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SAFETY & BUILDINGS
INDUSTMTRYENT OF REPORT ON SOIL BORINGS AND NDUS, DIVISION
LABOR ANDJ. PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/CITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
1114 1/4SE~/4 34 /T 30 H/R 19)6or) W St . Joseph 7 /a Deerfield
COUNTY: OWNER'S lf{MAME: MAILING ADDRESS:
St. Croix S. Henning & D. Norell 665 Walsh Rd. Hudson Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER ATION TESTS:
LJMsidence 3 n/a New ❑Replace 7-10-92 7-30-92
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rYSTEM-IN-IFILLIHOLDING I-u ~TAINK: RECOMMENDED SYSTEM: (optional)
❑ S ®U ~S ❑ U ❑ S ® U ❑ S DU ❑ S EA mound
If Percolation Tests are NOT re uired DESIGN RATE:
Q I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 42 ANC2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 78 101.45 none >78 0-9, 10yr3/3, L.; 9-38, i0yr4/4, sil.; 38-78,-
7_5yr414, sl. hard till
8. 2 54 101.45 none >54 0-8, 10yr3/3, L.; 8-36, 10yr4/4, sil.1; 36-54,-
1 4 sl. massive
B_ 3 60 100.10 none >60 0-10, 10yr3/3, L.; 10-42, 10yr4/4, sil.;-
42-60 7.5 4/4 sl. massive
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH
P- 24 noen 30 11-1 11-4 1124
P-2 24 none 30 1% 1 1 30
P-3 24 none 30 11-1, 1 1 30
P
P-
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.
SYSTEM ELEVATION 102.45
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(I' i 150
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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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 7-30-92
ADDRESS: CERTIFICATIO UMBER: PHONE NUMBER (optional):
1554 200th. AVe., New Richmond, Wi. 54017 2298 7 5- 6-6200
CST SIG T
/r
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
l
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6335
To be a cc; plate and accurate soil test, your report must include:
1. Comp' 1 I description;
2. The n must clearly indicate, wh, r this is a residence or commercial project;
3. MAXI iU umber of bedrooms or coma 'cial use planned;
4. Is this < ment system;
5. Complete i`-a rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL.
OTHER SYSTu JI.. ' RULED OUT BASED ON SOIL CONDITIONS;
5. PLEASE use the abbr -~..tions shown here far writing profile de ptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test Io. ~.:ns. Drawing to scale is p-.!ferred. A
-aratc sheet may be used if desired;
your benchmark and vertu ~)n reference i e clearly shown, ant -,,anent;
9. C= r.~lete all appropriate boxes as to da names, addressz ain data, percolatior ,t exemp-
tiof appropriate;
10. I i o -i ;n (such as flood Alai `ion) does not appl N.A, in the apf box;
11. w _ < fo ; rt and place your current . rid your certificu~, n-°;.
12. Mc pie copies auI distribute 1. ALL SOIL ;MUST BE FILED t`,'ITH THE
LOCAL AUTHORITY WITHIN 30 DAY- t F COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
rob - Cobble (3 - 10") SS - Sandstoncl~
gr G ~.vel (under 3") LS - Lirnestonk,
id H G W - High Gi~c,
cs Perc - Paco'-'-
reed s Sand W - vv'eII
fs Bldg- Bui° _
s L t C .
"sl n C
'sal - t Lo:rrrr BI
si - Silt Gy - Gray
<cl Clay L, y Ye lovv
scl - Sandy C'f ,.;:-n R - RE,,d
sicl - S liv Cl~, L mot - Mottles
my Clay vv;` with
sir.: Clay ffI - f fi~
p f. f 't r-mni
ni Mr d -
p l- rsi,
High vva:
Six' ,xtures srarf,:.
