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HomeMy WebLinkAbout022-1083-40-000 o w o I o f rm o d `i1 (D 1 v *t CD -o 3 (D • (4 \ 1 3 3k n 3' O N tN/~ O° W O (~7 z N 4 6 v C li 7 N N H• Sr d. 3 p C o f N d N O °W° n p0 ':y comQ Zam ur rnm f'c ro m a:3 ?~°Dw C cm 7 O W CD m m m _ :p "msr~s l 1 O. O O 01 N a Q ? n ~ O R O °o 000 ~ A 0) m CD o o D o° Ln (.0 3 C) ro U) ID m C/) D ° o m (n co co CD c~ N W d ca°o ` CD (n w o I c o. I~• o o~ l ~ v 3 - 3 O N O O• OOH, CN`O (D ~l CD L i CO CO K Z c0 c0 O n t- N O O -l J O cn O G (1) m~ 7 II W W K z 0 !V • m 0 0 C .N. ~ o Z 0 0 0 O o 0 O0 A ~y.~ a o n 0 n o -1 CD 0 Z vQ a~ uitnw o CL S NNVi D n 3 T m o M v O m o l~ ° O 01 sy ,O 7 d ~1 -6 fA ~i( ' ! I tQ (V U1 C C CD N z ' 3 d _ I N ~ ~ " I J l\V` CL ° N Z N O Z OW Z N Z w Z D a = D a O CCDD ~ • CD U) CD d ~ I ~ ca ~ I N e CD N C CD Q W d W CD a 3 a E s-4 cn CD C-D N Z ~ o p 2 sD 0 O N C " li ;a rt =3 I Z O CL 0 Q A OF! 0 cn N m 1.0 0o v 00 cD (D M C s z CL r L 3 c 3 o O " m o0 3 3 y .Z7 N Z (D CD W O W I N a N O A S tZ N cc N s? CD C a O f OQ C p =r 0 0 CD K O 0 N .D cn (D CD Cn CL CD X70O E+ a W 7 O d Z' CD Cn a p 0 ~ O 'aa Cl) N I A 7 p N :3 O p I y i ~ ~ b O O O d a M N 0 0 CD b p (D CD w ~ 0o CD o CD o O ° O AS BUILT SANITARY SYSTEM REPORT} FMR I , TOWNSHIP a°~IIVA&1,410124 SEC. T N, R~W ~.0~ ADDRESS ST. CROIX COUNTY, WISCONSIN. ??BDIVISION LOT LOT SIZE. PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM OPTIC TANK(S)MFGR.„~y _ CONCRETE L,""STEEL 140. of rings on cover Depth it DRY WELL _ENCHES NO. of width length area D no. of lines width J1• length,.JE:!~_ area dept top of pipe ✓GREGATR :RIB RA AREA REQUIRED AREA AS BUILT .sciaimer: The inspection of this system by St. Croix County does not imply complete / rmpliance 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 ,-stem operation. However, if failure is noted the County will make every effort to termine cause of failure. '`.EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. l `"INSPECTOR DATED 5 %PLUMBER ON JO LICENSE NUMBER o f 3 3 lot 0 0. B, on mw 4 I m 3 o m coo °:3 C-1 I C Z a va ~ O 00 C Z a o~ co (D CD al a o w > a N rd rt N G~ I j~s 9 17, 25 r hi o CO ro n D o w Z I 3 3 2 rt ~ ( V S (D U) u W ~ ~ N I 0 ci (D o N 00 H ' 1 m cc m ca a s cn c CD C) C, CL 00 CD ON 3 (D 'b Q'' rro I 0 N O ~1 CD CD I CL 3 co co o r CD (D 00 co 0 c (D CD 0) 0) rT 0* V~ \ 0 0 0 i N IS Ca (o Cfi v v; o 00 I °p o m m _ rn i S CD = 23 ()0 i 77 cjll -o 11 0 N! N , Z co o ~ O , ~ D 00 b x (D I 0 a N• rt I o CD CD Cl) H. CD ¢ I Co N CD a N tv W i ° 1 n 3 a Z = m ? Z C n n A Z N i W m co 00 m m z CL B A °o" m00 CD ? I ~ W O7 I m u! n I a a CD a I ° m c ma - 'J o a =r 0 CD N II Nm n ~o 1 y m 0) 0 ° a t 1 n cn a v o I y I CD 0 g o I ~ a N A o b ° CD O O O p O 1 p a ~ Parcel 022-1083-95-100 02/02/2006 10:33 AM PAGE 1 OF 1 Alt. Parcel 29.28.18.452H 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - POCIENGEL, WILLIAM A & JEAN M WILLIAM A & JEAN M POCIENGEL 1089 PRAIRIE MOON DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1089 PRAIRIE MOON DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.353 Plat: N/A-NOT AVAILABLE SEC 29 T28N R18W SE NE 2.353 AC LOT 1 Block/Condo Bldg: CSM 6/1794 ALSO 66' WIDE EASEMENT Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1040/161 TD 07/23/1997 777/223 2005 SUMMARY Bill Fair Market Value: Assessed with: 143881 226,600 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.353 50,000 179,100 229,100 NO Totals for 2005: General Property 2.353 50,000 179,100 229,100 Woodland 0.000 0 0 Totals for 2004: General Property 2.353 22,000 140,000 162,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1083-40-000 02i02i2006 10:28 AM PAGE 1 OF 1 Alt. Parcel 29.28.18.452A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - YOUNGGREN, WILMER-FAMILY TRUST WILMER-FAMILY TRUST YOUNGGREN 304 WASSON CRT RIVER FALLS WI 54022 Districts: SC = School SP =Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.520 Plat: N/A-NOT AVAILABLE SEC 29 T28N R18W SE NE N 50' OF SE NE Block/Condo Bldg: EXC CSM 6/1794 N/K/A PART OF LOTS 2 & 3 OF CSM 9/2644 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 779/607 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/17/1995 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER WxLMA9_ 14pw ~rL>: TOWNSHIP K,Z,MA=K,1AW2r_ SEC. 7-61 T ZSN-R 18 W ADDRESS R-1-7_L.