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HomeMy WebLinkAbout040-1123-10-000 N O ti oq ° I a a+ o I In co N N O O c c Y 0 U > ° e o ~ a t I T'D ° c 'y E m ~ ~g I a~ H ~ ~ wV G T ° N co ~ Z r~ I ii ° f6c o ~ ~aEiy I i E Q U ai a I C7 d. CL I 0) w (n O z w co i a m c I 0 o z C U 0 z ~ 2 fA F- r O N z E -o N = M c co N I U N ~ N U) O 76 a t Q z co N w z d 7 H E U N p ~a a a o ca c N Y! d p 0 ID No G C 0. N i rU) _E _a o 3 3 ° o v ' X 0 0 0 z o L v_i a ~ ~ LL (D CC) N J U > rn CO CO rn } C) Co r T? :3 o = Op co a o U) P) ° <n co ~i j 0 U a C, c Al _ _ O ° r ° 0) w 0) co O O C a- 0) N N `o y N ao O N~ 21 r_ N a r 06 ~ N N z .d.. N i..i dry o o E .c ' O o cNn F a°DO o Z p 2 cif cc I V EE ~ E `m CL # a L: n. `Iv E 75 21 c a~ A c0 ao aci o ~OI13- c d li o > > on B 3 o i i ~ cD a y ~\^1. Ate! 0 n N O C. 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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 GERALD L & CAROLINE L WOLF O - WOLF, GERALD L & CAROLINE L 498 CTY RD M RIVER FALLS WI 54022-2009 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 498 CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.500 Plat: N/A-NOT AVAILABLE SEC 32 T28N R1 9W PRT SE SE 1/2A COM SE Block/Condo Bldg: COR SE SE OF SEC 32, TH N ALG E LINE 198' TH W 115.5' TH S 198' TH E TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 32-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/23/2001 646222 1644/383 QC 07/23/1997 1066/571 WD 07/23/1997 753/626 07/23/1997 734/378 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.500 44,000 84,600 128,600 NO Totals for 2005: General Property 0.500 44,000 84,600 128,600 Woodland 0.000 0 0 Totals for 2004: General Property 0.500 44,000 84,600 128,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 >7 x Fo rm - S T C - 104 rr~~ J AS BUILT SANITARY SYSTEM REPORT OWNER A4 1X 1X TOWNSHIP SEC. ~ T N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION &t ' _ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM w6ll ;01 r a 9 ~'r i I L y. ~V 1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site:2- SEPTIC TANK: Manufacturer: 61eg~w Liquid Capacity: /f1u0 Number of rings used: ~j Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,0 SideQ)Rear, ~ , O feet From nearest property line Front, 0Side, 0Rear, 0 feet Number of feet from: well building (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE STDR PUMP CHAMBER Manufacturer: Idles ~ Liquid Capacity: dE: Pump Model: / 7 Pump/Siphon Manufacturer: Pump Size e&* Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer Alarm Switch Type: Aye!tcl~` Ft.- Number of feet from nearest property line: Front, O Side, O Rear 0' Number of feet from well: '7K Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: A Trench: Number of Lines: Area Built: Width: Length: 7( Z. Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, 0P't Number of feet from well: 63 Number of feet from building: 02 / (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. f 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: Plumber on job:o Dated: License Number:{/ 3/84:mj . ` Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT r OWNER Ate ~ 1Njd e- TOWNSHIP ! ✓o r ~ SEC. J J T W ADDRESS `J ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~ilk LOT LOT SIZE ~ 9 10 PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM govt W ~jt11~~~(r~5° 0 ~bp j c t a r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: IL9 Liquid Capacity: 1600 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Q Rear, O /,1cs feet From nearest property line Front 10 Side 10 Rear, 0 a feet Number of feet from: well Lbuilding: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE STDF. PUMP CHAMBER Manufacturer: Liquid Capacity: e Pump Model: 2D6j j I~SZ Pump/Siphon Manufacturer: Pump Size ~i Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: / Gallons per cycle: Alarm Manufacturer: `~~G~✓t", Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft.-2-~ Number of feet from well: ~b Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: / Length: 4 Number of Lines Area Built `Y 1-1-4 Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PITT 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: p~Y1Cc/J 'Vt /`SdV Dated: a- SILO Plumber on job: ~i SA2~~~ License Number : Z ~Pi~S 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & RUM4 RELATIONS SAFETY & BUILDINGS P.O' BOX7sfis PRIVATE SEWAGE SYSTEMS DIVISION MAD1,SON, WI 53707 BUREAU OF PLUMBING h • CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mark Wolf Rt. 3 River Falls WI 54022 4 - S"/-I Z, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: W _9 Vlkv REF. PT. ELEV.: CST REF. PT. EL SE SW, Section 33, T28N-R19W, Town of Troy Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Roger Timm 3224 St. Croix 88442 SEPTIC TANK/HOLDING TANK: MANUFACTURER: EALARM CITY: TAN INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L JLOCKING COVER PROVi DE DPROVIDEDI~) O BEDDING: VENT DIA.: VENT MATL.: NUMBER OF ROAD: YES ❑N PROPERY WELL: BUILDINGVENT TO FRESH ❑YES NO /f FEET FROM It,~' LINENEAREST ~oh C) ~('-JJ7 C. I-- DOSING C AMBER: MANUFACTU ER. BEDDING: LIQUIDCAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED: PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLS OPERArIONAL: ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN FEET NUMBER PROPERTY WELL BUILDING VENT 7O-FRESH FEET FROM LI"E AIR I"LE T PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONALSYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING COVER ! TRENCHES. MATE , RIAL, INSIUE DIA. #pITS LIQUID DIMENSIONS J r ✓ 6 PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. CIS . NUMBER OF BELOW PIPES. f( ABOVE COVER: ELEV. INLET ELEV. END: PROPE RTV WELL: BUILDING. V NT TO FRESH [rrf ~ ( fal^ /r r lJt PIPE FEET FROM LINE ~ !J ~ ~ AIR INLET. 1 / NEAREST'.----► (J y MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MAHKE RS OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED ❑YES ❑No ❑YES ❑Np CENTER: DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES: FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. N O.DISTR. DISTR. PIPE DISTHIBU TION PIPE MATERIAL & MARKING ELEVATION AND ELEV.'. ELEV.: CIA. ELEV.: PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS; PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST . ~1 1cf. o J . A 2 ) i4 c? f i✓ Sketch System on `3Ret 'n county file for audit. Reverse Side. SIGNATURE: TEE. DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNT (~YDILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT 4a-, -Attach cpmplete 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 ❑ NO PROPERTY OWNER PROPERTY LOCATION '4W'/a, S 3 3 T , N, R/ (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER UBDIVISION NAME 3 y Ld- CITY, STAT 'CODE PHONE NU B R CITY NEARE T ROAD, LAKE OR LANDMARK o7-2 VILLAGE : / ro 10 AS I' I OF 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. ❑ New b.tA 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. Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. UI See a e Bed b. ❑ seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /1-3 (0 16 • Feet ~vr I~ Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber 12-7 ❑ ❑ ❑ ❑ 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: Plum is A (Street, City, tat ,Zip Code): Name ofZs r: Z. 3z 2 7 VIII. SOIL TEST INFORMATION Certifi d SOJI Tester (CST) Name CST# CST's D ESS (Street, it tate, i Code) Phone Number: 1J~ c f 7/S -/8S IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved Sr harge Fee ❑ Owner Given initial /o~~~ Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber i 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 ye.la 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'h 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 Groundwater - included the creation of surcharges (fees) for a number of regulated practices which W,scoris n's a can effect gr.^undwater. The surcharge took effect on July 1, 1984. All of the water that b,ri fra,lre is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The morales collected through these surcharges are credited to the groundwater fund adrrinis-- terec by the Department of Natural Resources. These fug pis are i.!sed for monitoring ground- water, groundwater contamination investigations and est olis;}m{,nt of standards. Ground,,rrater, it's worth protecting. SBD-6398 (8.03/86) 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 O) 6, Y_ ~-Section „ T N-R~ W Location of Property Township f ;Jt Mailing Address -ye Address of Site Subdivision Name Lot Number Previous Owner of Property Total Size of parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 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) ceA i.by that att statement on thin botm cute true to the but ob my (oun) hnowt-edge; that I (we) am (cute) the owner(s) ob the ptopehty descklbe.d in this in6o4mati,on boAm, by viA tue o6 a waA an ty deed neconded in the O b bice o6 the County Reg.i 6ten o4 Deeds as Document No. and that I (We) pees en tty own the pnoposed site bon the sewage di,dpos system (on I (we) have obtained an easement, to nun with the above d6cAibed properrty, bon the conatnucti.on ob said system, and the same has been duty teco&ded in the Obbice ob the County Regi.6ten ob Deeds, as Document No. ) SIGNATURE OI? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) SIGNED DATE SIGNED H z cn ' H a ST C- 105 r" r • a ti SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d =rte/ ' H OWNER/BUYER k t~ 7 ROUTE/BOX NUMBER Fire Number CITY/ STATE ✓ PROPERTY LOCATION: Section T N, R W, Town of 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 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. t 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- ~ying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- 6,s;sary), the septic tank is less than 1/3 full of sludge and scum. Ceirtification form will be sent approximately 30 days prior to three year expiration. y µ,F I/W.E, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart-Hd 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 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 f'' Sign, date return to above address. DEP ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , LABOR AND,,. DIVISION PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:' SECTION: ,-4TOWNSHIP/UWAAQNAAL- ; LOT NO.: BLK. NO.: SUBDIVISION NAME: s e 1 3 3 /TJ-?N/R /9E O W 71Pe y / ~l a COUNTY: OWNER'S e' &NAME: MAILING ADDRESS: 'I.4oi "'OK woz-t / ~l ~Pf- - 3 ~;~E•e f //s, 4V15' S' ya, _2- USE DATES OBSERVATIONS MADE k NO. BEDRM S : COMMER IAL DESCRIPTION: PRO I E DESCRIPTIONS: PERCOLATION TESTS: Residence Z ❑New Replace G'rr~[_ IJ., ~ 3 dl-4. / Q T RATING: S= Site suitable for system U= Site unsuitable for system X Replace CONVENTIONAL: MOUND: IN-GROUND PR URE: SYSTEM-IN-FILLJHOLDING TANK: RECOMMENDED SYSTEM: (optional) sou as au osou osau os©u Qves7l, E if 0tloj1AXD C, *-V i1 I,v~ /'S r^ /070, If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: C~/¢ S S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7S X00.12- ),jr, > 9 ' ,).s,/ Z.s- -84l.-Gy 70 B- 40 - c y 9•~ 99~Q /q ' O ' S',3 ' ✓~'~'`j/ A!~/~.~ . S' ~ 6T ' -p-'e".44 - G y si /o , B- Sl~ • 75 AA- 3. " BAJ 5 Lev /f •4i X B- Ole -,8 s~ S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RIOD 1 PERIOD 2 PER O PER INCH P-/ P- P s S~ ' Z P- y P-,3 15,-,7 1 7:3 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 93'90 E E a t SEP i ~ Of 1 a z = \ r M1~ S 7 k f Z.uS 7',~//~ fio.✓ ~tJO TES I s ~ 00-~-~,~~~ ,f~E.uCEl fr ~`f R9 oJA''T t S ..-Q U Pec/, a 100" 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): HOTESTS WERE COMPLETED ON: MESITE SEPTIC PLUMBING CO. s /Q /Q p ADDRESS: ROBERT ULBRICK CERTIFICATION NUMBER: PHON NUMBER (optional): Q WAS. MASTER PLUMBER LIC. NO. 3307 M.P. R.S. 2 f/o Z- 346 IP f " MINN. N T LL CST SIGNATURE• I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L DILHR-SBD-6395 (R. 02/82) - OVER - ~~r,xte So,.._st, your 4 nc6icate v or cornrr 4, nr 5 n ONLY { ALL I Ml I REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 Project. T.n. _s'YsT' 44'-~ HOMES11E SEPTIC PLUMBING CQ LEG'S ND IT. i VNEIL RD., HUMN, M& 5" ROBERT ULIRICIIT o = Ba c kh o e 7 i t s WIS. MASTER PLUMBER LIC. Na 3307 ALPIK MINN. INSTALLER g DESIGNER m W. am X = Perc Locations w C.S.T. 2¢82 Q = :iilxisting Well Vertical Reference Point well e, 51A)6- V-evation of Vertical Reference Point /OD• Q f>r - - -Tot Fine N SCAM: Z 0` (t' o P SST ff;I~P ESX ~ ~ ` • oJ( , V, I "114C ~o U4 E# Mq'RK G~a~' - G) zti ~ISr - G. J u lG 3y,~ i 13 GARY 3 3+ M Ot CTL R 50 / - - - - - - LoT IY ftur'EIVEO ZONING OFFICE y Timm J O B S A R k G) l e f SHEET NO. OF xcavating Co. CALCULATED BY J• n. yY DATE-11 `;i 1e- R 1, BOX 192, WIISOnj WI 54027 CHECKED BY 900PE_ .OZ SCALE i-o 1000 u t . ~w+4r~. 0"J 750 ~ l',4 ddt ecd,~d I ~Z re Lo ~ r / "Jo wti o z ell ( ,,/s__ I < esi~Inc_ Groton, Mts. 01471, ` - /~'(GC.Y Lt/8 f PAGE OF w ~ r CrOSS Secjlon O~ A &-o J Steen Fresh Air Inlets And Observation Pipe i Approved Vent Cop Minimum 12" Above Final Grade 20- 42" Above pipe _ 4" Cast Iron To Final Grade Vent Pipe Mahe Noy Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 i 6" Aggregate Beneath Pipe ° Perforated Pipe Below j Coupling Terminating At Bottom Of System I 9h,/Z PrVPose~ Anal qr~~l< i SOIL FILL DISTRIBUTIOU PIPE APPROVED S4M'HETIC COVER OF/~6GR~GATE a '"''MATER14 OR 9" OF STRAW OR MARSH HAy MF-V OF 73rf EE le' 0F12-21e2 AGGREGATE ''t7 41 DIST'RIf3~JT100.1 PIPE TO BE AT LEAST _ INCHES BELOW ORIGIIJAL GRADE A►JU AT LEASTZO IAICHES BUT AIO MORE THAT) 42 IMCHES BELOW FINAL GRADE LL y 41 e 'r rc)c '64 41 &J MAXIMUM DEPTH OF EXCAVATiao FRoM M&vvu 6RADE WI BE b• FICHES MIN1MUM ®EF" OF EXCAVATION FROM 01Kt4IMAL (GRAPE WILL BE • INCHES r SIGHED: LICEM3E. AJUMBER: t1 f P ~ DATE: