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AS BUILT SANITARY SYSTEM REPORT
OWNER GJAY.,lVC L / xo 5 TOWNSHIP !S? '1OSeow
SECTION T3_N-R-Z9 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Sowr/4 Q~oDEPn/ INDI AT NORTH OW i A& A r " ti
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or ~vP.vE ~
BENCHMARK:Elevation and description: a~ of /y ?.w~iy i9r S`~~rr-o,&,e
Alternate benchmark A/ A ~L,dV icx~ ov'
SEPTIC TANK: Manufacturer: k)J 4s.4,r Liquid Cap. /000 OA4
Rings used:_L_Manhole cover elev: /Final grade elev: //G•~$~~Y4.
Tank inlet elev.: ` Tank outlet elev.: 90'
No. of feet from nearest road:Front ~ide ,.Rear Ft..-??(-
From nearest prop. line:Front Side Rear Ft.
No. of feet from: Well .69 .1 , Building: /S
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE-SIDE
r
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
J
Bed: -Trench:A 0/• ova Seepage Pit:
a Width: S Length Sc1 ' Number of Lines:___L_Area Built SrfO SOF1:
Exist. Grade Elev. A /D5- SAProposed Final Grade Elev.6 ic.2 ~D AV6
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear _Ft.//'
No. feet from well: ~L No. feet from building Sloes
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
i
Alarm Manufacturer:
INSPECTOR:
i
DATE: PLUMBER ON JOB:
LICENSE NUMBER:' ~
6/90:cj
~1T > ,5i~~ rt e75tofl ~i3~fr PH 33.30.~RIVAyjgMA SYST?A.E County:
Labor and j-luman Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) sanitary Permit No.:
GENERAL INFORMATION 171451
Permit Holder's Name: ❑ City ❑ Village [Town o : State Plan ID No.:
LIKE WAYNE A ST. JOSEPH
CST BM E ev.: Insp. BM Elev.: BM escription: Parcel Tax No.:
1,I)d 1.60, 410' a S 4- lZ win-2oo3-5n-nno
TANK INFORMATION ELEVATION DATA A9200216
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosi n 1J . id,
Aeration Bldg. Sewer
'
Holding St/ ,*(Inlet
TANK SETBACK INFORMATION t/ Outlet a,9D
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic cfs~~' NA Dt Bottom
Dosing NA Header,EWww*-
Aeration NA Dist. Pipe ~loA & '
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
anufacturer Demand -1 d° S CGv~
Model Number GPM
TDH Lift Friction Syste TDH Ft
oss Head
Forcemain Length Dia. Dist. To we
SOIL ABSORPTION SYSTEM
BED/TRENCH width t Length No. Of T enches PIT Inside Dia. Liquid Depth
DIMEN 1 N DIM N
LEACHING Manufactur
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O o n CHAMBER Mo a Num er:
;~.r,c€ /afi, SS ® OR UNIT
System:
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Lengths Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Overa) „ Depth Over r xx Depth Of xx Seeded/ Sodded xx Mulched
Bed I Trench Center -S~ Bed / Trench Eges 30 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
.COMMENTS: (Include code discrepancies, persons present, etc.) p
/Y7 !
Plan revision required? ❑ Yes
Use other side for additional information. Z7 ~k
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: e
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CouN
~s
•e~..wt •,u.w„~w.s~
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than /7 Ns-/
8% x 11 inches in size. ❑ check if revision to previous 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
GJi4 YN£ 5 9' '/a /v tjS 3 T T 30, N, R / el E (oro
PROPERTY OWNES MAILING ADDRESS LOT # BLOCK #
/c~ v f/ o ~E~s ~T tll.~ IV A
Cl , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
f kOSO^)
13
11. TYPE OF BUILDING: (Check one) CITY ` NEAREST ROAD
❑ State Owned V
4OWN OF: ILLAGE 5T /~JoS~ON ` r r, X_
❑ Public Z 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL AX NUM R(
111. BUILDING USE: (If building type is public, check all that apply) 0. 7o .2oo,
1 ❑ Apt/Condo
20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11,E] Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 RSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 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) 4 /ai. EbRIy SPN
41S0
SrO sQ. S 90 Sep fir. • ~G 3 d Of-Of 'Feet /03. ~ o'Feet
VII. TANK CAPACITY Site
in allons # of Prefab. Fiber- Exper.
