HomeMy WebLinkAbout012-1022-85-100
St. Croix
RICHARD D HAN71 IK Municipality. TOWN OF ERIN PRAIRIE
1670 165TH AVE Permit Number: 16150
NFW RICHMOND
WI 54017 Parcel Number 012102285100
Aft Parcel Number: 08.30.17.1216 10
Site Address: 1670 165TH AVE
Components
Component Manufacturer Description Last Next Status Schedule
Service Service
Septic Tank Septic Tank 07119,12013 07il9!2016 Current 36
Conventional Bed - Seepage Bed - Seepage 0711912013 07il9!2016 Current 36
Drainfield
a ntenance History
Service Date Maintenance Name Gallons Pumped
08/3112009 Not Available 0
0711912013 Not Available 0
Notes
Date TRXt
T40776 12:00:00 AM ADDITIONAL NOTES: Original 1976 CSM 3!686 shows house. CSM 5,1446 shows
house and has Jerry Amos listed as owner with Mike Peterson.
MIGRATED ON. 09/0412015
`No data found for Notices. Violations
qj
1
AS BUILT SANITARY SYSTEM REPORT
OW[JI?R , TOWNSHIP e SEC. T.-I-VN-RV7W
ADDRESS ST. CROIX COUNTY, WISCONSIN. -7- 11
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
311QW_EVERYTHING WITHIN 100 FEET OF SYSTE4
7v
I 1/ 41 - - - I 7--
I di ate oath Arrow
SCALP_:
BENCHMARK: (Permanent reference Point) Describe: &446,04K
Elevation of vertical reference point; i62n /1 `l Slope at site:
SEPTIC TANK: Manufacturer: ) G! Liquid Capacity:
Nulker of rings on cover ank manhole cover elevation "
_ Tank Inlet Elevation: Tank Outlet Elevation. 5?s',~
PUMP CHAMBER
Manufacturer: Number of gallons
i4aiiber of gal_ pump set or a cycle gallons; total capacity o
distribution lines gallon: size o pump -head;
gallon per minute horsepower _ brand name of pump
and model number ; Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
'T'ype of warning device
SEEPAGE PIT SIZE: - Number o pits feet iameter
feet liquid dept seepage pit in-e t pipe-elevation
bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines wi th le,.%Lh the de th
SEEPAGE TRENCH: width 1 gta
AREA REQUIRED )~--A AREA AS BUILT PERCOLATION RATE
INSPECTOR
PLUMBER ON JOB ~dJ p~~_d, DATED
LICENSE NUMBER - - _
KLPOKF 01 1NSPC-TION - IN I) IVIULIAI tiI(uAGk ItM
ti it vt 4 !alt i! .r rn,
ti.Ya~lE Sc';.,4.t
~rr •
~/~j/ /ITV Lot M ^Subdivi44 uvt - - -
- !Iitt Cu W6 Numbezi 06 cu►npalc.tmen-te
Wett-- - L~ - 6u4ediny 120 6t.upe - - -
N4.,lhwafieh
APq(i(K ;
yaCyorcb Pamp;Manu6ap.tu4ea Mode-t'. Nurnl,ea
IAN K
gateovte Namb,~n u~. Cur pa4ttment6
A,di1~t y~e7yn I
Liu Yd.c.rty~_ 12`o 4fope.
it r gitwa f i''I
J t ( rt c: it
IicctYdcvty _12$ et'npe_-r
l yltwu f c'r
tt UIMLNSIONa
tnench__- kelfu.c~ro(I Ir_4A v ? / ~f
'A each Ytine Oepth u4 noefi bveow C4f Irl
t'<rtee Uv~~CG~ u~ ~cuCh uvc>p f.cY;' 7' c,
,q u~ vtee_-/ Oepth u~ tilev Liveow gliaJV c' I►r
r' 4 V tv tip St'rF,c' ly Vl.NYrc'lr t rr . I'l 'r I t)U h l
I~tc ~Oki aav'A ~C ~'C tip l ypr oh Cvveit papv.; (111 h (9
,l c~ivi't' u•'ci,urtd roc fo ;(r~, ~~.1,
,r
rnl'f~~'I f i I hl'fOW fal'l'{
d~
I `
71~ t- 1 I 'I L L
r= OAT[ 7A
OATt
i'I !l i' I I l1ld
1
DLIPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IiVDl15THY, CC DIVISION P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
_ A I SECTION TOWNSHIP MU CIPALITY: LOT NO. BLK. NO.: SUBDIVISION NAME:
A/V '/T! 71 (or) W
UNTY OLNNE SiBUYER'S NAI LING A DR S:
S t ! j ,)L
USE DATES OBSERVATIONS MADE NO. REDRMS.: COMR1EHr:!1\L UESCRIPTION: I ONS: PERCOLATION TESTS:
AResidence ❑New Replace _ 7
U3
RATING: S= Site suitable for system U= Site unsuitable for system ?
