Loading...
HomeMy WebLinkAbout032-2034-90-100 n CA 0 3-0 n d _ 1 O y: C d O M 1 3 ~ ~ 3 A c^1 i y • 0 0 o m 0 o p ' o o co co °C CD d N p O O N r~J' lA\ N C 3 co 5 j N p pW C ! N N U CL G) CD -u 0 =3 (D --j 0 CD 0 C fC (CD n O cn O w III * n 3 ~i ~ F w =3 o ° D r .`7 n (n T. G7 m co N cc a s It- TJ C CD I W D (,z) d 3 co CD C) < ° (D CL C/) 5:t' o O m ! n r' N o o co x A a m Cl) 1c t}7 H W `G .N-. M ^ N Z O O O• cn C, Z A• o m ti r o o Z CD D H O O cNn = CD O~` Z v m U) _ m o H y r N 3 m m r N z J N z co z O CD 0 h CO m p D Q \ N O (D O ~p • O 00 w m CD v ly, 4- ( 10 ;s Z Z c m m C-* !EE ~ ' W 3 a c ~ ~ a 3 E (n p A z A N B Q G7 W w c~~F m o zt zz g A Z z m co a D v a O Z3 T 3 N C =3 o a 0 (D w I a ~ o a I A fi A `c O I N O i O V A p ti O 7Q a EA O ° O p * V po L ti t n y 0 3 v 0 C~ r c° F s m o 'o 3 v 3 \ 1 clD (n _ i O (n ,n (n O O O p' O m m O A O o (D W tCirl' .A W N r.~ O N N a 3 O_ O z Q W rn O N O N p N~~ N W~ m co A O N N O- ti O _ O 'T O O O n Q' (D O C CD n O O n 0 7 N W = O (/1 N W 0 C _ Cl) D m 0 o m cc7 N 'n a s v o W D 3 CL C) 0 < N i O N N O cl) n z CD (D K 0 r- (n Cn D m O O 'o CD 3 N cn D _ 6 m o v es O CD - N N W N y 'CD Ut CD f ~ N 3 W (D J z W z Q D CD O o O ~ N• a m CD (CD (D N D tU O - ' C (D ry (D C 3 3 m m -i cn O A Z CD (fl N C ~ =3 n A 2 O O (n W O co _0 m W fDa CD 0 z A ~ o - Z 3 co y Z O A Cl) m ° D m a 0 3 v c D' :3 Z ~o o 0 o ((D v v O_ a o M N O- (D (D (D G7 N CD ` CD 7 V DI Op - O O_ ti O O dC r` tv O o b o (D o a S EH 1 15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOI L BORINGS AND PERCOLATION TESTS LOCATION:~6 %A_0_%4, Section T~0N, R 11 f(or) W, Township or lb4aflrei~e~i~ S0 M S F~ Lot No. , Block No. County 7 -0 Subdivision Name Owner's Name: ~f:h ^_V ~o ~C~.,0 Mailing Address: ~n 60 -gs- 4:;~ 4f / A -5-6-:CIS Z TYPE OF OCCUPANCY: Residence 1 No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW L____ ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS A11W• SOIL MAP SHEET SOIL TYPE 4m02- /"~f~Jfi1 ✓ -Gri~ii7 - PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE 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_ b' b I ~ P- La At -j r P- ! Z A 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) B_ ell B Fo 5-, A/. PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and squar itable areas. Indicate number of square feet of absorption area needed for building type and occupancy. e f Indicate scale or distances. Give horizontal and vertical re rence points. Indicate slope. I i t ! t N If, i f ~ IIF a ~ t I TI- I t t _ i ~ f Y ; ~ t i~ ll / T' • t ~ I yY tf ~ I 7~~/// IfSili ~ ~ I 17 y I i i( f i i i 1 _ I C11 ~Q.~ ~CM.w+ _ I ' i 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 and belief. E~_- Certification No. z z 98 Name (print) p Address I C~ C~j Name of installer if known "I A -LOCAL AUTHORITY CST Signature Parcel 032-2034-90-100 01/08/2007 11:31 AM PAGE 1 OF 1 Alt. Parcel 9.30.19.605C 032 - TOWN OF SOMERSET 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 - JOHNSON, DANIEL E & JULIE R DANIEL E & JULIE R JOHNSON 533 170TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 533 170TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 10.030 Plat: 3657-CSM 13/3657 SEC 9 T30N R19W SE NW SW NE BEING LOT 1 