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Home My WebLink About036-1064-10-000 0 ~0. 0 II 3-0 n d ~1 O C N O 3 (D 13 v (D CD m 3 rt Z+ co OD :3 OD D to W 3 y O N O O N 7 z CL O C 3 W W 7 V A Q O N O N O 04 N F p CD CD V 0 ^ l~ 3 q y o 0 o C N N ~ ~ o m cn ~ D co N W rn CL c Z 3 O m ~ j m f I a ~I N CO W :3- O c N 3 O a D1 lrr 0 0 O O v vv-4 O d D N !V O N fD CL N Z o Z W Z D N O O o cn • CD a CD N O 13 O DJ N .0 Cc C (D N W @ a Z CD A Z c =h p z O CL O 0 cn -i N W - C j V CL " < Z 3 A 3 " cn CV N < N A I -0 W {y I CD CD co a CD o Q CD v C 0 o a N (0 s y I A v A A 4 ti N O i O I v o b C=D w ti O O p o CD 00'0 00'0 00'0 18101 soBJeya;uenbu!Iaa soBJe40 le!oedS s;uawssessy le!oodS ;unowV AJOBa;ea opoa le!oadS .iesn :spioadS L£6 4oles :Ole(] u014e31111jaa 1, :;uno0 w!ela :}Ipa.lo iGa}}01 0 0 000'0 puelpooM OOL'178L 008`696 00£`172 000'017 A:wedoJd Ieaaua0 :9002 Jo; sle;ol 0 0 000'0 puelpooM 00 L'1781, 008`691, 00£'172 000'017 A:wedoJd IeJauaE) :90OZ Jo; sle;ol ON 00L' I, 0 OOL' L 0007 W99 1S3b03 l`ddniif1mov ON 009 0 009 000' L 99 a3d0-I3A3aNn ON 001,`9 0 00 L'9 000'9£ 179 Tddniif1mov ON 008`9L1, 008'691, 000'LL 000'Z L9 WiN3aIS38 uoseab a;e;S le;ol anoJdwl pue-1 sai3v S8e13 uol;dilosea 9002/£0/90 :paBuey0;set :su01}enleA juawssassy anleA asn 09999L :ll;!M pessossd :anleA;aMJeW Jled 1118 Aadwwn$ 9002 avow LO£/6£17 L66 L/£Z/LO 99/9ZL L66 L/£Z/LO n -Z3 69Z/LO6Z £91,608 9002/Z 1,/01, OO 17LZ/L06Z 891,608 9002/Z 1,/01, odAl aBed/IoA # ooo a;ea :iGo;s!H IOWed :sa;oN ML L-N 1,£-LZ (17/1,09L 17/1,017 Bud{-unnl-oaS) :(s);oeJl :Bp18 opuoaploole MS MS 4017 MLLH NL£1 LZ 03S 319b'II`dA`d lON-`d/N :Ield 000'017 :saJov :uo!;d!Josea IeBa-1 011M OOL 1, dS 1S10 OVH3] i M071M H3ddn OZ08 dS aNOWHOI~:i M3N Z96£ OS 179 AMH 171,LL . uol;duosea #;sla adAl tiewljd :(se)ssaJppV AljadoJd leloadS = dS I004oS = OS :s;o!J;s!a L1,0179 IM (INOWHOIH M3N 179.1MH 17LLL 2Il 3 t/3-10'8 M S3W`df `NOlI`da - O NO11V4 211 3 17'3-10 18 M S3W`df aaunn0-oo;uanno = 0 '1auM0;ua in0 = 0 :(s)JauMO :ssoi PPt/ xe1 0 00 odAl;!wJad #;lwaad # uol;eo!iddV eaJbl saleS # deW a;ea leo!JO;s!H a;ea uo!;eaJO NISNOOSIM '.11Nno:D XI02I0 '1S X ;uanno NO1Md1S d0 NMOl - 9£0 91,17'L 1,' L£'LZ laoJed 1IH 4 d0 L 3E)Vd Wd ss:ZO LOOZI W 000-0 x-,90 V9£0 183aed AS BUILT SANITARY SYSTEM REPORT 1 w e IV ALei 5 TOWNSHIP /N-R 4~7W ADDRESS IV(, / CROIX COUNTY, WISCONSIN. SL M-H.VISIUN LOT LOT $12E C PLAN VIEW 0 i i Lances and dimensions to meet requirements of H63 `9s, ZON SO FMtYTHING WITHIN 100 FEET OF SYST OFFICE l F r ! 1 _ b 4 6 1 _ _ I _ { I di a e o th~Arrow I -A L-1 ,MARK: (Permanent reference Point) Describe: ,j, i ion of vertical reference point: Slope at site: i'i''I'IC TANK: Manufacturer: Liquid Capacity: Z.4c.• 41-. Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: / Tank Outlet Elevation: ,.g I'UMP CHAMBER Manufacturer: Number of gallons himber of gal. pump set or a cycle, gallons; total capacity -o- distribution lines gallon: size of pump head, lion per minute ; horsepower ; brand name Of p,I~np tnd model number _ Type of warning device IiOLD1NG TANK: Manufacturer Number of gallons _ _ 1levat°ion of manhole cover ype of warning device _ l;l ~'yGE PIT SIZE: Ism e-b- r of pits meet diameter t,-~et liquid depth seepage pit in e pipe-elevation r,t,ttom of, seepage pit elevateion feet. _ liL'D SIZE: number of lines width le ugth `f the depth j t;L TRENCH: width length s11,ATI.ON RATE_ i AREA REQUIRED AREA AS BUILT INSPECTOR PLUMBER ON JOB - 4 x - - r LICENSE NUMBERj_-,;o c'._._ 7 -P s - REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit State Septic A AMETOWNSHIP St. Croix County` .OCATION Sectio4mLot # Subdivision ,EPTIC TANK- ,J Sizegallons Number of compartments istance from: Well_11~)1(77 Building 12% slope Highwater JUMPING CHAMBER Size gallons Pump Manufacturer Model Number OLDING TANK Size gallons Number of Compartments Pumper Alarm System )istance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Trench )istance from: Well -mot _ Building 12% slope Highwater 'ABSORPTION SITE DIMENSIONS Width of trench t ft Required', ft. Length of each line- ft Depth of(rock below the in. Number of lines Depth of rock over tile in. Total length of lines ft Depth of tile below grade in. Distance between lines- c~ ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover: PIT DIMENSIONS %f J; Number of pits Gravel around pits yes no Outside diameter ft Depth below inlet ft Total absorption area ft i Area required ft INSPECTED BYi-~',- r TITLE APPROVED DATE 19 itEJECTED DATE 198__ REASON FOR REJECTION C AS BUILT SANITARY SYSTEM REPORT TOWNSHIP r., 4N ~ V SEC..O' -11~W AI,~~KI: iS ~f e,r ZY 3 Ne W CROIX COUNTY, WISCONSIN.. t M.) i LVISIUN LOT LOT $12E ` 1jj(3, P LAN VIEW prrl, o t arices and dimensions to meet requirements of H63 ION,NG JC( OFF/ _ VERYTHING WITHIN 100 FEET OF SYST ' Cf - - - - 10 1 AZI I di a e ~ o th~ Arrow - - - } - SC LE: (HARK: (Permanent reference Point) Describe: ion of vertical reference point: /6 b _ Slope at site S - . 411 IA C TANK; Manufacturer: Liquid Capacity. Number of rings on cover Tank-manhole cover elevation' Tank Inlet Elevation: Tank Outlet Elevation:.„ PUMP CHAMBER Manufacturer: _ Number of, gallons Nutaber of gal. pump set or a- cycgallons; total capacity o1- distribution lines gallon: size-6 pump tread, ),,al lon per minute horsepower ; -b rans-name of puu1p .slid model number ; 't'ype of warning device HOLDING TANK: Manufacturer_ _ Number of gallons____ elevation of manhole cover _ TYI)L, of warning 'device _ 51?I,:PAGE PIT SIZE: N-umber oF- pits Feet: diameter Icet liquid depth _ seepage pit inlet pipe-elevation I)OLCOm of seepage pit elevation tees. i,;\ i,l: BED SIZE: number of lines -_wicfth T' le~igth_" file depth ;I. TRENCH: width _ length (t )I.ATI.ON RATE 7 AREA REQUIRED INSPL:CT0R /em ~ ..u PLUMBER ON JAB - LICENSE NUMBER 4 i. PLB State and County State Permit # f< 67 Permit Application County Permit # S• for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: Ap vv '1))z c)v (,f/, B. LOCATION: '/a Section ,'9 T_f1N, R-~;7 E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# r Village Township C ~y C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms- P No. of Persons D. SEPTIC TANK CAPACITY c Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete _k` Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement A- Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rat Total Absorb Area-sq. ft. New Replacement__Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth`Jtop) No. of Trenches Seepage Bed:_ et Length- _ _WidthDepth Tile depth (top) 1 . P No. of Lines 2 Seepage Pit: Inside diamm ter Liquid Depth No. of Seepage Pits Percent slope of land- Distance from critical slope )i 44 WATER SUPPLY: Private 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 Certified Soil Tester, NAME C.S.T. # 1y~ and other information obtained from Al, Ae, i (owner/builder). Plumber's Signature MP/MPRSW# Phone # 5 7 Plumber's Address PLAN VIEW: Provide sket h 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. a i 3 3 I E e Do Not Write in Spac Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State T~ County Date Permit Issued/Dejected (date)'-/~ -/-Issuing Agent Name Inspection YesNo State Valid# Date Recd 1. county (whi e copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 L2. state (pink copy) 4, plumber (canary copy) Revised Date 7/1/78 DEP/R I`MENT OF REPORT