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AS BUILT SANITARY SYSTEM REPORT
OWNER, z2~' ,6 S 9-1 Z4 i //7,, ~ TOWNSHIP 6
SECTION- Z.0 _T 30 N-R -le W ,
ADDRESS 3~ 7 /d • 5~ ST. CROIX COUNTY, WISCONSIN
-26 IA2~
SUBDIVISION_ _LOT LOT SIZE~~~~
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
y5 I Gad
4;; ~
.S
3
2 '
led- ~
INDICATE NORTH ARROW
BENCHMARK:Elevation and description.
Alternate benchmark
SEPTIC TANK : Manufacturer: l'(5 0 • P • Liquid Cap. / y ~ ;Olv-
Rings usedkLmanhole cover elev: Z inal grade elev:
Tank inlet elev.: sz Tank outlet elev.: S 7
No. of feet from nearest road:Front ---~--Side Rear
From nearest prop. line:Front , Side Rear Ft. Z
No. of feet from: Well , Building:,Z,;~2 `
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model:_pum Siphon Manufact.: Pump Size
LAlarm: n of inlet: Bottom of tank elevation
elev.: Pump off elev.: Gallons/cycle:
an.• Switch Type: Location
from nearest prop. line:Front, Side_, Rear_Ft._
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: y Seepage Pit:
Width: .S Length n Number of Lines• ? Rr
Area Built
Exist. Grade Elev. Proposed Final Grade Elev. 6 e
Fill depth to top of pipe:_ 311--1 `
No. feet from nearest prop. line:Front , Side
Rear Ft. ZS
No. feet from well:--L,~-'No. feet from building -3 5✓~
HOLDING TANK
Manufacturer: Capacity:
No. of rings used:-El ation of bottom tank:
Elevation of inlet:
No. feet from nea st prop. line:Front
Side , Rear Ft.
No. feet from: ell building , nearest road
Alarm Man acturer:
INSPECTOR:
DATE : PLUMBER ON JOB:
LICENSE NUMBER:
6/90:cj
LOCATION: RICHMOND 20.30.18 PR VAT~SfWAGE ty~?eMRD. A Wisconsin Department o Industry, 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 a Town of: State Plan ID No.:
EININGER, JAMES RICHMOND
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9200279 I o/ZG pz
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic eks Cc 6 Benchmark ~ g~
ng , L /I~, Z.32 02,
Aeration Bldg. Sewer
Holding St/ Inlet -7-311 SZ
TANK SETBACK INFORMATION St/,~E Outlet 27,9'
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt
Air I
Septic NA
Dosi NA Header /_AUn. Az, r ,
Aeration NA Dist. Pipe - 5 /
Holding Bot. System
dZ .S
PUMP/ SIPHON INFORMATION Final Grade 9 22//
aM#rSZ16`er Demands 3
Model Number GPM
TDH Lift Friction stem TDH Ft
Forcemain I Length Eia. Dist.
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
S .02 d DIMENSIONS
DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer.
SETBACK CHAMBER
INFORMATION Type O nlJ. Mode Number:
System: -e-a,# ZS OR UNIT
I
DISTRIBUTION SYSTEM
Header 1 Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake
Length 1~_: Dia. S~ Length Sz Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ~v rr Depth Over ii ~i xx Depth Of xx Seeded/ Sodded xx Mulched
BedlTrench Center 3 -v Bed/ Trench Edges - 7v Topsoil ❑ Yes ❑ No [3 Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes B-_No
Use other side for additional information. D 902
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
f
E
e
-SANITARY PERMIT APPLICATION
. DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /7/ 5
8% x 11 inches in size. check If revision tdj~revious 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
James D. Heininger SE y,,W g 20 T30 , N, R 18 f(or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # n/a BLOCK #
599 E. Maryland
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
St. Paul, Pin. 55101 612 776-6056 Vol. #8- age 2214- document 4458732
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLLLAGE : NEAREST ROAD
.Richmond Co. Rd. 44A
❑ Public @9 1 or 2 Fam. Dwelling-#~ of bedrooms 3 PARCEL TAX ER(
III. BUILDING USE: (If building type is public, check Z11 that apply) / z d z d
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 $ ❑ Mobile Home Park 120 Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPPE1 OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. @d New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 I❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit I Pressure 43F-]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
450 585 600 .75 <3 96.10 Feet 99.80 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank x ; 1000 1 P "
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): Plumber' at re: (No tam ) PRSW No.: Business Phone Number:
Gary L. Steel 3254 715 246-6200
Plumber's Address (Street, City, State, Zip Co
1554 200th. Ave., New P,.ichmond, 14i. 54617
IX. C UNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa91tary Permit Fee (Includes Groundwater a e Issued Issuing ent Sign (No Sta ps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 000,
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 renew,il 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 (SEC) 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 & 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.