=0SLTy Q~p- ST. CROIX COUNTY, WISCONSIN R;~~. sgoZz LOT LOT SIZE SUBDIVISION 4_4 PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r Q, o~.ae WEAA_ r. fl ~ D;s~ u n , ,p Vh NI INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used (Dm QagtLe ,C 60wVt-ve 4PR" Elevation of vertical reference point: ICS.00r Proposed slope at site: Z% SEPTIC TANK: Manufacturer: WLESMg5 Liquid Capacity: /BCC Number of rings used: D Tank manhole cover elevation: 93 41& Tank Inlet Elevation: q Z.15 Tank Outlet Elevation: q2.4( Number of feet from nearest Road: Front 10 Side,@ Rear, 0 ooq 166, feet .From nearest property line Front G) Side 10Rear, 0 . Im feet Number of feet from: well OkICr1 l , building: 100-l" (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, OSide, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: z. Width: LZ Length: -19 Number of Lines: Z Area Built: Fill depth to top of piper I$`' Number of feet from nearest property line: Front,) O Side, O Rear,OIt.6ftw0O. Number of feet from well: &Atw- W'-6" Number of feet from building: '77t-O N (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 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, a Ft. Number of feet from well: J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: l Inspector: Dated: / Plumber on job: License Number: o? 3/84:mj I , DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX /969 BUREAU OF PLUMBING MADISON- WI X53707 yyI CONVENTIONAL ❑ALTERNATIVE State PI-1,D. N-1,11 (lf assigneA ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION D TE 97/ Wilmer Younggren Rt. 2 Liberty Rd. River FAlls WI 0_/-J(V M~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT ELEV SE NE, Section 29, T28N-R18W, Town of Kinnickinnic' Name of Piumtter. IMP/MPRSW N... C...ty Sanitary Permit N.mher. Paul Cudd 2739 St. Croix 83806 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVEN Ido a PROVIDED PROVIDED w~~ S '7q. 31 YES LINO ❑YES NNO BEDDING. JVENTDIA. VENT MATL.. HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING. VENT TO FRESH / LET ALARM FEET FROM LIN (AIR IN i~_ If NO NEAREST ` vl/ Gtivf ❑YES NO ` ❑YES DOSING CHAMBER: 1 J BEDDING LIQUID CAPACITY PUMP MODEL. IPUMP SIPHON MANUF AC TUNER WARNING LABEL LOCKING COVER MANUFACTURER PROVIDED PROV IDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: 71111P AND CONTROLS OPERATIONAL. NUMBER OF PHOPf RTV 11111 Lt BUILDING IVENTTO1He SIT (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ENGTH 1111AMFIEH 111ATI HIAE 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. DIA =Plfti LIQUID BED/TRENCH i TRENCHES - T RIAL: PIT DEPTH DIMENSIONS I-) I GRAVEL DEPTH FILL DEPTH UlSilt IPE ISTH. PIPE DISTR. PIPE MATERIAL NO. D ..TH NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH III PIP? ABOVE CO EAR, F I E V IN[ L U AIH IN-L7ET { f LEV. PND L 7- S PIPES FEET FROM LINE 6~ ` O~- NEAREST----m- 71 17/ / 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. ❑YES NO SOIL COVER TEXTURE 11111MANINT MAFIKFFIS UB51 RV, 11,11, WE I IS ❑YES LINO ❑YES LINO jD11TII OVER THENCR BED DEPTR OVER TRENCH BED =UPS)IL ST)UDF D SEf UFD JMD CENTER EDGES ❑YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES. LATERAL SPACING GHAVEL DEPTH BELOW Pit'[ F ILL DEPTH ABOVE COVE H DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR_ PIPE MNO OISTR IUISTH PIPE DISTIiIBII I ION PIPE MATE fVIAI & MARKING ELEV ELEV. CIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORHESPONDS TO APPHOVI D PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: E RVATION WELLSNUMBER OF PROPE B UILDING FEET FROM LINE ❑YES LINO NEAREST ❑YES LINO TE's ~5 2S Sketch System on ~ . Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) r" ' uneconsin APPLICATION FOR SANITARY PERMIT D I L H R St • Croix COUNTY (PLB 67) UNIFORM SANITARY PERMIT # -RBOR 6 MUR1R11 REIRTIOr15 3 p& -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Wilmer Youn ren Rt. 2, Liberty Rd. River Falls, WI 4022 PROPERTY LOCATION XXMX SE 1/4NE 1/4, s 29 , T28, N, R 18 xD[x Kinnickinnic EK*C) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER Liberty Rd. TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair X1 Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1000 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: XIS 1ng an O Remain IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Class 2 945 948 © Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the p 'vate sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP/MPRSW No.: Phone Number: Paul R. Cudd MPRSW2739 715425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, WI 54022 Art Wegerer COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial Approved Adverse Determination eason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 , To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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 Wilmer Younggren Location of Property SE 34 NE ' , Section 29 , T 28 N-R 18 W Township Kinnickiniic Mailing Address Rt. 2, Liberty Rd. River Fa11s, WI 54022 Address of Site Rt. 2, Liberty Rd River Falls, WI 54022 Subdivision Name Lot Number Previous Owner of Property Walter Weiss Total Size of Parcel 69 Acres Date Parcel was Created Unknown Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X No Volume 356 and Page Number 225 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) cetti6y that aU statements on this 4otm are tAue to the best ob my (ouh) knowledge; that I (we) am ( cute) the owner (s) o6 the ptopen ty des cAibed in this .in6o4matlon boAm, by vi tue o6 a waAAanty deed Aecotded in the 044ice ob the County Register o4 Deeds as Document No. 257362 ; and that I (We) pAesentty own the proposed site bo& the sewage dispad sys em (ot I (we) have obtained an easement, to tun with the above de c i..bed ptopehty, bot the constAuation o6 said system, and the same has been duty kecotded in the 046ice o6 the County Register ob Deeds, as Document No. 25,362 ) . k SIGNATURE OV,O SIGNATURE OF CO-OWNER (IF APPLICABLE) July 18, 1986 DATE SIGNED' DATE SIGNED u z • cn a STC - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z ry a /~$~X Wilmer Younren c OWNER ROUTE/BOX NUMBER Rt. 2, Liberty Rd. Fire Number 4352 .CITY/STATE River Falls, WI ZIP 54022 1 PROPERTY LOCATION: SE k, NE k, Section 29 T 28 N, R18 W, Town of Kimickinnic , 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 z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- 'o 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. f SIGNED 1 DATE July 18, 194 J 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. x N m v N ? N O CD CD - C-3 v=--Or w o ° o c o w w 3 ccoco 0 0 c 7' m p a m m O A yy CD 0 CD D 0,0 0 W p ~ cD t 77 N U CCD N a 4 . mwCD CD =r CD o3o o °~mw ~m , c oc o w o(O' o c `C L C Q•' c N• 3 to c 9t CUD M c ? v, mo W 0 W y o ° a - m acoo ~ a D N Q ;a m C 0 Q o aio~ 0Dcv~ c~ w o a o w CAD co o : Qc• m ocnm ?vm - C m c~c ju Z (A amp 3~mmaa Z ° CO) C? a SFf°0~ a CD 3 su CL (a o _ to c c a~ m ° Q~ N o m n CD 0 S. lw CD -4 Go aof aiccc~~ L7 ao o aaCCD (I L 47 Co , -1 1. m 0 C to w m mnc ~co° l< •mCD o° O 0 CL O us ~ 0 m o ; a p a m --1 CD c cc~9s r« "V f m 3 0~ m o 0 0 a °03 CD < to - ° m Q Z 1 J o O 7 I VISION DEPARTME#IT OF REPO ON SOIL BORINGS AND SAFETY & BD UI IVLDINGS ISION INDUSTRY, C LABOR ANR, PERCOLATION TESTS (115) MADISOP.O. BOX N W1 53969 'HUMAN RELATIONS • (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sE 1/vQ/ 2.9 TzSN/R »E (o \v-IQ k3 to - - S~B UYER'S NAME: MAILING ADDRESS: Z Ll1?j COUNTY: QAULFC. %T• Z-'VitX Wlt-»OR, `f©UtQG;MZ1,j F-Atu_z, L -J] S LI0 z2. USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: I Residence 3 N . N. ❑New .Replace -2 - _ g6 N • A RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: [ND-PRESSURE:rYSTEM71N-FILLrOLDI NG TANK: RECOMMENDED SYSTEM: (optional) .~S DU ®'S DU ~S ❑U ❑S CSM 0S ®U ~z~><_)9'0,>Ju v3na.~~+ L If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CLASS Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-I1S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 17aF ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- c~6•S' 1~Or.~E > 6.$ ► °•9'Z\-CSnIS T's ; z.~' Dh IS ;3.3~LlGttT ~3h 1`4'S B- Z C~.9 `6 I 6 C7 tr B- 3 G.7~ '3S,8~ ~I 7 6•~ ' ©.Q,' Z.9' ; 3,0' If P B- y PERCOLATION TEST to LNBIE DEPTH WATER IN HOLE TESTTIME DROP IN WAT EL-INCHES - \ RATE MINUTES INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER D PER INCH P-- P- P- PLOPLAN: 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. -Rp-rm I Off- BeLU N AVGE gJ SYSTEM ELEVATION 93.0 of -Mc-_ ti V4 IMF `T-HT , 6O E ' E OL> CONC , ✓ _ n~ E _ € - t l5 AiC ' `Fh~T of U(CN~ % l Q~D~ I 1 ) E CIO T. € q i F t 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: ~T 4 Ox- Z'Z(c CERTIFICATION NUMBER: PHONE NUMBER (optional): Ei LI..Sw(3 tZ w Sl4b)) S7L ?,S-o1 CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Ilk TI U TIt CIS FOR COMPLETIN-_ _ 1 IF To be a curate sail test, your report must it rle: 1. Complete 2. The use section n r! indicate whether or aject; 3. MAXIMUI. aoms or corn: 4. Is thi em; 5. Comawns. A rr r OR A ~ DING TANv nNLY IF ALL OTHER;'._ 'CUT 6. PLEASE tiis anci corn i I plot elan; y, test Ioc 'scans. Drawint preferred. A paint are clearly shown, _.,d are permanent; food plain data, percolation test exemp- 10, 11. _ t 1 THE ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Y R sic - cc - Mm d p VRP Faint TO THE OWNER: This soil test repot : is first step in securing a sanitary permit. The county or the Department may request verification of this ~c test in the field prior to permit iSSI-1- Mari ~~vate sewage system and a ~rmit application dust be submitted o obtain a perrnit. The sanitary hermit must be obtaine ' ; for to t tart: of r , H "1.0 PLAIN "IS how: Dosing chamber - E Location of building servedN JP, Septic tank LA Vertical/horizontal reference point Building sewer ~v system elevation is ` • O , F-I Effluent system Well F NA Replacement system area Nq Property lines w/in 50` of system 0 ~t ! Distribution boxes Scale - - \ or di*-ier.s'.oned L Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan,below: - O WALL j I i I i I Ii f -FE L t4U.~t Oi 3o OF LV \ $Dtt \tttL(_ BZ PVC \000 GPcL ~ - c~sl~as~ sTt: 5 ^$3 ~16' TS',rJ lU ~ZE➢7.SL..J ~ \ 3 ~ ~ ~ ~ ~,Sl'CZ1RL,~;1uti r'~! °E li~S'731Lt_ O1S71a$U~ll1ti ~ \ / E,L1X - PLUG ~ttiE Tv \ )9' FIST. Dcu4tNF~ELp \ \ \ 8 r y CZ vEFST v fix; ST~~ t 6 \ 4=~Xt s r7N G ZTZA, EY -T Qt Pe TeP EL • 9-) .b By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.GroixCounty and thegt.GroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. I -s MPRSW2739 1886 -P umbee's signa ure - ~cense Twe: Bate - T?