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HomeMy WebLinkAbout026-1002-60-000 0 cn 0 C m 0 d , CD CD 0 M 'a (D c (D 13 4t d W 3 ~ O o m v o CD CD ° °N 3 a c m w s w Q' 00 CO C) A Z n N o S 3 0 o h c m co M Z 0. ~ w o O N Q= 0 N N Q IV ►t \ 1 C) CD C') -r 3 0 * CD 7 N CL 7 O r• 0 !1 O p~ (D O L=7 CD n CD v, Q -0 (n co _oo° C CD ((D ~-d jd (D O 3 O ' V (D N l7 CD j cn nr rY CD m co 5 o r cn O 1- N can c°Dn CD ~ P rr O C7 v ~r N ON P, 7y v v v ° . O Z 000 (D O H v m 3 v v a'II, o 0 CD (D C-P N) CD v H N 8 w 9 ~ N 3 01 0 'I v D (D OD OH n J ` ~I ~I v z t7 I ° Z m z 0 o O D N n :3 tr 01) ID U) Ln x '0 U) I (D cn W c CD v~ H H U) w n O W ~ a 3 O r\r z CD cp (n ~r--i11 y O 0 O r 4 N a A 7 F-h I- o b Oo O 7d co 'o o CD CD N Z f) lD z co n C cn O N Z N CD C-4 a n I • D CL o - Z, -n m c z CL 0 CD N i I I S N N O O a ~ A 0 w O_ CD 7p A fA O r W O C v O • Parcel 026-1002-60-000 06/23/20 P06 03:27 PM AGE 1 OF 1 Alt. Parcel M 1.30.18.11 G 026 - TOWN OF RICHMOND 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 - VANBEEK, ROGER A ROGER A VANBEEK C - HANSON PAUL T HANSON PAUL T 26 SADDLE CLUB RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1703 140TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE SEC 1 T30N R18W 4A IN SW SW CSM VOL Block/Condo Bldg: 2/378 Tract(s): (Sec-Twn-Rng 401/4 1601/4) Notes: Parcel History: Date Doc # Vol/Page Type 10/21/2003 744427 2441/65 LC 992/310 WD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 4.000 56,400 246,300 302,700 NO Totals for 2006: General Property 4.000 56,400 246,300 302,7000 Woodland 0.000 0 Totals for 2005: General Property 4.000 56,400 246,300 302,7000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 547 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 Form - S T C - 04 AS BUILT SANITARY SYSTEM REPORT OWNER U\A \ t'-'.'_:' c cl TOWNSHIP tc ~A rr, u SEC. T ' N-R~W n ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I111R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6j~ r--~ f `r) - t ~ I INDICATE NORTH ARROW I) BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: J0>r~ Cl: Proposed slope at site: A SEPTIC TANK: Manufacturer: C Liquid Capacity: Number of rings used: C" Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: 7 LI7 Number of feet from nearest Road: Front,Q Side ,Q Rear, O feet From nearest property line Front 10 Side,O Rear, -.5 CJ feet i Number of feet from: well building: (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, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION,1 SYSTEM Bed: l Trench: Width: 1 Length: C Number of Lines: x' Area Built:." C'. Fill depth to top of pipe: Number of feet from nearest property line: Front, . Side, O Rear,0 Ft. Number of feet from well: J j Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ( F'J0 License Number : i` 5 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS DIVISION LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 796°i " MAD ISON, W I 53707 CONVENTIONAL ❑ gLTE R NATI V E State Plan I.D. Number. ❑ Holding Tank El In Ground Pressure El Mound IR Plan I. assigned) N INSPE TI N DATE- NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. p~ Darold Peabod Route 1, New Richmond, W1 54017 GSTRE`ELE~ . BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV. 1 T30N-R18W Town of Richmond SW 4 SW 4 i Section , Name of Plumber MP/MPRSW No County Sanitary Permit Number . 