j� PLAN VIEW Distances and dimensions to meet requirements of 11HR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Boo, v a J / INDICATE NORTH ARROW J BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: -Z A Proposed slope at site: SEPTIC TANK: Manufacturer: A `� �' ' Liquid Capacity: j „ z ej Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side 0 Rear, 0 f � feet From nearest property line Front,0 Side 10 Rear,0 feet Number of feet from: well , building: D'�� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE T DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LAErOR&HUMAN RELATIONS DIVISION P.O.BOX 7909 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON,WI 53707 V4I NEk, NW�,S22,T31N-R18W 000NVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: (i,assigned)of Star Prairie ❑Holding Tank El In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: I ADDRESS OF PERMIT HOLDER: INSPECTION DATE: LeRoy Knutson Route 2 Box 235A, New Richmond, WI 5401 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: im A. O'Connell 03259 St. Croix 92541 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: IWARNINGLAB L LOCKING COVER PROVIDED: PROVIDED. OYES ONO OYES ONO BEDDING: VENT DIA.: VENT MAT L.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET. DYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES 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) DYES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 1 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: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING: COVER INSIDE IA &PITS LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE IDISTR.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. NEAREST-► 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. El YES NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES. DYES 1:1 NO 1:1 YES ONO 1:1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.. DIA.. ELEV.: PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1:1 YES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: ❑YES 1:1 NO 1:1 YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLE. DILHR SBD 6710(R.01/82) 77- Zoning Administrator \ �1 PUMP CHAMBER 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: X Trench: Width: � � Lenith: T Number of Lines: Area Built ;J Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0)l?t .� 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: //// i Dated: �� —' - Plumber on job: License Number: D, c� 3/84:mj 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 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; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 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 <ate included the creation of surcharges (fees) for a number of regulated practices which Wisco il1'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Peas re.. is used in your building is returned tc the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The. monies collected through these surcharges are credited to the groundwater fund adrninis- terec' by the Department of Natural Resources. These funds are used for monitoring ground- t vlate , groun=dwater contaminatioi in,,-estigations and establishment of standards Groundwater. — s worth. protect ng. ,D-F--9%{9.03!86) E SANITARY ILHF� PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY/PERMIT# 9 9S( —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%2 x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROP RTY OWNER PR PERTY LOCATION Z25§-q aL '/a '/a, S T3 , N, R E (or W PROP TY NE 'S MAILING ADDRESS LOT NU BER BLOCK UMBER SUBDIVI ON NAME CI Y,ST IE I ZIP C DE PHONE NUMB CITY NE A EST ROAD, KE OR LANDMARK ❑ VILLAGE: TO 11. TYPE OF BUILDING OR USE SERVED: 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. El 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. 9 Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound I. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑Seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSE (Square Feet): 8 ;21 /L9 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY #of Prefab. Site Fiber- in gallons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete strutted glass App- Septic Tank or Holding Tank Tanks I Tanks 1610�1 J660 1:1 1 El Lift Pump Tank/Siphon Chamber ❑ Lj I ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installa ' n of the private wage em shown on the attached plans. Plumbe s Na a(Print): Plum is ignat :( t ps MP/MPRSW No.: Business Phone Number:4 , J •, Plu b is ddress reet,City,St Ate, ip Cod Name of Design Vd VIIL SO L TEST INFORMATION Z�i 1Z Certified oil Te ter, ST) me CST# CS D RtgS( tree,Ci y,State, i Code) Phone