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AS BUILT SANITARY SYSTEM REPORT
OWNER %cl~l~ TOWNSHIP t( /G/7fidi~
SECTION--_Z~_T ZO N-R_LK W
ADDRESS 3ff
ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT ----LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/Y
7
1G
3•
INDICATE NORTH ARROW
BENCHMARK:Elevation and description: ~ol/OiY~ a
Alternate benchmark
1-511
SEPTIC TANK:Manufacturer: f ell S Liquid Cap.
Rings used:-/-Manhole cover elev:--&~ final grade elev:
Tank inlet elev.: s~Tank outlet elev.:
No. of ileet from nearest road:Front , Side, Rear Ft. tea/
From nearest prop. line:Front , Side , Rear g_Ft..12
No. of feet from: Well- A~iO Building:S
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
v
PUMP CHAMBER
Manufacturer: Zzl2 e 1( S Liquid Capacity:
g~
Pump Model: ,-//'~'Pump/Siphon Manufact. : Size
-Pump
Elevation of inlet:~Bottom of tank elevation y0, S
~Wump off elev.: / y
Pump on elev.: f~` -,3r lons c cle • I
Alarm: Man.: ~Z- Switch Type: Q- Lo ion
Distance from nearest prop. line: Front_, Side, RearLFt.~~ /
Distance from: Well O~ Building ~C
SOIL ABSORPTION SYSTEM
Bed: r_Trench: Seepage Pit:
Width: ) 4' Length 6LE Number of Lines:-,-~:' Area Built
Exist. Grade Elev. 5f5" / Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side, Rear Ft.n
No. feet fro well: V No. feet from building Lrr>
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front Side , Rear Ft.
No. feet from: Well , building nearest road
Alarm Manufacturer:
INSPECTOR: J
DATE:- PLUMBER ON JOB:
~
LICENSE NUMBER: 3~ y
6/90:cj
1Q.CAT.I N: RIC, ND 14.30.18.199B NE NE, 157TH ST.
Viiisconsin~epartmento n ustry, PRIVATE S9WAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 180287
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
FERNSTROM, RUSSELL G & EDNA RICHMOND
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/GJ,GV %G , GIl yY? C . C :!:)7' 026-1041-20-000
ELEVATION DATA A9200364/o zo
TANK INFORMATION
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic a)u 1S C'~nC. / Uza Benchmark / p2) Ud
Dosing Z, jjkLK~, /S 9Q
AejAtiorff- Bldg. Sewer co
Holding St/ Inlet
TANK SETBACK INFORMATION St/ )K Outlet ` 95, 33
TANKTO P/L WELL BLDG. Aenttake ROAD Dt Inlet ~d,djj' 93
Septic 2, NA Dt Bottom 0 3" 3,/~ 9drS
Dosing j D l ~d' > 7~ NA HeaderL94au_ r 9(p, Z~l
Aera NA Dist. Pipe -7L.-O' q6,09~
Holding Bot. System ' QQ
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer
1 %0 C&I 01- Demand ~0~' G
.sw.- & z. 9
Model Number ge- 44 GPM -670/0 ° 5 v, 5 ~rS 97 g9~
Friction S stem r
TDH Lift Loss I~ ead / TDHq,O' Ft
~ r
Forcemain Length Diaz? Dist. ToWell>
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS g ~a DIMEN I N
LEACHING Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Moe Number:
System:COYN > l~ OR UNIT
DISTRIBUTION SYSTEM
Header /414am4s'd /l Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake
Length IL Dia. Length __22 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over r „ xx Depth Of T xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges J~ ' c to Topsoil E] Yes E] No El Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: RICHMOND 4~.,30.18.199B,NE,NE,157TH ST.