111. 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, lumber of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Cornp'ete for all
septic, purrip/'siphon and holding tanks for this systern. 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-loo
This application form is to be completed
the oc~ner(s) of the in full and signed by
will onl property being developed, An .
Y result in delays of the permit issuance. iShou ldathis
development be intended for resale
by house), then a second form should be reaiowntractor,spec
nedrand n ompleted(when
the property is sold and submitted n a to t
-ppropriate deed recording. his office with the
-
Owner -
Of property James D. tIeinin ej
Location of property SE 1/4 M-j 1/4, Section 20
T. N-R_ 18 W
Township P.ichmon
Hailing address 599 E. Maryland
Address of site Co. Rd. I/A, New Richmond, wi,
Subdivision name n/a
Lot no. 1
other homes on property? yes x
No
Previous owner of property Steven & Richard Ulrich
Total size of parcel 3 acres
Date parcel was created 7-14-92
i
Are all corners and lot lines identifiable? x
_________Yes No
Is this property being developed for (spec house)? Yes
volume 959 and page Number -X-NO
of Deeds.
492 as recorded. with the Register
•
INCLUDE WITH THIS APPLICATION THE rOLLOWING:
A WARIUI.IITY DLED which includes a DOCUMENT NUIWER, VOLUME AND PAGE
1IUIt13I R & THE SEAL or THE 1ZEGISTGR OF DEEDS.
certified survey, if available, ;would be helpful I o asdtoiOvoid
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
1 (we) certify that all statements on this form are true t
best of ny (our) knowledge that I (we) am o the
(are) the owner()
the property described in this information f
orm, by virtue sofoa
warranty deed recorded in the office of the County Register of
Deeds as Document no. 4$59$1
own the proposed site, for the sewage disp salt system ) or preIsently
we
obtained an easement, to run the above described for
the construction of said system, and the same hasopbeen,duly
recorded in the office of county Register of deeds as Document
No.
n ure of ap
Co-appl cant
i
6
Dat f Si net e
Date of signature
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
4185981 VOL 95fla 14 U,-'
REGISTER'S OFFICE
Steven M. Ulrich and Nancy D. Ulrich, as survivorship ST.CROIX CO., WI
marital property, an undivided one-ha.l.f_-inte.re5t_.and---------- ..Reed for Record
Richard L. Ulrich and Beth C. U1richihu.sband a.nd_.w if_e,_.... JU1.171992
as survi vorsh-ip__mari ta1__pro_perty_,._ an-i.de-d_.one-.hal_f
interest, as tenants in common Ot
- -
8:30 A. M
conveys and warrants to ......James D--__Hen_inger_.-and..____.._
-1 Starl_ene_K....Marsh- a-s--Jo-int._tenants 0 e4vwwLa
-
Register of Dee
RETURN TO
-
the following described real estate in . ........County,
State of Wisconsin:
Tax Parcel No_
That part of the Southeast Quarter of Northwest Quarter
(SE 1/4 of NW 1/4) of Section Twenty (20), Township Thirty (30) North, Range
Eighteen (18) West, described as Lot 1 of the Certified Survey Map filed May 21, 1990,
in Volume "8" of Certified Survey Maps, Page 2214, as Document No. 458732.
47A TTVES
This is not
homestead property.
(is) (is not)
Exception to warranties :
Dated this - 14 day of Jul y - - - - 19- .92..
,
r -w ` - ---..(SEAL)
~------.(SEAL) -
"~~teven M. Ulrich
Richard L. Ulrich
- -
J >
------------(SEAL)
*Nancy D. rich Beth C. Ulrich
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
SS.
St' -----------County.
authenticated this day of___________________________ 19..-..- Personally came before me this __.__...1- day of
My------- 19-92 the above named
StQVen Q. ULrich3._Nana!._D_..U_lrich.,..
