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HomeMy WebLinkAbout030-2047-90-000 N O C) 0 6 h o CP a c � o o r o ,•- O CL •O O m O O) E N E O O C N C O O L Y O O 'O Cl 1 cp O w X a) c CL a) Z o c 00 0) In ac I (p 3 O O C C E m@ a) O N C, N C - D C d .N O. -O N OO 4- O .� a g N�°o Oc) N O C O.N - C y d @ a) 0 N� ,C N 2 O ° c ) a U i(n N •a > @ E �o o ° @ O Lw E -o a) N . O O O O C b Z @ �+ C Z 7 N O +•�-• E Q' N @ C Y . C O'.- Y C@ 'O CO C F - 7 @ c C 7 @ O o I @ @ a) w W C a) LL C - @ N O N c p ip a) @ o _o �Ea) _o C@UOODU�C� c c a> . a - E - CL @ 3 a. - n o a) 3 m E Q ch0v E Q O�w�2 M a a a) a) O N N O O J '£ O Z 'a V 0 o a m a m N i c O z Z c c I d Z C c CD CD N a) cu N N a) N N N o N o • N d Cn _c d Cn O c ` O O V o N Q o N Q z m z z m z I c c I � II - c .. d1 N .. d I 7 C) @ E @ O @ E @ !V o v .. o a .. o LO 4) LO 4 ots CL m CL m a) o o a L O D d L U L �*\ 0 0 0 0 a 0 0 0 0 a N o a a CL o a a a IL o_ v O 0 O O O N 00 00 N f!! J U p 0 0 �_ } o O O cu _ M o a ao 00 CA M O q = C) o o o o Z a) � - c 0 0 0 0 0 n _ y N E N _ E O '.. 00 O O = a0 - 't:`; 00 f� to O_ en 7 � • O w r r \ cr a) �j 4 2 O 3 V) C V) C O Y O o2S Oa N o2S j N CO O O �- a. 4) U d L O u? L -C N C_ C_ eC6 N N e •O N N N N N N C) oM LC Y o o s o co Lo 0 Z N W CL L7 U to \J v� M . E m a a �'al'I gin. � a Lam r , E c°'i 'E c c c c "� 1 A u CL I I O in U O ire C) :reofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix FF Division INSPECTION REPORT Sanitary Permit No: 515098 0 .L INFORMATION (ATTACH TO PERMIT) State Plan ID No: Per;, ,formation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Clark, Keith & Maureen I St. Joseph, Town of 030 - 2047 -90 -000 CST BM Elev: Insp. BM Elev: BM Descripti n: Section/Town /Range /Map No: 10 • (1 Q d -a 6 ate 27.30.20.51 OK TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � � Benchmark � • / � � � �� � Dosing ! 7 r L Alter Aeration J lJ Bid . � �� -CAS � i1. ys �9• I Holding —/ 'l v S t Inle TANK SETBACK INFORMATION v .7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet d rut. /34 S Se tic 3) Dt Bottom Dosing 1/ 3 ) Header /Man. � Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION S 77 Manufacturer Demand f over q GPM ,S r 7 J• S O Model Number , (� • v 47t 7tt Z TDH Lift Friction LoilW System Head TDH Ft Forcemain Length Dia. Dist, to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO PP /L BLDG WE L LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacin SOIL COVER x Pressure Systems Only V xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil F11 Yes E] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_// lJ t Inspection #2: ! / Location: 1382 Hilltop Ridge Houlton WI 54082 Gov't Lot 2 27 T30N R20W ) metes & bounds Lot' "� Parcel No: 27.30.20.510K 1.) Alt BM Description= ` -S � C- T�N't✓� � 2.) Bldg sewer length = C� u�W /S� ✓tg - amount of cover = �J - - - - - - — — Plan revision Required? ❑ Yes o 3 i ` Use other side for additional information. S8D - 6710 (R.3/97) Date Insepctor's Signat re Cert. No. i Safety and Buildings Division County Goo f 201 W. Washington Ave., P.O. Box 7162 Visconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be lled in by Co.) Department of Commerce Commerce (�8) 266 -3151 6 1 6�f' Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information r A, may be used for secondary purposes Privacy Law, s15.04(l) Project Address (if different than mailing address) I. Application Information - Please Print All Information ✓C� RECEIVED Property Owner's Na me Parcel # Lot # Block # � M �R� C /��1� 0 9 2009 630 • Z ay7. 90. OVO Property Owner's M ailin Address Property Location 13 �� W, // to �D PLA PLANNING i ZONING OFFICE ��/ /�!), City, State Zip Code Phone Number �6 'A, A,Section 40 L ����Z 9 • �p� J Z (cucle o e) II. Type of Building (check all that apply) T N; R E o EV 16 or 2 Family Dwelling - Number of Bedrooms - h y G��Jtr nLN�� Z l � i CS Number t- / I' ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use []City []Village 16TQwnship of 3 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' 11 New System ❑ Replacement System Treatme I3sldiag -T-ank Replacement Only ❑ Other Modification to Existing System �tiLNytnber and Date Issued B. El Permit Renewal El Permit Revision El Change of El Permit Transfer to New List revi Qys Q ? 