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HomeMy WebLinkAbout038-1120-30-200 « § ; \ 0 � \ k � m � \ / \ i } # \ � \ ƒ f � $ \ (n e � ) c 2 ` [ 3 \ % ! � � / j � \ & § $ a m § ) z :!t 2 } \ k k c ? = o z , E \ ; co % 7 } 0 9 # E � \ \ \ } ) k ) ' \ § � $ , k � CL 15 § - i C) k 2 / CO / o Z a } 4 \ J / \ . - § \ § k • 9 E a a a 5 = k \§ � \ \ o } 7 / { g ] _ ® \ \ \ « { E a 2 c £ # G 2 a 0 c § \ ) E _ / � \ m ca \ \ \ , ® \ c / V. \ \ { \ / 9 § m \ ) @ 0 z f 2 ■ / k I M % CL C * e c , Q 0 a 2 3 k j 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: 1 Width: 1421 Length: S Number of Lines: 2 Area Built: Fill depth to top of pipe: pQ Number of feet from nearest property line: Front, Q Side, 0 Rear,0 Ft ./ea Number of feet from well d4> Number of feet from building: (Include distances on plot plan). SEEPAGE PIT . #�lle-r— Q/, / G h�/ /OQ i Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: I Area Built: Has either a drop box 0 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: —�� Plumber on job: License Number: ZI;1 2 .3 Z:/g 3/84:mj Form - S T C - 104 k l AS BUILT SANITARY SYSTEM REPORT OWNER j � TOWNSHIP, r G SEC.,,-,2.1,f _ T �V N-R /r- W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l ve".- - - : 6� 7. 31 V ay It INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used G• ,dfo_, ^Ge ` W4/, - StX tc y� Elevation of vertical reference point: !� Proposed slope at site: .3 SEPTIC TANK: Manufacturer: e G?S Liquid Capacity: '4 -x? p Number of rings used: /rOn,C. Tank manhole cover elevation: `D S• O S� Tank Inlet Elevation: `0,3 g<, Tank Outlet Elevation: 10.3, 4( Number of feet from nearest Road: Front 10 Side, Rear, O feet From nearest- property line Front,O Side,O O Rear, feet '7-6 A- Number of feet from: well , building: a�{ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&`,iHUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 969 BUREAU OF PLUMBING Mr'SON,WI 53707 ;SE,i S29,T31N-R18W VCONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: (If assigned) Town of Star Prairie 1:1 Holding Tank El In-Ground Pressure El Mound 100 Street, 192 Avenue NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mike Rand Route 2, Box 164A, Roberts, WI 54023 9- 17-8-7 A,^%S BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: jMP/MPRSW No.. County: Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 99048 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANKI EV_ TANK OUTLET EV.: WARNING LABEL LOCKING COVER �2 PROVIDED: PROVIDED: ��"" 0 0 O I11� ,�p IYYES ONO DYES 5 NO BEDDING: VENT DIA.: VENT MATL: HIGH WATER MBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: LINE- �, / AIR INLET: ❑YES �NO ( FEET❑YES NO N�ARESTM S ��S /V DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ❑YES ❑NO OYES ON 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) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER - '..INSIDE DIA.. #PITS: LIQUID BEO/TRENCH TRENCHES MAT E DEPTH. OitWENSIt?NS ply / GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER rOF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES.I' J ABOVE COVER. ELEV I/N�(ET ELEV.END ^ PIPES LINE- J r AIR LET: t l /a� �/W a b ' NEAREST-M 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 1:1 YES NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER EDGES. DYES El NO 1:1 YES ONO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: b WIDTH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BED/TIiENCFi TRENCHES: DIMEMSI[iNS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. 'i ELEVATFON AND ELEV.. ELEV.. DIA. ELEV.. PIPES. DIA.: ©LSTRfBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED FORMATION s, PLANS: DYES E NO 1— El YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELL NUMBER ROOFI. LINE: WELL: BUILDING: ❑YES ❑ ❑Y ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: ,....-•--�`''--- �''�"" Zoning Admini t straor DILHR SBD 6710(R.01/82) 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; 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 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'/z 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 (fees) for a number of regulated practices which Wisco irt' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuir is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY EZ: R , ro� In accord with 1LHR 83.05,Wis.Adm.Code STAT SANITARY PERMIT# Q –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 L1SI NO PROPERTY OWNER PROPERTY LOCATION .