HomeMy WebLinkAbout018-1016-80-100
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Parcel 018-1016-80-100 04/09/2007 09:29 AM
PAGE 1OF1
Alt. Parcel 08.29.17.123B 018 - TOWN OF HAMMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - BENEDICT, RONALD A
RONALD A BENEDICT
1007 160TH ST
HAMMOMD WI 54015
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1007 160TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 8 T29N R1 7W SW SW LOT 1 OF C.S.M. Block/Condo Bldg:
6/1507 EZ-U-1673/567
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/13/2006 840591 QC
07/23/1997 889/166
07/23/1997 729/158
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 9,600 48,500 58,100 NO
AGRICULTURAL G4 3.000 400 0 400 NO
UNDEVELOPED G5 4.000 3,200 0 3,200 NO
Totals for 2007:
General Property .10.000 13,200 48,500 61,700
Woodland 0.000 0 0
Totals for 2006:
General Property 10.000 13,200 48,500 61,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPA fVMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDISION NG
INDUSTRY, DIV
LABOR AND c P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME:
'/4 V4 /T~9 N/R/7 E ( A -
AI~W COUNTY: OWNER'S/B4*ER4&4" 0M1E_ MAILING ADDRESS:
-f/- a/I X, An', I
USE Pit, t 715 ^ x (vll DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
Residence 3 ❑ New P Replace
RATING: S= Site suitable for system U= Site unsuitable for system
rZS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TAN: RECOMMENDED SYSTEM:(optional)
❑u a s au E ZS ❑u a s u a s [Z uK ;r LKGS ;r S,' n
3
3 5- 71
1 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate' Floodplain, indicate Floodplain elevation: v
PROFILE DESCRIPTIONS
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.)
rr~ ',ao 3.S' S :1 7 of
B I O ~ N t > ;70
B- s
B- L ft) ?Y NON 7:1 . 7 8 , . M 3.2 ' s / 7 'L s .
B-
B- 3 j,2 ~'r 9 N ON ~c F Z B
13-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 --PERIOD 2 PERIOD 3 PER INCH
P- 7
Ll~
P-
P- 2 7 v / 3 'r6 : y p
P-
P- 3 •e 2,1
M ?
P_ m e g.11,' 6r 90. s !.r o
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-
yol
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings anjhe diroe`~ion and percent
of land slope. r~~
r
SYSTEM ELEVATION pf• 7
r
3
berth'
p r
i
17 t
3
'Ah
4 f
E
3
cji-
CP
I ~ ~ I r
E r 3
~.744 /Y 41 W44pgf1CE _
J _j_
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:
Licensed Perk Tester & Plumber 3, 3
ADDRESS: F r He~ t3 ~O~d CER IFI ATION NUMBER: PHONE NUMBER (optional):
S WISCONSIN 64023
one CST SI ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
IN3TRUCT COMPLETING FORM 1 - SBO - 6395
To be a cot acct.- yor ))c€st include,
1. Compl :e ! ;cription;
2. The use sect ust clear =e avhether this is a resider ice o,- commercial faroject;
3. MAXIMUi J be r or commercial planned;
4. a new o € 1~ ,-n;
5. !-t:e the sr g boxes. A SITE 1' ABLE FOR A HOLDING TANK ONLY IF ALL
C ; ° ~l SYSTEEI'- RULED OUT BASED ON SOIL CONDITIONS,
B. 3 -E ",~E use t` :arts shown liere for writing profile descriptions and completing the plot plan;
7, A LEGIF accurately locating your, test locations. Drawing to scale is preferred. A
supan to sheet mad if desired=
8, Mace sure your b k and vertical elevation reference point are clearly shown, acrd are permanent;
9. Co€nplete all ` boxes as to dates= names, addresses, flood plain data, percolatio€, test exemp-
tion, if aptaror
10. If the info as flo0 I sloes riot apply, place N.A. in the app) opriat:e box;
11. Sign the fc -ll your cc id your certification number;
12. Make legible cop" s and distrib€Al required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 D COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
I ' aaratES a:~ Textures Other Symbols
Stol )"i BR _ Bedrock
cob - Cobble 10") SS - Sandstone
gr Gravel (under 3") LS - Li€n rre
Sand I-IGW F , ~ „ ,,.--idwater
Coarse Sand Perc r Rate
mt Medium Sand W
Fine Sand Wdg
Is Loamy Sand
'Isl - Sandy Loam < t n
'I Loam Bn - rn
Isil - Loarn BI
si Gy
ci -
scl - L- am R .
sic; /C . Loam rrrot ILtloti:les
J dy e p, ' with
S 0-
sic; - Silty Clay fff few, fine, faint
Alc Clay c£; - common, coarse
pt heat nom Many, medium
ni Muck d distinct:
Is prominent.