TITLE: MEMBER STATE BAR OF WISCONSIN Ri_Chard_-L..___Ul.rich..and__Beth__C-__lllr_ i,ch-_-_..__
(If not-
authorized by § 706.06, Wis. Stats.) to me known to be the person:.----------. who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY ~r
REINSTRA,__VAN D1(K & NEEQHAr1_,__S.C.-__-____ * GarytH. Baillargeon(f
NewAi_chmnnd_,__hlliscons1n----- 4-017______________ Notary Public St,.__Cro]X------------ .-County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary) date: Sept 18 ( 94-_..)
I~ ~~-H:-BAR.
oil
*Names of persons signing in any capacity should be typed or printed below their signatures. ~I
WARRANTY OF.FD STATE, PAR OF WiSCON iN Wisconsin Legal Blank Co., Inc
1,011M No. 2- IUa2 Milwaukee, Wisconsin
L
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER James D. Heininger
ADDRESS: 599 E. Maryland FIRE NO:
LOCATION: SE 1/4, NW 1/4, SEC. 20 T 30 N-R 18
TOWN OF: Richmond ST. • CROIX COUNTY
SUBDIVISION: n/a 1 T--
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 system:
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.
,c
SIGNED: 17
DATE:
St. Croix County Zoning office
911 4th St.
Hudson, WI 54016
SAFETY & BUILDINGS
[)EPARTMENT OF REPORT ON SOIL BORINGS AND DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
. SUBDIVISION NAME:
TOWNSHIP/MIRY: LOT NO.:BLK. NO:
SE AT 1.J1 20 o/j30 N/R18rc(or) w Richmond n/a n/a n/a
COUNTY: OWNER'S B ER'S AM MA L N ADDRESS:
St. Croix Richard & Steven Ulrich 1338 170th. St., New Richmond, wi. 54017
DATES OBSERVATIONS MADE
USE NO.BEDRMSComm R ALDESCRIPTION: PRO I C O S: STS: kiResidence 3 n/a 'New ❑Replace I 7-7-92 7-7-92
L
RATING: Sa Site suitable for system U- Site unsuitable for system
KECOMMENDED SYSTEM: (optional)
UNVE4-T AL: MOUND: IN-GROUND ESSU 15 E: S STEM- N-FILLHOLDING NNT
entional
a S ~U S IU ❑ S CCU ~ S U conv
tf Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the n/a
under s.H63.0915)!b), indicate: n/a Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS page 35 ShA
BORING TOTAL ELEVATION P H T GROUNDWATER-INCH ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. OBS SERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
,
0-11, 10yr3 2,, L.-; 11-25, 10yr5 , S11. , -73--36
B-1 37 99.80 none >87 7.5yr4/ti, Is.,; 36-87, 7.5yr5/4, co.s. -
0_ 1, Oyr , L.; yr i, s1
B 2 84 100.00 none >$t
i 25-34, 10yr5/4, co.s.
99.60 84 0-13, 10yr3/2., L.; 13-23, 10yr5/4, sil.; -
3 34 none > 28-841 r5/4 co.s.
0-9 Ill 2, L. , 9-28, yr ,
B- s ;
4 84 99.20 none >84 Ill ''I r5/4 co s.
2.3-
11-2, 10yr5 11,
B_ 5 };g 99.40 none >88 10yr3 3
10 r4 4 co. s.
B-
PERCOLATION TESTS
decimal'
DEPTH. DROP IN WATER LEVEL-INCHES
TIME RATE MINUTES 11 T WATER IN HOLE TEST 7l, N
UMBER M`Iftil S AFTER SWELLING INTERVAL-MIN. D PERINCH
60J-Q J_ P- 1 3.70 none
P none
P none 3 <3
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe whet 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 96.10
o
E , I t? C y- _
1
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.
TESTS WERE COMPLETED ON:
NAME (print : 7-7-97 _
Gary L. Steel CERTIFICATION NUMBER: PHONE NUMBER(optional):
AUDRESS: 2298 715-2t+6- X200
1554 200th. Av.e, 1~1ew Ric}unon, tli. 54017
CST SIGNATU
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
r1Vr
R -
1'1) 1W .r,~, t".,'.1'1 W i`. !fI))
STEEL'S SOIL SERVICE
1554 nnn.~i_LI
LVVL. Ave.
Gary L. Steel
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 James D. Feininger (715) 246-6200
3'~I 1~ SE', DA A4 S20 T30N R18W
Richmond township
_ ~ 5• I
1 14
-~4 WO
~Ju
~Ao
ti -Q 7-2 ci
~7L
i
Gary L. Steel
7-29-92
REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1
10/22/92 14:54 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/26/92 AREA: JT
Activity: A9200279 10/26/92 Type: CONVSEPT Status: PENDING Constr:
Address: RICHMOND 20.30.18.303A-20,SE,NW, CO. RD. A
.Parcel: 026-1061-20-120 Occ: Use:
Description: 171513
Applicant: HEININGER, JAMES Phone:
Owner: HEININGER, JAMES Phone:
Contractor: GARY STEEL Phone: 246-6200
Inspection Request Information.....