� `,� �%4 Ei/4, S oZ T , N, R E (or PROPER OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER CITY EAR ST ROAD KE OR LANDMARK Y a a -- VILLAGE: T� a., v II. TYPE OF BUILDING OR USE SERVED: ( X1016-- coo oZO Number of Bedrooms if 1 or 2 Family y OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check¢#2,3 or 4,if applicable) 1. a. WNew 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.X Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.XSeepage 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): PROPOS D(Sgyare Feet): "C Ct5 15— ��d / Feet Private ❑Joint ❑ Public VI. TANK CAPACITY #of Prefab. Site Fiber- in allons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdina Tank X, 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): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: i o 4*� 3 I.,--soo, Plumber'f Address(Street,City,State,Zip Code): Name of esigner: Vlll. SOIL TEST INFORMATION Certified S) Tester(CST)Name ` CST# �Q� �� t10 CST's ADWESS(Street,City,State,Zip Code) t Phone Number: 'eol or IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Tdacc)ry Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) NA Approved ❑ Owner Given Initial rcharge Fee R `/Adverse Determination `+a "��7 �� ��/Y1/(f X. OMMENTS/REASONS FOR DISAPPROVAL: 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 his application form is to be completed in full and signed by the owner(s) of the roperty 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 AL 14 F-/— Location of Property _-1%, Section , TAN-R _LL W Township IF Hailing Address 'Rt , Ra x 14<14 Address of Site X Subdivision Name Lot Number L c7 T Previous Amer of Property F46 Total Size of Parcel Date Parcel was Created �U� ✓ /�T_/� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume _ 0 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 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) centLi6y that att etatementh on tW ohm ahe thue to the best o6 my (oun) hnowfedge; that I (we) am (cute) the owneAk o6 the pnopehty deJscAibed in .thiA .in601ma,ti.on 6onm, by v-chtue o6 a waAAan.ty deed heeohded in the 066ice o6 the Cc utt RegiA teh. o 6 Veed�s ass Voeument No. l of and that I (we) pneh entty c�un I phopoded A to 6oh the sewage diApoe dye em (oh I (we) have obtained an easement, to nun with the above deAcA bed phopehty, bon the eone.tAuction o6 said system, and .the dame ha.e been duty n.eeohded .in the 066tce o6 the County RegieteA o6 Oeeda, as Voc ment No. SI A Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE S IGdED DATE SIGNED J THIS DOCUMENT NO. — _—� WARRANTY DEED SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 429119 j --- — - AGISTERS OFFICE ST. CROIX CO., WIS, II ..AaY.Ig9 d..FagnE)n...And_.P aul i.ne,..F.agnan.,...husband..,and. Recd. for Record this 13th .wife-•-••--•-----•-•----....•-•--------•----••----•••----•.........................•----...-----.•--• . day of Au_,g. A.D. 1987 ........• •-------•••••--------•----------•--•----•-•-•--••----------------------•--• ........................... at 10:20 A& conveys and warrants to ..Milchael...0..---Rand.--and--Maw •-Z..•----•... � . "�4ames O'Connell �.Rand....husb and--and...wife,...as..mar ital ..property........ 19111111111111,w w` with..xigb-ts_..of-..surmi.vnrahip............................................... •------•--•••...---••-•-•------•-•-••---••..................•----............•---............-----......_.._..... ------------..................................................................................................... RETURN TO ................................................................. the following described real estate in ...........at,._.Croy County, i State of Wisconsin: Tax Parcel No: .............................. Lot Two (2) of Certified Survey Map, filed August 10, 1987 in Volume 117" of Certified Survey Maps, page 1865, as Document No. 428979, being a part of the Southeast Quarter of the Southeast i' Quarter (SE14 of SE]a) of Section Twenty-nine (29) , Township !I Thirty-one (31) North, of Range Eighteen (18) West. I $ a0. 0 This ....is.-not.......... homestead property. (is) (is not) Exception to warranties: � I � I 12th day of .........Auciust.....•-•-•---•••-•-•-••.............•-•.---., 19....87. Dated this .---.....---•-•-- I ...(SEAL) k. �?' GT. �7� (SEAL) Ra ond-. 'agna ._.• . i " ......................... ........................................ ........................................................(SEAL) - ..... .. .. ..._.._..............(SEAL) i Pauline..F.Ag.r.14A.............................. I!, M ................................................................ .................. 1! I AUTHENTICATION ACKNOWLEDGMENT I i Signature(s) _ STATE OF WISCONSIN - - ---------------- —- ------------------------• ------ ----- St.--- CzOiX...... County. sa. ii 12th i, authenticated this --------day of___________________________ 19------ Personally came before me this ................day of August....................... 19.37- the above named -------------------------------------------------------------------------------- Ra mond Fa nan and Pauline Fa nan Y........... g..........- Pauline..ne.. ----q- •- TITLE: MEMBER STATE BAR OF WISCONSIN .........................................................-...................... (If not, ............................................................ authorized by $ 706.06, Wis. Stats.) to me known to be the person _5..._.___ who executed the forego' instrument a acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - ---- --- -- -•---•------------• I j Rerlstr?t r--..V-a?l---Ayk--- &__�IC�dh,a[Cl-,---S..