69 610 1563 St. Croix Calvin Powers, Jr. SEPTIC TANK/HOLDING TANK: LIQUID CAPACITY . TANK INLET ELEV.. TANK OUTLET ELEV. PROVIDED'. MANUFACTURER -111 ABEL LOCKING OVER FIR ' 1 E,JYES ❑NO ❑YES NO f BEDDING VENT DIA VENT MATL HIGH WATER PROPERTY WELL BUILDING: (VENT TO FRESH NUMBER OF ROAD LINE AIR IN . ..N ALARM FEET FROM ? _J ❑YES ❑NO ❑YES ❑NO NEAREST MANUFACTURER BEDDING. L PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER DOSING CHAMBER: IOUID CAPACITY PUMP MODEL PROVIDED: PROVIDED ! ❑ ❑YES ❑NO [:]YES ❑NO YES [:]NO PROPERTY WELL BU ILDING AIR INLOT RESH GALLONS PER CYCLE: PUMP ANDCONTROLS OPERA TIONAL NUMBER OF PLINE (DIFFERENCE BETWEEN FEET FROM ❑ ❑ NEAREST PUMP ON AND OFF) YES tENGtr I DIAMETER MArERIALANDMARKwG SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) S LIQUID CONVENTIONAL SYSTEM: INSIDE CIA #PIT DEPTH WIDTH LENGTH. NO. OF DISTR. PIPE SPACING. MCOVE ATERIAL' . PIT BED/TRENCH -r TRENCHES E'. BUILDING-. VENT TO FRESH DIMENSIONS . NUMBER OF LINEy AIR INLET GRAVEL DEPTH FILL DEPTH UISTH. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO ISTH PROP RTY WELL FEET F BE LOW P PES ABOVE 3VER ELEV.INLET ELEV. END - P s. NEARESTM I f A _ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM MEASURED, SHOW ELEVA- and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. meets the criteria for medium sand. TIONS ❑YES ❑N~ . SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION W F LI.S ❑YES ❑NO ❑YES NO _ SEEDED. MULCHED SODDED DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL ❑YES ❑ NO CENTER EDGES ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER WIDTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF BED/TRENCH TRENCHES DIMENSIONS M IFO PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DDISSTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ANLD PIPES ELEV.. ELEV.. CIA ELEV.' ELEVATION AND VERTICAL LIFT CORRESPONDS TO APPROVED OLE slzE HOLE SPACING DRILLED CORRECTLY INDFOISTRIBUTRMATIONION H ❑YES COVER MATERIAL PLANS ❑NO ❑YES [11 NO COMMENTS: PROPERTY WELL: BUILDING PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE. ❑YES ❑NO ❑YES ❑NO FEET FROM NEAREST r yy 1 : 4.4 c. AK'' Retain in county file for audit. Sketch System on TITL&. Revere Side. SIGNATURE DILHR SBD 6710 (R. 01/82) 111111 Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY .~DILHR (PL B G oEaRRT 'EnTOV ~rLO V~) UNIFORM SANITARY PERMIT # 111111 InDUSTRV, LRBOR 6 HUMRn RELRTIons -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRES PROPERTY.: LOCATION CITY-: S L_' 1 /4 51.,11/4, S T , tN , R` { ) ~ F . / , (OY VII TOWN OF LOT NUMBER JBLOCK UMBER SUBDIVISION NAME N EAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 1 t o L, irl'r y TYPE OF BUILDING OR USE SERVED aa(9 _ ~~a 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): Al THIS PERMIT IS FOR A: )il New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ 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 1 L S c1 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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): t Z I j h g c Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation f the "private ewage system shown on the attached plans. r , Name of Plumber (Print): Si atu (le: MP/MPRSW No.: Phone Number: Plumber's Address: (/J v Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved r G L~ Owner Given Initial / , Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 1 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 ST C- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequawies 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 0r-p~ Location of Pro erty Lt. '1, Section 1 , T , N - R W Township i ~ V) J/ ~ Mailing Address f" 1 Subdivision Name ~r Lot Number Previous Owner of Property r 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 1 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION 1 (We) cvLti6y that att b.tatement6 on this 6o4m a&e tAue to the best o6 my (oun) k.nowtedge; that 1 (we) am (ane) the owneA(6) o6 the phopeAty de6cAibed in .th.i,6 .in6o4mati,on 6onm, by viAtue o6 a wwmanty deey~ ~y~ea d d .in-.-the 066ice o6 the 11 County Regis.teA o6 Deed6 a.6 Doeumer~11 N0 _ .r / !J a;4d that I (we) pneaentty own the p.Aoposed 6.ite Jon the sewage pUba by6tem (on I (we) have obtained an easement, to nun with the above duc ibed pnopeA ty, bon the con.bt.u.atc.on o6 ba.id 6yb.tem, and the same has been duty heeonded in the 066.ice o6 the County Regi6-teh o6 Deed6, a6 Document No. 1. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r N . H ' a - r S T C 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a Q H OWNER/iBU,Y94L,'Tr PQ-2ca. d' ra ROUTE/BOX NUMBER ~I Fire Number CITY/ST ATE "ZIP PROPERTY LOCATION: Section / T C N, R ; W, Town of Z, -J- St. Croix County, Subdivision AZ Lot number I 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 aI1_ n, <4 system,- ag ree k- ee tcr, m r: ner] maintained. The property owner agrees to submit to St. Croix County toning; a certification form, signed by the owner and by a master plumber, journeym'An 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 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 10 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. 1 ^ SIGNED/~i v DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. O Z V _ C, > -0 Co 16. 0 C: E O as 00 4) "0 0 C co (a U . N p O a O W N c O p 3 c 0 O > N C: 0 0 > L U N NL Y O CD } ~ 3 ~ o (D U) CD 4) tv -0 W 3 :3 En 0 0 ca ~ c o ~ E = as MO N~CCM:j0N ~i 0- cm co .Q tr- C ai O ~ C ai " V N N L O O o -C 0 0 ' r r o C a) - CO 30» ~as D W ~0 d to 3 rnvL N m a N~ ~ t c o W 0° 3 Y o aNi U) (n 0 (D I- Q N L L U y O C ii N H L C i+ co Co m U N 3: U) c Q Z N m " N N N N O ; - m dL_ C rn N y N m c O-0 0 m % i DI 7Q~ O oa L:3 O co - O N cc 0-- 0 C7 rn ~U)> O .0 0) . N C c Qaa.00) Nivc N (d cO^,, N y O W L c c 3 C L T O) z 0 °-0OE~0 DoE >N ? 7 O Co > 0 0 O 03 O .L, C C 0) 'O O 00 O 41 0 U O,. L D) C v- N rL-. ~ u y T N O i p m U v m M o Y o 0 3 a~ m rnc -ocvti U~~o a c 'v 3 N ° 3 o N O O a 1!~j' W Q~] o o o_ (D o a c z O CD - y Oi y O k T Y N CD CD 7 7 T co T. ca m 0 0 CL E L i 0 co L L 0 0 0 U 0Y '0 (D 3: 1 O A C O T `3 i N C L~ cti N d 0 E (n 0) c _ N J DEPARTMENT-OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR AND ' P.O. BOX 76 PERCOLATION TESTS (115) MADISON W1 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ tTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: t'i '/a w~/a /T-~>oN/R I (or) W~ n/:~ n!! COUNTY: * O ER'S/BE: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: JCOMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence (mil New ❑Replace cJ~- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING T NK: RECOMMENDED SYSTEM:(?ptional) 9S ❑u ZS ❑u MS ❑u oS ®u ❑S . u ~~~~~r ,0,0-1 Ck, 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:N 12SJ / Floodplain, indicate Floodplain elevation: / 03 cC_h P OFILE DESCRIPTIONS F BORING TOTAL DEPTH TO GROUNDWATER-I•I CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DES, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- J 7, O YI e J - s 4 13 -z. n s, 2, B- none Lf 0; B 3,' 6n Sil /I -`T_6 ,F..L B- ec.F~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER l AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- I 3 ) o a L ac S Y4 P-L L)oe ? Y- - c P- r~ r7 E. _i c- t 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 at all borings and the direction and percent of land slope. SYSTEM ELEVATION U'3; fs' 3 . e Pe(IC --T g~ - E .31 /7% V . . I f - ) _ i I, the under ' ned, 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: 1 CERTIFICATION NUMBER: PHONE NUMBER (optional): N<_,,,j Wk IJI 3 2- y 4 - C~ 1 3 CSi I N URE: J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - C I`ri aE „?