Number: 17 COUNTY/D PARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee Groundwater ate Iss An Agent Signature(No Stamps) 4Approved ❑ Owner Given Initial 7/ y� Sylch ge Fee yy� Adverse Determination ` 6V v C)e3 X. COMMENTS/REASONS FOR DISAPPROVAL: n SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 Location of Property ' �L , Section, T�N-R_� W Township Mailing Address Address of Site Subdivision Name Lot Number p(! Previous Owner of Property Total Size of Parcel '� Date Parcel was Created �,or 7� -9;-- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes �_ No Volume _42 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pa&e 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) cetti.by that att statement on thus boxm cute true to the best ob my (out) knowtedge; that I (we) am (ate) the owneA(.6) o6 the ptopeA ty des ch i.bed in this inboxmation boAm, by viA tue ob a waxtanty eed xecoxded in the Obbice ob the County Reg.c stet ob Deeds ass Document No. and that I (We) pxesentty own the pxoposed site boA the sewage diipozat Zyttem (oA I (we) have obtained an easement, to Aun with the above desclubed ptopenty, box the coast ucti.on ob said system, and the same has been duty Aecoxded in the Obbice ob the County Reg"teA ob Deeds, az Document No. ) . SIGNATtIRE OF OWNER SIGNATURE OF -OWNE (IF APPLICABLE) ,-5--- / a p 7 DATE SIGNED DATE SIGNED L:. 1 AM 2—1962 I i ` r i an.K----H and..-S_uz .nn-e..-H_ansQn--,----a�s_Q.. ST. C X 00.V WISE .nne_..K- H.ans.on-------- Rec'dd for Record ft 31st --------------------- --•-----.......--------•-- ----- - day of� A.D. 19_85 .:;rrants to .._._-__-Le_Ro-y L-..._Kn-Uts_on•_and• Kn-u.t-son ------ t 3:30 P I -hu.s.band...and wz.f.e -------------------------------------- -— - �Y1r awl. ------------------------ .................. - I --------------------- ------------------ RETURN TO ------------------------•-------------------- _ Ithe following described real estate in . 5 t•�_ State of Wisconsin: County, I ;I — j Tax Parcel No: ...___-._-. Lbts 8 and 14 , Northwood in the Town of Star Prairie , located i in the NW-4& Of the NW-41 and in the NE4 of the NW4 of Section 22 T31N, R18W. This warranty deed is given in satisfaction of land contract between Grantors and Grantees dated September 6 19 recorded September 9 , 1985 , in Vol . 720 85 and II number 405028 . Page 317 , document I j i' it II !I EBB l i 1. E.•��,D j l IXENW, This 15 __•_-____ homestead �I (is) (is not) Property. i� Exception to warranties: i I I I� I Dated this 26 i -- November I Y of —:.,. .. ---- —------ - 19 j ------- -------------- --•---- (SEAL) , II .(SEAL) Lar Y_._F.._.Hanson- ----- �I ------------•---•------------•--------------•(SEAL) �`'. J----------(SEAL) --Su.z n.e...K..._Hao.son----_-- I' -- ......... I� AUTHENTICATION Signature(s) ACKNOWLEDGMENT ____.--•__-_-_-- STATE OF WISCONSIN St . Croix ss. authenticated this _-_-•_--day of........................... 19-_--- County. ' -------------------------------------- i I Personally came before me this . 26 . .day of November_ ""' 19---8 5 the above named ----L.arx y..E... _Fi n o n pad d ------------------------------------------ Suzanne _ . Hanson I TITLE: MEMBER STATE BAR OF WISCONSIN (If not . 6, --------------- --------•---------..authorized -------------------------------------------- ................................ _ to me kno - be the S-_-- person __ who executed the forging n umenb�pd;acknowledge the same. • H . z H ' a + STC - 105 r a SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z t7 a H OWNER/BUYER ROUTE/BOX NUMBER Fire Number .CITY/STATEci,�ry�e„J,n 1/Vf,L ZIP��' �/f PROPERTY LOCATION: 3L, /�h�14, Section, T N, R W, Town of E� � ',Qi,P/ St . Croix County , Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you 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 I/WE, the undersigned , have read the above requirements and agree E to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Iv 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 . SIGNE 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 . 