I-AP'L High water ' .
Six r atr=s surfac€
f. 3ench M €
fir, Vet tic.' r c t
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted 1601iz;ap lA riaf;e $41 o" 4g.-Order to
obtain a permit. The sanitary permit must be obtained and
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WAN RELATIONS
(H63.090) & Chapter 145.045)
ICATI0N: SECTION: OWNSHIP/MUNICT/\LITY OT NO.:BLK. NO. SUBDIVISION NAME:
1/4 /T,-z? N/R E c
)UNTY: O NER'S BUYER'S NAME: MAILIN ADDRESS:
E r~ `O p DATES OBSERVATIONS M DE
N . BEDRMS,: COMM FIIAL DESCRIPTION: R I NS: AT N TESTS:
6,,-//esidence ❑ New E,,Replace f ~ ~j-f a
I TING: S- Site suitable for system i Site unsuitable for system
)NVENTIONAL: MOUND: IN-GROUNOPRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
C v
CiS❑U DS❑U ❑TS❑U ❑SEA RS EA
Percolation Tests are NOT required DESIGN RATE: If any portion of a tested area is in the
tder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
A) /W I
PROFILE DESCRIPTIONS
ED (SEE ABBRV ON BACK TEXTURE, AND DEPTH
TOTAL
UMBER DEPTH IN. O SERVED UNDWSTER I HESES TCHARACTER O BEDROCK IF SOIL CKNESS, COL
ELEVATION
3 f
49P, C
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WA ER•LEVEL-INCHES RATER INCH ES
VUMBER INCHES AFTERSWELLING INTERVAL-MIN. '-PERIOD t PERI D P RI
~ J 3
P_ 1
P
P- O d 3
P-
P- 3 rl/ 0 2 /s t
P-
LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
)ntal 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
f land slope. \_90 it
STEM ELEVATION
ll as rrx tl+w. rep.v A - - - - -
i
lc ;
by
v
1 '
.
IN
C ~r tt ,..a r,. ft" 3s ' 1 l9 so,
Af #A 1Q~P s~0.. ~ 1 I
AZI 4v
'dAl
L
specified in the Wisconsin
e in accord with the procedures and methods
on w Y m
I] th undersigned, hereby certillty, that the soil tests reported o this form were made b
P~Ci inistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
qTESTS WERE COMPLETED ON:
N o rint :
` CERTIFICATION NUMBER: PHONE NUMBER (optional):
A S
7 Vi
Z
IGNATUR~
o~Oer'V) wS S~o~L
STC - 104
AS BUILT SANITARY SYSTEM REPORT -a
OWNER
ADDRESS_ S IOO1
17 ~-r6s~e~-rte c~ s ya / S-
SUBDIVISIOnN / CSM# /SLOT #
SECTION d TAN-R 7 ,Town of
r~iyr~)sG`'
T. CROIX COUNTY, WISCONSIN f'
PLAN VIEW r
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/;/a sou ~
Ile K /I .0'e
w-
54
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: &Ia.d yap ,t r~~~ t
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION
Manufacturer: Liquid Capacity: ~S• 800
Setback from: Well > so House 7. Other
Pump: Manufacturer _7m,e~ _5--3 Model# Size
Float seperation 13 Gallons/cycle: 1 3 y
Alarm Location
.SOIL ABSORPTION SYSTEM
Width: Length t'o # Number of trenches .Z
Distance & Direction to nearest prop. line: _r
Setback from: well: > loo House >L/ ' 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:
PLUMBER ON JOB: -uc-
LICENSE NUMBER:
INSPECTOR:
3/93:jt
LQQU,TPA part +R i QtrP 8.29.17.7 )~ARSt11~A~~~YSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) sanitary ermit o.
GENERAL INFORMATION :
Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan I o.:
T BM Elev.: Insp. BM Elev.: BM Description: 7~ Parcel Tax No.:
U . i'2) Q wJ C•7
TANK INFORMATION ELEVATION DATA A9300257 a D 7 A2'
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St / ~tA Inlet
TANK SETBACK INFORMATION St/ Outlet / L
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet r
Ar I
Septic NA Dt Bottom Z 70 0(~
Dosing r , 3 S NA Header /
Aeration NA Dist. Pipe
Holding Bot. System ~7 -
PUMP /N INFORMATION Flna Grade
Manufacturer f~ Demand 61
2/
Model Number GPM T°~ 6 rSP ~^o J , 97 -1 TDH Lift Friction System/- TDH Ft
L Ha
Forcemain Length - Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width S / No. Of Trenches PIT its Inside Dia. Liquid Depth
DIMENSIONS S e;Z DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ufacturer:
SETBACK
INFORMATION Type O ie an r ,9 CHAMBER Mo m er:
System: t~,-,WK S OR UNIT
DISTRIBUTION SYSTEM
Header / RlFarti#eld ~j Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length ~Z Dia. J~ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems O
Depth Over #i 2 i i Depth Over 1 " xx Depth Of xx Seeded odded xx Mulched
rench Center a~ '3 I ,/Trench Edges ( Topsoil s ❑ No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HAMMOND 08.29.17.123B,NW,SW,160TH
r
Plan revision required? ❑ Yes No /
Use other side for additional information. f~
SBD-6710(R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
i
SANITARY PERMIT NUMBER:
e
SANITARY PERMIT APPLICATION
OIL HR In accord with ILHR 83.05, Wis. Adm. Code COPTY
jT
STATE SAN ARY PER IT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ i8n
8% x 11 inches in size. Ch k r s to pre ous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
o %a S T.217, N, R E (or)dV
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Val S O rf~399~Yv ~Ilflnpl
OtA
0 CITY II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST
: /~R/y1/110Sf T~
~ MW ~
❑ Public ❑ 1 or 2 Fam. Dwelling of bedrooms L- PARCEL Ax NU
III. BUILDING USE: (If building type is public, check! l that apply)
o ~ -v ~ loo
xvl-
1 El Apt/Condo
2 ❑ Assembly Hall 60 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 120 Service Station/Car Wash
5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.E1 New 2. 0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 El In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
r S /(or4
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RAT 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
/70 It 70 2 r- Feet A8 91 Feet
VII. TANK CAPACITY Site
in alIons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 4A*91 2 rt E]
Lift Pump Tank/Si hon Chamber, - Q (~/rC f+
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the ons' a sewage system shown on the attached plans.
Plu er's Name (Print): Plumber's Signature: (No mps) MP/MPRSW No.: Business Phone Number:
v7A~ r r / . 1 3~5~
Plumber's Address ( tre , City, State, Zip Code):
0 o13
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent S' ps)
Approved ❑ Owner Given Initial Surcharge Fee)
:2-
Adverse Determination /YO • 0U - -
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & 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 the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicab e.
3. All revisions to 'his permit must be approved by the permit issuing authority
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form ` BCr 6399) to be
submitted to the ol-ity prior to installation.
5. Onsite sewage svst,_rns must be properiy rnaintained. Th •'i<; tank(s) mui;t be ~ Wf lied t>, o 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 & Buildings Division, 608-266-3815.
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.
II. 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 bodes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system tyae
VI. Absorption, system information. Provide all information request= -,d in ##1-7.
VII. Tank it for~:iaticn. Fill in tti apa<,ity of every new and/or axis,'+;. t r list the total nuxn'cer of
tanks and r ,artufacturer's nar--,c. indicate prefab or site construc left and tank material. t'o-riplete .'or all
septic, purnp/siphon and hoiding tanks for this system. Check F:,_ .-rimental approval only ir, tanks received
experirr 'al product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, Breese number with a r repriaie prefix (e.g.
MP, etc.;, address and phone number. Plumber must sign api,!,c,a!ion form.
IX. County, IDepartment Use Only.
X. County/Department Use Only.
CorrP;e;`c F;lens an! specifications not smaller than 8'/s Y '1 ,i., E., mu ,,t be submitted t#if county. The
p ans wusi include the following: ;?k,,1 o,,sn, drawn to sc <'o:oplete C',:' e i in, 1:)cation of
holder c. ' n'k(s), septic tank(s) or other t ,-&rriFe.ot tanks; bill dir,,i o wells; water' ca: -,v ater service;
streat,is Hncf lakes; pump or siphon tank; 0i,, ribution box--,4, -~-i r _ rrtion systems r~F~i>ic"rr~er~t system
areas, an6 f;,z !ovation of the building B) hcrizonta: t ,c,_?M el vatiorl~rFf °renCr,} points;
C) complete specifications for pumps and controls; dose volurr,&, -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 surcharcr s (t s) foT < r,ur,.Der of
regulated prac`.ices which "an effect groundwater.
The r,-,)P'es c:oilected through these s` rcharges r€s,: use for srnonito-inn . "i7 vV a` 3• C.;rc; ,end-
water contamination investigations and •establishmY~it; or standards.