7CJ�p Before Expiration Plumber Owner 'WOU. IV. Type of POWTS System: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe W (explain) V. Dispersal/Treatment Area Information: 6 X157 A) Design Fl w (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation • 7 -Jo N"At A C," .SLOE 4.r u / i f �/</ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank "V tv / M 4 011 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature W /MPRS Number Business Phone Number Rp13��T Z1 jb�i� ZZee37 45' 77a •3 f Plumber's f Addre ss (Street, City, State, Zip Code) 5 W 7 <e VIII. ount /De artment Use Only - Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent igna re tamps) Surcharge Fee) ❑ Owner Given Reason for Denial �L IX. Conditions of Approval /Reasons for Disapproval 7 �� . -� qty>�( 2 / r �G1Ci I2 C E �✓� yLr �i CGhoC (.GCi, C� c_'G� Attach complete plans (to the County only) for the system on paper not 1 s than 81/2 x 11 ' es in size SBD -6398 (R. 01/03) s s s a l/t./- .c.T/1 C! ter/ / /•` DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 5`3707 P.O. BOX N9 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number.. El Holding Tank 1:1 In-Ground Pressure ❑ Mound (11 assigned) NAME OF PEPERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D TE: Keith & Maureen Clarke R. R. 1, St. Joseph, WI 54082 !/"�S BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. NE NW, Section 27, T30N -R20W, Town of St. Joseph rame m of Plu ber: MP /MPRSW No Tst ounty: Sanitary Permit Number: Robert Ulbricht 3307 . Croix 58906 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1/ 5 PROVIDED: PROVIDED: �( [:]YES LINO ❑YES ONO BEDDING: VENT DIA.: VENT MA L.: HIGH WATER ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: { LINE: AIR INLET ❑YES NO ❑YES 0 N ` DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL:► i.. PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE 0 AIR INLET: PUMP ON AND OFF) ❑YES ❑NO �1' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: w` WIDTH: J LENGT NO. OF D SP ACING: CO INSIDE OI A.. #PITS: LIQUID ERIAL: b DEPTH: TREN S: GRAVEL DEPTH FILL EPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO R i4 PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES I� ABOVE COVER: ELEV. INLET ELEV. END PIP �� �s .t °. LINE: I I AIR INLET: 4 r c MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL COVER I TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO ❑YES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER 7RENCHlBED DEPTH OF TOPSOIL: SODDED: SEEDED - . MULCHED. CENTER. EDGES. DYES ❑NO 1:1 YES ONO 1 YES 0 N PRESSURIZED DISTRIBUTION SYSTEM: "- WIDTH: LENGTH: NO OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: t' TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.: ELEV.: PIPES: CIA.: HOLE SIZE HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: DYES 1 NO 1 ❑YES 1 NO 1 r �f Cqf Sketch System on R in in county file for audit. Reverse Side. SI N T RE. TITLE: DILHR SBD 6710 (R. 01/82) . n 2 0."0 n c \ m m .5. m' �� � §�/ $ ƒ [ ° g o m § \ 0 , g _ p- \ J [ § ƒ § « 0 o N ■ ) \ \ § E ( ¢ $ ¢ \ �\k 90 0 k ® E E I % 8 E o ID i © , m ¥ > . E m E e a ® A /3 [ co @ a §� \:I J o r ■ k i R t L . - m E } 0 0 o Z / \ { CO) § CO) 2 O 0 R 7 a ° $ £g� » : 7 E § \ 0 e / ■ § CL CL \ § 7 m e g 0 �- ƒ § r 0 cc [ k . / e - F ° 2 z CD ` / } ) \ R 2 / . \ / \ CL § % E k \ma » CD ` \ �a ] % CL U ? 2 CL CL -. -0 @ a \ \$ 2 \ 77 EC ) §)fE CD Ma k 0 q m q 0 � /8% % 0 / ; G / , f / } % 0 ` CD \ F orm S T C 1 0 AS BUILT SANITARY SYSTEM REPORT e400f 7 OWNER /' TOWNSHIP S S SEC. T O N - 20 W ADDRESS ST. CROIX COUNTY, WISCONSIN ,l( rf SUBDIVISION LOT LOT SIZE c r " PLAN VIEW M AN � Distances and dimensions to meet requirements of H 63 S"/A d •` SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM P9 T� U. R��. �f • � S o �iE v , 3 00 yy i S 77. 