for I disposal - Bench
T THE OWNER:
Th -port is the fi. ~ ~I in a sanitary i . The c„ a e D- rest
this sc p-rmir
a a t rn
i i t. The sani? ( r:t d
f
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY DIVISION
~y P.O. BOX 76
H
UMA `A EL PERCOLATION TESTS (115) MADISON W1 53707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MX4ITY: f OT NO.: BLK. NO. SUBDIVISION NAME:
IXT t/4 SE~/4 34 /T 30 N/R 19&or► W St . Jose h 7 /a Deerfield
COUNTY: OWNER'S ,{DAME: MAILING ADDRESS:
St. Croix S. Henning & D. Norell 665 Walsh Rd. Hudson Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPROFI DESCR PTIONS: R A ION TESTS:
I residence New ❑Replace
3 n/a 7-10-92
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENT ONAL: MOUND: IN-GROUND-PRESSURE: S STEM-INS~-F111'LL HOLDING TTA11NK: RECOMMENDED SYSTEM:(optional)
❑S®U ~S❑U ❑S®U ❑SLiu ❑St U mound
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 42 ANC2
BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST, GH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 78 101.45 none >78 0-9, 10yr3/3, L.; 9-38, 10yr4/4, sil.; 38-78,-
7-5yr4/4, -.I- hard till -
2 54 101.45 none >54 0-8, 10yr3/3, L.; 8-36, 10yr4/4, sil.'; 36-54,-
6 7.5 4 4 sl. massive
100.10 0-10, 10yr3/3, L.; 10-42, 10yr4/4, sil.;-
B- 3 60 none >60 42-60 7.5 4/4 sl. massive
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI oz PER INCH
P-
P-
P-
P-
P-
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.
SYSTEM ELEVATION 102.45
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce eta d s 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 b
NAME (print : TESTS WERE COMPLETED ON:
Gary L. Steel
ADDRESS: CERTIFICATIO NUMBER: PHONE NUMBER(optionall:
1554 200th. AVe., New Richnond, Wi. 54017 2298 77155- 6-6200
CST SIG T
f
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
r)11 1IR 1,3RD-6395 (Fl- 09/82) OVER -
1
~g 110
4 1995
STC - 104
AS BUILT SANITARY SYSTEM REPORT
t CsftC;E
OWNER
ADDRESS
SUBDIVISION / CSM#_ LOT #
SECTION & T_ Z4 W, Town of
S1. CRO X COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/1. /3r-,
J' 7.2 f
y~ .
~ r
7l
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
r,
ALTERNATE BM:_ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 1 ZI Liquid Capacity: Z4~_~
~
Setback from: Well House Other
Pump: Manufacturer Model# - Va Size
Float seperation y5~~ Gallons/cycle:
Alarm Location
-.SOIL ABSORPTION SYSTEM
Width: Length ,y. s ' Number of trenches
Distance & Direction to nearest prop. line: ?j S;,,
Setback from: well: House_ Other
ELEVATIONS
Building Sewer ST Inlet, ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: Z 9,
7
PLUMBER ON JOB: /
LICENSE NUMBER:
INSPECTOR:, m
3/93:jt
Wjscoi)sirf'Department of Industry, PRIVATE SEWAGE SYSTEM County:
LaborandHuman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village aTown of: State PIA
DIERKE, STEVEN X
CST BM Elev-: Insp- BM Elev.: BM Description: Parcel Tax No.:
may; ~
L.4/,
TANK INFORMATION ELEVATION DATA
TYPE. MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S C. Benchmark
~GYFr GrJG' ~C10,
Dosing 3s S/
Aerati n Bldg. Sewer 7-~9 , 0 ,
H Ing St/rK Inlet
TANK SETBACK INFORMATION St/0 Outlet ~.7~v " 97.96
TANKTO P/L WELL BLDG. Ai Intake ROAD Dt Inlet 97411
Septic >..0 ' ~,4 NA Dt Bottom 3
Dosing 3 may' ti 3 NA met / Man. ,91
Aeration NA Dist. Pipe SL Q9,3
H - Bot. System
PUMP / INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
Friction/ f
a,O TDH Ft
S stem lI /7TDH Lift (Q,(Qg Loss Head
Forcemain Length Dia. Dist. To Well 2
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION 72 ( DI
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI n
SETBACK CH BER u
INFORMATION TypeO /7e,,,... r Mode Number:
System: ry~et_,,Cj, I-S54. 7lv .vrt. R UNIT
DISTRIBUTION SYSTEM
Manifold Distribution Pipe(s) „ , x Hole Size x Hole Spacing Vent To Air Intake
~ ~r / ~i
Length 3~0"' Dia- length 76 Dia. a Sparing 3 `f
SOIL COVER x Pressure Systems Only 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 ❑ Yes No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)-
LOCATION: St. Joseph.34.30.;9W, NE, SE, Lo 7 '14
70 i J rz v~
d ioi
Plan revision required? ❑ Yes P- O
Use other side for additional information.