V
Plan revision required? ❑ Yes E~l I1` O
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
e
D# R SANITARY PERMIT APPLICATION
COUNTY
In accord with ILHR 83.05, Wis. Adm. Code 5~4 %4
G
STATE SANITARY PERMI #
-Attach complete plans (to the county copy only) for the system, on paper not less than onto
8% x 11 inches in size. cn if ~f prew us application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROP TY OWNER PROPERTY LOCATION
7i,p S 44 T,70,. E(o
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR C~SM NUMBER
L L .1ai - -71 t/04-
II. TYPE OF BUILDING: (Check one CITYA
=N OF: GE : r NEAREST ROAD
) State Owned VLL /i C'/?.,0n0 a
❑ Public E41 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) ro ^ ~p Y / iZC
1 ❑ Apt/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 in line A. Check line B if applicable)
A) 1. ❑ New 2. R Replacement 3. ❑ Replacement of 411 Reconnection of 5.0 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 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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
Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumb 's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
u is Address (Street, City, te, Zip Cod
f 4
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing A na ps)
Surcharge Fee) -
Approved El Owner Given Initial l o -
Adverse Determine ion
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years. "
2. Y6ur 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 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 punipeddby'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 & 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.
Ill. Building use. If building type is Public, check all appropriate boxes 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 type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Gumplete 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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
STC-100
1,11is application form is to be completed in full
the owner(s) of the ~ and signed by
property being developed. Any inadequacies
will only result in delays of the issuance. Ss
development be intended for resale byt owner/contr ctor d 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 propertyf1/4 ~1/4, Section
_ , T_&,N-R -
Township
c
flailing address /
Address of site
Subdivision name
Lot no.
Other homes on property? es
y - .~No
Previous owner of property h
k r
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 ,,d0o
Volume` and Page Number ' as recorded. with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUIWER, VOLUME AND PAGE
NUMDI R & 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 the owner()
the property described in this information form, by virtue sof oa
warranty deed recorded in the ff' a of the county Register of
Deeds as Document No.~S and own the proposed site for the sewage disposal t sI (we
ystem) orr I e(we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
Nocor i the office of County Register of deeds as Document
Signature of ap~licant
Co-appl cant
Date of Signature
Date of Signature
1 ,
DOCUMENT NO. t WARRANTY DEED
VOL 424 PA STATE OF WISCONSIN-FORM I
E _ _ -
i THIS SPACE RESERVED FOR RCCORDIN6 DATA
lj t , S
THIS INDENTURE, Made this ...16th day of......... Ma_Y-............. A. D. 19L66 I RL-. GIsTiKFt:3 OFFICE
r01..0 ....?41 ...jj.uxrsYST. CROIX co., wi c.
between 14
wife
r..................................................................................................................................... ReC d for Record this..?th _
part!es._. of the first part, and day of__ June 19 66
Edrja-•F-._-•Fernstrm.-bta---_, at_ _-_00 ___L, M.
Russell G-, Fernstrom..and
wife: -New Richmond,. Wisconsin!........................................... ,
f es i Reg r f eds
..part. i of the second part,
Witnesseth, That the said part _._le.S. of the first part, for and in consideration - -
of the sum of__..--_-...~ xt...Th.UBand-_.ai3d...Ko/-1QQ..1?ojjars._-.. RETt'R" To -
to..._ them.. in hand paid by the said partAe,A.. of the second part, the receipt
whereof is hereby confessed and acknowledged, ha_Ve___ given, granted, bargained, sold, remised, released, aliened,
conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey, and
confirm unto the said part._~.eS. of the second part t-helr heirs and assigns forever, the following
described real estate, situated in the County of..._.te r....__Qi.x'QJ.x and State of Wisconsin, to-wit:
the South Twenty (20) rods of the East Forty (40) rods of the
Northeast Quarter of the Northeast Quarter (NE*NEJ) of Section
Fourteen (14), Township Thirty (30) North, Range Eighteen (18)
I
West , -
- n - i
A 4 _ -
(IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE)
Together with all and singular the hereditaments and appurtenances thereunto belonging or 'n any wise
appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part ...eS. of the
first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and
their hereditaments and appurtenances.
To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto
the said part _ies_.. of h sec d a and to_.themselves s _theirheirs and a si ns g REVER.
And the said 0 ?n T p Murray and Katherine _1TLirray, hid wire
for...~'e11~IASteIV-eB.i...t'ekleir........ heirs, executors and administrators, do.......... covenant, grant, bargain, and
agree to and with the said part_1e$__. of the second part, heir........ heirs and assigns, that at the time of the
ensealing and delivery of these presents hey___arV..... well seized of the premises above described, as of a
good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are
i
free and clear from all incumbrances whatever, and__no_eX-QePtt3.l2t1&
and that the above bargained premises in the quiet and peaceable possession of the said part IQ$ of the second
part, __their....... heirs and assigns, against all and every person or persons lawfully claiming the whole or any part
thereof, ..they........... will forever WARRANT AND DEFEND.
