HomeMy WebLinkAbout008-1035-10-000
n cn O 3 v n C7
o c m o
d f to ~1
c
~ v i .o' 3c c
v 3 v
m
co o m o cn - r m N °O ~C •
m 3 O C fD W a I ~ N T FBI
(CD O W
m n A Z d N CD j p
Q M N m W N
CD O W
N jl (D w ..t ` 1
Q
CD
ro o
D (D
CD 0 0
3 w O
7 N O
o
N C ~ II ~ l~1
cl) U) < D a
o, N~ a a
Q O O co p C
rl) lot
(D N o
L O I
y O O O co d O C
N
(D Q
rr ~
N. v .
z 0 0 0
v v v O eQ
O ~ f'D .Oi N
O D
N
N O
C1
N 7 ~1
N
Z
Z Z c
O
D
p D
C
N D
` N.
O N
C d
03 W
(D
Z (3D N
O O A Z O
C
7
Z
n I A O
CL C)
0
Z N N
03 -0
p (D co
z
a
0 s Cl)
rn
N z
(D
w F
N D
n
~ o -
m m
N -
02 OL O
X CD
cn N
F
s A
N `„C
CD b
7
N ~
7
N ~
Q ti
N
O
O
a
A
O N
d0 b
O
N
Efl p
O N y
O L ~
00'0 00'0 00'Z6 6 lelol
seBje40;uenbullaa sa6ae40 lelaadS s;uawssessd lelaadg
00766 lN3WSS3SS`d IV103dS ElOViRi` EY LO
;unowy tioBeleO opo0 lelaadg iasn
:spioadS
£69 43188 LOOZ/LWV0 :ales uolleal;IIJaO :;uno0 w1e10 :;ipaa:D /Gal}ol
0 0 000a,'0 puelpooM
009'906 006'6L 009'LZ 06Y'} Y A:pedoJd IeJaua0
:5002 ao; slelol
0 0 000'0 puelpooM
009'906 006'6L 009'LZ 06b'b Aljadoad leJaua0
:9002 Jo; sle;ol
ON 009'906 006'6L 009'LZ 06ti't, 6J IVUN30IS32i
uoseem ales le;ol 'snojdwI PUB-1 Saud sse10 uol;dljasea
WOW 6/90 : paBue40 ;set : su01}en IBA
009' 69 6 C960L 6
:4l!m passessv :anleA;a3IaeW aged 1118 Aadwwns sooz
~7L 1
( C 9~
Q (J'I n z
tiS/Oti8 L66 6/£Z/L0
ads .L aBed/IoA # ooa alea
Le5,' Y 7 :tiols'H laaaed :sa;oN
/N
M9 6-N8Z-Z 6
(t'/6 096 v/6 Ov 6u~]-unnl-oaS) :(s)laeJl
(OL91L066-f1-Z3) 966/b lOA WSO
:BpIq opu00/maol8 6 101 MS MN NI V6b't, M9 62] N8Z1 Z6 03S
318`d1I`dAV ION-`d/N :leld 06Vtb :sajov :uol;dliosea Owl
011M OOL6 dS
tJDW 311IA000M-NIMaTdB 6£Z0 OS
8 GH AlO 6£lv uol;dlaasea #;sla adA1
tiewud :(sa)ssaippy A:pedoad IelaadS = dS Ioo4aS = OS :slowsla
8ZOV9 IM 3111A000M
8 aN A10 6£b
f `d10Rildd'8 f alt/2130`IOHdW(12i - O IOHdnnH fVIORilddv f GWd3J
aaumo-oo;uaiino = o '1aumo 3uaaano = o :(s)Jaumo :sseippy xel
0 00
odAl;IwJad #;IwJad # uolleallddd eajy sales # deW ales Iealao;slH a;ea uol;eaa0
NISNOOSIM '.llNnoo XI02iO 'lS X ;ueun0
Elide nV3 30 NMOl - 800 08LV96'8Z'Z6 IOWed 'lld
6 d0 6 3E)Vd
Ad 69:170 900Z/6 U 000-0 VS£0 x-800 laoasd
I
A.
/ AS BUILT SANITARY SYSTEM REPORT
'NER ( .1 C u S TOWNSHIP " G d 1'- SEC. L2, T N, RL_L_W
0• ADDR SS ST. CROIX COUNTY, WISCONSIN.
3DIVISION LOT LOT SIZE l
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
Bey / 'L.
c
'TIC TANK (S) l(~ i•' MFGR.~, CONCRETE' STEEL
NO. of rings on cover Depth DRY WELL
~~NCHES NO. of 2 width length SJ area ! ®c>
D no. of lines width length area ,
depth to top of pipe
'RELATE
;K RATE' . (o AREA REQUIRED AREA AS BUILT l
.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
-.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 SYSTEM.
`'INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER fir'
b
z -
REPORT 'OF INSPECTION! INDIVIDUAL SEWAGE SYSTEM
Sanitaty Pehmit "?00
State S v p,ticj'7,- s'
r"
NA1~;, Township St. Ctoix County
Location ; f Section
SEPTIC TANK
Size gattons. Number o6 CompaAtments
D.iztance FAOm: Wett 12% on gneateA stope 6.t
Bu.itd.ing 6t. wettands 6#.