-^ria. t,t E;TC a nCi acr ,rn 3 iVI k 0UHU u7 ; tat€iber of Es;- tI`*atn-ris. c r t rnnn = i ci, i Uts 5 Co ?A.1ve the ..w €bdity .fir, a€ n. A SITE IS SUITABLE FOR A H ?a_ L IN TANK ONLY IF AL[_ 0FHE R SYSTEMS ARE t. E.E., OUT :f F`S D ON _€'d ,fink DI IT ION""', 6. . PLEASE use the aI"7€B"€ tt'an 3 s st"IC€nm now Or 'ld t€[ tt mohle desaiprom and completing the riot plan; r, ...>.K~ A LiatBE„~ (jt;,77E racUu€«t.,' €:,Ccl.:i€y y;a_(t a,S$'ttmAi:3.Ci(mEi!g to isCae3kt, 3S t)tek.it'd, ye We gve y€- n b . ;€wk xy ai tE ,b €,.;t F`,}€.t rain! are c4 3 .y shown mki are petPa?Iarwilt; .w.€_ . < to 1a ,.aas ;.3 to • st):.t lama d pre-cololion tent exen-lp- Don, it pp[Kopr kne; „j, 4 , i qt:-at. , , f..!t (0101 a Wood pion, t.,a,` an) dos nor ,.at.tt j , rA ac a.A, ;t-, the i ppI'aptime tartx; 11. SS_h s.',":c°, Tt€if?T and r3€,t„E. ytt;!?" iii 3-{,m afzii€! S.a <3....n e_ ,id Cm S,t';z.t3k I,aC' s 'a?'. A.o and dat= f mte _ri-e! ALI. SOIL _','EST,'-, L b_`~ _ B FILED t1E lT€3 6 ...t C,e,L_ AU F OI ' , Y WI ? €N 30 DAYS OF tai R` ILE_ s ION. Soo fit" a,.? us and , Mum i?rhe yvv~ cl:. low" Qvm W) HR Bawmi< SS sarminum Combo A - 17) 3") Lmmmmc o a €aLa o h 8. rat. s"59 :E_-5 Pa c P€ E Syti.t a Elie t?s - hA .d ,.a., sob A spa `i .?3 E € 1€ S _d 951ce - d ; c ta-Amv Sand da ca€a ; Than s - Loy _ .emu,€~I~i ' fr;~4"t €c~iifl a. a `y€a _v,,?_; TA Lom it BKO'k C?.„ mac' . a ash-`u ,,a v € € + t € y Ltnwrt R Hud A b~ _ xe., CL~e Wr= €1 rt - 3 0twf£4 SO= Clay, - Sky Clay fit 0 Fin t:,m Gay nr conownh mane Rimy, nymbum i Hk;h ; i st:.l tt ?"b. a kT , a Snarl a < _sP'=3 r ,i, a .mI a€a to r f ; i='h€. ,r. OT t., F P ; in h An t€€= to a€_. .r tt,is Er E1. or t usCi~ tir cet I ~rvf~ ~j/~' CAGY p-t ! 'j I 3 ( S tZ~ z F.L°)• ~ ~ 34,9' _ 4 j OJ ~~r~ CiecL 10 cdv j~ yy y 6-c- l_ scI Nk PAGE OF << 3/J ry-~-O r r c) 0 C) J y Fresh Air Inloh. And Obcervallon pipe Approved Vent Cap Minlmum 12" Above Final Grade [U- 42° Above Plpe 4 Cuet I_, To Final Grade Venl Plpe Liar sn Noy Or Whelk Covering Min 2" Aggregole Over Pipe OluriDallon Pipe - 0 0 0 0 0 - Tee _ b" Agg,egale Beneath Pipe 0 Pertoraled Pipe Belor f-Puna Terminating Al tlottom Of Syetem CD C. J ~ for"1 o~ SOIL FILL D15-1 kIBUTIOFI PIPE APPP ->VED Sy►Jj IE rir r-OVFp 2u OFAGGREWE MATERwN ~,n ;TRAw OR MARSU HA-j ELf_V. OF 2 A (;RFCATE FEET_ 3y ~r DISTRIPk 1.1 TIOIJ PIPE T ~ y U Bf AT !_EA5? _-4.--_ IEJCHES BELOW 0RIGIfJAL GRADE A Ikll- AT LEAST 20 IU(HES BUT LIO MORE -rHP,ij y'-_ WEHES 6LL0W FIUAL - P.ADE MAXIMUM ®F-QrH OF F-XVAVATI(DO FXom DKi&VVAL 69hoF- WILL BE IKI HEs MINIMUM ®EPT-H Of FACA%/ATImN FROM. 1*161WAL G949E WILL BE J) INCHF s SIC>AJED: LIC- EEISE KjUMBER: DATE- /1 I ~To ` 0 m f 0 F 0 3 m n c1 L O 7 0 CAD 7 iD O n l< 'a M CD w m v d m 3 3 - 3 3 co i~;T 0? 0 S Z o m co 2 2 v, z -u x o o = N 6) _ O CD n Sli 61 M Cn O V O n N i-• co Q 7 O (D Q (D 7 O O C CD O N 67 C^1 i.r ry 1 0- =r Q N W D. co L1 C1 7 N CJ7 0 O ° M K 7 (X1 O N D- A] Cn N N K 'A CD d ~T C) C:, 0 Q- w a) CL o~0 NWT m o_ c V M W ° O y ° m CD o o y V C a w° a° W (D cn m D CL CD CD D 1 Cn Q -0 41 CL o° Q m o o° 0 0 -4 E; (D N C/) 3 o ~ = V L A O O O Cl) C`7 A zt D G "WAWA N U cn~ N CD o -4- Z fn O C !1 CD CD Q lV f M -00 -0 ~ -0 "A • 3 o O O O 0 o=r 3 y fcn fn co n' Ln fn cn = O ' D a y(D I ID O m a 'a o _O a o CD d 'C O lA (D CD M N N N G ~ N -0~ 601 ~ ~ ~ ~ !V v 7 3 m O N) j. y o J CL 7 V : 0 V co z z z Zco Z N zco z CD 0 O D a L D CL ~ m I° <D CD [D cD W "WA• CD (n CD U) CD p1 C- C l~\ill n (D N N (D CD C CD N W (D d - 0 W ~ d O Q z (D Ll z CD r O c O D p A Z =3 Ll p~ Cl A z O O cCn C9 CMD W < W 1 O CL z 3 0 3 O r: In •3 0 in z N Z CD P CD ? V D c 67 N J> a N a ~ N 0 Q cl) C X CD G Ln O 'O V 61 o n '3 N O (p C Q L1 ~ ~ (QD `G O G ~ d V o N C N O CND CAD ' O N O ~ 67 X O ' S C5 0 z ° O A 3 o- =r CAD 0 a Cn o p 3.~ N o CD T cn 0 CL N CD =r CD Con Ln n o 00 a o ~ 21, V CD * (O CD O ~ O 0 Ia o i b AS BUILT SANITARY SYSTEM REPORT OWNER it v p~~x, . T , TOWNSHIP -C SEC . J T3 c~ N, R ~Y W P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM K! ~j ~ V w /OOH S A I SEPTIC TANK(S)2-0 MFGR. 1:1 ~,ONCRETE STEEL NO. of rings on cover Depth W / DRY U,TELL TRENCHES No. of width length area- Yc- BED no. o lines width ) 2-' length 1a- /o<f' area dept to top of pipe )6 " AGGREGATE 1 Yz - PERK RATE E_ AREA REQUIRED 3/c) AREA AS BUILT DISCLAIMER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determii~qt cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH T S INSPECTOR DATED PLUMBER ON JOB LICENSE REPORT OF ITTSPECTION--I DIJIDUAL SETJAGE DISPOSAL SYSTEM s Sanitary Permit State Septic -7 T 7XI1E TOWNSHIP 2 . Croix C unty SRPTIC TA'TK Size gallons. ''"umber of Compartments Distance From: !Jell ~ ft. 12% or greater slope ~~✓~JA Building ft. Wetlands f` ,Tighwater ft. DISPOSAL SYSTL.1 < Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope ft Building ft. Wetlands FIF-.LD J,iphwater ft. Total length of lines 19-2 ft. Number of lines. Length of each line ft. Distance between lines ft. Width of the trench ~_ft. Total absorption area ~C(DO sq. ft. Dept;: of rock below tile in. Depth of rock over tile in. Cover over rock Dept's of tile below grade in. Slope of trench ~in per 100 ft. Depth to Bedrock ft. Depth to around water ft. "Dumber of pits Out J- 'aneter ft, Depth below inlet ft. Gravel around i es no. Total absorption area sq. ft. + ✓1 Z Square feet of seepage trench bottom area required ,quare feet of see age ni area required r Inspected by: Title: Approved - Date e 197 7 . L Rdjected Date 197_ REPORT OF ITTSPECTIO_D--INDIVIDUAL SET,IAGE DISPOSAL SYSTEM Sanitary Permit-, ' State ,eptic '.'A'. 1E TOWNSHIP t. Croix County SRDTIC TA'TKI L Size gallons. "lumber of Compartments Distance From: TJell ft. 12% or greater slope f~. Building ft. Wetlands f* T~ighwater ft. DISPOSAL SYSTEA Tile Field or Seepage Pit(s) C. Distance From, TTell ft. 12Q/, or greater slope ft Building- _ ft. Wetlands f: FIELD ~Tir;hwater 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. DeptL. of rock below the in. Depth of rock over the in. Cover over rock Depth of tile below grade in. Slope of trench in ner 100 ft. Depth to Bedrock ft. Depth to around water ft. PITS "Dumber of nits .;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 bv: ' Title: Approved Date 197 Rejected Date 197 r EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,.BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: S~'1'/4, Section , T-UN, R 1~ E (or)(10J~Township or Municipality Lot No. , Block No. County Su ivision Name Owner's Name: - - Mailing Address: J TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGSL~" 7 PERCOLATION TESTS f` SOIL MAP SHEET SO1 L TYPED PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL F BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN 40.6 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES I NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) rj,,. 