HomeMy WebLinkAbout022-1024-60-000
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AS BUILT S ~11I TA:Y SYSTEM REPORT
"R • L-- TOWNSF:I SEC. T N, R W
ADDRESS _o ST. CROI COUNTY, WISCONSIN.
,DIVISION _ LOT LOT SI 1ZE_-
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 s t-
lox
TIC TANK(S),!'(,y MFGR. CONCRETE X STEEL
NO. of rings on cover Dep th~ DRY WELL
INCHES NO. of _ width length area
no. of lines_ IL width length ~7w area ,
ep h to tap of
LEGATE
RATE AREA REQUIRED AREA AS BUILT
claimer: The inspection o this system by St. Croix County does not imply complete
,)liance with State Administrative Codes. There are other areas that it is not possible
_nspect at this point of construction. St. Croix County assumes no liability for
`_em operation. However, if failure is noted the County will make every effort to
-i'mine cause of failure.
=IS .'S AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED PLUITER ON JOB
LICENSE NUMBER j
REPORT Or IJISPECTION--INDIVIDUAL SE14AGE DISPOSiV, SYSTEii
Sanitary Permit 3_1
• - State Septic
,."A! 1E
TOWNSHIP
.fit. Croix County
S,?PTIC TA'IK
I
Size gallons. lumber of Compartments .
Distance From: 'dell ft. 12% or greater slope
Building` ft. Wetlands ft
Highwater ft.
DISPOSAL SYSTL.1 Tile Field or Seepage Pit(s)
Distance From: i1ell ft. 12% or greater slope ft
Building; ft. Wetlands f.
FIELD Kighwat er ft.
Total length,Jof lines ft. Number of lines Length of
each line ft. Distance between lines ft. Width of the
trench ft. Total absorption area sq. It. Depth
of rock below file in. Dp-pth of rock over the in. Cover
nver.rock,, Depth of tile below grade in. Slope of
trench in per 100 ft. Depth to Bedrock £t. Depth to
ground water £t.
PITS
'lumber of wits 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 by: Title
Approved Date 197
Rejected Date 197.
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: NEB/4 NWT/,, Section 9 , T A, R 18 E (or) W, Township or Municipality Kinnickinnic
Lot No. , Block No._ County Saint Croix
Subdivision Name
Owner's Name: Alvin VanBeek
RR 1, Roberts, Wisconsin 54023
Mailing Address:
TYPE OF OCCUPANCY: Residence X No. of Bedrooms 2 Other °
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
Au 3 1978
DATES OBSERVATIONS MADE: SOIL BORINGS Aug. 30, 1971 PERGOLA ~ON TESTS .
SOILMAPSHEET St. Croix Co. Interim SOIL TYPE Otterholt silt loam
BSA-IFF-115
PERCOLATION TESTS --W!
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_ 16" dk bn Ts sil, 36" bn sub-
1 58 soil sil, 6" s 20 no 10 3/4 5/8 5/8 16
P_ 14" dk bn Ts sil, 38" bn sub-
2 58 soil sil, 6" s 20 no 10 3/8 5/8 1/2 20
P- 15" dk bn Ts sil, 37" bn sub-
3 58 soil sil, 6" s 20 no 10 7/8 5/8 3/4 13
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- 1 94 none 94 16" dk bn Ts sil, 36" bn subsoil sil, 42" s
2 94 none 94 14" dk bn Ts sil 38" bn subsoil sil 42" s
3 94 none 94 15" dk bn Ts sil, 37" bn subsoil sil, 42" s
4 94 none 94 16" d b 8" "
5 94 none 94 17" dk bn Ts sil 38" bn subsoil sil 39" s
6 94 none 94 18" dk bn Ts sil, " "
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square ttof suita a areas. Indicate number of square feet of absorption area
needed for building type and occupancy. ?6U sq't' trench, 630 sq. ft. bed Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope. /
387_f - - - r . t
I t l
boe `old t"st'
I ebc tests ! I J
w reer~nc$ eev tin l
II
I i k
~
i ; 1$ t Lot s ze is i 2 Q cres '
well 251
ro osd +
-bedroom i I § N
le
1081 on _
t (3 ) 'f
i
1 j € $ 9% Slope r- f d>~ ve _'f w R t
` Y
Y
I - IOyal" }I
l ( It
I _4
horizontaliand elevation
teforeMce'ba5e of Qorrer',post 1001 eiev i
44
owi Road;
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) Roger A. Swanson Certification No. 55-606
Address RR 5, Box 124
Name of installer if known Calvin Wan
CST SianaturP 4' A,_
State and County State Permit # X?Z)
PLB67 Permit Application County Per .t #
for Private Domestic Sewage Systems County 1
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY i ing A~ldr_eess: 6
-40--
B. LO ATION: '/&oV Y4, Section , T ,2,2-'N, R_,zTE (or) W Lot# City _
Subdivision Name, nearest road, lake or landmark Blk# Village
Township /V, A/4/, GWi r/G
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family - ~ - Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher -,%e YES NO Food Waste Grinder YES 'Z NO # of Bathrooms
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY Zelf, O
Total gallons No. of tanks l
*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),Z O 3) /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 ,5 Width _ Depth Tile Depth _Y6' No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size `Y
Percent slope of land Distance from critical slope,-1-
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 e _/L_ S'~j so C.S.T. # ~'y 6 and other information
obtained from j~T (owner/builder).
Plumber's Signature MP/MPRSW# 4 Phone 4r /d_
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
: i
z
fro
.
t ,
l ~ E
3
E
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
C G'
Date of Application fC! Fees Paid: State IC. ,CC County ~ Date j 10 -~CJ
Permit Issued/R.a}eeted (date) ( T 76, _Issuing Agent Name, Z
Inspection Yes~-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
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Parcel 022-1024-60-000 12/07/2005 01:05 PM
PAGE 1 OF 1
Alt. Parcel 9.28.18.133C 022 - TOWN OF KINNICKINNIC
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
JOEL M & KAREN M Z DITLEFSEN O - DITLEFSEN, JOEL M & KAREN M Z
488 VALLEY VIEW RD
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 488 VALLEY VIEW RD
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH )\40 Legal Description: Acres: 1.540 Plat: N/A-NOT AVAILABLE
SEC 9 T28N R18W 1.54A IN NE NW LOT 1 OF Block/Condo Bldg:
CSM IN VOL 3 P 737
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-28N-18W
Notes: Parcel History:
r Date Doc # Vol/Page Type
09/15/1997 1264/09 WD
07/23/1997 W'97TT84 ) WD
2005 SUMMARY Bill Fair Market Value: Assessed with: Gr ►1~S/•
88066 182,800 L"Gti~~ l~
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.540 30,000 154,800 184,800 NO
Totals for 2005:
General Property 1.540 30,000 154,800 184,800
Woodland 0.000 0 0
Totals for 2004:
General Property 1.540 15,000 119,000 134,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 120
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00