QNVEN I IONAL: MOUND: IN-GROUND-PR LU)RE:ISYSTEM:]N-FILLIH'OLL)INGTANK:IRECOMMENDEE) SYSTEM:(optionall
XS ❑u ❑ S ❑u OS ❑u ❑ S ❑u ❑ S ❑u
Percolation Tests are NOT required DESIGN RATE: I If any portion of the lot is in the
under s.1-163.09(5111b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UND%4%INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED E HEST TO BEDROCK IF OBSERVED (SEE ABBRV, ON BACK.) 13-
9AL
/V B- c ? I B. e0v
IN" B- , ~9a7
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE _ TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AF I ER SWELLING INTERVAL-MIN. PERIOD t_ ____PE 1 D2 q _ _ PER INCH
P- ' r .
P - j P YQ A6" 10
P-
P-
P-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
.:ntal 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 lard slop.
; SYSTEM ELEVATION 23
'4 (S Ut~%niJtc~.J - occ~ ~fb.s~' J.
X ~rx:~ nom a j pLi~ /}~dilxr l
O f ff
I~
N
i
Y~711 ~r 4v y
J'
I
Aoqo
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin !',dmimistrative Code,
and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
DAME ( n.0: TESTS WERE COMPLETED ON: .4 7 A,DD CERTIFICATION NUMBER: PHON NUMBER optional):
t - _
~ CST SIGN TURE:
r~ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DI LHR-SBD-G395 :14. 03181 }
J
y State and County State Permit PLB 67 ' County P rRl
Permit Application Y r 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.
ZZ B. LOCATI t, Sectio" L, T,a N, R'12 Q (or) \1~ Lot# _City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY. "Commercial "Industrial 'Other (specify! Variance Single family Y Duplex No. of Bedroorns No. of Persons
D. SEPTIC TANK CAPACITY aW -Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete_X _ Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement ~X
Lift Pump Tank or' Siphon Chamber Total gallons Pr fab concrete Poured-in-Place Other (Specify)
L EFFLUENT DISPOSAL SYS10.1- Percolation Rate Total Absorb Area sq. tt.
New ReplacementX_Allernate (Specify)
Seepage Trench: No. of Linea Ft. Width Depth_._ --Tile depth (top) No. of Trenches
Seepage Bed: ,X Length~_bVidth _Depth- Tile depth (top)es No. of Lines ;;2
Seepage Pit: Inside diame er Liquid Depth No. of Seepage Pits
Percent slope of landQ Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal
Owners name as listed on EH 115 if other than present owner:
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 LH-115 prepared
by the Certified Soil ester,
NAME ~ur~,ES JZ C.S.T. and other information
obtained from (ownerihuilder)
Plumber's Signotuie MP!MP SW# SSG s Phone r# -sz z_ Plumber's Address i
4 21L
PLAN VIEVV Provide sketch below of system (include direction of slope and all distances in accord with H62.20- Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
• I - t
5 i
{ 1
i I r I ~ i
I I
HEDo Not Write in Space Below
~ FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application / Fees Paid: State/, &I e - -U Count d~ Dat 7 '47 /
Permit Issued/J4e}er•tisd (date)- r}- Issuing Agent Namt =
V It 1--ti- VG[ Nn Ct~to V_,lirll n2fa Ror`'ri
1. county (whith copy) 3. owner (green copy) y V DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copyl 4. plumber (canary copy) Revised Date 7;1;78
ct.' i~./va.n/~~ G✓ l LA /Al
I
n 70'
l~i~,Ehii9y
m
0
o o co~
J71 I l
3 r
cn 3= u z n z D m o o
'c o m co o m o o 0
°
'S
a 7 O y (A O O p N N N C n
N c
C) 0 CO
:D Ln
o C q
«CDDD r -I cr S~
S o
O = \ O N N 7 O C
r -4 y m ~1 tNp O O 0 lv
O ,o m w a O m VD. a a mrn
= N 1\ \ N CA
d O O d 0 0
U N S O W N D
a CD
D o co
fr Z
CD -4 -4 V N ~ CC/) p c l4V
Z
c !ri
z O O O 0 0 0 3 \r,
~ z o o ~ ao Z
< Z /yam
n Cn v1 V1 = Vi c-, N N N O D V `I
v a O G
U 'a
~m g 'm
= n n~ v C7 m y " 0
C d N a < N J
tV m
fD J O CA
N
L z 03 z z co z
G D n° O D o(D 0
. _ \r
z C" ~N
c rn c m m _y
w 2 n
Z fC (D V1
Z ~o
_ = A Z O
CL n O
--I Cc
03 -0 W m °m m g o
CL a - j z
0 3 0 3 a
o o Z J
M cd
v w ~ p
c7 c v_+ O D 3
I IV Z p AEG 5. CL CD
a 7
cnZ-' x CC
tD A "n
o~ ml C ~J ~ ~
CAN 3 ~O cJO Z m
03
w I o=r cnn v
m ( z
v (D
=a0)
En v
m 3
W
a
N N O 0
iN 30
m
N o ' o J°
N
~J
c O
11 O fD o°
Q a
C O
, 'JR,^ C.,.
< R
`~ffl ~ Efl Cr, V
O O S
O Z Ol O T-
r ~