HomeMy WebLinkAbout040-1117-10-001
0 cn 0 9 T 0
d
o 0
T `D m (D
\ 1
co -I o cn
O Z p w o h
at O w O W N O A
lD 3 fD O ' `G N FBI
CL z 0 (n PO
O O
0 }y N .Z7 (O v C
N N CL O O (I 7 A
O O
T n = S O
O O cn
O
A W T
C
3 < II O
O
m c o R
D cn
o a n
(D N T
O
n r cn
w co co <
A A ~R N a
T L "
v a
z 0 0 0 N
z O O O
0
- c -q ~ ~ - o Z
a cn cn cn cn - D
CT 9 v v A
o 0
o ro ^D y NJ Ul
E II N II
fD = CD v]
D1 N
=3 O
O_ 7
z
0. C co Z
(D O
p j a 7
O T
O (D ~2
3 (D
7
N
N
(D C
C N
(D
w N O.
Q 3 5
z lD cn j --1 cn
O O A Z CD
N C ,a 0-
0 Q A z O
p
0
M N O
W C m co
a 3 z
O r. ~7
O U m
N z
(D A
W
N Q
C Q
n O -
O O T
Q ~ C
d - ~
oz o
N y
rt,
1
e rA_
r
Q.
~ N
N
O
O
a
i
0 O
CD
O Tj O
ti
O o N
0
Form- STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Roger W. Olson TOWNSHIP Troy SEC. 30 T 28 N-R19 W
ADDRESS Rt. 3, BOX 132A ST. CROIX COUNTY, WISCONSIN
River Falls, WI 54022
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
* Ai
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Wieser Liquid Capacity: 1000
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: q Tank Outlet Elevation: 9
Number of feet from nearest Road: Front,0 Side 10 Rear, 0 feet
From nearest property line Front, 0Side, 0Rear, 0 /Q feet
Number of feet from: well / ~ building: 1-
(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 SYSTEM
Bed: Trench:
Width: <~G?~ Length: Number of Lines: 5 Area Built: ~d
Fill depth to top of pipe:
Number of feet from nearest property line: Front, 0 Side, O 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 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: g
Dated: 11/184.. Plumber on job: Paul R. Cudd
License Number: MPRSW2739
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADIi~ON,';'VI b3707
®CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number.
(lt asslgnedl
E:1 Holding Tank El In-Ground Pressure El Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
RogeA W. Otson RR# 3, Box 132A, Raven FaM, W1
At-
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV..
SF SW, Section 30, T2 8N-R 190/, Town o4 Tno y
Name of Plumber MP/MPRSW No.. Coumy. Sanitary Permrt Number.
Paut Cudd 2739 St. Croix 58874
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED'. PROV D
91 3~ ! `~!r YES ONO S ONO
BEDDING'. VENT DIA.. VENT MATL JHWATER NUMBER OF ROAD
JJyy PR OPERTV WELL BUILDING VENT TO FRESH
ALARM FEET FROM / LI"E/~ AIR INLET'.
DYES O DYES NO NEAREST lf~`'
DOSING CH MBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP; HON MA ~REWARNING LABEL LOCKING COVER
PROVIDED: PROVIDEDDYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. MBER OF PROPERTY WELL BUILDING (VENT TO FRESH NIU (DIFFERENCE BETWEEN ET FROM LINE AIR INLET
PUMP ON AND OFF) DYES D EAREST 1110 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ENCTH DIAMFTER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until R C E
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR. PIPE SPA ING. CO INSIDE DIA xPITS LIQUID
BED/TRENCH TRENCHES + M PIT DEPTH
DIMENSIONS _o 3
L-✓
GPAVEL DEPTH FILL DEPTH 1111ST11PIPE 11 DISTR. PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE V R ELEV INLF t ELE Oil. 7 E, PIPES FEET FROM LINE. AIR INLET.
71' - Ul /7 NEAREST --w- 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-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TEXTURE PER ENT MARKERS. OBSERVATION WELLS '4 YES ONO DYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL S DIED ED MULCHED
CENTER EDGE S
. ES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
W I DTH. LENGTH NO.OF LATERAL rACI G'. IG AV L DEPTH [LOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS 1
MANIFOLD PUMP MANIFOLD DISTR. IPE MANIFOLD MATERI NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.' DIA.. ELEV.'. PIPES DIA.:
ELEVATION AND .
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO DYES NO
COMMENTS. PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'.
~U FEET FROM LINE
w DYES ONO 7 DYES ❑N NEAREST
NU '
- r
t -
l.r L
Sketch System on
ty file for audit.
Reverse Side.