3 3 �� �ft STi�� �'IF�hTinr 4r ��,ut ?joy W fit - ;s 9� 73 • fop (e prl� s/r�o - -` r - - - - -- AO S H" fo %D ° 1A 9 s ° ��� ��T%a O 0'ma S , 9�p�dv�° ,H��vh�✓�- 9 y � 3 X3.3 i F'lev• 0 0 -30 %3.k/ 303y� G �/Ev #Tio,J� O INDICATE NORTH ARROW 0 � _ p %s BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: �' Proposed slope at site: �v ever e14Ao a ?��v,� is SEPTIC TANK: Manufacturer: EX% ST -' le' Liquid Capacity: Igno s q i Number of rings used: Tank manhole cover elevation: ! 1 . y Tank .Inlet Elevation: V, s Tank Outlet Elevation: P Z- Number of feet from nearest Road: Front,O Side,Q Rear, O > feet From nearest property line : Front, 0 Side 0 Rear, 0 -3 feet Number of feet from: well � building: 13 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) # SEE REVERSE SIDE W i-4A T tat - ��- 13AF -me Lh9 I . ISOO - 1 $ - I qk2� PUMP CHAMBER _ n Manufacturer: �t��S Liquid Capacity: V Pump Model: 2 4 i / Pump /Siphon Manufacturer: Zot �� Pump Size Elevation of inlet: PV 6 7 Bottom of tank elevation: y Pump off switch elevation: /- 0 Gallons per cycle: Alarm Manufacturer: �fyE� � /�� `'o Alarm Switch Type: ' STS Number of feet from nearest property line: Front, 0( © Rear,0 Ft .- ' Number of feet from well: Number of feet from building: 3D (Include distances on plot plan). S ABSORPTION SYSTEM Bed: x Trench: 2 " j Width: �� Length: !�� Number of Lines: Area Built: _ „ Fill depth to top of pipe: A4 i)-Al yo Number of feet from nearest property line: Front, O Side, O Rear,O Ft . Co i Number of feet from well: � Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: ber of pits: Diameter: Liquid depth: Bottom of se it elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: .Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated • � /j/ " Dy- t 1 ( a Plumber on job: HOMESITE SEPTIC PLUMBING CO ROBERT ULBRICHT License Number: WIS. MASTER PLUMBER LIC. NO. 3307 14P.R.1 MINN. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj ocn0 0 y0' - 00 t:7 �1 d f 0 c lu 0 `� 1 m m c A(D m a rn1 v M CD AD cn 2 2 O C7 O N yz O E P,) � E N O m y m y � w w C • O CD O C , b O is a 3 CD � 0 O N '.►r7 n m cD j N - a� a a� � m p= O� N K) A O N N N N N N a. v d cn �. 3 N �_. v -n 0 0 0 0 0 0 0 N O > 0 --1 0 O 9. o cfl O N O o o CL o T. 0 N C C C C O C7 d <D N w O N C W Z D m a(D rn v o m N a �u D a j 83 N T C w0 q W v N N N N N N O O : 2 w; CO O O O O ' m m v rn W (D (O -° a Z O0 O • (7 r to ` 00 co 0 c (Q O CL Z CD CD 000 000='' °: C p C T ! ! cn cn cn fn U1 Cl) !, CD , f O D <D - M Qo 0 � CD v, I 0 m cn I v (D .. d O <D M d co C (� OD ' N N z m z z co o Q 0 D a m 0 D a (D �• N N (D N L1 o N TJ o N N CD C CD d C N N C N N �f D a fl. 3 (D O O z f1 N C N C ; CL CL ;' z 3 N W W 0 O v CL G Z 3 r o - p ° nD .•i N O m N `� 0 0 0 w m I w v m \Q ' O CD m m� 0 a CD �m a m m ° m ° C v ° W C O O n n N O: G Q n O O (D N N Q N = T T a o m a — a= N@ N C N C � CL co 'p N O `G N Z a Z a O O 77, O cn co F cc a m m so CD CD m << °7 a _ CD = N ti O y a a .� OS a 0 yC 7 T N O X a N 5 a �co-0 cn� � o 0 o CD x 3 e 0- = oo rn C do 7 -p 27 O O O p p b O ;L 0 o A 0 0 O O O b ( CD o < m 0 0 o 0 oCL oa a �(a 0 3 -0 0 / � G « ■\�k] » � _ 0 ƒ/ 0 o a 0 §-4 o , @© �§ - ; w k$ k a� � S k) E kkCk 0) \ � j CD k 2 ® o \ \ ; ` g E § 8 E E c a © 2 @C> � \ � E s m � e , / \ m e e > © §� / = 2EC z I 0. § � k o o 0 o t § ƒ § § § 0 5 3 ■ ■ ■ , m \ M. Tvo\ ( . �CD § ® I E \ ff , / \ \ =_;i 2 2 \ / / , a ƒ 2 C CD / E / 3 .4; k \ = c � ■ � \ CL 0 .. 