Block/Condo Bldg: LOT 1 CSM 13/3657 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/23/2004 760457 2555/330 QC 04/21/2003 717805 2210/311 WD 06/21/1999 605416 1436/88 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 146125 384,400 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.030 83,100 208,400 291,500 NO Totals for 2006: General Property 10.030 83,100 208,400 291,500 Woodland 0.000 0 0 Totals for 2005: General Property 10.030 83,100 208,400 291,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2034-90-000 01/08/2007 11:28 AM PAGE 1 OF 1 Alt. Parcel 9.30.19.605B 032 - TOWN OF SOMERSET 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 GARY W GORDON O - GORDON, GARY W 417 208TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 6.378 Plat: N/A-NOT AVAILABLE SEC 9 T30N R19W THAT PT OF SE NW LYING Block/Condo Bldg: ELY OF A LN BEG 310'N OF CENTER SEC 9 - TH NWLY TO A PT 1070'S OF A PT 550'E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OF NW COR OF NE NW TH N 1070'& THERE 09-30N-19W ENDING EXC PT TO CSM 13/3657 Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 682/08 2006 SUMMARY Bill M Fair Market Value: Assessed with: 146124 Use Value Assessment Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 6.378 200 0 200 NO Totals for 2006: General Property 6.378 200 0 200 Woodland 0.000 0 0 Totals for 2005: General Property 6.378 200 0 200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12104/1998 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 TOWNSHIP f SEC. j T N-R / j W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i i I I ;7A INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: r(, Liquid Capacity Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O feet From nearest property line Front,0 Side, (D Rear, 0 i feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) 1 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: ; Pump Size -i Elevation of inlet: i, Bottom of tank elevation: T Pump off switch elevation: ( Gallons per cycle: ' Alarm Manufacturer: ; Alarm Switch Type: Number of feet from nearest property line: Front, Side, O Rear, Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / Bed: Trench: - J Width:, Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, 0 Rear, 0 Ft ^ Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid dept:'/ Bottom of seepage pit elevation: • Area Burt: Has either a drop box O ar distribution box O been used on any of the above soil absorbp3on 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. License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HLil1^.AN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7962 BUREAU OF PLUMBING MADISO,'4,`✓VI 53707 X CONVENTIONAL ❑ALTERNATIVE State Plan II)D Number ❑ Holding Tank El In-Ground Pressure 1:1 Mound (If assigned 14 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Gunn W. GotLdon RR#2, Box 232 Q, Somefuset. W1 ?