The URL can be used to link to this page

Home My WebLink About042-1078-80-000 a • n fo O o to o 3 y c C7 o y c CD -u n ~z # O CD 3 3 r Z N o n O N Nn O CT A CD O N (NA O N N N H • .r V CT Cp C CD W (D 3 0 -ID 0- CL C) I,a3 CD z W~ CD 03 & 1 n z! Q Gl N N N 3 CU N (D O (b O 5- CT :E 4 0 t o 0 Z) CD -P~ Cz E: CD C, rn 3 N CL N J ° ~ U) 0) r N N N `n$ N N C y N C -04 D N a o Cn m m W S o Cf) o o ;-o- D cf) ° 0 0 I (D m ~ ~ o `v° 0 ~ ' vOi o c rr C7 "Mi O O O O O O I C C C O << G A 2 "0 ~V'p < N z z CD -i -i -1 p o c to N N° O D s G G w a 9 O 0 w CD CCDD C^D N N m_ y W tai 7 3 E 0) 3 a r N O z co z z W o 'I O ya0 Do 0 ~r O "WA CD N N -1 En CD v CD (D (D N C CD CD C1 C1 w CD d 3 3 -4 cn z CD Cp 7 A Z CD O N O C n Q f1 N N Cl) W C CD W CD m m 10 Z g C 3 A O " O z aD m N z m z CD CD I w F w~ I I CL m m a a m c m c o, o z a N aD z a a m w o U) f m C:L F N z '00 Q SA b (CO Q Q, tv N I i (D O O A O O Z q CD (=D Cp O O O O b CD CD C) 0- C) s' f 00'0 00'0 Iol seB.ie4a;uenbullaa soBie4a leloads s uewssessy leload a; S 00'56 1N3WS63SSd Td103dS ONFMAOD2I-M ;unowV tioBa;ea apoa leloadg aasn :sleioads 434e8 :a3ea uol;eolliveo 0 :;unoa wlela :Ppaao Ajoijo-i 0 0 000'0 puelpooM OO9'ObZ 0051766 000'97 0£7'7 Azjadoad leJauaE) :9002 Jo; WWI 0 0 000'0 puelpooM 009'07Z 005'766 000'97 0£7'7 AijadoJd leJauaE) :900210; WWI ON 009'07Z 009'766 000'97 OE7'7 69 It UN3aIS32i u0sea21 a;e;s le;ol ano.idwl pue-1 saioy ssela uol;dl.iosea 6002/ZZ/0 6 :peBue4O ;set : suopenlen 009'6ZE Z6967 6 :431M passessV :enleA WPM fled II!8 Aadwwn$ 9002 667199L L66 6/EZ/L7 Z6£/699 L66 6/£Z/LO aM 80 6/000 6 L66 6/CZ/LO aM 9£0/ 6£Z 6 L66 6/£Z/LO edA.L aBed/IoA # ooa a;ea :iGo3s!H lamed :sa;oN M8 6-N6Z-6Z (7/6 096 7/6 07 Bud-uMl-oaS) :(s);oeil 609/Z IOA :BPlB opuo o V460 30 lb'ld3H ON138 CRJO 898/£ IOA WSO O/~I018 Z 10-1 3N MS NI 7'£7'7 M862! N6Z16Z 03S 3-18b'-IIVAV lON-b'/N Meld OE7'7 :sa.iov :uol;dljosaa leBa l 011M OOL 6 dS WHiN30 XIOZIO IS ZZ7Z OS 1S H1L06 Z9L « uol;duosea #;sla odA1 tiewiad :(so)ssaippd A:podoid le1oadS = dS I004oS = 0S :s;ou;sla £Z079 IM SIH38O J 1S HILO 6 Z9L N N331HIVN'8 0 alndd 'AH2 IM0-i - O A83MOI >1 N33-lHiVN V 0 (1lAda jaunn0-oo juaiinZ) _ 0 'jauMO juann0 = 0 :(s)Jaumo :ssaippv xel 0 00 adA13!wJad # 3!wJad # uo!;eollddV eeiv sales # deal a;ea leo!Jo;slH a3ea uol;eaja NISNOOSIM '.11Nf1O0 XIObO '1S X ;uaiino Ng2:2 'M 30 NMOl - Z70 8L77'86'6Z'6Z # laoaed "31V L d0 L 3E)Vd Nd os:Z6 90OZ/LZ/zL 000-08-8LU-M 103-1ed i • AS BUILT SANITARY SYSTEM REPORT ,.tER 3- CA =rAl , TOUNSHIP SEC.,,-,-, i T~4 N, R j," W ADDRFSS_x~sC.~-,s ST. CROIX COUNTY WISCONSIN. T- :DIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I ;r _7771 , CA &A-d . LL • j, I I I I { i I ~ i I ~I i 7 I iz /6 I ndicate Nahth. A,~.nvw "TIC TANK(S) MFGR.~~~a~~ CONCRETES STEEL Sca.2e 0. of rings on cover Depth el ` DRY WELL _4 A_ ."'.CHES N0. of widthA/,/- length area no. of lines width / lengthy area`' depth to top of pipe 100V ;:LEGATE O L . • RATE AREA REQUIRED AREA AS BUILT ,claimer: The inspection of this system by St. Croix County does not imply complete ,Dliance 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 tem operation. However, if failure is noted the County will make every effort to -ermine cause of failure. ._.ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTLM. '-INSPECTOR DATED PLU:1BER ON JOB - ; - b" LICENSE NUMBER ~ . r REPORT OF ITTSPECTION--I,V)1V1D1IAL SE7,)AGE DISPOSAL SYSTEM ~ Sanitary Permit State Septic /?77_70 -7 TOWNSHIP St. Croix County SIRPTIC TA'?K Size U gallons. 