Loading...
HomeMy WebLinkAbout030-2034-70-000 a Oo g. 0 3 0 N . p f» v +y Oq N 0. 0 7 ~ U ~1 n O I N ~ N fA o Fa U N O O r O . e O ca u°i LL N a) O L T ` C N Ca O N N a> C Q) _ W C Z a) rn c m -0 d c LL ° _°0'o X y Q N O V i 3 co N V Z W O 3: O ~ Z O z c\v E v ° a co ce) N I- O Z a ° i o c d n E C U ~ N N ~ c4 O N n to CD (1> CD o aa) Q O O Z ca z N 00 E a CL '.o U (O N N y d N to O w o a ° N Z j v fn !A !A 7 O a a 10 • y X00 a ° L C o o cm o to J U 2 M- a-) ° Z O _ 0 O N N O O 0 0 0 r} N N N E Lo c) -CS N a N O O Cl) co N a> N tS1 c r O V 7 r Q U) ❑ O O 3 C t/1 C O E (D O 6~~ > U O= O O M r- m a~ n° u a o 6 M 0 0 y L O C -O N N N N V O C) N C co c N C O I N 3 - C) N O O N N O N O C N CD N 0 C Z • in' O N U) D M Z N 2 F- (n O r~ C #t ' E V ca L ~ m m a o as a ` a • a m .2 a> y c E r- A U a E 0 v~ 0 AS BUILT SANITARY SYSTEM REPORT OWNE R TOWNSHIP t; ADDRESS SEC.~T. N, R~W -~-r ST. CROIXN Y'WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of "62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t P f e I di ate oath Arrow SC, I SEPTIC TANK(S) MFGR. CONCRETE= STEEL N0. oT rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. ~~-bbEL N0 . GALLONS Per Cycle TRENCHES NO. of width - length area , BED NO. of lines width length y/ area dept to top of pipe z NUMBER OF SEEPAGE PITS outside diiam~eter total pit area AGGREGATE t/. ' PERK RATE AREA REQUIRED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas tha' it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR 1 DATED PLUMBER ON JOB f--LICENSE NUMBER s d' REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM ` San.itahy Penm.it.. State SPp.tic.,ZZ -Ll NAME" rownsh.ip St. Cno.ix County Locatiox u! Section SEPTIC TANK Size gattona. Numbers o6 Compantmentb j ViAtance Fnom: Wett it. 12% on greaten stope 6t Bu.itd.ing it. Wettands ~ . H.ighwaten a it. DISPOSAL SYSTEM Distance Fnom: Wett it. .12% on greaten zZope it. Bu.itd.ing , St. wettanda Ft. • H.ighwaten it. FIELD DIMENSIONS: Width o6' thench it. Depth o6 rock below tite.in. Length o6 each tine it. Depth o5 rock oven t.ite .in. Numbers o6 tines Depth o6 tite below grade .in. Totat .tength o6 tines _6t. Stope o6 trench in pen 100 it. Distance between tines_____Lt. Depth to bedrock it. Total abz o,%bt.ion area 6t2 Depth to gnoundwaten it. ..Requited area it2 Type o6 Coven: Papers on Straw PIT DIMENSIONS: Nurrbex o6 pits GAavet around pits yes no Outside d.iameten it. Depth below .inlet St. 2 Totat abzonbt.ion area it Area %equited it2 m INSPECTED BY TITLE APPROVED , DATE 197 REJECTED , DATE 197. !4 PLB ~ ~ - State and County State Permit # " 2 Permit Application County Per # 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: S"T LS C h/iE ~rrn Z r GC1% B. LOCATION: ALj4t % /f Section TOCN, R !E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township (7 V C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family A Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY/&ZP-0 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 L. f Total Absorb Area 1>_3 sq. ft. New- Replacement Alternate (Specify) Seepage rench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches 11 Seepage Bed: sLength _WidthDepth _Tile depth (top) No. of Lines a ;r cm Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land xzz~ ~?4 Distance from critical slope 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 Cer ified Soil este _ NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# 1-36 3 Phone #-WZ Plumber's Address- k242 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. 6CH 1 L l 1 m , { a ~ 3 , Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USEe'PLY Date of Application 12-7-7 -Fees Paid: State Co n Date .~~Zz Permit Issued/Rejected (date) 7~] Issuing Agent Name Inspection Yes 4 _No State 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 7/1/78 EH 11 8 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 ~~JJ REPORT ON SOIL BORINGS AND PERCOLATION TESTS 011 LOCATION: W/4,AA&'/4, Section , T , R or) W, Township or Municipality Lot No. , Block No. '1Ly rtea r e` c:~ County Subdivision Name Owner's Name: l~~~,/T.Ec 1 Mailing Address: TYPE OF OCCUPANCY: Residence- No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW 1C ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS /~a 2 /c, PERCOLATION TESTS l0 SOIL MAP SHEET SOIL TYPE C PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WAI 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 /ro P- 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) 51 B- c, y.2 D 50 i c > j: 44 4 B_ S r .a 1 of -scz L S©_,d~ S< . 5,0 77 _7 PLAN VIEW (Locate percolationtests,soil bore holes an 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. Z JY' Indicate scale 00, or distances. Give horizontal and vertical reference po' ts. Indicate slope. znn ( / ~ k f ! 1 ~ t t~ 1 I I w~ f t 2 ; 11 1 t t f i - - - > - ! 0, 7~ 1 t ' I y1 e a" ~ ~ ----~i ~ -~--__-;firs -~i __4_ ~ • _ I ~ N t 1 t ~ i _ t t I ~ I t i I t ~ I I i 1 ~ y I I( III { j ~ t t{ I li S 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 an elief. Name (print) Certification No. Address Name of installer if known J / , COPY A - LOr`_ CST Signature