_r~y BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: C . PT. ELEV. SE NW, Section 9, T30N-R19W, Town o4 Someuet Name of Plumber_ MP/MPRSW No. 1C. unty. Sanitary Permit Number. Gary Steol 3254 St. Ckoix 54946 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER J PI, ~V °ED'. PROV1QED'. L7Y~ES^ ❑,NO ❑,YES LINO BEDDING. VENT DIA. VENT MATL. HIGH WATER t NUMBER OF ROAD: PROPERTY WELL. BUILDING: VENT TO FRESH . JA LARM. FEET FROM _ 1 L~ JN//E7-- e AIR LET' ❑YES LINO / ❑YE6`~ LINO NEAREST /:c" L ~ 1 l ~ DOSING CHAMBER: - MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFA TUBER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND C ONTROLSOPE ATIO AL. ZEET MBER OF PROPERTY WELL BUILDIN G.I VENT TO FRESH (DIFFERENCE BETWEEN FROM INE AIR wLET PUMP ON AND OFF) ❑YES ,NO AREST illp SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth f plc LEC4Tfi JDIAMETER 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 CONVENTIONAL SYSTEM: I/ WIDTH. JLENGTH NO. OF IDISTR PIPES ACINI, COV INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES y MA '[?IAk PIT DEPTH DIMENSIONS J GRAVE I_ DEPTH FILL DEPTH DISTR. PI PE DISTR. PIPE DISTR. PIPE MATERIAL. NO. ISTH NUMBER OF PROPERTY WELL. BUI LDING. VENT TO FRESH BF LOW PIPES AIlUVE COVER. ELEV. INLET ELEV END PIPES FEET FROM (LINE. , AIR INLET. e ! I NEAREST-*-s > 1 ` 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 ON REVERSE SIDE. SHOW ELEVA- ❑YES meets the criteria for 7,ecliu sand. TIONS MEASURED. LI NO / SOIL COVER TEXTURE PERMANENT ARKERS OBSERVATION WELLS ❑Y S LINO ❑YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TOPSOIL CUED SEEDED MULCHED CENTER EDGES 11 / YES NO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERA PACIN JGRAVE~t DEPTH BELO PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MA FOLD MATERIAL NO DISTR. [STR P IPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEVDIA ELEVPIPES A.: ELEVATION AND DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER ATERIAL P VERTICAL CAL LIFT CORRESPONDS TO APPROVED ❑YES NO ❑YES LINO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES LINO ❑YES LINO NEAREST I r• I. l f u r~ d } i Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 (R. 01/82) r wlsconsln APPLICATION FOR SANITARY PERMIT r ®ILHR ti'EPRRTmEnT OF (PLB 67) COUNTY UNIFORM SANITARY PERMIT # InOUSTRV,LRBOR&HUMArIRELRTIOnS /I~♦ -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 ilf rp { ~j 7 -s ,Z r PROPERTY L ATION CITY: V+L-L AG E : 1/4flJ01/4, S TN, R (or) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER / ~j p, UIJ rt %i &J. /%1.~ Y`~N~vnri u~; 'I v ~~r TYPE OF BUILDING OR USE SERVED • d -o 3L/ ~Q-61110 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: V 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 QSeepage 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 J Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 3 yl bi , C i 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): _2" ® Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. /MPRSW No.: Phone Number: Name of Plumber (Print): , Signature, C IMP A_' 16v_ / ~ / p ~ i/i ~ ~ ~ -S j~ (~l/, 1? SSG /y 7_L.~ Plumber's Address: Name of Designer: `J`a`r%I.~. ~f j/M~/ll;p'/./l; i/_4 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial {'P 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 t 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. APT'L,lCA'I'!0N FOR SANITARY PERMIT S C - 100 This app)_i_cit tion 4orm is to be CoP1p!etec~ 'n 'u'' :III(! sit>ncd 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, (it spec house"), then a second form should be retained and completed when the property is sold and submf '_ed to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -a Owner of Property l c3 H Vt . 