-'T t CROSS SECTIOIJ OF A BED t 2`• OF AGGREGATE .cam SOIL FILL DISTRIBUTIOU PIPE - _ --APPROVFD -`_-I►.ITHETIC COVCR MATT-RIAL OR 9" OF STR1,W Of MARSH "A J (o OF%2-21/ pAGGREGA F- ~ s t" `ice\~ //ice ELEV. OF `~3.0 FEET Z7 INCHES BE1-01-J ORIGIFJAL GRADE DISTRIBUTIO/.t PIPE TU BC AT LEAST AUD AT LEAST?O INCHES BUT Uo MORE THAM 42 IUCHES BI LOW FlUAL GRADE S -I 11JLHE5 ` MAXIMUN% DEPTH OF F-XCAVATIOQ FROM ORIGIQAL GRADE VJILL BL MINIMUM DLPTH OF EXCAVATIOIJ FROM ORIGIUAL GRADE WILL BC INCHES SIGIJED _ L IC E US I UWABE R: _MPR.SWZ739- - 'Z:~. N-r : 7/18/86 r - a r REPORT OF IPISPECTION--Ii4DIi1IDUAL SE14AGE DISPOSAL, SYSTEM Snnitary Pernit O r S ate Septic 4 Llr.~h✓ TOWNSHIP t. Croix County Sr PTIC TA'M% Size gallons, `Lumber of Compartments Distance From: Well ft. 12% or greater slope it. Building' ft. Wetlands f: ILigh~aater -__-_ft. DISPOSAL SYSTEM Tile Field.or Seepage Pit(s) Distance From: 'Tell ft. 12%.or greater slope ft Building; ft. Wetlands ~ f FIELD High-water ft. Total length of lines ft. Number of lines Length of each line ft. Distance between lines ft. Width of the trench- ft. Total absorption area sq. ft. Dept:: of rock below tile in. Depth of rock over tile in. Cover -,over-. rock, Depth of tile below grade in. Slope of trench in per 100 ft. Depth to Bedrock ft. Depth to ground water ft. PITS Number of pits Outside diameter ft. Depth below inlet ft. Gravel around pit: `_yes no. Total absorption area sq. ft. .Square feet of seepage trench bottom area required :square feet of seepage nit area required . Inspected by: Title':. Approved Date 197 Rejected Date 197. EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 E MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS l ANA) j le /n~lU 1 C LOCATION: '/4, / 14, Section, TN, R E (or) W, Township or Municipality Lot No. , Block No. b i County Owner's Name: Mailing Address: #f t~ - CA TYPE OF OCCUPANCY: Residence ~>e- No. of Bedrooms - Other EFFLUENT DISPOSAL SYSTEM: NEW eu ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS d` PERCOLATION TESTS 7g SOIL MAP SHEET SOI L TYPE C 1~ 4,0 A rv,,_Y 6,11 OWTU ky'-- I~ -'s PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER 'S&L BCkI&J65 Z(o Y/ )49 P N h (1 L/ P 31,v- 3, 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) NW ~ N h• . e i . q KN 4 F5 c LJFerelz A t - 3$ t.s. ba fl~12o PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference . Indicate slope. r- IC . -Zj i l r~ r e- -AA1 0~ 1 gig r e tN ,r r lei 'T *e7, ..1111C iL 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 location of test holes are correct to the best of my knowledge and be I f. Name (print) u Certificajon No. Address Name of installer if known CST Signatur J-^0V A trsr•A1 AIITWnDITV _ ~ P L B 6 7. State and County State Permit # Permit Application County Per # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: oepppd B. LOCATION: Section T N, R-,IrE (or) W Lot# -City_ Subdivision Name, nearest road, lake or landmark Blk# Village 1 Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family / Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste GrinderSNO # of Bathrooms Automatic Washer A--<ES NO Other (specify) E. SEPTIC TANK CAPACITY / 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) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New A~ Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length- Width Depth1Tile Depth~sr No. of Lines ~I Jt Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land / 4~ Distance from critical slope 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 C.S.T. #~(1 and other information obtained from wner/builder). Plumber's Signature P MPRSW~Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 4 Do Not Write in Space Below FOR DEPARTMENT USE ONLY l~ Date of Application All Fees aid: State 10i®Q County z f Date ~T Permit Issued/Rejected (ate) i :IMM Issuing Agent Name Inspection Yes No Valid# Date ii"dec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76