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HomeMy WebLinkAbout040-1035-95-000 n N O 3 v 0 r~ °c = 3 R 3 d L/1 v ~ m ~ m .r Cl) i= w z N) fn c) 0 90 -11 7' O O C O W (O y IV Q h-~ W A O Q ro Z o- z tOfa W (3n O j N O O W= ? O cn p 1 N N N O- 0 Cu N O O 00 -0 n n ~ O Cn (n O Ul N (Ji 3 O p 0 m O 7 N A O p d (D rn O cn D W A (D (p (D N G (D v, 07 a N CL C O W N N 3 O Q W 0 00 (D N to i O Sn~f N O O a N C C ~ a 0 0 0 p"VIA • O O O ? 0 co to co - D p N Z 'ma y v o v A C) CD m m(D N C) w CD I (D (O (D m N M O Z O Z (n z O A _o D (D O No = O D ~ O 0, N .'D N m E; N• N -u C Z CD M. C N N O_ O CD p 1 CD p, CD N C ;u :3 A Z O Z --1 oD W M N 07 i O 3 A ~ O Z Z 0 (D Z (D a w FDA D O O 0 y (1 3 N 0 cD n c 0 (D - (D -d N 7 T O (a (O (U C N 3 O Z d CD O 'OOy~ ID N N C) o - yfi Q~ O O F 00 ram„ R O (D O C 3 0, - O 0 0 : n - o0(D o -0 F N. (D S?'O N ~N O N O (D ] N ~ ~c O 0 b CD a o CD ao a <n O `v ° ° b O CD • AS BUILT SANITARY SYSTEM REPORT ADDRESS , TOWNSHIP~^ SEC. TTtN, R~IJ ST. CROiX COUNTY, WISCONSIN. ;DIVISION ' LOT ? LOT SIZE PLAN VIEW Distances S dimensions to meet requirements of H62.20 co RF +,'r o CFi~F r~ r- SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM n Cr 2~ " _T41--4 J ►4' rt i j 1 ` fi -I - - - - -4- _ - - ( - L~ I _ ! ( T~ 7 i ' v Irtdseaetorth ArroT7 ISCALE: 'TIC TANK(S) / - d 466-. i✓i CONCRETE "J STEEL NO. of rings on cover Depth c'~ DRY WELh -L-NCHES NO. of width length area_ no. of lines width length area depth t`top _ of pipe - GRrGATE RATE AREA REQUIRED AREA AS BUILT vsclaimer: The inspection of this system by St. Croix County does not imply complete oppliance with State Administrative Codes. There are other areas that it is not possible o inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County will make every effort to 'e ermine cause of failure. GASES AND OILS SHOULD NOT BE DISPOSED THROUGH HIS SYSTEM. '-INSPECTOR DATED PLUMBER ON JOB i LICENSE NUNBE - - - z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sani tarry Pe4mi t /0,3 • State Septical 92? NAME CcUrot O I"ownahip r S~. Cnoix County Loca.t-.ox N L Mk-L- Section SEPTIC TANK I Size tvL9 d gatton4. Number 06 Compa4tmen,t4l / DiAatance FKom: Weta l St. 121 a,% gnea-ten 64ope 6•t 13u4ed.tng~6•t. We.tZand4 6.t. DISPOSAL SVSTEM N~ghwaten 6.t. Di4 Lance F.%om: 6.t. 121 on •quaten a.Zope 6$• >Iu4td~.ng~6-t. We.t•Ean44 Ft. FIELD DIMENSIONS: Width 06' nench -~--~~--4 Depth o6 nocfz be•Cow, .tine Length o6 each r 6 D •th 06 rock oven •tize Numben• 06 Depth o6 .tite below grade in, 16 To.ta.t 'ceng.th 4 ,t. S.Lo pe 06 -trench .4,n pen 100 6.t. Di4.tance between Zinea____lt. Depth .to'bednock 6.t. Tota•t ab4 o4btion area 6.t2 Depth to gnoundwa.ten 6.t. Requi4ed a4ea 6.t2 Type o6 Coven: Papers on StAaw PIT DIMENSIONS: Numben o6 Pit.4 64avel. around pit4 yea no -Y- Du.t4-i.de 4iame44 pe.pU be4ow iAZe-t___.3 6,t. Tota.t ab4onb.tion area 6t 2 : z Area 4equ.44ed--6't2 m INSPECTED,--~-~ - TITLE APPROVED. DATE v C 197 REJECTED , DATE 197 . y ~ 1 V 4. t .-,r.~;. ...•w....,-ti-w•-............r.:.r..crraw .o».+..:r..s.rnr~.svsarr«..:..,.n,..;w.;.......ow..ws,U,....w....... ..m,. nu=.r.c.r+u. ' EH 11J Rev. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: '/4,Section ~ T -N,R/J E (or)aV Township or Municipality Lot No. y Block NO. 1f}l~(L~S <p~i~- $'vy~r~~ County ' ubdivislon ame Owner's/Buyers Name: CA)rc N Mailing Address: f/ 7 (11 TYPE OF OCCUPANCY: Residence No. of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MAD IL BORINGS `~~''C 3 Ift PERCOLATION QTEST Gtl-41446 0 -see ~c4.~~ SOIL MAP SHEET 565 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_ ^11le P- 5;T4 74j; 6ALC CS EGOW E~7j~1: ED S©i ~Q frE ' P_ off 2 . 2 d i~ 6 5C S r' l1~rL D Fa~P S P- E,}9014 w IP- E G -If 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- / %YS~ ~Uf1,tfE /©'A 4Nh~l fPoM / " / d W Z~04,4 11 `*6P. So..sfiA)v /a ` B- 33"- / 64. sc;L Ev f f, c-: . MytS "c5 /L - w f. B- 2 pfd<VE "AIMP--V-0 „Q~" «G!•/3N sc[ tc, )(0 Y3 11 1 B- 3 J~ NOrt1~ I ~`C ,uL f~O.M "~i~Bv,LOAM `~``/.QN•LOMy 11ZATO.SC, "~jj►EQ R. B- 33 V o " 14 MAD `'L eN. Sty w ~ . M,04r, PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 5- JCZ4W .Indicate scale or distances. ~jpyE/~S Give horizontal an 2.7 12 d vertical reference points. Indicate slope. d VAPO.