HomeMy WebLinkAbout042-1080-90-600
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• AS BUILT SANITARY SYSTEM REPORT
,R TObTNSHZP SEC. T N R -
ADDRESS ST. CROIX COUNTY, WISCONSIN.
TY, WISCONSIN.
jiVISION LOT LOT SIZE '
PLAN VIEW
Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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£IC TA K(S) MFGR. CONCRETE - STEEL Ind S cat e
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NO. of rings on cover____,8~_ Depth ~ DRY WELL
:C17ES N0. of ,7idth length area
no. of lines ___3_ widtb / length area -~~G '
depth to top of pipe /_y_
,,GATE
AREA REQUIRED AREA AS BUILT //;jam
_iaimer: The inspection of this system by St. Croix County does not imply complete
Iiance 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 make every effort to
ermine cause of failure.
USES AiVD OILS SHOULD NOT BE DISPOSED THROUGH °1IS SYST.
DATED P1,12MMER ON JOB
LICENSE N`JrME:? 4__ ~
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REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
i 4
Sanitatty PeAm.it,,t
State Septic
.
NAME (ownship St. Cnoix County
E
Location Section ~ j'SEPTIC TANK
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S.ize~ ~gaZZons. Numbett o6 Compatttments5
D.vstanee Ft-cm: Wed'_6t. 120 ott gtteaten z.-ope 6t
Bu.itding 6t. WetZand,5 6t.
H.ighwatett 6t.
DISPOSAL SYSTEM
D.i,tance Fkotr,: (lez 0 6t. 120 on gtteatvL sZope 6t.
Bu.iZd.ing ,~..5 6t. W etZandss Ft.
H.ighwate,t 6t.
FIELD DIMENSIONS:
Width o6 thench 6t. Depth o6 stock be.iow t,ite ;;,'--i,n.
Length o6 each Zine_ 6t. Depth o6 hock overt t,iZe Z- an.
Numbese o6 Unes Depth o6 t.ite betow gAtade26-in.
4 otat Zength o6 UnesIiF06t. Slope o6 tsteneh Z-- in pv. 100 6,z..
s11 v Distance between .roes 1~ 6t. Depth to bedttock. 6t.
T otat ab~s ostbtion astea11j-2,6t2 Depth to gttoundwate,t - 6t.
2
Requited area 6t Type o6 Covet: Papett o taw
PTT DIMENSIONS:
Nu-nbett o 6 pits Gttavet astound pits ye/s~_rto
Outside diamet Depth below .inlet 6t.
2
Total abz ostbt - on attea 6t z.
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Artea equ.t.tted_ 6t2
INSPECTED BY TITLE
APPROVED -wCJ DATE / 197.
REJECTED ,DATE --197-
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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
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LOCATION: I)LV-114,!:~~'/4, Section 9 , T2!~N, R A&(orcdTownship or Municipality
Lot No. , Block No. County ~7- O_ ~,X_
Owner'sName: /V 4L~C-1 Subdivision Name
;
Mailing Address: A .77
TYPE OF OCCUPANCY: Residence ✓ No. of Bedrooms ~J Other
EFFLUENT DISPOSAL SYSTEM: NEW ✓ j ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS bg- A PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS
TEST DEPTH I CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MINI),
BER ry~> 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P / 74 d S 1O R S A/ .30 / 3// ' / ~~~e
P_ If
/'y lye.
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 Q 2 ft'ti'tt 2C S.L ;L l G[
B- it SL'
PLA VIEW (Coca e z6 t°`." 3~4►vD cu4y
pr olationtests,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. /PiF .&X /.?,eve b' At'A%L 11.2S El' N,e*r p k Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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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.
f
Name (print) Certification No. _5
Address a~94sE nsd % j~ii dom. !"sa.(AC Sa C.015ei 1AV ZZ_
Name of installer if known
G CST Signature
PLB State and County State Permit #
-67 , Permit Application County Per i j 1,7
Systems Count
for Private Domestic Sewage Y,
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
17v & ire-
B. LOCATION: Y4 `5.(' Ya, Section , Tk~ N, R~ E (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 Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 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 *&xk-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: t/ Length 6'? Width /4 Depth 34Tile depth (top)-ZM ~ No. of Lines
Seepage Pit: Inside dia~jeter Liquid Depth No. of Seepage Pits
Percent slope of land ~e %c 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 <F /'C'otl,_ C.S.T. # 73 and other information
obtained from (owner/builder).
Plumber's Signature M /MPRSW# Phone
Plumber's Address
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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.
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Do Not Write in Spac Below )PR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State r County Da - Ci /
Permit Issued/R (date) - - -7
Issuing Agent Name'
Inspection Yes x 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
MMMERCIAL TESTING LABORATORY, INC.
r 514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
MOIX COUN f :3/29/90
sURTHOUSE -E-TVE 3/27/90
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ATIONI. 728-107th St., Roberts
.LECTOR*. M, Jenkins
URCE OF SAMPLE'. Kitchen faucet
IFORM. 0 /100 ml
"ERPRETATION' Bacteriologically SAFE
< Ippm
pier 10 ppm is safe for human consumption.
OE,,twEDENpEHl.
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
!tCEIVEO
EIVEO
ST. CROIX COUNTY ZONING OFFICE j~j8y
cn=.
l~• ? St. Croix County Courthouse
~ CRC -
911 4th Street
Hudson, WI 54016 `OcF F
Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $175.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00_ j%
(Determines if system is properly functioning at time of
inspection)
Property owner's name- >
Property owner's address
Legal Descz iption ~`'/1/b) 1/4 of the 1/4 of Section , T/ N-R
Town ofLot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER'
Color of house, ,.Realty sign by house?_/-If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:1~;>~~?~r~~,
Telephone Number',' - ,
REPORT TO BE SENT TO:
zzz
Closing date
Signature
29
WARREN T29N--R.18W
E S "GE
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LAI(ES
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Dependable Hybrids
yra~,~'n ~'p~ From Dependable People
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..y Do CABINET DOORS.
4 Richard H. Kamen
( q~ ~ rYIN .r•~.Mk~.o T.,. v ~H~o Roberts, Wisconsin '~(•'+T 7 ~1 1 ~ ~ t ~ ~ ~11HH
CALL: 749-3332 }r~~ 1 t }
' ST. CROIX COUNTY
` WISCONSIN
ZONING OFFICE
xs3~
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- 715) 386-4680
March 27, 1990
JoAnn Persico
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Ms. Persico:
An on site investigation of the septic system on the property of
Dona Lansing Bracht, 728 107th St. Roberts, Wisconsin was
conducted on March 26, 1990. At the same time I also obtained a
water sample and submitted it to the laboratory for testing. The
results of that testing will be sent to you as soon as we receive
them back from the laboratory.
At the time of the inspection, the sanitary system appeared to be
function properly for the existing use. The inspection of this
sewage disposal system was based upon a surface inspection of
said system and did not involve any excavating or chemical
analysis. Accordingly, there is the possibility of hidden
defects in the system not discoverable by this inspection. This
does not in any way warrant or guarantee the continued proper
functioning or operation of this system. It is recommended that
the system should be pumped once every three years. Therefore,
the prolonged life of this system is totally dependent upon
proper maintenance of this system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
Mary ;n ins
Assistant Zoning Administrator
MJ:cj