'umber of Compartments Distance From: We 11 C ft. 12% or greater slope fi. Building ft. Wetlands f*_ Highwater ft. DISPOSAL SYSTL:1 Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope --fL Building, .eft. Wetlands f: FIELD Fifhwater ft. Total length of lines -ft, Number of lines ~ Length of each line -eft. Distance between lines C,• ft. Width of the trench Z~lft. Total absorrtion area sq. ft. Depth of rack below the in. Dp-pth of rock over tile in. Cover over.rock, S,, Depth of tile below grade -`f in. Slope of trench in ?per 100 ft. Depth to Bedrock ft. Depth to ground water - ft. PITS "Dumber of pits Outs" dri Ver ft. Depth belcw inlet f ft. Gravel around pit e' no, Total absorption area sq. ft. .Square feet of seep~kpe Drench ottom area required `'.quare feet of sele pap, nit r c~uired • - Inspected by. Title: Approved , Date 197 Rejected Date 197 R I State and County State Permit # -PLB 67 5 Permit Application County Per it # C 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: CSC!/ % IVI Section 29 , T21 N, R %g F-- (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family 1/~ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks % HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation V 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: 1W Length 57Z ~ Width/%~ z* Depth Tile depth (top) ~No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 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 Certified Soil Tester, NAME C.S.T. # SS-~ and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# '7~11~3 Phone # 71l Plumber's Address 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. 033 *4; t ~~c l ."..-4 I I, l ar Do Not Write in Space Below r FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application ~-/,i Fees Paid: State County ~ f D a t Permit Issued/Fed (date) Issuing Agent Name Inspection 'Yes 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 115 (1~1-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH i • P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: '/4, Section T-N, R _ E (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE 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 BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- P- 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- B- B- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give reference point. Indicate slope. f N 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) Signature Certification No. Name of installer if known _c -al Auth~aalta f PLB67 State and County State Permit # Permit Application County Permit,- for Private Domestic Sewage Systems County 0 *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 29C )-./T ~ D ~ rL fs, l rJr s' S Yaa 3 B. LOCATION: 5 '/IVA- ~ Y4, Section T" N, R j' j (ap W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village p~ " Township C. TYPE OF OCCU- *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons _s D. TYPE OF APPLIANCES- Dishwasher YES NO Food Waste Grinder YESr/NO # of Bathrooms Automatic Washer ~ES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks 'Holding tank capaci'ty/ Total gallons No. of tanks New Installation t/ Addition _ Replacement _ Prefab Concrete Poured in Place Steel Other (specify) FFLUENy DISPOSAL SYSTEM: Percolation Rate 1) 2) ~3) Total Absorb Area -,cl :Pl ew Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length /L~Width 1 Depth 3` " Tile Depth ,2 Y No. of Lines ~Z- _ Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, t11isconsin Administrative Code, and that I have sized the effluent disposal system f„ _,n the E I 1 1.5 prepared ay the Certified Soil Tester, J NAME ~f U ✓ t C.S.T. # and other information 4 obtained from (owner/builder). :'lumber's Signature Gcl MP/,MPRSW# to -Phone #&t Plumber's Address 9, PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). f - r _ OV3 ( )Z:7 atl i I yz-1 j Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application Z / Fees Paid: State C Cunt Date ~e 1,77 Permit Issued4Ba4o@ted (date) IC 77 -Issuing Agent Name -~14 Inspection Yes_L_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