~~ 110016- (:26 X) k !v;/f W% V f~, Oc;r n I ;G ~ r • " yA, e M bowal TEST meA s~p~S RNA A/T~/c'~t1~¢TE' S°7.E I p . ~~E 3 fa~P 31 a ' Tr s T P 7AF) AFXCZ- tq j "r go r} • I~4i~uTEfy - /EUy17-10-v = IC '13 lpajf -iF i~--♦_°yt V i r< y _ v ~._.7" 1, 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. 4 Name (print) Certification No. a SO V 3 Address 1wElL ed. s Name of installer if known c~ ~ i~ r C Copy A -Local Authority CST Signature . E H 115 Rev. 9178 or REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:Nr'/<, Section ,T `w N,R&E (or) W, Township or Municipality Lot No.2--, Block No.+~5 z~p~~ County G;~mL ' Subdivision ame Owner's/Buyers Name- s- 7 3.d JCT , doPSO.'tf Mailing Address: ` TYPE OF OCCUPANCY: Residence X No. of Bedrooms 2 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW A REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS SL)UC F3 iWO PERCOLATION TESTS SOIL MAP SHEET S~ 7;~ NAME OF SOIL MAP UNIT J'AU S1)P70 E 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 AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES Aze AV - co .4f L B- *0A; E A..1Z) " Se, B- 0AX0, 7" B- " Al -QN. L'S w B- l 9",13 ti,0 ,Por "D/. / sL ~Z,. )»E~.s 9 `'ScL w .f 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. jA XA0_A W; NCl;rjF ff If14 060 SoN.P oj• 5;e l- ~Xisis _749at>0644ou7T • f ~'NDt G,yTEf o4 T 'Mzot e /S 4 -It cp f~^~}.Sil,f1 ALL y 547U,e4 TED ZoAop r- 1`~ii~ S'~`~P~9 /~E.s 4wA94-t 4 MA4,014 Z_ A c-D o 7Z E•~ cy 4949,E A` IJoA--' -Sy sTe,-7 &;,00A0 l1'E ~O •JS TieUc TED . S wU~~cJ'/10.~4 L S~S)'E.y tvi/l ,va'T' tcA'.e-, ZV 5`re, ,0 A ~iP Ll1EL L SEA E T S~,Pp wit t.~ t " y C 4 k &~co w 0S T f~e ~a r L'e.;► s - ' x E } 4 a 3 t ? T- E 1, 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. ~1 L 6 APT ~ / c / Name 'prirtt)..._ /h Certification No. Address di-3 D; 1C1Z- AA") • UP50 W/s • 5,"01 ~v Name of installer if known ST Signati:re ~tf~!~!.L_...'__.L~•> Copy A -Local Authority r CC p r ` • E 115 Rev. 9/78 ~y REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: Section T"N,R~E (or) W, Townshi or Municipality I C 1e pp,~,(:~ Lot No. 2 Block No. __.lAl 2_,APP~ i?Lwwo` County L SElJ4iVSd Subdivision Name Owner's/Brs Name: ~ Mailing Address: S~•~~~'~ ms's TYPE OF OCCUPANCY: Residence A, No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW K REPLACEMENT ALTERNATE SYSTEM OTHER SOIL BORINGS U*-k 13 fQ /6p0 PERCOLATION TESTS DATES OBSERVATIONS MADE: SOIL MAP SHEET Se S' 7 NAME OF SOIL MAP UNIT 51 77~edF_ 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 AFTE INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- P- P- 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- -PIV.1k 13- 13- 13- 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. E ~ 3 40,09! r' 7-16-4.) 0,4c- e ~ l/E ff.~K~f DST 1.u~£D ~Pc~~, jD~ 3 U N - E 9 ° 412 . 2 I . / f 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) Certification No. Address Gz Name of installer if known I-- Copy A -Local Authority P-18 67 State and County State Permit # Permit Application County Per it # 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: / GJ / B. LOCATION: AJ WSection T i N, R El (or) W Lot# ~Ir City Subdivision Name, nearest road, lake or landmark Blk# Village i ~ Township ( -f ,j C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms + No. of Persons D. SEPTIC TANK CAPACITY `S : Total gallons No. of tanks_ No. of tanks HOLDING TANK CAPA ITY Total gallons Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation y 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 'r- 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: side diameter Liquid Depth No. of Seepage Pits:::~ Percent slope of land- + Distance from critical slope WATER SUPPLY: Private F2 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 Cer fled Soil Test ~f 1 NAME ! i ( L C.S.T. # J:;nd other information obtained from + s (owner/builder . .1 7 Plumber's Signature Phone Mr/MPRSW# Plumber's Address ^ w + ,~+w PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- V/^ tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors ' ro ert . If well has not been drilled lease indicate. i j e z. P lJ t 1 ( t~ d rte.' nC n A 01 Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State County dz D-a to Permit Issued/Rejected (date) r, "a 6 -AC) Issuing Agent Name eLa~ l Inspection Yes _e~ No State Valid# Date Rec'd 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