6-2,0 / . 0 --cps p - yl c4 B Z) 0 a AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Aicate 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 points. Indicate slope. C~ =tea i t (i i q7 777- 3 a ~ ~k0 e I I I 1, th 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 0 Name (print) Gu/-~ r _S , A 14 Certification No. Address L3 14, I h Name of installer if knows I~ CST Signature COPY A -LOCAL AUTHORITY EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TEST LOCATION: Section TjPN, R I E (or) W, Township or Municipality /t c_ f, o~zc Lot No. , Block No. County S7 ~ Subdivision Name Owner's Name: j~ - Mailing Address: ~1+ I. I - TYPE OF OCCUPANCY: Residence No. of Bedrooms Other ~'JAZL°' EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLAC ENT J D DATES OBSERVATIONS MADE: SOIL BORINGS- (1 / PERCOLATION TESTS SOIL. [\A AP SHEET - _ SOIL TYPE H/7S4y1 S~ L~►- G, ©/¢~l PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE i NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P-2 Alt .7 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) sj' ~n -EO 5 'do-Sy 10,5 ` b l1 r-A2 ! c 7 X - /r--s ICy~ - CS' U S o co t- L) `lb f= 5 ' AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) icate 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 points. Indicate slope. t IN " I " , 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 an ef. Name (print) ~ ViLO r Certification No. Address 1. Name of installer if known Sa-= Ov CST Signature COPY A -LOCAL AUTHORITY PLB67 State and County State Permit # Permit Application County Permit.#. for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED ,-7 Date Approval Received from State if Required State Plan I.D. #i A. OWNER OF PRC' RTY Mailing Address: B. LOCATIO '5 , Section/ 3e+ N, R I/Y E (or) W Lot# --City Subdivision Name, nearest road, lake or landmark Blk# Village "D-7! Township/C' 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 GrinderYESNO # of Bathrooms-- Automatic Washer YES 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 Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 1, 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 Tester, i NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/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). X a Do Not Write in Space ~elow FOR DEPARTMENT USE ONLY Date of Application ` 7 Fees Paid: State County C~ Date Permit Issued/Re#eeted~ ~ate►` i" _Issuing Agen Name=~~ P Inspection Yeso Valid# Date Rec'd 1. county (white copv y 3. owner (green copy) PY DIVISION OF HEALTH P.O. BOX 309, MADISON, WI 53701 ) 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76 7 State and County State Permit PLB6 Permit Application County Permi # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED r! Date Approval Received from State if Required State Plan I.D. # A. OWNER ROPERTY Mailing Address: B. LOCATION: 4 %St_ Ya, Section Li-, T_C N, R E (or) W Lot# - --City Subdivision Name, nearest road, lake or landmark Blk# _ Village Township ` rum 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 Grinder YES NO # of Bathrooms-- Automatic Washer YES NO Other (specify) 5-d Total gallons No. of tanks E. SEPTIC TANK CAPACITY 'Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement Ptefah Concrete 'Poured in Place Steel Other (specify) 1= EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area Sq. New Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Nisconsin Administrative Code, an~1 that I have sized the effluent disposal system f,,2 the li S prepared by the CertifieO Soil Tester, ~ J _ NIAME C.S.T. # ,~5 S and other information obtained from (owner/builder). Plumber's Signatur MP/MPRSW# 1 sCF-3 Phone 1 Plumber's Address - PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Do Not Write in Space Below FOR DEPARTMENT U E ONLY Date of Application - ' Fees Paid: State/?