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; 1 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; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagrarn accurately locating your test locations. Drawing to scale is preferred. A separate sheen may be used if 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 (over 10") BR - Bedrock cob Cobble (3- 10") SS - Sandstone gr Gravel (under 3") LS - Limestone *s -- Sand HGW - High Groundwater cs - Coarse Sand Perc Percolation Rate need s Medium Sand W - Well fs Fine Sand Bldg - Building Is - Loarny Sand j - Greater Than *sl Sandy Loam < - Less Than ,I Loarrr Bn - Brown *sil - Silt Loam Bi Black si - Silt Gy Gray *cl Clay Loam Y Yellow scl - Sandy Clay Loarn R - Red j sic! -- Silty Clay Loam mot - Mottles I ;c - Sandy Clay w/ with sic - Silty Clay f;f few, Fine,faint .c Clay cc - common,coarse pt -- Peat rnrn - Many, medium rn - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report: is the first step in securing a sanitary permit. The county or the Department may request venfication of this sail test in the field prior to permit: issuance. A complete set of plans for the private sel4va, system and a permit application must be submitted to the appropriate local authority in order to Obtairr is permit. The sanitary permit must be obtained and posted prior to the start of any construction. i r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (H63.090)& Chapter 145.045) LOC TION: SECTION: TOWNSHIP MU OT O.:BLK. SUBDIV ION NAME: 1 1/a /T � COUNTY: OW E 'S BUYER' N ME: M NG ADDRESS: EvUSE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCI DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑New Replace RATING:S=Site suitable for system U=Site unsuitable for system f y CONVENTIONAL: MOUND: ND-PRESSURE:ISYSTIEM-1N-FILCH LDING TANK:RECOMMENDE SYS M:(optional) ZS ElU ®S ❑U Q1 IN-GROUS F-111 ❑S ®U 0 ®U If Percolation Tests are NOT required DR ATE: If an y portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH M, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 13 7 Y.'7 B- �3 /0 -� ,us B- B- r B- PERCOLATION TESTS NDEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES ER -}NG++E AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH > G 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 ' I _.F a �=1 _ F —L-4 —1 E ti .........:.....� _ Y ,... ..._ _ ..�..e._ �„.„.....a...�.._._. __,._.._. ..� ..... .. .._....� .I_....._.�,�7 ....,_.._.. _.._.. 3 l 1 t A 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(p i TESTS WERE COMPLETED ON: ADD S: CERTIF CATION N MBER: PHONE NUMBER(optional): 14,L -Z4-Z;? 00_ZV C_ CST I URE DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — �� /�'✓r'/>igtJ,O �� S�/7 S���t' �.�i°9i�P,c J �u1 z/09 i � PAGE OF Crc� SS Szc �' ton Or �'t �e� SyS �e� Fresh Air Inlets And Observation Pipe Approved Vent Cap Mlnlmwn 12"Above Final Final Grade 20-42"Above Pipe _4"Cost Iron To Final Grade Vent Pipe Marsh Hoy Or SynlMll- Covering Min 2"Aggregate Over Plps Distribution Pipe 0 0 0 0 0 --Tee 6"Aggregate Beneath Pipe 0 Perforated Pipe Below 0 Covpiing Terminating At Bottom Of System 1 81 Pru�oSet� �lnwl ``qr�.�l< ��\\���\ , SOIL FILL DISTKIBUTI0F,1 PIPE APPROVED S4WIETIC COVER ° MATEIti^I OR 9" OF STRAW rOFgGGREGAIE --/r OR MARSH NAY (o OF 12-2�/2 AGGREGATE tL E V. O F-26EET, DIS-rRtf!JTIOIJ PIPE TO BE AT LEAST IIJCHES BELOW ORIGIUAL GRADE AI.IU AT LEASTP-0 WCHES BUT KIO MORE THAI) H2 IMCHES BELOW FIAIAL GRADE MAXIMUM DEPTH OF EXCAVATiOP F'9014 0KI&INAL 6KhDF- WILL BE INCHES M41MUM ®rFTM OF EACAVATIOW FROM c*161WAL GR49E WILL BE INCHES SIGIJED: �1 LICEIJSE AJUMBER: /1/ 13v, % DATE : 1 — � 110 i I ONNi� I I 'NER hl' Gt' //"1 i-�. , TOWNSHIP,4 '�:h".'�:SEC; _ TTN, R '..0. ADORE S .�=r _ ,E .�� _r17 ti ST. CROIX COUNT 'BDIVISION' LOT - LOT SIZE PLAN VIEW -Distances 6 dimensions to meet requirements of H62, SHOW EVERYTHING WITHIN 100 FEET 0, STEM './G ' ' 'TIC TANK(S) . MFGR ' r "S _. ,(,CONCRETE �' STEEL NO. of rings on cover Depth DRY WELL FINCHES NO. of width length area no. of lines width_ lengthy area depth to top of pipe REGATE X " _UDC RATE, '� AREA REQUIRED � ,���� AREA'AS BUILT ;claimer: The inspection of this system by St. Croix County does not imply complete % .pliance .with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for _tem operation. However, if failure is noted the County will make every effort to _ermine cause of failure. i BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. "INS OR f� DATED PLUMBER ON JOBS LICENSE NUMBER PURPORT OF ITISPECTIO11--I74DIJIDUAL SEWAGE DISPOSAL SYSTEM -, Sanitary Permit • • r State Sentic T&IMSHIP St. C _&L County SEPTIC TA'11: Size _1G� gallons. lumber of Compartments ,. Distance From: *Nell ft, 12% or greater slope ft Building ' ft. Wetlands f: Iiighwater ft. DISPOSAL SYST H Tile Field or Seepage Pit(s) Distance From: ' Tie lI _ft. 12% .or greater slope ft Building ft. Wetlands f 7. FIELD Hifhwater — ft. Total length of lines ft. Humber of lines 2- Length of each line -;5' ft. Distance between lines _ft. Width of the trench-eft. Total absorption area - sq. ft. Depth of rock below= tile min. Depth of rock over tile Z- in.. Cover aver.rock , Depth of tile below grade ,2 C, in. Slope of . trench in per 100 ft. Depth to Bedrock — ft. Depth to ground water — ft. PITS (lumber of pits Outsid diameter ft. Depth below inlet ft. Gravel around t es no. .Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of seepage nit ar a required Inspected b �G!� '-` Y� Title:. - Approved _ / , - Date 9 1978. Rejected Date 197 State and County State Permit # PLB67 Application County Permi for Private Domestic Sewage Systems County a, *DENOTES STATE AP!:ROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. WdAT-IbIVA Section QW, T N, R-4 E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township Sri& auarzz C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family 1�( Duplex No. of Bedrooms No. of Persons c D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES VNO # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Wao Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete *Poured in Place Steel Other (specify) off F. EFF�NT DISPOSAL SYSTEM: Percolation Rate, 1) � 2)_�3) J�Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length�,Width /d� Depth _Tile Depth__.26 No. of Lines .2r Seepage Pit: Inside diameter Liquid Depth Tile Size is Percent slope of land _9� Distance from critical slope 21M I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Test NAME t; ✓1 q, C.S.T. # J'�S-`7 and other information obtained from Ow (owner/builder). Plumber's Signature MP/MPRSW# 5_6 _Phone #Z'!6 Plumber's Address �' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). v _ 1b r VY� Do Not Write in Space Below_ FOR DEPARTMENT USE ONLY �// J�/� Date of Application Fees Paid: State Count Date 5� Permit Issued/Rejeo*d ( ate) _Issuing Agent Name ^ Inspection Yes_jNo Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON,WI 53701 state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76 EH 115 WISCONSIN DEPARTMENT OF I{EALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BLLREAU OF ENVIRONMENTAL HEALTH _ P.O. BOX 309 MADISON,WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: '/4, 11AA/o,Section.,T,3/N, R-CE (oroTownship or Municipality Lot No. , Block No. County 4 %' Subdivision Name Owner's Name: 4 x y �'��� Mailing Address: TYPE OF OCCUPANCY: Residence No.of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ,d ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS — - 2I2 PERCOLATION TESTS - SOILMAPSHEET SOIL TYPEs:Rt3�x'!� PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 J , P-a �c is SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) H - �� ; S av 4 G" -,P- e_3 PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet o juitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. (P 0l Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. S e. ' E1 p I Nl , ci n •A ' J4 ea t N WD f I,the ndersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the WisconsiP-D inistrative Code,and that the data recorded and location of test holes are correct to the best of my knowledge and beli Name (print) V' Certification No. .� —s3 Address Name of installer if known CST Signature COPY A—LOCAL AUTHORITY I-crc i iritU JU tT MAP \ RECORDED I VOLUME 2, PAGEI563 82 d d PC P I r t ID tip _ I " 100' 3 s to o 86 to Z to r 332 to EXISTING 66 % HOUSE 68� 70 85 N . 100' 33• (4 100' 71' 7 N O o0(D Q a tD aD O N;t tD too N .v tD aD O N p n n w cD w cD tD cD f� r t` r` N dD CO CD m CD rn m m a+ rn O ATER 62.40'E L - 7, 1978 EL.62.46 �.�� CONTOUR 2593 .77' 64.40' EL. UNPLATTED LANDS 6I = BORING ,HOLE erin PROJECT TITLE company LARRY HANSON lEYING • BUILDING DESIGN RTE. 2 r fth' wI sc"sift NEW RICHMOND, WISCONSIN SHEET TITLE LOT LAYOUT :3 , Parcel #: 038-1156-80-000 02/10/20 PAGE 12:11 PAGE 1 OF F 1 1 Alt. Parcel#: 22.31.18.728 038-TOWN OF STAR PRAIRIE Current X ST. 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 0-OLSON, CURTIS W&BARBARA A CURTIS W&BARBARA A OLSON 2077 110TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): `=Primary Type Dist# Description '2077 110TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: COF Acres: 1.830 Plat: 2230-NORTHWOOD SEC 22 T31 N RI 8W P RTHWOOD LOT 8 Block/Condo Bldg: LOT 08 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-31N-18W Notes, 'Qom/ / l.�t �I � I(l Parcel History: N d r A g `��O_, 1 b Date Doc# Vol/Page Type 07/23/1997 922/75 � ,( ` 4 u� d 07/23/1997 832/231 07/23/1997 — �0 s ML Iq� /- 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 119976 206,700 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.830 30,800 172,300 203,100 NO Totals for 2005: General Property 1.830 30,800 172,300 203,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.830 30,800 172,300 203,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 lopy yi•' r � .. Y .... ei Ji OD Cy 04 tv 19 IE :;A N Pt4 E'D D low >: Q �QRINO" HOLE r rd '. n ud`�"N ,15r t RT 2 ' NEW Rit-K.M04D. IS-CONS t N_