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HomeMy WebLinkAbout020-1092-80-000 r 0 N O K-u n 3 O N b f I C,) 0 0 C ° ~~clll a (D 3 ° \ (D CL Z a- .7 0 C) (O (p (n p) O 0 O W N 'S • 1\ N N Q. O- O J O a CO O O 7 CD 7 O R CD (D 6 O _ = N r p O G y (D O !a LTI (D n Q W A N W N (m O O N N \ J lU O O N f N 0 C:) cn o r co Co m n °r r v v ° Pr• O O O ° v C7 0 A m D m m o Sp w v rn ° N cl (D Cl) z W z O D CL ° O !y h • CD (D -1 cn N CD v O (D +1 C (D (D ~ O ? Z CD O A O_ Z O ~ O C/) I W -0 N CL z 3 a ~ O Y z co 3 C _00 a C.0 m O n > 3 0 0 0 ~0-'gym C- ID (D o W ~ : O M Q n a v O ° p~ N fl- a E3 d 3 E- i N o p 0 O j v O N O (D O 7 (D d S A Co 71 N p O p ~ p n 3 C O N ' p O (D O O 0 a N C = N N O O N = K 0- (D O O (D ZZ O O_ CD O ^p O Cb O a O S O (D 1 0 O. V • AS BUILT SANITARY SYSTEM REPORT TO4TNSHIP t;tli SEC. T N, R W . 0. ADDRESS ST. CROIX OUNTY, WISCONSIN. -,DIVISION LOT LOT SIZE 1~4t/ PLAN VIEW t T Distances & dimensions to meet requirements of H62.20 ~Agy, 7 SHOk' EVERYTHING-WI-THIN 100 FEET OF SYSTEM ~ M ; , l I i 4 , ~ ~ Ir~d i c a te North row i f - ~ ;SCALE . ;PTIC TANK (S)!~~ a MFGR.~~ CONCRETE STEEL NO. of rings on cover Depth DRY WELL 'NCHES NO. of + width length area no. of lines widthl_ length area depth to top of ipei IGREGATE 4 RATE G-. AREA REQUIRED AREA AS BUILT, - ISSglaimer: The inspection of this system by St. Croix County does not imply complete .o-Pliance.with State Administrative Codes. There are other areas that it is not possible ;o inEpect at this point of construction. St. Croix County assumes no liability for ,13tem operation. However, if failure is noted the County will make every effort to 1E~errtine cause of failure. I(EASES ARID OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTE11. -'INSPECTOR DATED PLUMBER ON JOB ~11tz LICENSE NUMBER I 1 • .a 1 Z REPORT OF INSPECT70N IN0l VlVUAL SEWAGE SYSTEM SanitaAy Pe.Amit - j ; State Septic_" NA1i j" z owns h ire . CAoix County Location c Section _ PTT'.' FAY K i i~ _ga.eto . Numbed o6 CompaAtment.6 Size,, D.i.6tance F,Lom- We.U_ 12% oA gneateA 4tope -6t it. Wettand~s g h ct~ at e jc a t . Hi DISPOSAL D.iztance EAom: WetZ' it. 120 oA gn.eatvL 6tope it. Bu.it.d.ing g:t. wettands Et. H ighwateA it. HELD DTMENSIONS: (V.id:th o6 trench It. Depth o6 Aock below tiZe in. Length o6 each Zine it. Depth o6 Aock, oven t.ite in. NumbeA of Zinez Depth oii tite below grade .in. Totat Pength c6 Zines it. Stope o6 tAench in pen 100 it. D.%:stance be-'ale-en Una t. Depth to bedteock Total ab~s o%~.i, '.ion aAea ~t 1<'er{cc~.Aed a 2 Depth to gAoundwa.teA ~.t. a~eA StAaw 2 Type o6 e c6 Coven:/ P A . area it Y PTT DIP::EN~%TONS: Nu mbeA of pits GAaveZ around pitz ye,6 no Outz.ide d.iamet t. Depth b eZow .inlet 2 z Total abzorbt o► aAea. it Ar..e.a tcqu:i Aed $t2 rn - INSPECTED BY T17-LE APPnGV E:D - _ , DATE 19 7~. REJECTED , DATE 197. l z EH.115-, WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES'\ qI LIB \ ~ DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH/ P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS 22 ` LOCATION:/4; Section nshl unicipality Lot No. , Block ~No. -County Ow~nVY'NIN'- e: rC© ~I/~tlE u Ivlslo i~ Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other REPLACEMENT /1,e~l 4VE~ EFFLUENT DISPOSAL SYSTEM: NEW JADDITION DATES OBSERVATIONS MADE: SOIL BORINGS//' PERCOLATION TESTS !t~~ /5l ~77 SOIL MAP SHEET SO TLI YPE 5'")R14' / 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 40/ ',D ~F OrN . A L_ .21" 1-1-ISV- 51 3~ 9 e.0 , 's, -7Z /Q Z_ , zG P-3 ~/O 0; 0^ 5LIP 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) '7'/ 4e0A?E / ,y 5'a .,.ter. r-9-5, 3e., ~L ? L . S ~D 63" S, 36 72 PLAN VIEW (Locate perco lat ion tests,soi I bore holes and suitable soil areas.) Indicate 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. 1f-6-,01Q '17-Fvo-t ~'y Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. a B/L - - _ 4__ X III j , t _ I I - N I t ! j a Z ~,'M w I f , i i ~ j t J_ , Af)r v I i j I 3 I t I I ~ i I ; ~ I , I a , I { I i I I I , 1 ~✓i 4 ' - _ I -~,t , ' 1' ~ .4 OA ~r /1)0 0 k 16'0 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) 7- Certification No. Address y o/ Name of installer if known Z J/ CST Signature2 PLB " 67 State and County State Permit # . Permit Application County Permit # for Private Domestic Sewage Systems County - *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. LOER OF PROPERTY Mailing Address: .,olvl.~ ec< 4t Y B. LOCATION: Section T~ N, RIci E (or) 111E Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village (/)/)A fled ~ Township 77( G- i,\,l C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 1 "C') Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete,` Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place_Other (Specify) E EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. NewYReplacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. -Width-99 th Tile depth (top)No. of Trenches Seepage Bed: Length, _Width. Depth Tile depth (top)-/ No. of Lines E> Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 41P L' L - Distance from critical slope WATER SUPPLY: Private A 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 EH-115 prepared by the Ce fied Soil Tester, 1 NAME E?~ ) C.S.T. # and other information obtained from (owner/builder). Plumber's Signature Phone 5 MP/MP W# Plumber's Address 2 Ae tj PLAN VIEW: 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. 00 Cl t f , , E ~ peg , E , E , Do Not Write in Spage B11FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application /7,/ Fees Paid: State t Couq~~ Date f/ Permit IssueclMejectsd date) 77;' / Issuing Agent Na Inspection Yes No State Valid# Date Recd 1. county (w ite 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 7/1/78