0 G) / \ CL z 0 t E 2 CD CD �f k_0 2 000 �a CD CL M ; «§EID R ƒCLGO[ 3CCD< 0 �aa @ «E3� 2 ��� ¥ � kC= CD ro ƒ ( 7 E CL CD 14 (n - q CD x xco 6 [ ) J i -o �4 , 8 � k Parcel #: 030 - 2047 -90 -000 02/22/2005 10:50 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.20.510K 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner " CLARK, KEITH H & MAUREEN KEITH H & MAUREEN CLARK 1382 HILLTOP RIDGE HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 1382 HILLTOP RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.400 Plat: N/A -NOT AVAILABLE SEC 27 T30N R20W PT GL 2 COM NE COR, W Block/Condo Bldg: ON N LN 1198.2 FT, S 7 DEG W 702.9 FT, S 5 DEG W 87 FT S 4 DEG W 56 FT TO POB: S Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 4 DEG W 94 FT, S 76 DEG W 238 1/2 FT S 6 27- 30N -20W DEG W 347.8'TO S LN TH N 46 DEG E 257.1 FT, N 49 DEG E 90 FT, N 24 DEG E more Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6117 384,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.400 210,000 168,200 378,200 NO Totals for 2004: General Property 1.400 210,000 168,200 378,200 Woodland 0.000 0 0 Totals for 2003: General Property 1.400 108,500 149,300 257,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i r Form - S T C - 10 AS BUILT SANITARY SYSTEM REPORT OWNER /' TOWNSHIP S S!!2 —.0 SEC. — T 30 N -R 20 W ADDRESS ST. CROIX COUNTY, WISCONSIN 3 J-4 SUBDIVISION , L O OT S' LOT SIZE rU1/� L o - r 2 , PLAN VIEW Distances and dimensions to meet requirements of H 63 � SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �� 1/v 3�1 `f `� o°� / )1 i' Q f �. kef. �'� ` 's gig V, y yy i S 97 13 '"� ' ftst �IE��tTI�✓ �r GL to / , - --rl is 17,73 i Z /3 3 " foA Q 1 A �fiTiOa - c.z • F /& pd 0 60-, 7 � SN y" Si �p NIAM�✓� �p�N� , ?3 / st�frG pU � / f / I /3o1f0'� if Opi'v ���• / x _30 73.x1 �1/G ' t a fTlo O � � s' INDICATE NORTH ARROW co�eN F• , BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /0 0'0 Proposed slope at site: �D �a Nor eivOwN z T ,4N& / SEPTIC TANK: Manufacturer: E'X/ S Ti� lr '(- Liquid Capacity: 10710 S' Number of rings used: Tank manhole cover elevation: / q S .S • < Tank Inlet Elevation: 0 �. J� Tank Outlet Elevation: Z Number of feet from nearest Road: Front, X Side, Rear, 7 i O D O > feet r From nearest property line : Front, OSide, XORear,0 .5 a feet Number of feet from: well -' building: 13 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE # cvO 130 . P,- tFP'1ES l PoO• 15 — rgky f • r PUMP CHAMBER Manufacturer: ��F�S eKc- Liquid Capacity: Pump Model: - -/ "V Pump/Siphon Manufacturer: � �• Pump Size !/ Elevation of inlet: Pa. (0 -/ of tank elevation: � Pump off switch elevation: U /• 0 Gallons per cycle: �� 5 Alarm Manufacturer: Lf�E� A�� //�� `a Alarm Switch Type: ' M 7 %44TS Number of feet from nearest property line: Front, ot © Rear, 0 Ft �d ' Number of feet from well: `,1 Number of feet from building: 30 (Include distances on plot plan). S ABSORPTION SYSTE� Bed: X Trench • Width: J� , Length: ��(� Number of Lines: 3 Area Built: Fill depth to ` top of pipe: � /M jl-Al 76 Number of feet from nearest property line: Front, O Side, O Rear, O Ft. � / � Number of feet from well: — Co o Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: ber of pits: Diameter: Liquid depth: Bottom of se it elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job �V O V. �� HOMESITE SEPTIC PLUMBING CO. i ROBERT ULBRICHT License Number: WIS. MASTER PLUMBER LIC. NO. 3307 MARX MINN. INSTALLER & DESIGNER LIC. NO. 00663 3 84:m' DEPARTMENT OF�INDU TRY � S INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI b%3707 • LZCONVENTIONAL ❑ ALTERNATIVE State Plan I.D. Number: (if assigned) El Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION D TE: Keith & Maureen Clarke R. R. 1, St. Joseph, WI 54082 BENCH MARK (Permanent reference PotnO DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT. ELEV. n . NE NW, Section 27, T30N -R20W, Tow of St. Joseph Name of Plumber: TP/ No.. F St. ySanitary Permit Number: Robert Ulbricht 3307 Croix 58906 EPTIC TANK /HOLDING TANK: MANUFACTURER: - LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ( PROVIDED: PROVIDED DYES E N O ❑YES ❑NO BEDDING: VENT DIA.: VENT MA L. HIGH WATER ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET. DYES