SBD-6710(R 05/91) Date Inspector'sSignature\ Cert. No-
ADDITIONAL COMMENTS AND SKETCH r
SANITARY PERMIT NUMBER:
-
. f r C',b~ ck /Yr t. o- f7~
~cl c rc ' ' s C r
d v .C/14oe4 r„ dpi,,'
--ll
C144 V~~ll d~
Safety and Buildings Division
v,`rin SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State SSaa~nit~ary PP rmit NNu ber
The information you provide may be used by other government agency programs El Check it li vision tito prLfviolapplication
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Prope ner Name 1AF & Property Location
1 /4 1/4, S T , N, R o
Property Owner's iling Address Lot Number Block Number
140 hr 7
City, t e Zip Code Phone Number Subdivisio ame or M u ber
. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it~ Nearest Road
❑ VII age
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
At 30 C2C2-
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. jQ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. Q Repair of an
System System___ Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was,previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21A Mound 30 Q Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. Inch) Elevation
375- Feet Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank &VO Z4= ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber Abe) I - ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
[,the undersi nil, me responsibility for instal do o(ffi jen sewage system shown on the attached plans.
Plu ber' Nam r Plumber' Si re: p MP/MPRSW No.: Business Phone Number:
J.-// -7Jk-~~ s=- ql
'All
lumber's ddres ee , Ci tat ode):
,~9 7-/Mg ~2 ~~L ,
IX. COUNTY / DEPARTMENT USE ONLY
t -P r (No St ps)
❑ Disapproved Sam ary Permit Fee (Includes Groundwater ate ssue Issuing Ag nt Signa
ur
pproved E] Owner Given initial harge Fee)
a ryj~ 0?~~ 9
Adverse Determination O C//
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2_ Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4_ Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of -
Wisconsin, Safety and Buildings Division, 608-266-3815.
' I
To be complete and accurate this sanitary permit application must.include:
1. Property owner's name and mailing address., Provide the legal description and parcel tax number(s) of where the
system is to be installed.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number.with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a -115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
SAFETY & BUILDINGS DIVISION
i
State of Wisconsin
Department of Industry, Labor and Human Relations
August 7, 1995 201 East Washington Avenue
P. 0. Box 7969
Madison WI 53707
ULBRICHT & ASSOCIAT. 4~61~ 0
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
4
RE: PLAN 595-02749 FEE RECEIVED: 360.00
DIERKE, STEVE
NW,SE,34,30,19W
TOWN OF ST JOSEPH COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
nce ely,
neth Stiemke
Plan eviewer
Section of Private Sewage
(608) 266-8230 7:00 to 3:45 Mon. thu Fri
ff'r-INAL
SBDA-7987(8.10/84)
z ,
•ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX S95-02749
DILHR Plan I.D. # S95-02749 Date 8-7-1995
Owner Steve Dierke, Lori Dierke Phone 715-386-3023
Address 1013 MoonbeaM Rd. Hudson, Wis. 54016
Legal Description Lot 7, V Deerfield Subdivision. NW 1/4, SE 1/4,
Sec.34, T30N, R19W.
Town of County
_ St. St. Croix
C.S.T. Gary L. Steel CSTM 2298 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION
New construction. For a proposed 3 bedroom sized home;
estimated daily wasteflow- 450 gals.
Soils are fairly permiable, perc rate 30 min./inch (or-5
GPD/ft2 design loading rate).;However, soils are massive at
depths below 36 A long narrow mound sy step is proposed.
j
aa~aa~unrmrnnnu'~
Pg.l PLOT PLAN VIEWS a .
RON" W. ' . y}•
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS R ~ M~6
71 HUDSON, vn
Pg.3 PIPE LATERAL LAYOUT
d • Az-
Pg.4 DOSING CHAMBER CROSS SECTION %lGl`1
unurmua
Pg.5 PUMP PERFORMANCE SPECS
This design for installation is based entirely on measurements, elevations, Qb
landscape conditions (slopes etc.) and soil suitability provided by CSTM 22-I, ,
The accuracy of his specs, as reported, shall remain the sole responsibility
of the CSTM. 'i
i
Any use of this POWTS design by any licensed plumber, or any
related unlicensed parties or persons (excavaters, laborers)
r shall not be construed as an assumption of responsibility by
i the designer for the workmanship, construction, placement,
substitution or selection of any components not specified, or
d component
any assumptions by the plumber that any effects of Pool!
are state approved or proper, or the effects of Judgement
if working under adverse damaging weather conditions (wet/frozen
soils) by any such parties or persons.