-C_... • Ruth A. J son I; New Richmond•,__wT __ 540]��__•_______________________ Notary Public ...._St,_..Croix_.___._____..._ County, Wis. - -- (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) 2 2 I! � date: ._...�...,�...�l.�Q..-•............................. 19_...._...) i •Names of persona signing in any capacity should be typed or printed below their signatures. C= STATE BAR OF WISCONSIN CawwL Alw 7 4AA9 H z cn a . r ST C - 105 r' • a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a H OWNER/BUYER R4&Z ROUTE/BOX NUMBER }� ��1;� � ;�//� Fire Number CITY/STATE &A5' (ill ZIP y�► �� PROPERTY LOCATION : _' , S`t Section_, T _N , R _W, Town of _SrtAQ 191F 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 put into {I 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 . 0 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- 'v 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 . SIGNED DATE "� � U l St . Croix County Zoning Office P . O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . INSTRUCTIONS FOR COMPLETING FORM 116 - SBD - 6566 . To be a complete anel accurate soil test,your report must include= 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or cormercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement:system; 6. Complete V)e suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED GIST 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, $. 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 exernp- 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 36 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 med s Medium Sand W - Well fs — Fine Sand Bldg - Building Is - Loamy Sand > — Greater Than sl --- Sandy Loam < Less Than "I Loam Bn Brown s 1 Silt Loam BI — Black Silt Gy Gray cl - Clay Loam Y — Yellow sel -_ Sandy Clay Loam R - Red sicl - Silty Clay Loam mot — Mottles sc — Sanely Clay w/ with sic — Silty Clay fff — few, fine,faint *c Clay cc common,coarse pt - Pest mm Many, niedium rn — Merck 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 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 obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR ANb PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS • (ILHR 83.0911)&Chapter 145) LOCATION: SECTION: OWNSHIP UNICIPALIT ' LOT�NO.:BLK`.: SUBDIVISION NAME: SEA 4j; �/a /T,�/, N/R/IE (o COUNTY: OWN R'S B ER'S NAME: MAILING ADDRESS: r � USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILEDESCRIPTIONS:1PERCOLATION TESTS: EAResidence *---n ANew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) S ❑U CMS ❑U ®S ❑U ❑S ®U ❑S �U If Percolation Tests are NOT required DESIGN RAT : If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indica Ay Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) -- X/fin 5, e i 5 .� B- /©a- oc � © B- 3 lv A,,,x_' B- 103,or 1tAll ✓' . B- ��f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH P- P- 6 3 P- ` L 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 t all borings and the direction and percent of land slope. i J/ fCsr��U 4-5— SYSTEM ELEVATION 1 y _ v 4 We t4)v� E , 3 • . _ _ _ tN ON , T � , 3 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): d 3 7 L CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) —OVER — t s1 � J I PLOT PLAN I II PRC15ECT ADDRESS 1, �r</�cj - s 4�da �rnir�ZOUNTY 4 „�� 1/45 . 1/4/S�y/T,�/ N/R/ W TOWN,St�..- MPRS Byron Bird Jr. 3318 DATE 6 °1-12- —g'� BEDROOM CLASS PERC / CONVENTIONAL,< IN-GROUN-DOIRESSURE CONVENTIONAL LIFT MOUND—HOLDING TANK SEPTIC TANK SIZE =Z LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA 5�,zY PERC RATE BED SIZE ►\ Benchmark V.R.P. Assume Elevation 100' X o Location of Benchmark * H.R.P. s — 1:3 Borehole Q Well Scale Feet Y O Perc Hole System Elevation TYPAR COVEEING 2' 12' 3' 0 6' 3' 1 Sewer Rock 12' Air wb Itr �r 1)e 3 V-14 4 9 g C' - 4-0 p1i13 nUGM(0)wy � ��y Zg {� CERTI IED SURVEY MAP LOCATED IN THE SE1/4 OF THE SE1/4 OF SECTION 29, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN APPROVED El/4 CORNER SECTION 29 AI AU G 0 5 1987 T31N, R18W wi E-1 �1 Si. CROIX COUNTY dl AI COMPREKENSiVc- PARKS PLANK4HO ZI AND ZOMAG CO)AW71Ei Pi 1 -C41 N. LINE OF THE SE1/4 "o zI a1 OF THE SE1/4 M :3I U N P L A T T E D L A N D S M 192ND AVENUE - _ - _ M M M °• 589°42'19"E 417.00' —� _ _"E _ M S88°44'45 _ \� ° 33'1 LOT 1 N1 LOT 2 °` I ra i C.S.M. _ w 2.288 AC± Being 99,663 S.F.± 33�'� zl VOL. 6, PAGE 1534 rn rn _c^v `°o Including Town Road Right-of-Way �I DOC.4�402649 0 0 ^ 1.681 AC± being 73,211 S.F.± 3 ,-q o M Excluding Town Road Right-of-Way w N al " z " Flo Cn 11 00 1.00 E-41 CDI" to AI g N1 W 375.81' c°n 1,1 ' off) �1 N89 042'19"W 417.00' °I� 1.41 H UNPLATTED POINT OF � 6' 0.1 w BEGINNING 133' ( 33'' zl o L A N D S �I z H a W H • c4 W � n O -4 —4 G SE CORNER z SECTION 29 T31N, R18W OWNER & SUBDIVIDER z SCALE IN FEET RAY FAGNAN R.R. #4 ~ NEW RICHMOND, WI. 54017 0' 100' 200' LEGEND w SECTION CORNER MONUMENT, FOUND (BERNTSEN CAP) . x 0 1"x24" IRON PIPE, WEIGHING 1.684/LINEAL FOOT, SET. • 1" IRON PIPE, FOUND. Vol. 7 Page 1865 This instrument drafted by James T. Swanson.