SBD-6398 (R.11/88)
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PAGE OF
PUMP CHAMBER CROSS SECTIOW AND SPECIFICATIOUS
VEWT LAP
l"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUNCTIOW BOX MANHOLE COVER
25' FRCM DOOR,
WIMDOW OR FRESH 12"MID. I
AIR INTAKE I
GRADE I
I '1" MIN.
_ 18" MIIJ.
COIJDUIT
16"MIN.\
IAIi_.E T PROVIDE I
AIRTIGHT SEAL I (i I J/
I I I
APPRO`JEE JOINT A I I I APPROVED JOINTS
41C.I. PIPE. I III W/C.I. PIPE
EXTENDIAJ(• 3' I II ALARM EXTENDINb 3'
.)NTO SOLID SC:'. B I I ONTO SOLID SOIL
i I
I I ON
C
-f ~ PUMP -1
r► OFF
D
CONCRETE BLOCK
RISER EXIT PER'MIITED OIJLJ IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFICATIOUS
TIC AND ~
TANKS MANUFACTURER: f NUMBER OF DOSES: Z PER DAU
TAWK .*Zf R~ GALLOWS DOSE VOLUME
ALARM MANUFACTURER: %s~e~/~ /~f7 T IMCLUDING 6ACKFLOW: -2 3O GALLONS
MODEL WUMBER: CAPACITIES: A= 22 INCHES OR 396 GALLONS
SWITCH TSFE: B= 2 INCHES OR 36 GALLONS
PUMP MANUFACTURER: ge. u r- -INCHES OR -2.3Y' GALLONS
MODEL WUMBER: J-3 D- _Z INCHES OR 22- GALLONS
SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE
PUMP DISCHARCwE RATE YD GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFEREMCE Bi9o'WI;EN PUMP OFF AND DISTRIBUTJON PIPE.. FEET