In Witness Whereof, the said part...ie - of the first part ha.Y_!'_.... reunto set ....then' hand..!- and
seal..►a. this day of......_.._._ +y- A. ffRX
19.
k ~~~F•
NED AND SEALED PRESENCE OF .(SEAL)
J K hurray
0
--~14/ - (SEAL)
Paul 0 Swe b ~Natherine urray
---._..........---....._...._._...._...._--_._..._-_---(SEAL)
.
_4101
NLr~J o~,Sage r
- ...(SEAL)
State of Wisconsin, !
_ Late _C_r0 ount,Y~ personally came before me, this 16th day of.. MY A. D., to the above named _.____O n•_.n.e_•-Murray-.-and .Katherine Murray, his
-wife
to me known to be the person.S. who executed the for stru nt nowledged a same.
I
- . -
j
THIS INSTRUMENT WAS DRAFTED BY Paul O.Swen/b~~
NOTARY Notary Public R___91!A.. !
SEAL Y . - S -••t- - County, W15.
Paul 0. Swenby, ealtor I'
My commission (expires) ( ._.._OC t OT~e ' _R tlx•_--. 1965
(Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon
the names of the grantors, grantees, witnesses and notary. Section 59.513 similarly requires that the name of the person who, or govern-
mental agency which, drafted such instrument, shall be printed, typewritten, stamped or written thereon in a legible manner.)
STATE OF WISCONSIN Wisconsin Legal Blank Company
WARRANTY DEED _ FORM No. _V M1Nvnnknn anannnstn oalrto
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ 'F_C4 oL
ADDRESS: I-N 6_eil ei ~lkl (,~,~p ~ FIRE NO:
LOCATION: l 1/4 ► 1/4, SEC.Z'X T,ZZ.9_N-R /L W,_
TOWN OF:- ®C r ~js~?dh- ST. • CROIX COUNTY
SUBDIVISION: LOT NO.
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 systems
St. Croix County residents may be eligible to receive a grant to
help with the cost of the 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 the St. Croix County
zoning a certification form, signed by the owner and by a master
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. Certification from will be sent approximately
30 days prior to three year expiration.
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 form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
expiration date.
SIGNED:
I.
DATE : "~p
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
N SOIL BORINGS AND SAFETY & BUILDINGS
I)E:1'ARTiV1ENTOF REPORT 0 DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS MADISON, WI 53707
HUMAN RELATIONS ILHR 83.090) & Chapter 145)
TOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
I Ot A110N:_TSECTION: . 1
i I ( r~1 C
MAI .ING ADDREi S: ~7 r '
COUNTY: /'C r ~.6' /1? s! -
DATES ~u i
`✓r(U rte' CJ' OBSERVATIONS MADE, Gv
USE: - - - - PROFILED CRI DNS: PE 0 ATION TESTS:
NO.BEDRNLS COMMERCIAL DESCRIPTION:
TI -
( - .)New XReplace
RATING: S= Site suitable for system U= Site unsuitable for system
~CCiNVrEN TIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:loptional)
- - -
- ~U ES iL UU.'~';~ o ~
I E-51
S CCU- -S C_1U _ DS _
S DU
-
DESIGN RATE: I If any portion of the tested area is in the r
I If Per olation Tests are NOT required L v ~j
Hier s. 83.0915)lb), indicate: Floodplain indicate Floodplain elevation:
ILHR
PROFILE DESCRIPTION _
TEXTURE, AND DEPTH
BO[iINC, TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLORBAC,K.)
NUNI[iER DEPTIi IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON `
B- A617
13- 3
B-
B-
B-
- PERCOLATION TESTS
DROP IN WATER LEVEL-IN HES RATE MINUTES
I l "T EPTH WATER IN HOLE TEST TIME pERI D PER INCH
NUMBER E AFTE SWELLING INTERVAL-MIN. PERIOD 1 I f
- ---00,
P
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-
ontal „nd vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
I
+,f land slope.