M
1
S95-02'749 ~
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S'95-02749 Di ST RiGuTt oo a. AygQc-SATE-
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sysr~M
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E IEVh riOo
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VIII plows 0 T o p S
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Z % SlopE FORCE" EIEVATAOO UOPEfR
MAW
Rep ioi y~
40 Fr. E.LEvArio-0-5
fir. lmvaRr of IATGR/4(5 . FT Top of Rock /03.2-6
G 4 FT.
• Top °F / 2 IATERAIS
H FT. '
PLAN VIEW OF Mou.~jD wirti 13EO
Fo R cE M Ai N A s I o Fr.
L B 7S Fr,
I I
/O F r
13
k ~I a T ~z FT-
N W Z~o
Fr
o
tE s,NP°f- sYST
BE V OF~r 'tditionaj1Y
I.Ll To I C
Pv< <APpEp
A L ED
99P
!Nr
0 3SERVATIoX3 ® T
N I
IAP
A-if p p E S
tAB~ SOLID Lf10~1S~Y'SAE
PERMAA) EAuT M AR kERS P~NOENG~
REcqumeD BASAL, AReh _ 'pAfLY tuAsre'r - s
900 t_ 1010'rPAT1b 7 S~. FT,
C Apnci ry
PRoposeb BASM Mel = B X (A
12-7.5-
/2-
s Q. FT,
P 6 of b
DiSTRI f3uT oA.3 PIPE N F T-w_o_R.K L /o-u'r
TOThI- XltT LJOppC ~f71 U~t ~5 " o 2 t 4 7
i2.9p
s \
P R
MA~~V°`O
0
OJT
~n\ E
Fr
~ P 7v
R 3.o Fr
FoRcE M/4ik3
21 Fr. o f p V c ` 1 u c N ES
VARi*Af3LE
Gals , 'PiST^,3CL-
TOTAL VOID UbIu,t-AE '
H olE •D,AMETE'R ` IN~NES
I.hTEI?/4l. ~ Z, INct{~S
MAWFOLD -2,
INCf{ES
Of= HOIE5/Pi PE PVNM9 •onali I.uVERT ELEVATIOo
O
LATERAL 5
11 pf SON-
0 END cAp
hTE Q]
PER Fo'R
REMovE h1I TRill f3VR R5 1 \ y
' NOTES IOCATeV o,J BOTTOM ~ Ego.Ally SPACED ,
DI STRi (3UT•lom 'DISChAR CyE RATE FOR eRch LArt'ERJ L
f'tR oti S _ 2" Z 3 GAT-
l TOTAL 7(STRi(3OTIO►J CIScHER& FATE FdR
VET WOR K yy 416 GAS-~M1JV. a•~ M I'MI'MU M
1
SPUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,41E ~ of S
-VENT CAP
4"C.I. VEfJT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
25' FROM DOOR, (vAj(NlNfl- IA13EI
WIIJDOW OR FRESH 12"MIU.
AIR IAITAKE I
GRADE I ~IiTl MIIJ.
Z-- , B"MIIJ.
/0/,("o CONDUIT
1/0
~IEv~+rl
INLET PROVIDE I
J_ AIRTIGHT SEAL I III
G t1! I III
/ 6O y I V G I III APPROVED JOINTS
APPROVED JOINT IN ~rJK I I I W/C.I. PIPE
PE ~ , \ I III EXTEUDIUG 3'
EXTENDII 3' O ALARM
' yy I I i i ONTO SOLID SOIL
0"TO SOLID SOIL
i I 0"
C
55~ 3
f-LEV.FT. ' PP OFF
,SAN k IgE nPl~ '
IEUAfi0d
0 RISER EXIT PERMITTED OWL4 IF TANK MAUUFACTUR6R HAS SUCH APPROVAL /
SEP-r1C E SPECIFICATIOUS
DOSE TANKS MANUFACTURER: *,~J4,P~ IJUMBER O~~DOSES: 3 PER DA-4
TAMK SIZE: eo GALLOUS, D05E VOLUME
GEL Co INCLUDING BACKFLOW: GALLONS
ALARM MANUFACTURER:
0 GALLONS
MODEL "UMBER: CAPAQTIES: A= INCHES OR 30
SWITCH TYPE: INCHES OR GALLONS
PUMP MANUFACTURER: Z~,~~/ G= ~J INCHES OR !J~_ GALLOIJS
MODEL NUMBER: a YZ ~t P J~1/9 V D= /1 ` INCHES OR 3 GALLONS,;,
SWITCH TYPE: ~193YahG~ /LIF~P~U/~/ ~~~'¢T NOTE: PUMP AMD ALARM ARE TO BE
MINIMUM DISCHARGE RATE~GPM INSTALLED ON SEPARATE CIRCUITS -741 -r/~ S~~( •
VERTICAL DIFFERENCE BETWEEN PUMP OFF Akio DISTRIBUTION PIPE.. FEET A~~` S .
