HomeMy WebLinkAbout036-1044-95-000 (2)
0 N O o co O 1 -0 0 d _ 1
O p~ _ 01 f 0 O
• 7 A CD 7 CD CD F)' A '6 •
"a 7!
CD CD D? N 1
CD CD
3 3 A~
n d O O vNi O O N C N N O O N F,- CD OW O•
S 7 a c O 0 Ol Ol C O, i ] ~ 91 ICI
(O d = (D N (D =r N FL 2 N N CO CD O p lA\
C 3 CD :3 W W O ~ ? J C 1
D. tV N CD a) N CJ
W O
CD -U C CD CD CD W N N CD (D 7 O A~ O
0
3 C1 • O
7 N 7 N O C
A ''7 !V
(D A N tti1 G CO
Sli (!1 z C d j U7 E N CD j
m cn 0 Cnn d. cfl N C
W o = co
3 a 00 C a c 0
O c D O D 1I ~I
CD j (D (D CD j "%WA
C co CD CD -4 m CCD: C) 3 r a
co co CD N CD CD CD 0
v
o 0005, 0000
I, Y h~_r•
A
~r2 --j - -j
C) -a 3 y y N n CD 3 N y y a -
. CD _ v v v v << o ~1
6'
O O O O CD N G7 O (D
CA s N m ' 2 a I T
< !r
DOj ~ ? d . N CJt
N 4~, 00
N N E O 9 W
N
z W z z w z 0
D m o D a CD 0
m 0 a m
CD CD CD N •
N O N
m -O N U o c
CD v CD
c CAD N C N CDD.
C•J @ a a
a 3 3
o CD_ o o A z CD
N c I i_ ~ •T
0 a a z
v O
0
m W cD
Q CD W(D
CL z
3 a x
Z
3 3 ~-4
N V!
CD A
a w
CD 0
- D m NG) D 3
3 a O a CD
N
CD n
CD 3 n
a
I =m c T~ v c I
oz a n o a
N z v m
O
CD m m
E* CD
o
o' m a
1 > > m
0
N
3 m ti
X
A
0 v
CD CD 1Dn •A~a
c O cn0 N
00 L 0
:HER S( i , TOWNSHIP:~ ~ SEC. 1 y T. / H, KLW
3.
A RES L?; , ST. CROIX COUNTY, WISCONSIN.
3DIVISION LOT LOT SIZE C-"
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
G 52'
V
'TIC TANK(S)MFGR. CONCRETE STEEL
140. of rings on cover j Depth 12 " DRY ELL-
N.CHES NO. of width length area
no. of lines Width!; , length area G z err'
depth to top of pipe
,REGATE (wa1 1t7~ 4~f cY.
.a RATE S1 AREA REQUIRED AREA AS BUILT
-claimer: The inspection of this system by St. Croix County does not imply complete ;
pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
-'em operation, However, if failure is noted the County will maize every effort to
-ermine cause of failure.
:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'INSPECTOR`
DATED___~~~~/ PLUMBER ON JOB
LICENSE NU11BER >7
z
rREPORT~ OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
. San.i.taAy Penmi.*41
State Septic,/-
~ Township ! -c St. CAOtix County
NAME
Location-I,,, Section i
SEPTIC TANK
Size,* gattonz. Numbers o6 CompaA,tmen-t6
Distance FAOm: WeZZ it. 12% on gAea,teA .5tope it
Buif-ding it. Wet.Land.3 ~ .
N.ighwateA it.
DISPOSAL SYSTEM
Distance FAOm: WeU 120 oA gneateA zZope it.
Bu.iQding it. Wettands Ft.
H ighwateA it.
FIELD DIMENSIONS:
w.iRh o6 trench it. Depth o j Ao ck b etow Cite in.
Length o6 each tine it. Depth o6 Aock oveA tiZe_ in.
NumbeA o6 .-inels Depth o6 ti.Pe below g,lLade in.
Totat tengih o4 Ziness it. Stope o6 tAench in pen 100 it.
Distance between tines it. Depth to bedAock. it.
Tota.e ab,s oAbtion area 6t2 Depth to 9,toundcvateASt.
RequiAed aAea , it2 Type of Cove,_: Paper oA S.ttc.aw
PIT DIMENSIONS:
NumbeA o6 pigs GAavet around pits yens no
Outside d,iametvL it. Depth below intet /st.
2
TTotaZ ab~smbtion atcea it z
A
it2
AAea Aequ-iAed rn
INSPECTED BY TITLE
APPROVED DATE 197 l
REJECTED DATE 197
t
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: 11%, Section a, T.~IN, RZ2E (or) W, Township or Municipality
Lot No. , Block No. County S / l
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS c~ ~-PERCOLATION TESTS
SOIL MAP SHEET ! - SOIL TYPE _1
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
2 t'
C`
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)
13-
2 2-
PLAN VIEW (Locate percolation tests,soil 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. _ - - Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
i i
r ~
-t4
`
3 f
4 i
i i t I ~ C
! ~ I i i i 1 3 i I ~
l i I
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) '1 Certification No. 3
Address '
Name of installer if known ~j
CST Signature
PLI36.7- State anCounty State Permit
Permit Application County Per i #
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:
B. LOCATION: i Section I? T N, RJ~y E (or) W Lot# -City_
Subdivision Name, nearest road, lake or landmark Blk# Village
Township r
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance-----
Single family l/ Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES I--NO Food Waste Grinder YES L --NO # of Bathrooms-/Automatic Washer tS NO Other (specify)
E. SEPTIC TANK CAPACITY / Total gallons No. of tanks _~rZ
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement I% Prefab Concrete
*Poured in Place Steel i Other (specify)
sq. ft.
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) , 2) , S 3) 5 Total Absorb Area
New_ Addition Replacement L -*Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length S~ ' Width Depth Tile Depth V ` No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope
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 Certifi Soil Tester, f
NAME A/ e / G--, W_/Lf_d~//rS C.S.T. # / 3~ and other information
obtained from (owner/builder).
i• 'S tip-
Plumber's Signature L - _ MP/MPRSW# - Phone #
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
_ . o I/ Ile
- C
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application - C - Fees Paid: State ~ge C4Cou ty Dat ,
91-
Permit Issued/Rued (date) ssuing Ant Name L~
Inspection Yesx_ 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 (canarv coo-' -