1A . Q~ (3~~_ - i Location of Property 15 Section T -30 N - R W Township ' ?So -p b Mailing Address 2 ; 2 r~ - - - r 0 Subdivision Name Lot Numbers Previous Owner of Property ~ Akio" ~ 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 i% No Volume and Page Number 07 as recorded with the Register of Deeds INCLUDE. W?TI TF1IS APPLICAT'ON ONE OF THE FOLLOWTNC 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. PROPFRTV OWNER CERTIFICATION I ((ale) cetrti~y that aXX. 6tateanentA on th.ts Ko~rm ane t uee to the beet cl ~ my (ou~`t ) {znowhedge; .that I (we.) am (are) the owner (15) o the pnopen -y de,~ c-A bed in ,tbu'A 4n~olmation ~onm, by viv-tue o{ a wa",an.,ty de_e_d heeonde_d in the, OAOiee oo tile. County Re.gis.tm. oo Vee.dA a,5 Voeumen,t No. and that I (we-) pneseyWy own the pnopo,~ed bite, ion the Aewage di. poha. l5yAtem (on 1 (we) have ob,taine.d an easement, to )run Witki the. above_ dMnibe_d pn.opelyty, iowt the. eo"tAuction o{ 6a,id byh.te-m, and .the A-cwe h-aA been duty heeon_dM gin. the OA(ice oly--Vl& County RegiAt_e.',l- ol~ 1~e_eda, (L.S 1)()C_umeYLt No. ) . SIGNA'TUR, 0^ 0 NER SICNATURE OF CO-OWNER (IF APPLICABLE) 1, . ` !)A"'i? STGNI,") !)AT1: STGNEI) H UI y N , r y SRPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z ~ r7 y OWNER/BUYER Polio!~ ~ rn - I ROUTE/BOX NUMBER Fire Number I i CITY/STATE ZIP PROPERTY LOCATION: Section 7 N, RW, - Town of h St. Croix County, Subd i vus ion_ Lot number . I Improper use Jnd 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 s_ept=ic 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 m_ax_imum 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. 0 I/WE, the undersigned, have read the above requirements and agree v to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zon' Office within 30 days of the rhr-ee year expiration date. S T_CNE DATE i I I St. Croix County Zontnq Office P.O. Box 2.27 Hammond, WI 54015 715-796-2239 Sign, date and ror„rn to above address. unscama, SANITARY PERMIT ` DILHR County ,iGROUNDWATER SURCHARGE WIDLASTRY, Sanitary Permit No. -5- 4 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that 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 monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground t Signature of Issuing A ent: Gro ndwater Fee: Date: Wisco it';i!S buried 1110" ro' DILHR SBD-7289 (N. 05/84) o 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:4Z.X'/4,1 O Section C , TI-ON, R)_~7 9(or) W, Township o~#y 50M Lot No. , Block No. County &,0 1)4, /D ubdivision Name Owner's Name: / M) O r o io Mailing Address: 95So r4~~~wA~l ~~Ji.~n> S'SOc~ z TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS ~5~ ! l y 7 g PERCOLATION TESTS 5Ljs1_ 1 ~7 C✓ SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WA 1 ER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE 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 l SGT- ter- o vr'/z 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) Z 1117 -7 -7Z* 72- I 7-2 1, _7 i! f. 5. / 0'• S , - 7Z " 72 " , <S, " S PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) i Indicate on the plan the locationand square feet of suitable areas. Indi e num, eqr of square feet f absorption area needed for building type and occupancy. /.5 d' D360 ffyA9,115~b/E Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. f t }E . I - ' I. E 1 ' t'TJY •J !l! 00 t ~ i ~ f ! 