HomeMy WebLinkAbout026-1041-60-050
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AS BUILT SANITARY SYSTiM REPORT
OWNER TOWNSHIP S ,T cti SEC . T ,7c- N, R f S W
P.O. S ST. CROI COUNY, WISCONS N
SUBDIVISION LOT LOT SIZE >';~~G"c U
PLAN VIEW
'
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
f~(J °
MFGR. CONCRETE STEEL
SEPTIC-TANK(S)
N0. o rings on cover r Depth DRY WELL
TRENCHES No. of width e-ngth area
BED no . oT lines - " widt~i length area / f A/ '
depth to top of pipe
AGGREGATE
PERK RATE AREA REQUIRED AREA AS BUILT
DISCLAIMER: The inspection of this system by St, Croix County does not im7
complete compliance with State Administrative Codes. There are other are
that it is not possible to inspect at this point of construction. St. C'
County assumes no liability for system operation. However, if failure is
noted the County will make every effort to determiT-af:~ cause o failure.
GREASES AND OILS SHOULD 140T BE DISPOSED THROUGH.' 7 SYS
INSPEC
PLUMBER ON JOB
,DATED
LICENSE
3.r
Rx:POP,T OF I1ISPECTIO?1--I NDIVIlliJAL SEiIAC,E IaSAI, J1'; TEti
~nnitary Permit
• • State Septic
1,1E T61,11ISHIP
t. Crop; County
SF.''TIC TA'?Y.
Size gallons. `lumber of Compartments
Distance From: Well ft 12% or -
Z . greater slope mot.
Building` ft. Wetlands ft 5_4 11ighwater ft.
DISPOSAL SYST7:1_Tile Field or Seepage Pit(s)
Distance From: Uellft. 12% or greater slope ft
Building _ft. Wetlands f
FIELD aighwater ft
Total length of lines r~~C ft. Humber of lines Length of
each line eft. Distance between lines ~ft. Width of the
trench / ',-2 ft. Total absorption area sq. ft. Depth
of rock below= tile /"'-in. Dp-pth of rock over tile in. Cover
aver . r.ock,, Depth of tile below grade in. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS %
Number of pits 0 si ameter ft. Depth below inlet
ft. Gravel a-rou es no. Total absorption area
sq. ft.
.Square feet of seepage trench bottom area required
Uquare feet oz se g'e ni oa required '
Inspected y: Title:
• Approved Date L:t r 197
Rejected Date 197.
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'
LOCATION: '~--'/4/"_%, Section T,kN, R,CS (or) W, Township or %4~ity
Lot No. , Block No. County
Subdivision Name
Owner's Name: c L 4
c
Mailing Address: L t`' c F
TYPE OF OCCUPANCY: Residence No. of Bedrooms - Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SQIL ORINGS ril c_7 K_ RCOLATION TESTS
SOIL MAP SHEET _ SO i L. TYPE ti-Cq
PERCOLATION TESTS (L
(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
I 1
p I/
2VAI
Z
P- -7
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)
P-
Z, R Al
~f -7
-2,, J
`'t_AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
~dicate on the plan the location and square feet of suitable areas. Indicate number of quare fegt of absorption area
(,c=eded for building type and occupancy. 41-11 1", Indicate scale
of distances. Give horizontal and vertical reference points. Indicate slope.
s`f
I
I
FF-
A, 7Z
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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 ptf,,
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 kn wledge and belief.
V
Name (print) C 1", Certifi ati n No.
Address
Name of installer if known
CST Signature
COPY A - LOCAL AUTHORITY
State and County State Permit # `
P LB 6 7 r Permit Application County Pe~rrmij #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. # -
A. JWN OF PROPERTY Maili ress:
.
B. eNC Se ti on / T N, RL E" (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village )
Township L /
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance _
Single family C_ Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher _A_.,~ES NO Food Waste Grinder YES 'ITO # of Bathrooms
Automatic Washer Z-~ YES NO Other (specify) _
E -EPTIC TANK CAPACITY , Total gallons No. of tanks
`!folding tank capacity_ Total gallons No. of tanks
'`few Installation Addition Replacement Prefab Concrete
Poured in Place Steel Other (specify)
FLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) Z 3) Total Absorb Area /.sq. ft.
I' ew_j,/Addition _ Replacement *Fill System
:seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
-Lepage Bed: Length 6,21 Width 1Z Depth _ Tile Depth 264 No. of Lines 27-
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land a Distance from critical slope
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 ' d Soil Tester, /
NAME lC1j~ ► / 11C 7`E C.S.T. # 2. ? and other information
obtained from (owne uilder i
Plumber's Signature MP/MPRSW# / Phone
Plumber's Address "
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
-5 7-,
i
r~
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State Count Date
Permit Issued/R- (date)- Issuing Agent Name!
Inspection Yes 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) 11 r:-
r Parcel 026-1041-60-050 04/04/20PAGE:1 OF1
Alt. Parcel 14.30.18.202A-05 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
11/12/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - DEAN, JOHN B
JOHN B DEAN
1556 140TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1556 140TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R18W 37.06A SE NE EXC W Block/Condo Bldg:
15870F N258.7'&EXCN417.6'OFE
208.8' SW OF TN RIDS EZ-U-1216/421 EXC AS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DESC IN 2694/252 14-30N-18W SE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
11/12/2004 779720 2694/253 AFF
11/12/2004 779719 2694/252 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
95611 Use Value Assessment
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 22,500 108,200 130,700 NO
AGRICULTURAL G4 34.320 5,600 0 5,600 NO
UNDEVELOPED G5 1.390 100 0 100 NO
I
Totals for 2005:
General Property 36.710 28,200 108,200 136,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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