-I- MINIMUM NETWORK SUPPLY PRESSUR7TEE~ . . . . . . . . . 2.5 FEET EAC(A. o~ P r
+ 2~ FEET OF FORCE MAIN j' / F 100 FT.FRICTIOU FACTOR..' d L FEET U~ f S ~O~
TOTAL D9k)AMIC. HEAD = 10,72- FEET
INTERMAL_ DIME."SIONS OF TAUK: LELIGTH -;WIDTH ;LIQUID DEPTH
F- SYST'aM
C®nditiana ,Y
APPROVED
wousMY, A~ lea UM tDtN6i fif
DIVISION OF S
3_cF OR ONOENCE
595-02'749
HEAD CAPACITY CURVE 3 7/e 5 1/4
MODEL "98"
30 4 S/e
e
2 q
I 3 5/6
S2 ' +
O
1S 4 3/16 SINN
71 4 °
10
2 i I/2-11 1/2 NPT
s
0
U.S. GALLONS 10 20 30 40 50 60 70 a0
LITERS -
Do 160 240
• 0 FLOW PER MINUTE
TOTAL DYNAMIC HUWLOW PEA M airrE
EFFLUErn' ANO OEWATEM4
CAPACITY 12 '
HEAD UNITSIMIN
FEET METERS OALS L'M8 /
b 1.52 72 P73
A
10 3.04 at 231 71
14 1.47 14 170
i' . 20 6.10 24 as L-i
3 S/16
LA 1k V"
• 1
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical altefhaiors, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without. alarm switches. variable level long cycle controls.
a
i. , ,ru IkW SELECTION GUIDE
Standard all models - Weight 39 Ibs, - IA H.P. i ^eg operated 2 pole mechanical switch, no external control required.
96 8erles 2. Single piggyback mercury Ow ewltch or double la0gyback mercury, Moat
Control Selection switch. Refer to FM0477.
Model Volve-Ph Mode Am Sim lox Du lox 3. Mechanical alternator 10.0072 or 10-0075, i
M98 1 iS t ulo 9.0 1 or 1 A 7 - 4. Soo FM0712, for oorred model of Electrical Allomalor, "E•Pak"
5. Mercury woor float switch 104225 used as a control actho for +pectfy
D96 230 1 Auto 4.R 1 or 1 A 7 _ duplex (3) or (4) Moat system
E95 230 1 Non 4.S 2 0. Fqur, (4) hole "J-Pak". Iuricti~Fi box, for tliiirNO19M conned ion or wired-in sim-
4. R S 6 3 or 4 A 5_771
pNx or duplex operation. 104002, . ,
} 7. Two.~I bolo "J•Pak". for watertight oortrllic6on or spiwl
For Irtformstlon on additional Zoeller products refer to eatabp on Comdnntlon &arter, F140514; CAUTION
Piggyback Mem" Switches, FMO477; Elactrkal Atlernator, FM0406; Muchanical Allarnatw, AS Ina sn"ae of ~tOb' toM ~t0e t s ftd 9 K and r, - I aheald b ~'dirlolfts iring be
by burr e a r wp.
FM07Yl. Alarm Packsga. FM0513; SumWBowapa Basins, FM04s7; and Rirnplht Control Swt, me " ww" re"od NiNnsf EM se1rls c (NEC) aYw~Oeoupso $a" stool
Health Ad (011HA1
RESERVE POWERED DESIGN
For'unusual conditions a reserve safety factor is dfgineered Into the design of o,it3ry Zoeller pump. {
•
MAIL T& P.O. BOX 16347
l Alm/~~~ " M 717. ?80 O0?56.0341 Manu/acfwers Of...