SIGNATUR
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT
p 1 LHR St. Croix COUNTY
DEP.iFT1T1EnT OF
(PLB 67) UNIFORM SANITARY PERMIT #
InpUSTRV, LRBOR 6 HUTRn 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 ADDRESS
Roger W. Olson Rt . 3, Box 132A, River Falls, WI 54022
PROPERTY LOCATION RRX_ i
SE 1/4 SW 1/4, s 30 , T28, N, R 19 5,y~~ Y VA K: Troy
1WFW TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
County #'F
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
X 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 -
El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity 1000 1 X
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: Wieser Concrete Products
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Class 2 960 960 [1 Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): gnat re: MP/MPRSW No.: Phone Number:
Paul R. Cudd 2739 (715)425-2049
Plumber's Address: ame of Designer:
Rt . 5, Box 364, River Falls, WI 54022 Laurence W. Murphy (2445)
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
!y ] El 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
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.
APPLICATTON FOR SANITARY PERMIT
S T C - 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 `
Location of Property jW '4, Section T N - R W
Township - Q
Mailing Address
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 ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
Tn 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.
PROPERTY OWNER CERTIFICATION
1 (We) eelLtiAy that xet statement6 on the ~onm ahe thue to the best ob my (oust)
know edge; that 1 (we.) am (ahe) the owner (6) o{ the pnopen-ty d"nibed in tG,,L6
ip{onmation Aonm, by vivLtue oA a waAAanty deed neconded in the OAAiee oA the
County Register oA Deeds as Document No. _ ; and that I (we)
pneAentty own the- pnopo6ed Aite Aw the sewage ~~o~ System (on l (we) have
obtained an. easement, to nun with the above de cAibe.d pkopetrty, {ion the.
consthuetion oA said system, and the same has been duty recorded in the O{()ice
o~ e ounty Regi~sten o4 Deeds, as Documeat No.
t 11"
C Q- C _U x~oL-
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
s
CLRT1FI--;D SURVEY M iP
Pf:UL J OHNSON
Part of the Southeast 1/11 of the Southwest 1/4 and the Southwest 1/4 of the Southeast 1/4
of Section 3C), Township 28 Piorth, Range 19 West, Toiai of Troy, St. Croix County, Wisconsin
NI/4 COR. SEC. 30,T28N,R19W
( COUNTY SURVEYOR'S MON.) 1
33 40' 1
UNPLATTED LANDS I i
i n
I I 0
S 88.0235"E 357.19' S87°54'51"IE 60. 3' W
258.19' 99.00' 43.03' ~17~ I ?
1 50' I v W
I P. 0. B: I I x n
~ I ~ n
JI LOT 1 = 2.606 ACRES Np
I of X0
o 1131517 SQ. FT. o i a 00
W W CD I N W X
7
~I 0 v ; I GI 0
N - I W
I M
J N = " 0 i 1 ~ F
31;
1n _
- LL
Y.. N D 1~ h I W
Z 0 0 W I Q Cr
Z fA Z W ry I J
h - N
o i.
0 a
z I W 0
• I m M
J L;
N 87° 23' S6"W 398.07' Z ' I J W
a vi
348.07' 8 1 50.00
1 I
0 50' 100' 200' 300' ~ 1 50
40
I
3 1
I
0--i SCALE I"= 100'
50
.OQO N 02° 51 '00"E 66.00'
UNPLATTED LANDS APPROVED
N
0 S87°23'56"E
N
S 1/4 COR. SEC. 30, T28 N, R 19 W, 66.00'ROADWAY EASEMENT
(COUNTY SURVEYOR'S MON.) MAY 02 1984
• Indicates 1" iron pipe found
o Indicates 1" x 24" iron pipe wei;_rnin~; 1.1J lbs./lin. ft. set ST. CROIX COUNTY
COMPREHENSIVE PARKS PLANNING
AND ZONING COMMITTEE
DESCRIPTION:
That certain parcel of lauid located in the Southeast 1/4 of the Southwest 1/4 and the
Southwest 1/4 of the Southeast 1/4 of Section 30, Township 28 North, Range 19 West,
Town of Troy, St. Croix County, Wisconsin, more fully described as follows;
COK,!~NCIP~'G at the South 1/4 corner of said Section 30,
thence N 01' 47' 58" E 737.3 j' to the POINT OF BL'GIN LING of the parcel to be herein
described; thence S 870 54' S1" E 45.03'; thence S 020 51' 00" W on the West R.O.W.
of C.T.H. "r" a, distance of 286.57'; thence leaving said R.G•W. go N 870 23' 56" w
398.07'; thence N 020 ?O' 20" E 282.17'; thence S 880 02' 35" E 357.19' to the
POINT 0? 3EG1r,:ING, containing 2.606 acres, more or less, being; subject to easements
of record, and also including an easement for ingress and egress more fully described as fol-
(For purposes of this description all bearings are referenced to the North/South lows;
1/4 line of Section 30, T28N, R19v1, assumed N 010 47' 58" F.)