ON SOIL BORINGS RF~E/VE~ & B DI LDINGS I N VISION CtUSTR Y, , LABOR A PERCOLATION TESTS (11 sEP '9 Ins, - 'P•O. BOX 7969 HUMAN R17LATIONS Zohq~gG MlkD~SON, WI 53707 0--\, LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: =LOT NO.: L "O.: SUBDIVISIO E: 6t~ '/4sw'/a ;7 /T3) N/RE(o W e c~ COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: i epot sew Rees e, o USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL ESCRIPTION: PROFILE DESCRIPTIONS: ER LA ON TESTS: Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system C:MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RCOMMENDED SYSTEM:(optional) S ❑U ZS ❑u 0S ❑u [:]S XU ❑S ®U If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the under s.H63.09(5)(b), indicate: C1~Ss 3 Floodplain, indicate Floodplain elevation: j i PROFILE DESCRIPTIONS 4~£T~ C- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- 7,7 Q F r> 75 ot, f '64 13- .3 jr 13- 1741 ~r v 7 S' I TS 9- B S 3 f 9y B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 1 0 P- 2 !V L) ,30 13 "ALI AN - - P- t? 47 -3o I ha. j A10 > P_ P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distC' ibe flat 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 slop. SYSTEM ELE ATION '73 *6 1"ZI ~ c.' 144 ec( . -d ;kl a N tea, cr o q oo p +b - 7 "6 W tG fi riLN I,Ithe undersigned, ere certify that the soil tests reported on this form were made by m L ord with th procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are crrect to the y kn W.Q and belief. NAME (print): TESTS WERE COMPLETED ON: 11 , -r 4 ADDRESS. CERTIFICATI N UMBER: PHONE NUMBER optional): CS ATU L 'IBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. i-SBD-6395 (N. 03/81) (COUNTY: UWNEH'S/BUYEH'S NAML: MHtt_nvu NuuncOa: k, s & I S3 -G /U~c, ,cJ,md~ Q G(JS cI't3/ cpo tie`7s . .2-'e S -C ,)SE DATES OBSERVATIONS MADE - -E R-- - - TIO. B F [)RMS.: COM M CIAL E$CRIPTION: _ ~~FTLEDES`~Rlp'f`I~NS: PERK A STS: Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system .ONVENTIONAt MOUND. IN-GROUND-PRESEIJRE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) uu s out c-s ou_1o s c u ❑ s ®u Ci,dttEA;J~,~j~~~ _ _ It Percolauon I ests art, NUT tetluued DESIVN RATE: SY~ 1 M E L If any portion of the lot is in the Flood lain, cate Floodplain elevation: (undet s H6d 09(6)161 indicate: C/NSs 3 1 r _ _ _ _ _ ~-L_-_ - 1----- Pa F PROFILE DESCRIPTIONS IJORiNG -TOTAL P H TO 'R UNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH (NUMBER DEPTH IN, ELEVATION OBSERVED` _EST. I E ' TO BEDROCK IF OBSE=RVED (SEE ABBRV. ON BACK.) i J ?1 --.1C7s a 1 1. 4, 4 I[JiSI A- - dk ° ,J 5 7f), -9j 5, 16 A, SA 3:1* f D&J001 J9 B- PERCOLATION TESTS TEST DCPI H WATFR IN HOLE TEST TIME DROP IN WATER LEVEL.-INCHES RATE MINUTES PAUMBEH INC IILS AFI'Eli SWELLING INTERVAL.-MIN. 77TCc PFR INCH r l h 'LAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dist~'~es. escnb what are the hori- untal 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 ,I land slop. ~ ~ F -75 PILL/-.boa YSTEM ELE ATION c73 ale ~~Q~► Oil p 1 p ; _q I ,.y C i . C. a rn Irk ! ~ ICP I,jthe undersigned, ia~certify that the soil tarts raportad on thlR turrn wilco Ina"a dy In I~yyGGltid wtUt ill y1;purit4wrM1 frtatNt~cla 41w," M00 w tlt%" Wiwi t m Admimistrative Code, and that the data recorded and the location of the tests are correct to the st of m k and belief, NAME (print TESTS WERE COMPLETED ON: ,~_..~l. i t-- - - ADDRIESS------~ - - CERTIFICATI N UMBER: PHONE NUMBER optional): _ QS _ '~la_11~~ ST _ sss z~ - - CS ATU DISTRIBUTION: Or tgutal -Local Authority, 2nd page Bureuu ul Ptutntnny, aid twye Property Owner, 4th page-Soil ester. DILHfi-SBD-639h (N. 03/81) 5v)s ~ ~ r sy f~~,~ YA! s~ 4 \d 1 v J I a r