ONO ❑YES ❑NO NEAREST D OSING CHAMBER: MANUFACTURER. J BEDUING. . LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES E1 NO DYES LINO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL OF PROPERTY WELL. BUILDING. J VIENTTOFRESH (DIFFERENCE BETWEEN FEET FR(iM LINE / ,/ AIR INLET: PUMP ON AND OFF) ❑YES 1:1 NO RAREST v Lp' { OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FoRce LENGTH DIAMETER MATERIAL AND MARKING r excavation. (If soil can be rolled into a wire, construction shall cease until he soil is dry enough to continue.) MAIN, C ONVENTIONAL SYSTEM: •WIDTH. LENGT NO. OF DISTR �pIPE SPACING. CO INSIDE DIA. #PITS: LIQUID E>1?TElr! / TREN S / ERIAL' PIT DEPTH. GRAVEL DEPTH FILL ffFPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO R MBjEft,OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELE V. INLET. ELEV. V. EN - PIP ` :LINE: I I AIR INLET: G FEET FROM r NEAREST �L OUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ OIL COVER 7EXTUR E. PERMANENT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES ❑NO � EPTH OVER TRENCH /BED DEPTH OVER TRENCHlBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. ENTER. EDGES: 1 YES El NO DYES ONO I EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: fi�ea..y� WIDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO_ DISTR. J DISTR, PIPE DISTRIBUTION PIPE MATERIAL & MARKING: spa ELEV.. ELEV.. DIA. ELEV.: PIPES. DIA.: HOLE SIZE HOLE SPACING DRILLED CORRECTLY_ COVER MATERIAL_ VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES El NO — ]YES ❑NO C OMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: _' PROPERTY WELL: BUILDING: LINE: ❑YES El NO DYES 1:1 NO f If It 1 ketch System on R in in county file for audit. everse Side. SI N T RE: TITLE: /7 ILHR SBD 6710 (R. 01/82) r I^ APPLICATION FOR SANITARY PERMIT �/ l c_ C OUNTY L_! (PLB 67) T- EVIT OF UNIFORM SANITARY PERMIT # InOUSTRV,LR60R 6 Humpn RELRT10n5 .a 90 6 — Attach complete plans in accord with s, H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /ix 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Ois PROPERTY LOCATION COY: ��� VTC=E: N6 1/4��1/4, S � , y�N, R E (or TOWN OF: d L,�O LOC N ER SUBDIVISI � NAME �� ARES ROAD, L STATE PLAN NUMBER T � ` Y TT PE TT OF BUILDING OR USE SERVED 0.W — Vr7_ [Z0 1 or 2 Family Number of Bedrooms: v ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-in-Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity "iS71N6 Lift Pump Tank /Siphon Chamber Q x Holding Tank capacity Manufacturer: Q (,Q IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: Z /lJr/ Cj! - PERCOLATION RATE ABSORPTION A A ABSORPTION AREA WATER SUPPLY: (Minutes per inch): J : R EQ UIRED tSquare F ): PROPOSED (Square Feet): r, i p 4 I �y6 �,] Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber ""Ft'TE SEPTIC PLUMBING CO. Signature: /MPRSW No.: Phone Number: D p Rt 3 O'NEIL RD., HUOSO l 3 3 (715 ► 'Q l Q Plumber's es : ULBRICHT Name of Designer: MSTER PLUMBER LIC. NO. 3307 M:P.R.S. MIN COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 0a/ ow El Owner Given Initial G, < / d Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: D I LH R -SB D-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. I TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 1 r APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /eontractgx,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property / Location of Property / '4 / ) 14, Section Z / , T 3 y N - R 1 W Township Mailing Address ' I �— sj IFS Subdivision Name Lot Number Previous Owner of Property ^ ��� Total Size of Parcel ;2- �7 s Date Parcel was Created `Z Are all corners and lot lines identifiable? Y Yes No Is this property being developed for resale (spec house) ? Yes I No Volume r4 and Page Number =- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. --------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) ee&t%jy that aU etatement Ozame a to the le,�t ob my (aun) k.nowtedge; that I (we) am (ane) the o 6 the pnapeAt e a ' bed in -th,i,a in6oAmation 6onm, by vi4tue o6 a w ed neconded in the 65 ce of the County RegisteA o6 Deedb as Doeume 0 ; and th I (we) ptaent.