Requestor: STEEL, GARY Phone:
Req Time: 09:10 Comments: 9
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I
I
i
~I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSH I P/ML90t5MUUffY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
SE 14Mt'' 1/4 20 /T30 N/Rl€ *(or) w Richmond n/a. n/a n/a
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Richard & Steven Ulrich 1333 170th. St., New Richmond, wi. 54017
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DES RIPTIONS: PER ATION TESTS:
Residence 3 n/a New ❑Replace Il 7-7-92 7-7-92
RATING: S= Site suitable for system U= Site unsuitable for system
rONVENTIONAL: ccMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
EJ ❑U ~S ❑U S ❑U S EiU I F-1 S ®U conventional
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 35 ShA
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 37 99.80 none >87 0-11, 10yr3/2, L.;11-25, 10yr5 , si".,; 25-36,-'
7.5yr4/4, Is.,; 36-87, 7.5yr5/4, co.s.
2 34 100.00 none >84 0-11, 10yr3 2, L.; 11-25, r sz -
B- 25-34, 10yr5/4, co.s.
3 84 99'60 none >84 0-13, 10yr3/2, L.; 13-28, 10yr5/4, sil.; -
B- 23-84, 1 5/4, co.s.
4 34 99.20 none >84 0-9, 10yr3 2., L.; 9-2 , 1 , Si l.; . -
B- 1 5/4 co.s.
B-5 38 99.40 none >88 0-11, 10yr3 2., L.; 11-23, 10yr5 , sil. 23-88,-
1 4/4 co. s.
6-
decimal' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH
P-1 3.70 none 3 6 6 6 <3
P_ 3.90 none 3 6 6
P_ none 31 6 6 <3
P__
P-
P- _ QQ
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dista .8 c i 4v a a e hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bo ' a e directio p cent
of land slope.
SYSTEM ELEVATION 96.10
_
t
1
}
0 0
Ori
3
V
~N ICY/ -
6"
3
.
E. ,
- _
E
.
E
i
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 7-7-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Av.e, New Richmond, T~ 54017 2293 1715-2467f)200
CST SIGNAT /10
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must irl<;lude:
1. Cornpline legal description;
2. The use section must clearly indicate vv' this is a residence or commercial project;
3, MAXF IUM number of bedrooms or srcial use planned;
4. Is ' or replacement system;
5= Co ~11it;ihility rating boxy, SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHI RULED T BASED ON SOIL CONDITIONS;
5. PLEA."- iatior - ere for writing profile descriptions t completing the plot plan;
7. MAKE r barn ao locating your test locations. Dr scale is preferred. A
if desit
8. M. e rk and v 1 Elevation reference print are clf v!, and are permanent;
P_ cc ! ail boxes =s, names, address, ~1:iora lest exemp-
tion, if.,i)propria. ,
10, If the informati~.~ , as flood l: ration) does riot ; -'.ly, place N, A, in appropriate box;
11, Sign the forte your current -,;s and your corti tion num[re-;
12, Make iegi ' "Ad distribute required. ALL & TESTS ML ~ _ED WITH THE
LOCAL AUTHC - Y WITHIN 30 GAYS OF COMPLETIC
ABBREVIATIONS FOR CERTIFIED SOIL_ TESTERS
Soil S{ d Textures Other Symbols
1a"j BR .l ort,
_ {3 - 10") SS - if Isto le
ge - let, 3") LS I.t....
HGVVV High
cs - Perr; .
rnecI s - d IN
fs - Bldg i
is lo\rv
l oarn R
n mot
sic - fff -
P1 - r rn
(,f fJtOn`i~
HVv'L - f+,i't
3' <rs <tures
f,.r d ~.,;osal BM ; rv'a~
VRP i R
it
TO TI
fii I -utii y ;..,mit. 7 c( m ti- r lee