+ MIIIJJIMUM NETWORK SUPPLY PRESSURL~E.. . . . . . . . r3' FCET
+ FEET OF FORCE MAIW X F/✓,ooFT.FRICTION FACTOR.. FEET
TOTAL OSWAMIC. HEAD = ~i~ FEET
INTERWAL DIMEWSIOWZ OF TAIJK: LEIJGTH ;WIDTH p -;LIQUID DEPTH
I
SIG1~lED: LICENSE DUMBER: DATE: p 22
-117-
T D N A PA C QTY C U, F-
h
I
3 n TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
V EFFLUENT AND DEWATERING
SERIES 53.55-57-59 97 137-139 163 165
28 _-r__e-M LTRS LTRS ' LT RS 'i LTRS LTRS
1 2 163 248 394 231 1 231
EFFLUENT AND DEWATERING -
i 3,05 1 129 216 300 231 231 1
4.57 ! 72 • d 163 1 242 227j 227
26 SEWAGE AND DEWATERING 6.1 0 104 136 1223 1227
t \ 7.62 .1 30 216 4223
s V 9.14 + 206 ` 1220
12.19 9 172
24 206
\ ,5.24 125 j191
i 18.29
i 57 161
22 - \ \ 21.34 - 114
\ .,u 24.38 14 53
MODEL MODEL Lock Valve: 19' E5[ 26' 66' 87' 1
20 163 \ 1165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE
\ SEWAGE AND DEWATERING f
p SERIES 267 268 282 284 293
18 - \ \ .T M LTRS t ^ ` LTRS LTRS U LTRS LTRS
152 408 386 492 681
3.05 227 273 360_ 598
16- \ 4.57 76 1. 163 238 511 I
r \
` 6.10 y. 30 125 401
7.62 _ 288
163 292
149.14
^F,j \ 17%13.72 7 227
.6 174
28 106
12 4 45
MODEL Lock Valve: w 16 21 26 35• 53 I
-
101", I 293
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MODELS I
8 137 139
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MODEL f
284
4 MODEL MODEL I
10 268 \ 282 t
2 MODELS
53, 55, MODEL MODEL
57,59 97 267
t 0 20 30 40 `y0 61 f 7~) 80 190 100 110 120,230 140 150 160 170 180 190
LITERS 80 160 240 320 400 480 560 640 650
FLOW PER MINUTE
3280 Old Millers Lane Manufacturers of .
f Zj027ZIA7 ouiBox 1 entu cky 40216
(502) 778 273 L `/,UAL/TY 17
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DAVE F'OGERTY PLUMBING
Licensed Perk Tester & Plumber
63233 63284
Fogerty Heights Road
ROBERTS, WISCONSIN 54023
Phone 749-3656
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
• LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME:
'/4 V4 /Tz 9 N/R~ E (CA
COUNTY: OWNER'S 136((- a=B•A1,4A - MAILING ADDRESS:
USE 'e 70; - DA ES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: R FI E DESCRIPTIONS: PERCOLATION TESTS:
Residence 3 ❑ New Replace -R 9 3
1
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMME/NDEDSYSTEM:(optional)
❑U [ZU 2$ ❑U ~-1U [Z
U %clfes 3- r'x 9s' st
3' ' 3`
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate-, Floodplain, indicate Floodplain elevation: /
PROFILE DESCRIPTIONS
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- / 0 O •l 70 r0 Y S-r y 7 ,r
B- _'Z
B- Z Oro Noh < 7 z . 7 !J r G 3..2' / 7 rL s
B-
B- 3 z 8r 9 NoK~ > F z- s/
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PER PER INCH
P- 37 14~ X0
P-
G d / T rr S
P- 2 3 7
P-
P_ 3 •e
76
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 an the direltion and percent
of land slope. i*~ ~o
SYSTEM ELEVATION psr 7 r
t t i ! 3
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17
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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:
Licensed Perk Tester 6 Plumber 3 3
ADDRESS: Fo HeiShts Road CERTIFICATION NUMBER: PHONE NUMBER (optional):
SCONSIN $4023
4
BE WI
Qne CST SI ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBO-6395 (R. 10/83) -OVER -
e ~
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS SOB 7 S~ ~Gk~G/yr~~ 61z FIRE NUMBER I e7
CITY/STATE ZIP S- y® /
PROPERTY LOCATION: &&)1/4 4C-) 1/4, SECTIONZ T- ,9N-R l7 W
A A7
TOWN OF St. Croix'County,
SUBDIVISION , 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 a 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 must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration date.
SIGNED:
~►•~o
DATE:
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
STC-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/contractor,(spec
house), thenla 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//W_1/4 ,s_1/4, Section T_ f_N-R /Z W
Township
Mailing address -1007'
1 D 07' tiF c101,
Address of site _il,00 7 wL _r go / S`
Subdivision name Lot no.
other homes on property? yes No
Previous owner of property 01 Q 0
Total size of parcel lD~
Date parcel -was created
'Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house)? Yes -7ANo
Volume Srf and. Page Number 1"~ 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 & 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. X-63-s ft/ , 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 County Register of deeds as Document
Signature of applicant Co-applicant
Date of Signature Date of Signature
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13uw,4A J }iELAT10NS (H63.090) & Chapter 145.045)
LOCATION: SECTION: OWNSHIP/MUNICUZALI t Y. OT NO.: BLK. NO.: SUBDIVISION NAME:
'/y t/ /11 N/R E( 1 gILIN ADDRESS:
~ / -
COUNTY: O NER'S BUYER'S NAME:
f , `0 P~ DATES OBSERVATIONS M DE
USE PROFI E D RIPTIONS: E LAT ON TESTS:
BEDRMS.: COMMEFIIALDESCRIPTION: ❑New LLJReplace
l![fResidence
RATING: S- Site suitable for system U- Site unsuitable for system
ONVENTIONAL MOUND: IN-GROUNt}PRESSUR_E: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~❑U~T2 S ❑U BS IOU ❑ S CCU CAS ❑U (a~
If Percolation Tests are NOT required DESIGN RATE: Lf an y portion of a tested area is in the
11 oodplain, indicate Floodplain elevation:
111 11,
under s.1-163.09115)(b), indicate:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION P H T~ R UNDWATER INCHES CHARACTER OF SOIL H H CKNESS, COL TEXTURE, AND DEPTH I TO GO NUMBER DEPTH IN, OBSERVED S I HEST
TO BEDROCK IF OBSE ED (SEE ABBRV. ON BACK.)
/
B- J s 83 fu
B- w 3.
.3~
B- Z t~ o. , t " rr
B- _0 f
3
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B- g ,
PERCOLATION TESTS v
DROP IN WA ER•LEVEL-INCHES RATE MINUTES
TEST DEPTH WATER IN HOLE TEST TIME P RI D P R PER INCH
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 3
3 t
P-
P- 3
P- p
P- /t !
P- 3 N Z 101
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. TEM ELEVATION
/I01 p t9yt)Se {litJj.
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lth undersigned, hereby certi that the soil tests reported on this form were made by me in accord with the procedures and methods speci ied in the Wisconsin
inistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
TESTS WERE COMPLETED ON:
N rint
CERTIFICATION NUMBER: PHONE NUMBER (optional):
A S: _
2
o IGNATURr
DISTRIP(JTION: Original and one copy to Local Authority, Property Owner and Soil Tester.