O O tN/F l0: 3 80 hr Millers lane a
' i . j„ ta:)Sl /t; xy 40216
Ir, ezuellrAnAw fiw /9.?9"
(502)718-2131: • UT(502)774-3624
TMENT
REPORT ON SOIL BORINGS AND SAFETY & B DIVISION
t n AN P.O. BOX 7969
n A► PERCOLATION TESTS (115)
IUMAN AEL AiI S MADISON, WI 53707
(1463.0911) & Chapter 145.045)
. TOWNSHIP/I}QIQp[1 ITY: LOT NO.: BLK. NO.: SUBDIVISIO NAME:
OCATTliiTj I
1A1 1/4 .0/4 VN/R144,0W St. JOSe h 7 i/a Deerfield
t tTr r~ f y " - i11€: 7~Dfi €SS:
St. Croix S. }[enning & D. Norell 665 Walsh Rd. Hudson, 11i. 54016
SE_ DATES OBSERVATIONS MADE
LE DESCRIPTI
T~U~ t i ~COh LDESCR PT101~: (PROF
77-30 AT STS: RCOL ON ~
3 ' New Replace 7-10-92 -92
ING: S- Site suitable for system U__= Site unsuitable for system _
JVE_Wr1?)_NT\Li MO1 D: IN-GROUNDI~ S 3 FBI F~FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
AS®U LaSDU~ ❑S®U ❑SgU ❑SHUI mound
f Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
nder s.H63.0915I1b1, Indicate: n/a Floodplain, indicate Floodplain elevation: ri/a
A
PROFILE DESCRIPTIONS page 42 ANC2
ORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
I IMBER DEPTH IN, ELEVATION OBSERVED EST. HIG I1E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
0-9, 10yr3/3, L.; 9-38, 10yr4/4, sil.; 38-78,-
f )-l 78 101>45 none >78
7.5yr414, q1. hard till
2 54 101.45 none >54 0-8, 10yr3/3, L.; 8-36, 10yr4/4, sil.'; 36-54,-
7 r4/4, sl. massive
Bt- 100.10 0-10, 10yr3/3, L.; 10-42, 10yr4/4, sil.;-
3 60 none >60 42-60 7.5 r4/4 sl. massive
PERCOLATION TESTS s
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
!MBER INCITES AFTERSWELLING INTERVAL-MIN. 1 PERT D2 _ PERINCH
- - n 1 i
24 nQen-_ i 24
lI
2 24 none_ 30 1% 1 1 30
3 24 non 30 11-1, 1 1 30
JT PLAN;, Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
,tal and vertical elevation reference points and show their location on the plot plan. Show the surface el i on an 'percent
land slope.
'STEM ELEVATION 102.45
a1~6_ I r
Y
b .
ff
`ll1 ,
~ I I~ . I t o+ '1 i r I s
ill ~l ►i ~1 ?r
he 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 Wiscondin
rninistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. j;
MF p!int : TESTS WERE COMPLETED ON:
teary L. Steel _ 7-30-92
DRESS: CERTIFICATIO NUMBER: PHONE NUMBER(option0:
1554 200th. AVe., New Richmond, Vi. 54017 2298 7 5- 6-6200
CST SIG , TU L j
1
rAiBUTION: VWni`11 clad one topy to Local Authority, P, ty Owner and Soil Tester. y
.
+1 - OVER -
r- ~ ~
i `w~
j
• ' DOCUMENT NO. j~ WARRANTY DEED I~ TNI• S►ACIE RESERVED ION RECORDINO DATA
(STATE BAR OF WISCONSIN FORM 2-1981!
ssss8 , ~ Mlp~~E444 ! _
i~
l 1 C"RC, .X Co., WI
li STEVEN W. HENNING and NORMA J. HENNING husband and V
S,
wife.,. Grantors j! RecdtbrF.aoolr~
APR 19 1994
it If 1100. A
conveys and warrant o .._STRVEN J.e...D .$R(CEi_.4 d--LORI •A.-•DIER... at
t+•IR.-V
husband and we as survivorship martaY pi::perfy,
I
Grantees of 0"a
ij
II RCTURl1 TO
following described real estate in t-,-. CYOi]c - - - - -
..................County,
State of Wisconsin:
Tax Parcel No:..............................
Lot 7, Plat of Deerfield in the Town of St. Juspeh, St. Croix County,
Wisconsin
fr%AN
FT- S
TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and
rights-of-way of record, if any.