1 j i I i f 1 T, , I i i i t f f t y i - I I I i I d` 1 1T f ¢ C ...._~_.~.-tt--_..._... . i_. O ~..._.._._.-{..'W"y__ :tea 7\ I i ~ I II ~ I ft , 4i ` r 3 I ` t ~ ~ I ~ y ~m~ I I ~ I I~: ~ f I f 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 belief. Name (print) G&I- , Certification No. z z Address q s? A f. _C G A n ,0 (7 V, yy~,B~ y U) i, S[,7i'7 Name of installer if known A-ge CST Signatur COPY A LOCAL AUTHORITY DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPF+Ab'N+e+PAttTY: LOT NO.:BLK. NO.: SUBDIVISION NAME: r 1/ ~`l1/ N/R/y or) - - COUNT : OWNER'SMtfl`ER'9NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Q e Is Bence - I 0-New ❑Replace r~ RATING: S= Site suitable for system U= Site unsuitable for system CONVE(NTIONIA'L: IMOUND: OU~`IN-GRROUN~`D-PRESSURE:SYSTEQM-IN-FILLHOLDIIN`G TANK:RECOMM/nENgD,rEDSYSTEM: (optional) Elu [:]U Do QU 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: } ) 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.) B- / ~rJ ( In-~~ B \4d kl-j B- z" PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH P- P P- 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 - -1 I I _ T, fN 1Z, 1 F yy cut L~ / o 'F r i t E 3 _ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: r- ~ ADDRESS,- CERTIFICATION NUMBER: PHONE NUMBER (optional): ,l/~- `~'1~.'✓-~".,o,,~'_? - l~/'if~t.~4":~(~1~vv-, ~1'Jo 'lil._y CST SIGN RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 1 ks, Q , , A COB WO ,k13 ractk>,Ft scr( t,t: V ur i e[)o ,-I L~"; kiIcI„clsa i he tlbf? I . ,r, ?°rt,..,_. C Hu, f F,.'atH Wf r It E a t"F alta , i,._ . project; o kjt,rhnis._,. unmmmKI rAa,tr,C,; 144 a navy 0'' E l o., n nt 'y":: PTNne on u aa, , n at, p r 1% SITE IS BL k :1 HOI BIN AN ONLY ( Al HE! SYMEMS ARE RULED Ot IT BASED ON SWL C01,401110AS: FASF we Han ahbl :vin t, t, she i nine for mri~np „?,tt. W ro _,v, 3 and corr,p la ,-iq he p 1 t1 pl,an .r.£ LEGM r dz?!_sian a__,. t y (3C`mkg ymu tr=st ioca iunr:,, t ?sv;ng to sc.alc= eS prc[e r; i. A t to Sheet my r, WS S! if z , 'd, ,'3:, . we x. di~ O, r j T'i2;1,, and t W t 5v,. b-,"pi3t Z>d,!3 ul~ C;it,<..y Shic fm,>i#"its a€f, p-".tl,siricf1C; Wr. L. all ,a C the ht.xim? . W €tei R €,an i ,cht u , 11o d f-,!(7,rt data, p,rcola!io l to, . e,,..,,llp- "!-i us r L A t rak, „ ,,,1,. o . dues not a w y ,r1m £r . _ rib, e i)r,r%;: -lhw tfm <.; d in y rt, m o vent eoA ,yo I!' kr !Ilai k,le r; "3 w t .,nhum 'oS i 1 AMk_ W € S ,BE FSI ED VviTrt THE Now own ) RR Hokwk v Lamoi-ic yr . a° r`it-rtt - tl F ° P Coo 4t: s.r3k,t r. 1° r . '.it:W, ,,aitt r( l SmAj - 3 > .rra,k r „ , - .i-' r r l y - IV it G - G "k'r. Clay, ml? - 1 )..v Slky E Sm"N ISO,' 10 Kill ` <av Fit - e" nai=l rs - raw, 1iyd i"t E y rib: _'k, In Ea ;W0=. ronnop W. "3o , I m 3 h f I Jul 8, 1983 Bulletin CL2.1A1 6,40 r_ a. Submersible Lm ffluent Pum Models y . , l Li-J Rugged cast iron construction and stainless steel impeller - especially suited for effluent