SYSTEM ELEVATION
- 1
+
I i
i _ JA
I
i
INS
44 1
. Q ,ems G? erg
v~
1
dW.
me in accord with the p ocedures and methods specified in the W' consin
dcn'signer ,hereby ceru y that the sort tests reported on this form were made by
elief
,,.in inc.trative Corle, and that the data recorded and the location of the tests are correct to the best of my knowledge and b.
TESTS WERE COMPLETED ON:
~ 91 (Ptint~ t
Y'~~ _ S - CERTIFICATION NUMBER: PHONE NUMB ER(optionaU:
zr Z11'6
CST SIGN UR
DISTFilBUTION: Origmai and one ropy to Local Authority. PropectY Owner and Sorl Testor.
n\IFR
PLOT PLAN
. PRO,JECT_,, cfn~ "112t,", ADDRESS / /674
o
1/4/S #/T /d N/R/g~'W TOWN .c COUNTY st-Grv~j.~
MPRS Byron Bird Jr. 3318 DATE B- -
BEDROOM 3L CLASS PERC Co- 10
RESSURE
CONVENTIONAL LIFT
,MOU~HOLDING TANK
SEPTIC TANK SIZE /o LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
"'ABSORPTION AREA _ Zj2, 'Z) PERC RATE -e--.21 BED SIZE ja x-
1116 Benchmark V.R.P. Assume Elevation 10o'
Location of Benchmark •
H.R.P.
❑ Borehole Q Well Scale = Feet
0Perc Hole
System Elevation
Uent
12'
G de
TYPAR COVERING
12' 3- 4 6' Q 3'
I 6- Sewor Rock
r~ 12'
P ~2
o"
A ~
etc
/
&Lit b G
-1 Izi
d(r Gh
s.:~v7 Z.J~~i~1CtTY CU RV E
CO.
Dc
W
H
W
30 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
EFFLUENT AND DEWATERING
7~- SERIES 53 SS-57-59 97 117-139 163 tie
28
M LTRS LTRS LTRS LT-RS LTRS
1 .52 1 23
EFFLUENT AND DEWATERING 31.05 129 5 In 248 394 1 231
21i6 6 300 2311
2331 231
26 4.57 7z 163 242 227 227
SEWAGE AND DEWATERING 6.10 104 136 223 227
oonn ♦ 7'62 30 216 ?23
24 vU % 9.14 206 220
\ 72.19
172 206 i
\ 15.24 125 191
♦ 18.29
22 ♦ 57 161
21.34 t t4
24.39 53
MODEL',♦ MODEL Loek Volvo: 19 24.s 29 66 e7
20 163 1655 TOTAL DYNAMIC NEADICAPACTTY PER MINUTE
SEWAGE AND DEWATERING
18 SERIES 267 let 202 204 293
M LTRS LTRS LTRS LTRS LTRS
\ \ 1.52 409 396 492 681
3.05 227 273 360 598
1 S 4.57 76 163 238 511
0 6.10 30 125 401 -
7.62 288
14 ` 9.14 163 292
\ 10.67 227
♦ 12.19
13-72 1 06
12
,04
i 15.24 45
MODEL Lod Valve: IS' 21' 26 35' 53•
10 35 293
0
8 MODELS 1
X25 137 139
6 J- I
MODEL
4 284
1)E ' MODEL
282
2 r MODE Sj'\%
53, 55, MODEL' MODEL
0 57,59
97 267
~U.S~GA'CS - 10 030. 40 X50 60 X70 ~'~}80~"~90;~100 10:120^" 30~140~150 :1601`770 ;780. 190•"~
LITERS 80 160 240 320 400 480 560 640 650
FLOW PER MINUTE
3280 Old Millers Lane Manufacturers of. .
Box 16347
Louisville, Kentucky 40216
(502) 778-2731 '
_ QUAL/TY ~/Mf~S j7/V-'1- ~~~J~~~ ~
8
" PAr,F CF
PUMP CHAMBER CROSS SEC-101 AUr, SPECIFICATIC)Q5
VEIJT CAP
4"C. Z. VEVT PIPE
WEATHERPROOF APFROVED LOCKMIG
2 Z5' FROM DOOR, JUAICTIOAJ BOX MANHOLE COVER
WINDOW OR FRESH 12"MIU.