�y own the pnapobed site boge pobao.6ystem on. 1 (we) have obtained an easement, to 4un with th e de,6c/ bed pao y, bon the constnuct,%on a6 dald eystem, and ts e n y neconded 4.n the 0 o6 the County Regiz ten o6 Deeds, as Document No. ). SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED .AA { DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2 WARRANTY DEED 3 THIS SPACE RESERVED FOR RECORDING DATA I'I BY THIS DEED, Howard A. LaVenture m,:,G:.6TERS OFFICE ST. CROIX CO., WIS. Rec'd f�eb�iis nth _ Grantor conveys and warrants to Keith H C lerk an Ma uree n A . day of_, ci ark; husband and wife as j oint tenants, a t__ _ 8.30 ___ . ht. � f adc Grantee S for a valuable consideration and in performance of a contract r e -R ETURN TO corded 5/24/72 in Book 484,pages 447- 448,doc.31038 the following described real estate in St. Cr oix _ County, State of Wisconsin: Part of Government Lot 2, Section 27, Township 30 North, Range, 20 West described as follows: Commencing Tax Ke a __ -- at the Northeast corner of said Government Lot 2; This is homestead property. thence North 89 West on the North line of said government Lot 2 a dis- Itance of 1198.2 feet; thence South 7 West 702.9 feet; thence South 5 '! West 87.0 feet; thence South 4 West 56.0 feet to the PLACE OF BEGINNING; ;thence South 4 West 94.0 feet; t31ence South 76 West 238.5 feet;thence `l outh 6 West,347.8 feet to the South line of said Government Lot 2; thence North 46 East 257.1 feet; thence North 49 East 90.0 feet; ?I thence North 24 East 127.0 feet; thence North 4 East 133 feet; thence North 85 West 33.0 feet to the PLACE OF BEGINNING. ,,Together with an easement for an access road and for the installation of ;futility lines, so located as to not interfere with the use of the area as a ;!road, over the following described land: Commencing at the Northeast corner I said Government Lot 2; thence North 89 West on the North line of said ; 2;,a distance of 1198.2 feet; thence South 7 West 702.9 feet to the 'PLACE OF BEGINNING FOR EASEMENT; thence South 5 West 87.0 feet; thence South 4 West 56.0 feet; thence South 85 East 66.0 feet; thence North 26 East 90.3 feet; thence South 89 East 524.2 feet, more or less, to 5WcKWx=xx=mxx State Trunk Highway "64 "; thence Northerly on said highway 77.1 feet; thence North 89 West 656.7 feet, more or less, to the POINT OF BEGINNING - OF EASEMENT. A S c to ov is s t Out the Aff' vi of Ho a LaVenture, recola is 2 igi� in �olumue AP4, page iq9, f documen r 3 0 86. Executed at Hu dson, r -( soon $ n this -? _ y o f �� °' t "` l `'' _S' day 19.2 SIGNED AND SEALED IN PRESENCE OF 4 _ (SEAL) Howard A. LaVenture (SEAL) r�t� (SEAL) j 1 R.P : \� �i La L il • _ Q (SEAL) ii FEE - Si of Howard A. LaVenture _ 1! authenticated this ^ ���'t day of L� s"� O ' 19? 2 j ohn D. Hevw II Title: Member State Bar of Wisconsin)eZ:RjbffZ5VEM it Authorized under Sec. 706.06 viz. if STATE OF WISCONSIN 1 I County. } ss. Personally came before me, this day of 19_, j the above named to we known to be the person_ who executed the foregoing instrument and acknowledged the same. This instrument was drafted by John D. Heywood, Attorney at Law 1 Hudson >niiscr�nsin Notary Public County,.Wis. i )f The use of witnesses is optional. iNy Commission (Expires) (Is) Names of persons signing in any capacity should be. typed a pr inted below their signatures. a. pp ������ d p �( KcMaca )" tARRANTY DBBD - 8TAT6 BAR OF tiISCONBIIJ, FoRM�N0 9 Z71A ,, 36 .