This homestead property.
(is) (is not)
Exception to warranties:
Dated this / - day of AP.ril . 19.. 94
(SEAL)`---~~~...... _ (SEAL) „
l ' . STEVEN W. HENNING
(SEAL) (SEAL)
- . W~ _i
NORMA,.J.-HJ NNING........ -
j AUTHENTICATION ACKNOWLEDGMENT
I!
Signature(s) STATE OF WISCONSIN
I.
St. Croix se.
•-----.County.
authenticated this ........day of 19...... Personally came before me this day _.~..of
4ril 19---94_ the above named
I
i
d
TITLE: MEMBER STATE BAR OF WISCONSIN Steven_•W. Henning. a.......................................
(If not, ___Norma J ...Henn--• ing k ly,
;i - - -
authorized
by -'§-7'06.06, Wis. Stats.) to me known to be the person , _who execdtSd'-the
foregoi 1 4a- ument nd ack rlge th ame. THIS INSTRUMENT WAS DRAFTED BY --Attorney.-----Ba-... Lundeen 1W
rr ~tUUDGE, PORTER & LUNDEEItr;..S.L" .k""_..._ "
110 __Second Street: .Hudson, WI 54016
Notary Public
--SC_. -.Cr-Q1X gouRq' Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not,..aU}g_e"p ition
are not necessary.) r?
date: Af-c';-L------ca2Q--• 69---•)
•Nams of persona aligning in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2 - 1982 Milwaukee. Wisconsin
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
~Say All ~~c-~"S~.
MAILING ADDRESS
PROPERTY ADDRESS
(lo anon of septic system) Please obtain from the Planning Dept.
CITY/STATE _
111/7-
PROPERTY LOCATION S 1/4, 1/4, Section ?~Z T N-R ,ZC? W
'SOWN OF ST. CROIX COUNTY, WI
SUBDIVISION~D,* ,e . F & t j LOT NUMBER 7
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained rjjust be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three
SIGNED: :09121~-
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the j
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/ contractor, (spec
retained and completed when
house), then a second form should be
t
the
the property is sold and submitted to this office with
appropriate deed recording.
----•---••-------------.-.--T-----------------------------------~.---
C
owner of property)
Location of lpropertyl/41/4 , Section, T„~rN-R~2 W
Township Mailing address In&3 Yl Aer~ ~ea..r,
Address of site
Subdivision name Lot no.
Other homes on property? Yes_ N
Previous owner of property -
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes ~No
Volume D 2_~and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 5"/S~~ , and that I (we) presently
own the proposed site for the' sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature Applicant Co-Applicant
Kato of Siionat'ii- D'Ito of SionatiirP
I
i II I~
ii -
I
1 I
DOCUMENT NO. WARRANTY O FED !I THIS $PAC& R[SCRV[D FOR RLCOROINO DATA
STATE BAR OF WISCONSIN FORM 2-1982'
~I STEVEN W. HENNING and NORMA J. HENNING, husband and i R►d4 ,ix C0 f.......
;]41\
w er.I.. Grantors APR 19 19911:00iI
...:....::..................T............... ..LORI..)°l...DIERKE,• .I ~
I convey add war ant ??o ...S EY.EN .Js...Q}F.RK -
i~ husbannd an w~Le as survivorshiQ mar taY property,
~i Grantees Rsp~soerofDeeCs
.9TURA TO II
S Cox
the following described real estate in County,
State of Wisconsin:
Tax Parcel No:
i
Lot 7, Plat of Deerfield in the Town of St. Juspeh, St. Croix County,
WiscOltsin
I'LS
TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and
rights-of-way of record, if any.
This is-not homestead property.
i'
(is) (is not) C(D[F"Y.
Exception to warranties:
I
Ap.r.il . 19. 941.
I'• Dated this . day of
'I (SEAL) --_-..(SEAL) ,
STEVEN W. HENNING
•
•--•---•-----.......(SEAL) (SEAL)
I
NORMA,. J.. BE.NNIN.G . .
I`
iI
II AUTBBNTICAVION ACBNOW LEDOMBNT
•4
~i
i Signature(s) STATE OF WISCONSIN
I as.