H.ighwateA bt.
DISPOSAL SYSTEM
Distance FAOm: Wett 6t. .12% on gneateA 4tope 6.t.
Bu.i.td.ing 6t. W ettanda Ft.
• H.ighwa#eA 6•t.
FIELD DIMENSIONS:
Width o6' t&ench 6z. Depth oS rock below .t.ite .in.
Length o6 each tine St. Depth o6 Aock oven Cite .in.
NumbeA o6 ,t.inea Depth o6 tite below grade .in.
Totat .length o6 tined 6Z. S.eope o6 tAeneh in pen 100
Distance between tines 6t. Depth to bedAock St.
Totat ab.6 oAbt.ion area 6t2 Depth to gxoundwateA 6t.
Requited aAea 6t2 Type of Covet: Papers oA Sttaw
PIT DIMENSIONS:
Numbet o6 pits GAavet aAound pits ye.a no
Outside diameteA St. Depth below inlet gt.
2
To.ta.t abzonbt.ion aAea St A
Area Aequ.iAed 6t m
INSPECTED By TITLE
APPROVED , DATE 197 REJECTED DATE 197-
Cy
EH 1 1 5 Rev. 9/78
i REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: NE SE Section 12 T 28 N,R 16]t (or) W, Township s Eau Galle
Lot No. , Block No. County St. Croix
Subdivision <Ime
Owner's/Buyers Name: Lyle E. Larson
Mailing Address: Woodville. Wiseonsin 5)4026
TYPE OF OCCUPANCY: Residence X No. of Bedrooms- 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT. ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS 12/h/79 PERCOLATION TESTS 1216/79
SOIL MAP SHEET 79 NAME OF SOIL MAP UNIT AmeTY
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- NCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL D2 PERIOD3 MIN/I^ j
I jf!
BER 1ST WETTED SWELLING IN MINUTES PERIOD1 PERIO
P-1 36 6" topsoil, 30" Sand 24 None 30 3-5 8.6
P 2 0 TMjoij. TMjoij. '~Q- Sand 24 e 0 .0 10 .0 .
P- 6 8" o it "2$" Sand 2 Nond '0 4.0 44 4.0 7•
o_
P-
P-
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- 1 84" None unknown 6" Topsoils 8" Sand
B- 2 84" None unknown " " Sand
B- " None unimown 6" Topsoil, d" Sand
B- $ " tVone unknown 6" Topsoil, 78" Sand
B- d411 None unknown 6" Topsoil, 6" Sand
B- 6 64" None unknown 6" Topsoil, 8" Sand
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 LL95 sq. ft. Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
L/ C', /
L,r1.1 i
3 4 3
3 z
i
3
3
e v
a r
V t
m~
3
z.._._ _ s
,
i
t
z
I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures anrf.mwilods
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the bell' of my
knowledge and belief.
Name (print)_._.._ Stephen L. Asby Certification No. 11L0b
Address Wood:villgS Wisconsin y4Q_) 1
Name of installer if known Aaby Plumbing
*:opy A - Local Authority `
State Permit #
W State and County 4
~
PL867 ~ Permit Application County Per # 00 D
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:
Lyle 2" Larson Woodville, Wiaconsin
B. LOCATION: NE Y4 SE '/4, Section 12 T 2t1 N, R 16 f (or) W Lot# --City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Eau G91le
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance_
Single family X Duplex No. of Bedrooms i No. of Persons h
D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste Grinder _ YES X NO # of Bathrooms-1
Automatic Washer X YES NO Other (specify)
I:_ SEPTIC TANK CAPACITY 000 Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
New Installation X Addition Replacement- Prefab Concrete- .L
`Poured in Place Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 6*6 2)3.~ 3)7.11_Total Absorb Area 495 sq.
'wew X Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet 99 Width 13' Depth 3611 Tile Depth _ 24 No. of Tr es
seepage Bed: Length Width Depth Tile Depth --No. of Lines
-
Seepage Pit: Inside diameter Liquid Depth- Tile Size - 4"
Percent slope of land 10;7, Distance from critical slope none
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20
\'Jisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME Stephen L. AW C.S.T. # 1 06 _ and other information
obtained from Lyle E. Larson (owner/builder).
;amber's Signature MP/MPRSW# 514 Phone # 715 - 69d-2407 -
P ;rnber's Address ood illts. Wisconsi rj402d -
4 FLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with i
H62.20, including well). 0
I J
i
, ! ~x fl►t Tpt K
o
'57X C- Ze
r
s
Do Not Write in Space Below FOR DEPARTMENT USE ONLY /i~
Date of Application )l 11 ;,7 -a Fees Paid: State /5•0Coun y - ~te C
Permit Issued/B~e (date)a7- Issuing Agent NarRa
,ection YeVitecopy) No Valid# Date Recd -
y my (w 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
(pink copy) 4. plumber (canary copy)
I
i
/ I <?'f' o.
r. `
Q
lj ~ ~ pv
I
- f f 'l
_ - - <