� H H ST C- 105 r 9 y SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County r7 OWNERk*4- F-F.R ROUTE /BOX NUMBER / Fire Number CITY /STATE ��-� ZIP PROPERTY LOCATION: N� �" � ' Section 27 , T ` N, R 20 W, Town of , St. Croiy County, Subdivision , Let numb Improper use dnd maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant f'or a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o E I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNE T r DATE D L / St. Croix County Zoning Office P.O. Box 98• Hammond, WI 54015 715 - 796 -2239 or 715 -425 -8363 Sign, date and return to above address. v r � 2 � 2 r ' e o go ��w o Q 3 0 z ° 0 `< 3 c cQ 10 ID g w v 0 �o � 'P 0 w O - c�D (D a N �a CD 0 i r �c,3Q o.w�. ° (Dww n 0 0 5 o w o`° 3o `<. C- o c - w r ' l< * o 0 1 3: c c�D w w N , � w ti o O tD w? N cc- A < �D w Q O •+ CD O _N O n �O D A G - i ci n p C tG 0 w O O d wM - % O,cx A�1 C 0 to N O (D -1 o Cl - CD -1 0 9)(0 a D D CD o� v —I Q ° �O (D v, w w =r a ac CO) v \v C w° rnwww -- 1 (D G O a 0 O 3? i ti 4 O(D �D Q y . (D a 3 - 0. ca p� R O cD -1 n N (A a Gcr 0 Yl Gfa'► CL w CD y 171 OL w CL. c � . S • , � (0 =r (D ' CD ao= oroa c °-. to ;< a caw �cD -�m " 9L - 1 1 O O Z O I it QEP*jiT ENT OF REPORT ON SOIL BORINGS 7 FETY & BUILDINGS INDUSTRY, DIVISION LABOR AND 7 7 ,� pR ( 1 � DISON, WI 530 HUMAN RELATIONS PERCOLATION TESTS o �� (H63.090) & Chapter'145.045) G LOCATI • , SE TOWN HIP LOT BLK�I [�f ME: ,v 1 /4 /a /T-'w N /RAE (o � TOseP _ COUNTY: OWNER'S ' NAME: MAI ING ADDRESS: X �. SI /A j 1 11�.f jVdWa/ elitetF- -1. / Sf �St�ly � s • �„ USE DATES!? l NO. BEDRMS.: COMMERCIAL DESCRIPTION: P O IL D ONS: ER ✓ ATI N TESTS: K Residence 3 y ❑ New Replace Z y— Fy 1 ' ,9C T . 17— RATING: S= Site suitable for system U= Site unsuitable for system W ENTIONAL: MOUND: IN- PRESSURE: -I - FILLHOLDING TAN K :RECOMMENDED SYSTEM: (optional) S ❑U ©S ❑U ©S ❑U ❑ S ©U ❑ S Z Al cow E-vt If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the Z under s.H63.09(5)(b), indicate: I Fl i n di ca t e Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER -IN , CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) q 2 B- 7. 9� s /gyp— > .0 ' , A /g J :5 /-/- 4AJ- s � 2 : & ' Sri X aF / .V. � d' ' Z ? /3N. /f 3 - RN. *-4 . 75 76. /.Z 71p- 7 75 3.S' 41. 9 ). ' • Is w -4.3 5�' s B- J 7. 97 1Y/ ' ?r- > 75' y (30. /s j• ��' aa: � s W ' ��►. $a. B- s/ �� c�e-E rsj �.S ' -F e Z/ 13 0 • S/ . B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD I PERIOD 2 PER1003 PER INCH P_ / 3. /D •Z / c, -Z P- P -2 .33 O / 1 Z P- P- (I P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. � J . SYSTEM EL EVATION / ¢ . _ LL'�X'��` te�- �" ! !!R'� /T TM - moo _. _ _ h� _. — 3 T _ ^y t ^It AP ROV V �� 4 I ft�r cn entiohat tir s stir+ x E _c_ N - -- E _ _ __ 1arr —� 6 '¢. _ - w { + ------ - : 1, 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print : SE PTIC PLUMBING CO. TESTS WERE COMPLETED ON: RT 3 VNEIL RD., HUD SO WI D N, S. 54016 C r �� ADDRESS: INIS. MASTER PLUMBERLIC. N0. 3307M.P.R.S CERTIFICATION NUMB R: PHONE NUMBER (optional): MINN. IN STALLER SS — o l y� z �� ®®� f6 ' CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) —OVER — l INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly - indicate whether this is a residence or commercial,project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be Used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, It the information {su(lh as flood }Main, elevation) does riot apply, place= N,k in the appropriate box; 11, Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL_ AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cot) Cobble? (3 - 10 ") SS — Sandstone gr -- Gravel {under 3 ") LS Limestone S — Sand HGW — High Groesndwater cs Coarse Sand Perc. - Percolatic =n mate med s #.t e iurn Sand W — tV e 1 il is - I'me Sand Bldg Building} Is Loanay Sand > -- Greater - f parr 'sl -- Sandy Loam < - Less Than "I — Loam Bn - Brown * sit — Silt Loan) B[ Black si — Silt Gy - Bray c -- Clay Loam Y Yehovv scl — Sandy Clay Loam R Red S16 Silty Clay Loan mot — Mottles sea Sanely Clay furl with sir, — Silty Clay fff ._ few, first, faint C, Clay ce -. Wrnmor,, coarse pi heat _ rYam — Many, ma - '(Ii.inr ni Muck d — distinct p — ptominent HWL High wat =.r level, Six general soil textures surface: kvatet for liquid V"aste disposal BM — Sench Mil , k VRP — Vertical Reference Paint r ' TO THE OVVNER This soil test report is the first step in secorinq z, sanitary permit. The country or the Department may request >ri #ication of this soil test in the field prior to t)ermit issuance. A cornOote set of plans for the private scvvi qie system and a perrnit applicatim'i must he subniitted to the approwiatEe local authority in order to olJ ±arn pon -n €t. The ka=rate y pet mit grease he r ritaim�d and 'posted prior to the start of anay corastrUci.iona T D H HEAD/ CAPACITY CURVE TOTAL DYNAMIC HEAD/CAPAC1fY PER MINUTE 30 EFFLUENT AND DEWATERING SERIES 53- 55 -57 -59 97 137.159 189 186 M LTRS LTRS LTRS LTRS LTRS 28 1.52 163 248 394 231 231 EFFLUENT AND DEWATERING 3.05 129 216 300 231 231 4.57 72 163 242 227 227 26 , 6.10 104 138 223 227 SEWAGE AND DEWATERING % 7.62 30 218 223 \ 9.14 208 220 24 \ 12.19 172 206 % 15.24 125 191 18.29 57 161 ' A \ 21.34 114 22 \ \ 24.38 53 A MODEL \\ MODEL Lock Valve: 19' 24.5' 28' 66' 87' 20 163 165 TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE ` SEWAGE AND DLWATERINO \ SERIES 267 268 982 984 293 18 ` ` M LTRS LTRS LTRS LTRS LTRS \ 1.52 406 386 492 881 % 3.05 227 273 360 598 16 `� 4.57 76 163 236 511 6.10 30 125 401 7.62 288 9.14 163 292 14 10.87 2% 12.78 1> `\ 1 13.72 106 12 15.24 45 M O DEL I Lock Valve: 1 B' 21 26' 35' 53' 293 MODELS 6 137 139 6 MOD 282 EL 284 4 MODEL MODEL Z �, 268 2 MODEL V —" I\ 53, 55, MODEL MODEL 57,59 97 267 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of .. . V P.O. Box 16347 Louisville, Kentucky 40216 (502) 778 -2731 QUAL /rY PllMP9 SiWr J,,9.`. N a 4 . Per �� �• �ri r>*aT�a 4h► s4,e X67 0 = A13-a � as K PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEAJT GAP /1 'i 'C.I. VENT PIPE � eye- WEATHER PROOF APPROVED LOCKIWG 3 JUUCTlpN BOX MAWHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 1,2"M {L►' p/ y I AIR INTAKE (t0 I GRADE-- I y MIAJ. m k CONDUIT PROVIDE I IIJLET AIRTIGHT SEAL ( I I i I i APPROVED JOIN A R APPROVED JOINTS �S� UR I II W /Cm PIPE 6/t�D/wfT W /C.I. PIPE EXTENDIIJG 3' I I ALARM EXTEIJDIUG 3' ONTO SOLID SOIL B �� I I ( ONTO SOLID SOIL 1 I oN FT { r �j� (�• /"' - 3' 0 PUMP 1 OFF D r -j CONCRETE BLOCK Q' A r RISER EXIT PEAMJTfED OIJL!J IF TANK MAMUFACTURIFR HAS SUCH APPROVAL -I� 7. N ZTI SEPTIC oosE E SPECIFICATIOKJS - `go ' i � J 3 TAUK�S MANUFACTURER: WMBER OF DOSES: PER DA' f�i+ TAAJK SIZE: GALLONS DOSE VOLUME � ALARM MANUFACTURER: ZM6 At- / tM �',� IKICLUDIAIG SACK►LOW: -GALLONS pk MODEL NUMBER: CAPACITIES: A a UlCHES OR GALLOAIS SWITCH TYPE: 14 /� �o �' IIJCMES OR y GALLONS PUMP MANUFACTURER: 10 Ca 09 -� -s GALLONS MODEL NUMBER: , D = =14ESOR r06 GALLOMS 1 SWITCH TYPE: NOTE: 'PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS !• �� ye�o` MINIMUM DISCHARGE RATE GPM q 0 �/� VERTICAL DIFFERENCE bETWEEAI PUMP OFF AND- QISTRIBUTION PIPE.. _4 -CSC— FEET ��Nk / �'�s I ?'j� "X Q.BH � + MI A0 SUPPLY PRESSUR .. . , FEET - 0 i ♦ 0 FEET OF FOR MAIN X 3 F loo nFRICTIOIJ FACTOR.._ FEET TOTAL 09WAMIC. HEAD = �• �FEET i IUTERUA4. DIM €W Sl ous OF TANK: LEIJGTH 8 ;WIDTH LIQUID .Q ? 81GIVEP: LICEM UUMBER.. DATE:_._ C/Xt eE S 3 PLB 6,7 ftoT' and CR SECTION PIANS 0 w 11 1 I 69 ' I ' I � 1 � I i 1 � ' 1 M Q ZIF-67 I '--- - - - - -' NE Y A-110 % Si ff TJOA-) OeZO � S 1 rrNFD r- R� 3 � / HQMESITE SEPTIC PLUMBING CO. Qaf�(N�fELO Rt 3 0 NE IL ROBERT ULBRICHT 54016 WIS, MASTER Pt UA R 1 WC Nn X I o o c MINN. INSTALLER & DESIGNER UC. NO, 00663 • Fresh Air Inlets And Observation Pipe SOIL TES TuJg B y NOMESITE TESTING rG. ( .— Approved Vent Cap RT -A o'tim Ro HUQSON WIS. b4016 Minimum 12" Above Final Grade rr � 7P,3 Fr. M� oe ass yZ Above Pipe 4 Cast Iron '1 o Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 f7' 1, Aggregate o Perforated Pipe Below 9 3•� Beneath Pipe o Coupling Terminating At Bottom Of System F(e- v,4 o f /�v i f=