pumping. Oil filled motor - sealed in high grade r_ turbine oil for efficient heat dissipation and permanent lubrication. Powered for continuous operation. All ratings are within the working limits of the motor. EP0311 ii Model EP0311SS has a stainless] stee, `ease 41- L 5ted 0' s o GOULDS PYMPS, INC. NEW YORK 13148 EP0311SS 'Canadian Standards Associated listing pending. GOULiDS Model EP0311 & EP0311SS Submersible Effluent Pump 25 a, 3 20 Model E P0311 EP0311 SS v 1 15 x E 10 C a D ~o 0 ~ 5 0 4 8 12 16 20 24 28 32 36 Capacity - Gallons Per Minute Discharge: 1'/," NPT. Will accept adapter for 11/2" discharge pipe. .t. EP0311 " Motor. Full 1/3 H.P., 115 volt, 60 Hz, single phase, thermally protected (auto reset), com- pletely sealed in high grade turbine oil. 13 Amps maximum, 1750 RPM. Motor Housing, Casing & Top Cover. Heavy wall cast iron construction with stainless steel i fasteners. Model EP0311SS has a stainless steel base. Power Cord: Heavy duty 3-wire 16/3 SJTW-A with NEMA 5-15P Cap., 15' long. UL-listed wire 4 and plug. Impeller & Handle: Stainless steel Solids Handling Capability: 318" Temperature: 140°F max. liquid Temp. Weight: EP0311 - 34 lbs.; EP0311SS - 32 lbs. EP0311SS Note: Pump can ne controlled by a timer or ' external switch. Specifications are subject to change without notice. GOU LDS PUMPS, INC. Form Litho in U S1AA SF -NECA FALLS. NEW YORK 13148 ©Goulds Pumps, Incorporated 1982 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FRGM DOOR, WIkICOW OR FRESH 12°MILI. AIR Irv TAKE GRADE I y' MIN. I8° MIIJ. CONDUIT-- IB"MIN. \ IL1L.F_T PROVIDE I AIRTIGHT SEAL i I ICI APFP.DVFC JOIN? A I I APPROVED J0INT5 1n.)/C.-1, PIPE m I III w1c.=. PIPE EXTENCI IC. 3' I I ALARM EXTENDING 3' ONTO O;.ID Fr I I ONTO 5oL1D SOIL 6 ( I i I ON ~ I I I PUMP--_ OFF D CONCRETE BLOCK RISER EXIT PERMITTED GNLd IF TANK MANUFACTURER HAS SUCH APPROVAL SPCC.IFICATI0QS SEPTIC AND _ DOSE T .IJKS MANUFACTURER: NUMBER OF DOSES: PER DA' TANK LIZE: ;2.0 GALLOIJS DOSE VOLUME INCLUDING BACKFL.OW: / GALLONS ALARM MANUFACTURER: MODEL NUMBER: CAPACITIES: A= 7 INCHES OR GALLON5 SWITCH TYPE: b =INCHES OR GALLONS PUMP MANUFACTURER: (:3o [41 J INLI+ES OR/-5'L0/'? GALL01J5 MODEL NUMBER: D- INCHES OR~ GALLONS SWITCH TYPE: _ Y LP op U,,,Y 14 NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARGE RATE GPM INSTALLED ON 5EPP RATE CIRCUITS VERTICAL DIFFEKEMLE bt•t wEEAJ PUMP OFF AND DISTRIBUTION PIPE.. ' FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , - FEET _7, Al + 30 FEET OF FORCE MAIN X F, Y,()oFT_FRICTION FACTOR.. 1 FEET z fi = TO'i"AL OBWAMIC HEAD FEET ~7 3 I ~.~I' ' cl'~ 13 WTERNAL MmEWSIONG OF TAQK: L-E71 NTH ` WIDTH S LIQUID DEPTH 51GKJE LICENSE WUMBER: _ -11~- ~V 14) 1171 i r' #0 3¢- 34 8o o ~1 i QU r u- I i ~fi ~r ? Wisconsin Department of Industry, B-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing Name o remises Date an No. -StT"t -tttT oun y Sanitary Permi t T '3 as er um er irm ame ar ss 3 i; rl : uO Journeyman Plumber Address Owner Ac ress W 6iN L tit v 2 A 't><s /--1 F iC ~ !ET _ t c. 7" 1 ,-AVA Qh1A- -t _ E - x 1 4 , ' s a f .D y} .a. ~ x - ff ~7 E Discussed with Signatulqq { )See Attached. DILHR-sBD-6192 (R. 1 1 /83) Signature o Dist. . um~bi nng Sulu, o =S e as e eci a i s