(EASEMENT DESCRIPTION ON REVERSE)
State of Wisconsin)
County of Pierce)
I, Laurence W. Murphy, registered Land Surveyor, do hereby certify that by direction
of the Owner, Paul Johnson, I have surveyed and divided the lands shown hereon in
accordance with official records, Chapter 236 of Wisconsin ;'tatutes and the Ordin-
ances of St. Croix County; and that th,-~ above map and description are a true 0. a
correct representation thereof'. \S001vs.~4iA,
Dated: 29 February 19984 io
' LAURENCE': •
( = m ' W MURPHY ac
S 1713
CO RIVER FALLS,...
Vol. Page Laurence W. I0urn> ).y ; WISC. +
Certified Survey ,i ps Iaegister(-d Land Surveyor LAND•S
r s
EASEMENT DESCRIPTION:
COMMENCING at the South 1/4 corner of said Section 30,
thence N 01° 47' 58" E 737.371;
thence S 87° 54' 51" E 43.03';
thence S 02° 51' 00" W 286.57' to the POINT OF BEGINNING
of said easement;
thence N 87° 23' 56" W 50.00';
thence S 02° 51' 00" W 66.001;
thence S 87° 23' 56" E 50.001;
thence N 02° 51' 00" E 66.00' to the POINT OF BEGINNING.
i
February 29, 1984 Laurence W. Murphy
Registered Land Surveyor
,~~~111111 f 1•p404
Vol. Page \SC //S~ ~
Certified Survey Map ~ 10.
St. Croix County, Wisconsin `.LAURENC•. p
m W MURPHY "c
S 1713
~.NA• RIVER FALLS, •J~
<0 WISC. Q`
F49 LAND S~
N
H
a
ST C- 105 r
' a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
r d
a
OWNER/BUYER
ROUTE/BOX NUMBER j~LLdrL'l~ 14 Fire Number
CITY/STATE ZIP 2
PROPERTY LOCATION: 14, Section Q T _~,Y N, R _)y _W,
Town of St. Croix County,
Subdivision 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 all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a 1
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. Ho
I/WE, the undersigned, have read the above requirements and agree U)
to maintain the private sewage disposal system in accordance with H
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 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
Sign, date and return to above address.
v_ N
~ n
s ~
o s
~mc~iv30
v ~ u, w m o ~
c,0ID~
mcD CD
N a =r =r w
e ' o 3 c cC cC
_ 'O tD d N (D p is
t°n p O N p N
ga° m a O w 70~" (D CUD N co
0 -0
N (D (D N
(D 'o
CD gr
0 6 CD CD Co
o 3 a o. ;100 w
o m c p w o
cc
w c =0
=r c- c w c FA* - c c: * a 00 13:
3 Z (0, c Q= f
L y p 0 a N j
0D v v D
< ~N Q ACO Q o
Cl) o D c ~ ~
Mo -w o we
°e CO ~ O c~D a O f (A a 0u'N N0"uwcn Z D
O N
w 0 v Z
o -i o
$ aa ° 3 w Co m ?a a -1
CD 0 N N
O 7
S0- wfoM= m
a ?
w
0. CO) "a
avc,fww
o a m
N cn w w
v 3 ~ m O wv
p» mN? oam'%
a 0 ~
Ki o cn p „n. a
w a (D
O n w
:3 c
E- :E wow m~~0v w i0 f11
(D L CL
C-O Q~ anti
mco0 o0m0 3 g
0 o co a
a c m oQ S
CL c OD Co~cDOO3
ar> f°~ o
ao O 3
o < -
0 o
_PARTMENT OF ~ SAFETY & BUILDINGS
DUSTRY. , PORT ON SOIL BORINGS AND DIVISION
~80R ANY PERCOLATION TESTS (115) MADISOP.O. BOX N WI 1969
)MAN RELATIONS 53707
(H63.090) & Chapter 145.045)
SON SECTION: TOW S I UNICIPALITY: [OT NO.: BLK. p. -SUBDIVISION NAME:
IUNTY: ` BU ER S AM A ADDRESS:
Z
7'", G~c:cJix ,~',4 vL ~ ~~~/'V .1✓ .E' ~ .E'er e- Z
✓c- Y✓/. .5~~'U
E DATES OBSERVATIONS MADE
NO. BEDRMS. CO Wr A L E R I0fl-0 1 - DESCRIPTIONS:
PERCOLATION TES
PROFILE
Residence
1 -:5 New ❑Replace I,_--3 E 3 ¢ 71
TIN(I B- Ville suitable fal eyalas►► U- BIM ►►naullat►Ie lut rayslau►
NVENTIONAL MOUNbc IN-GHQUNI?PRES"IIRE: SYSTFM•IN Fll i iOLbiNG FANK: HE(aQMMENOFI) 3YSTEM:loptlnn'+II
As~u1 suu ~SUU lus `cisku :c*. clsA_,A
"ne-
'areoldtrun -rests are NOT 'squired DESIGN HATE: If any portion of the tested area is in the
Jet s.H63.09(5)lb), indicate, T r._~ -<s S Sv Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
RING TOTAL DEPTH TO WAT Hfa... ~ C CHARACTFR OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
MHEH UL-PIH IN. CzLEVATION
Ukla - VEIJ lU
NEUHUCK If UUSLHVtU (`JFE AdUNV, UN BACK,)
IV 1
III ~3 -7- PERCOLATION TESTS -
DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES A MINUTES
MBER INCHES AFTERSWELLIN INTERVAL-MIN. p PER INCH
..~..2.....!~.-!Yl ..ct..L._s~+.~ _._.:....Sia.._ aa..-_..l.~.na.._. _
T PLAN: Show locations of percolation tests, soil tairings and the dimensions of suitable soil areas. Indicate scale or distances, Describe what are the hori-
dl And vertical elevation rrlarrucr points and slurw tbulr lucaoun on the. plot plan. Show thu surface elevation at all burings and the dlrretlort and pe'(rrtt
od slope.
- A '~Fa V. R. P. ~'j
'STEM ELEVATION F3 = T -
10
I -
♦>'~1~ rtr,c T Acv:
. - t fA
i
,-LOT .
I
,~-o,~. ~.-ax, c , .•-t --•1 ~ ~.~.*c ~ lit ~ ~'I
II -
I
Y
~ i
. la/
I
two .
Az
1 i
1
I i
I 1
'
it undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the prgetlurgt iLnrt methods pacified in the Wisconsin
iini trative Code and that the data recorded he of the s d and t location o th tests are correct to the bast of my knowledge and bee'of.
AE Tp'u~rj_._ T0f6 WERE COMPLETED ON:
-i c~ c . c' ' .c c_ c vL! ~4~t U ~C f-O"•c / Y -0-
)RESSCERTIFICATION NUMBER: PHONE NUMBER (optional):
URE:
fRIBUTION i)r,gm;'I .uu) mn.• yrr ur I ural Authmr'ty. Prml►rrrty OwnNr e1111 Smil i'•NA1
c-,rJN
V ~T PIPS wf hpP'"QuE, cC
I ~~ti, tZ" 5~8oVE F1}-~~Sti GRAD=
FiivAL 6RFc
C SLOPS Fti>;' T~;r~r~r, !~J
A? PRJU`~ S 4 i..)`Tti ETl C \ 4 ~ ~ v C b1 ~ 18J`('] o/~i
S`Tru" 'o o-R 1-) A R SN
~jJ C UC~~
pERi-URrITE~ P 1 P s
of
3 a
DISTRIBllT10U PIPETU BE AT L1:AST JUCHES BEI-Ow DRICIIJAL GRA D I-
; ,T LEkST ZO IKJCHE'S BUT UO MORE TH)l V3 H2 IAICHES BFL-DW FIYIAL GFADF-
11t410 MUr, DEP-: H UI EXCAVATIOU FROM ORICIIJAL GRADL \-JILL BL 6`- IOLHES
/'tltllMllM DEPTH OF EXCAVATIOU FROM DRIGIUAL GP ADE WILL BE INCHES
i
SIG"CD:
LIGEI,ISC UlMBPR:~
D AT L
Owner's name San. Permit No.
H63.05 PLOT PLAN r
Show:
Location of building served Dosing chamber
Septic tank Vertical/horizontal reference point
Building sewer Q System elevation is b _
Effluent system Q Well = v>Jt~uo ~rJJ
Replacement system area Property lines w/in 50' of system
, Distribution boxes Scale or dimensioned
1JA Pump and controls: - - - - -
14-fr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal, per t•iir.. Gal. per Cycle
Place check mark in appropriate box, indicating item is shovm on plot plan below:
1~truC:_. 1t2P to y~'V~T PiP~S HRP ~
~ g5
30' ~
~y ml3l6 I6 I6 ~3 tID
~ I
1 4,,Pvc I I i
1 IN -7 -
8b
,e
I ~ Z
a ~
Q~
2I ~
i
h
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued,Si,.Croix County and the St.CroixCounty zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
III omission, examination oversight, construction, or any damage that may result in or
a e installa ion.
PY111 her s si 3- -ure icense o.