• St.
rsonally came before me this .....!J..day of
I authenticated this ........day of 19...... Pe Croix County.
ii AQril 19_.9. the above named
II TITLE: MEMBER STATE BAR OF WISCONSIN Steven_.W...Henning..and
;y
(If not, ----Norma.A't Henn p8 , R ly
authorized by § 708.08, Wis. State.) to me k wn to be the person : who execdf,Gd"ihe
foregoin Is ument nd ack 4e th ame. '
THIS INSTRUMENT WAS DRAFTED BY
1
y Barry C. Lundeen z _ yr
Attorne 7- - _
~tUUppGE, PORTER b LUNDEg1~, S.C__...- •._.........LJ..I
110__Second Streetl..Hudson. W. 54016 Notary Public St.....C.01 c. -Cou , ;Wis.
ll
My Commission is permanent. (If no(`, -a3A#~ypretion
(Signatures may be authenticated or acknowledged. Both , ^
are not necessary.) t V- 1~ W7 .
date: Afel. •
-Names of pfd sicuing in any capacity should be typed or printed below their signatures.
WARRANTY DERD STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2 - 1982 Milwaukee. Wisconsin
T , rMEIiT REPORT ON SOIL BORINGS AND SAFETY & BUILT
,SrRY DIVISIo
OR AND PERCOLATION TESTS (115) P.°.13Ox 7
1l1MAt1AELAiI S MADISON, WI 53370
(H63.09(1) & Chapter 145.045)
-O( ATI6TI S TOWNSHIP/MMMK •ITY: UT NO. BLK. NO.: SUBDIVISIO NAME:
?Al 1/4.10/ :1oM/R1`1&) w St. Jose h 17- Deerfield
St. Croix S. ITenninP & D. Norell_ 665 Walsh Rd. Hudson Wi. 54016
3EDATES OBSERVATIONS MADE
rJu. U1 - CUK LNI=SCRII' I TUN' RO STS:
~Yt`tidence 3 n/a New ❑Replace 7-10-92 7-30-92
ING: S- Site suitable for system U° Site unsuitable for system
JVEF3T1UNAU M~O~UIND: tN GROUTV lTi [SYSTEM-IT-FILL IOLDING TANT1 ECOMMENDED SYSTEM:Ioptional)
-is ®U LAS ❑ s ®U • _Els oU ❑ S ®U mound
f Percolation Tests are NOT requlred bESIGN RATE: If any portion of the tested area is in the _71 nder s.1163.69(5)Ib), Indicate: n/a lFloodplain, indicate Floodplain
elevation: n/a
PROFILE DESCRIPTIONS page 42 ANC2
ORING TOTAL DEPTH T R UNOWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COL R, TEXTURE, AND DEPTH
1M6ER DEPTH IN. ELEVATION OBSERVED 1 EST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.)
9-1 78 101.45 none >78 0-9,710yr3 , L.; 9-38, 10yr4/4, sil.; 38-78,-
2 54 101.45 none >54 0-8, 10yr3/3, L.; 8-36, 10yr4/4, sil.'; 36-54,-
I r4 4 1. massive
100.10 0-10, 10yr3/3, L.; 10-42, 10yr4/4, sil.;-
3 60 none >60 42-60, 7.5yr4/4 sl. massive
PERCOLATION TESTS
tESI DEPTH WATER IN HOLE TEST TIME DROP 1 WAT R LEVEL-INCHES RATE MINUTES
WIRER INCITES AFTERSWELLING INTERVAL-MIN. P F3=DD PER INCH
1- 24 _noen Z-- ' ' 24
.2 24 none 30 1' 1 1 30
3 24 non 30 1' 1 1 30
JT PLAN;, Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the ho
tal and vertical elevation reference points and show their location on the plot plan. Show the surface el _ on andOperce
land slope. -
(STEM ELEVATION il~ 102.45
+
if 6- : t
Nit 11
,P ,
I
+1 ' I W I r
he, 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 Wisconif,.
rninistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 1
MF print TESTS WERE COMPLETED ON:
;ar_y L. Steel - - 7-30-92
DRESS: CERTIFICATIO -NUKIRER: PHONE NUMRER(optionAl)
1554 200th. AVe., New Richmond, Vi. 54017 2298 7 5- 6-6200
CST SIG, TULE
_ /C j
7
Tlf'fIRUTION: Ul" Irrtal qhd One tnpy to Local Authority, P- ty Owner and Soil Tester.
rt. _ OVER
` W,I ~ It.trn, 111 r+'+/rt')1