AIR INTAKE l
GRADE -
, '
4" MIU. G
I IB"/`KIA1.
COIJDUIT
18"MIN.
IMLET PROVIDE I
AIRTIGHT SEAL
A I II
IIj
ALARM
I 1
*APPROVED I ON
JOINTS WITH
ELEV FL I
APPROVED PIPE
3 ONTO PUMP OFF
D SOLID SOIL
CONCRETE BLOCK
RISER EXIT PERMI'rrED OULy IF TAAJK MANUFACTURER. HAS Su APPROVAL
SEPTIC E SPEC. IFfC.ATIOUS
DOSE `6__/
TAUKS MAUUFACT URER: IJUMBER OF DOSES'
• PER DAM
TAWK SIZE: GALLOUS DOSE VOLUME
ALARM MAUUFACTUR. ER: IIUCLUDING BACKFLOW: _
GALLONS
MODEL UUMB'ER' r t'
CAPACITIES: A-3._S.lur-1IESOR 6%10 GALLOWS
SWITCH TYPE: - f e YlGC4 INCHES OR 40
-GALLONS
PUMP MANUFACTURER: G C = J UILHES OR Z-3-0 . CALLOUS
MODEL UUMBER: 91 C INCHES OR 120 GALLONS
SWITCH TYPE: L le I's NOTE: PUMP AUD ALARM ARE TO BE
MINIMUM DISCHARGE RATE-__GPM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEtAI PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MIIUIMUM NETWORK SUPPLY PRESSURE FEET
FEET OF FORCE MAIN X loortFRICTIOU FACTOR. FEET
TOTAL DYNAMIC HEAD =FEET
III,ITERMAL DIMEWSIOUS; OF TANK: LENGTH 2_,;WIDTH --Z -'LIQUID DEPTH
41r_►~rn. ,
REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1
10/19/92 15:13 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/20/92 AREA: JT
•Activity: A9200364 10/20/92 Type: CONVSEPT Status: PENDING Constr:
Address: RICHMOND 14.30.18.199B,NE,NE,157TH ST.
Parcel: 026-1041-20-000 Occ: Use:
Description: 180287
Applicant: FERNSTROM, RUSSELL G & EDNA Phone:
Owner: FERNSTROM, RUSSELL G & EDNA Phone:
Contractor: BIRD, BYRON JR. Phone: 268-7616
Inspection Request Information.....
Requestor: BIRD JR., BYRON Phone:
Req Time: 15:10 Comments: 3,30
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
~ 1/4 /T L,O~I~/ ( r e Off?
COUNTY: / MAI LING ADDRESS:
4L le I
SE DATES OBSERVATIONS MADE '/~Zjr-
X NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTION-9: PERCOLATION TESTS:
Residence ❑New ,Replace
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: optional)
S ❑U 2$ ❑U $ ❑U ❑S 19 SU z65-o
If Percolation Tests are NOT required DESIGN RATE: If an
y portion of the tested area is in the
under s. ILHR 83.09(5)Ib), indicate: G( Floodplain, indicate Floodplain elevation: /yd
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- C - 6 ~n a
o - 1" c3/sr ~~-16 107 .0 r_/AC - j- A
B- y~ 5 ~G s~ S
B_ 3
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER Miffib G6 AFTE SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH
P- z o t ' A
P- O ! 3 '
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or a s. Descr& what are a i-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all nd the fBilect(=nd
of land slope. C f'-"
SYSTEM ELEVATION 73,0,/ C C: X ~
II_ i
le- a
c~
I t
E s
yr/~1 r
j
j t -
i I i 3 I
= 1
3 0._ 3 30 ` _ _ ,moo`
1114. i .00
4~r
13
j
j 7 I~ j I
A .1
i
1
ellov
r ~ r
t
1
I, th undersigne hereby certify that the soil tests reported on this form were made by me in accord with the p ocedures 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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
R-t -4 A90 x6 ,r C.q o0 3 i- 6/.6
CST SIGN UR :
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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 scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur 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
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
Is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
'st - Loamy Sand < - Less Than
'1 - Loam Bn - Brown
'sil - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
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 to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.