~_ ~ ' County Date Permit Issued/,B~~7date) -Issuing Agent Name1 Win' - Inspection YesV"No Valid# Date Recd _ 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 f ~ -g Lo~ _ r.. Fil r { y 3 T i 4 iZ_ `S,Ttr ~ yyy $ ZIN -mss G ~ ; J ~G C~ r,7 i ;'I ! 1 ~,F •t3 ~ ' fI r p Q• q ~ ~ D Z to ro f .c..., N Q f'D t C7 ra 4 x D r Q v'tl 11 :3 0'a no v Q tv N O ID 4 i C-r o z ~ s Q: ~w O T cD ~ :r rr c.f~ G 7 /70 P•ROJEC,T DET41L DATA SHEET AME OF BU,S I NESS i - ILI LOCATION r -4` - } • a~____.__._ stree~ or city or township ---r-_ LEGAL DESCRIPTION county OWNER Mailing address - - - ARCHITECT OR ENGINEER ZIP - l~ ~_Address PLUMBER`, ..r•~=___r ZIP" _ Address y1 t Z P-.~ ,7 1• Check appropriate building usage (s) and fill in the information requested Opposite Existing building If addition to existing buiNldinbulding g'attach de4teT m me o _for Addition ( ) Drive in restaurant each. ( ) Restaurant " " Car spaces _ ( ) Dining hall Seating capacity (10 sq. ft./person ( ) Motel ( ) Hote.••' " Per meal served _ Toilet waste Yes Cottages Number of units: 2 No persons/unit ( ) Churches 4 persons/unit _ TOTAL NUMBER OF UNITS ( ) Bar or cocktail •lounge•...... Nbeof persons Kitchen Yes ( ) Nursing or rest home Seating capacity No . Number of beds y (10 sq' ft./person) ( ) Mobile home park Number of units dependent (camper trailer) _ ( ) Retail store - nondependent Number of employees (mobile home) ( ) Service station Number of customers -l'(Tq, ft./person) ( ) School „ • " " " Number of cars served (daily) " " Number of classrooms Mea 1 served Yes ( ) F`; Showers provided Yes No Number of sh ( ) Apartments` persons (total all shifts Other Number of bedrooms Specify 2• Indicate whether or not the following facilities are Food waste f grinder Yes No __I Dishwashcorrected: Automatic clothes washer--Y-es Dishwasher Yes _ No Other (Specify) NO Automatic potato peeler Yes 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned r" Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPO RT SHEET COMPLETE OTHER SIDE *y 71 . • 1 , trench bottom area planned Widt~l Seepage linear feet depth , • 'width Seepage bed area planned 3 linear ' C 70 depth feet outside diameter Seepage pit planned depth depth below inlet 4. See approved plan for specifications and details. STATE DIVISION OF HEALTH, PLUMBING SECTION Signature of person completing form: P. 0. Box 309, Madison, Wisconsin 53701 0 ,r - Approved: Date: Address: J ~ THIS APPROVAL IS BASED ON STATE PLUMBING THE l Z I P, a CODE REQUIREMENTS AND DOES NOT EXEMPT TOWNSH 1 P VILLAGE, INSTALLATION FROM CITY, Date: OR COUNTY PERMIT REQUIREMENTS WRATTENHAPPROVAL - VOID IF REVISED WITHOUT OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY of t r ,~~;6a >_i a canal repaorted uPm by fhe Se 'on `l~sr~,'ist,g and Fire 'Protection Systems, Bureau of l rviTonniental Health, Vivirsion of Health,. j Department of Health and Social Services. F JAMES A. SARGENT, Chief Section of Plurnb'ing & Fire Protection' APPFG'Vg1P y Division of Health, Dept. Of i lecalth qnd Social Services, subject to conditions, et _fcxfi,, ip 4he lei'ter of approval IRAPH L. ANDRE.ANO Ph.D. ' Ajmini rotor ,reric~stion .