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CROIX COUN WISCONSIN. ;'SPIVISIOH LOTJ~LOT SIZE PLAN VIEW tAirtonces & dimensions to meet requirements of H62.20 i' SNOW` VERYTHING WITHIN 100 FEET OF SYSTEM I .i. is . 2' 1 ~ T~y "F~ rJ I F Y Lr '~M~ 1f Q r A Y ~4'{4n`lx t RF F a R 4 11i. / 10,64 a ~ Y 1 ` r il~T4* skk;! ~►Mn~ CONCPLTE L-f" STEEL o *Lhgs on cover Dept1j DRY WELL rea / l ength a pill, ~ , area lerngth t dCept s ps ` A REQUIRED / AREA AS BUILT ~c im+er: 'the inspettion of this system by St. Croix County does not imply complete p.~id~nce with State Administrative Codes. There are other areas that it °is not pos<;ible. iASp+ee.t at this point of construction. St. Croix County assumes no liak>i.lity for ?tes~q operatior► However, if failure is noted the County will ruake every effort to rsr} 4t a gause of failure. . A S A I,II,S S1iQtxLt~ NOT BE DISPOSED THROUGH THIS SYSTEM. "INSPECTOR PLUMBER ON JO 17 q, LICENSE NUMBER S Z - REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM ' San.i-tany Pe in i,t State Septic NAME rownsh.ip S-t. Cno.ix County LocatioA Section SEPTIC TANK I . Size ga.Z.Zons. Numb en o6 Compantmen.ts j Vi.6tance Fnom: We.Z.Z 6Z. 12% on greaten s.Zope 6-t Bu.i.Zd.ing 6t. Wet.Zands 6t. H.ighwazen 6.t. DISPOSAL SYSTEM Distance Fnom: WetZ St. .12% on gnea.ten s.P_ope 6.t. Bu.i.Zding , ` , 6t. W et.Zands Ft. H.ighwaten 6t. FIELD DIMENSIONS: Width o6 trench St. Depth o6 Ao ck b e.Zow t.i.Ze / ---kn. Length of each .line 6t. Depth o6 rock oven ti.Ze .in. Numbers o6 Zines ? Depth o6 -t-i-Ze be.Zow grade-. in. Tota.Z .Zeng.th o6 2.ines ! 6.t. S.Zope o6 trench in pen 100 6.t. G Y Di.6tance between .Zines 6.t. Depth to bedrock 6 . Tota.Z abs onb,tion area y 6.t2 Depth to groundwater 6t. Requited area it2 Type o6 Coven: Papen`on S.tnaw PIT DIMENSIONS: Numbers o6 pits Gnave.Z around pits yes no Ou.ts.ide d.iame.ten 6t. Depth b e.Zow .in.Zet t. 2 Tota.Z absoab.t-ion area S.t Z Axea %equiAed 6t2 r INSPECTED BYLALf~~( ~ TITLE APPROVED , DATE 19 7 . REJECTED DATE- 197. 'EI 1 115 Rev. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: ~L_%, Section 14 ,T~8 N,R ±1 W, Township or44eftei}9eFi Lot No. 3 1 , Block No. C'7 LCD YL-(Z. TAT v+-t County S-C. G IZo +-,c Subdivision Name Owner's/Buyers Name: QCN r4' 5 b y) -e kL Mailing Address: ~ l4 I-A Z'`• g S-c. l iE~2 1r Al ~ , , ~ JI) Z_ Z__ TYPE OF OCCUPANCY: Residence 'K No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW Ic REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 1 0 `7 C1 PERCOLATION TESTS "?'A SOIL MAP SHEETS. NAME OF SOIL MAP UNIT 15 4>Rit-t_1AR0"T C?.y. GZ~ 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 MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- i o I.a TL-s-r Crr Dv C S:0 I L_ t a p 1 G ir-r P- SotL- G~NOi -too tE7X . 'Y I C_ kN A$ C- o ct mco P- 0 sC__ C)r h5 Sp► P17-o . 4~ ?i-Ts P U ~ ti L~ R n l O "~f~ SID- t P- t21=~ Nr1 [ L 'T G)` I N Co Z10 i 1.i ~y t"L t. 1LYt o P- 1-4 2A o/+ 1O~i~sw~ 3P%rH`~ T~cft' 'B TIC ~L~ K&Aroli20 S-, jLs. AT Dmarl"-5 ,c4FIT> g47 'So ►LS AT D Ptt+s a~ 3Z~<< •rz SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- { -73 NONE 7 -7-7. 1t~`` g1 t. Tr , Zv, L Z" Gt- Ord" 5 B- Z -13 Na r.5 F -7 3 1 $i L `T 0, j L v 4' 6 v- 4d" o,4:c1 s B- 3 _17- m t5 ►4c '7 _7,Z gyp" `f'S • 10- P>, L Sz'` M d . S B- -74 ND &)E > 74- 1Z~ t ~ TS - 1 4z B- ra -z Z 130 ~J(f -7 '7 z, 11" IM L 'Cy • \3" R n L 4-v" w~u d , s 3- 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. ~U L-~ 'b, AOw-A = ~ ~c ZqS - (o( . C~ ►-C e! VffiZ tNsi~aLZ©-ttOrr. aa tUIX -TIC S 1 K p 1 G ~z~ s OF Ce;h1G ; ~r(ph/VNb£l~li ~ 1 NstFK+~-A- T,2ptits , 13A•C w iko t5 V t T 4 MA iA A• lLoA O h A~ Tua na -to LCcA't %3&J , D CL . 0 GebUt4o CL-CnY OT PtT i. ~,11rTic►.t5 i i r - 4' S I A eu•',- T!4,i_L- a}aCA (~k i N 4v )(70 = Z 6co r-r i J 3 I 1,oY . 4 l spa N w - jl~z i0(7 E __m.... 3cc' ~ - 5 3s ¢3' U" 11t/ I, the undersigend, 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) 10%tA,L~ L- M V ?-P "v Certitication No. 5 ° 5 e'.-7 Address -3 0~ 1A Z w-O 5K, 5e0-Z_Z .Name of installer if known FAu~- C uC> So+vs y Copy A tt e - -Local Authority - 40, State and County State Permit LB 67 11 Permit Application County Permit~~# 5 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 f- '/a Section, T~ N, R E (or) W Lot#l City Subdivision Name, nearest road, lake or landmark Blk# Village ~ Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms i No. of Persons D. SEPTIC TANK CAPACITY LCfe Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation s 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. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth top) No. of Trenches Seepage Bed: - Length Width Depth Tile depth (top) ~ No. of Lines - Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land r 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 Certi ied Soil Tester, NAME C.S.T. # j and other information obtained fr m (owner/builder). Plumber 'sSignature kw /MPRSW# Phone t t~ y-Y 4 r .T _ u I Plumber's Address f t 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. E ~ C r E 1 , , , i m _ i t k 9 \ .....ate. . d e . a~ a a . e d s w 3 ~ E j t Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Application Fees Paid: State C0 Co nt ` hC7 Date ssued/Reiee1:ea (date) G' z Issuing Agent Name L~ Yes AI No State Valid# Date Rec'd (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 ink copy) 4. plumber (canary copy) Revised Date 7/1/78