INFORMATION New lExisting anks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank "_gi SE
Lift Pump TanW Si hon Chamber
Vfill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber' Signature: (No Sta ps PF-5, PRSW No.: Business Phone Number:
ZVOA Revs f 5 33,9 S 3err- -Wwsc,
Plumber's Address (Street, City, State, Zip Code):
P/,5 V T,v S7' /V Itlu,0 SU-v ~t 54~vs
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issue ng Agent Signat o Stamps)
Surcharge Fee)
9 Approved ❑ Owner Given Initial
Adverse D t rminati n
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: r 0,
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
t -
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 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 (SE'D 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, E08-266-3815.
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.
ll. 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 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. 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% x 11 inches must be submitted to tha county. The
pans must include the following: A) plot plan, drawn to scale or with complete dimensions, ocation of
holding tank(s), septic tank(s) or other treatment tanks; buJ!ding sewers; .yells; water mains, water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; repla ;ement system
a eas; 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; fried m loss; pump
pc,rformance 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
1933 Wisconsin Act 410 included the creation of surcharges (fe:crs) for a number of
regulated practices which can effect groundwater.
The w.mita collected through these surcharges are use:f for, rn~,-,nitoring groundwater, ground-
water owamination investigations and establishment of standawds.
a
SB3-639!3 !R-11/881
•
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), 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 property1/4 //3./4, Section-
, T 30 N-R_Zy W
Township _
Nailing address
Address of site f
Subdivision name /
Lot no.
Other homes on property? es -1/-, No
Previous owner of property I-ir,- 1`2- , i
.12
Total size of parcel ~
Date parcel was created Q
Are all corners and lot lines identifiable? - v/_
Yes No
Is this property being developed for (spec house)? Yes _je~No
Volume ozi/and page Number „&(~g as recorded. with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUHBER, VOLUME AND PAGE.
NUMBER & THE SEAL OF THE REGISTIIZ OF DEEDS.
certified surve In addition, a
y, 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.
I
PROPERTY OWNER CERTIFICATION
I(%qe) certify that all statements on this form are true to the
best of ny (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. 1V(Y2-gZyI
oo:n the proposed site for the sewage disposal and t system) orr IQ(we)
obtained an easement, to run the above described for
the construction of said system, and the same hasopbeen,duly
record 7d in the office of county Register of deeds as Document
No.
Signature Cif ap¢licant
Co-appl cant
Date of Signature
Date of S gnature
J t
V ~
:f OOCtimoff NO. ltAM a" 0!'1~~O~Oy a I Foam 1_1 *rn►nrrt~lr
WAMMw W i a/ivI ' Fl
_ - __,8001(=_ _ 0 PA" - REG IS
aT. CftE~IfE -
This Deed, .t,.a. ha.... ~'d der f
aR 1 .
T~mrba.v....Peters,...a_ v~~~e.>?~r.~......•--• Nov OT W"
i 8s_V AA
ad ..Wayne. A...Llkies....• .sl»>zle..~ex~ola.•--••---•
- a
I
_
. ciraatee,
Witnessseth, That the said Grantor, for a vale" onsideration......
-
RKTUI l To
I) conveys to Grantes the following described real estate in ....St .••Cro1Y _ ,
County, State of Wiseman:
Lot 1 on Certified Survey Map filed December 19, 1979 _ - -
i! in Vol. "4" of CSM, Page 902, Doc. No. 361932, in the
Office of the St. Croix County Register of Deeds, being
a parcel in the Southeast Quarter of Northwest Quarter of Section 33, Township 30
North, Range 19 West, Town of St. Joseph.
Together with and subject to the following:
a. Easement for St. Croix County Trunk Highway "E" over the northerly portion
of said > 1;
b. Private Road Easement as shown on said Certified Survey Map, and southerly
extensions thereof in the future;
c. Declaration Establishing Obligations Toward Private Road Maintenance dated
and recorded December 26, 1979, in Vol. "606", Pagea 369-371, Doc. No. 362022.
fj d. Any other easements, reservations and restrictions of record.
I'
S
is not EE
This homestead property.
(is) (is not) ~
Together with all and singular the hereditament& and appurtenances thereunto belonging;
And.... Taasxha._Y..._PSZ:CrgQA.....
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except (
easements, reservations and restrictions of record
and will warrant and defend the same. i .
Dated this day of - l9._$$.
~i
(SEAL)
- --(SEAL) kw.
' . RHA.V, ..ET S i. :
(
. -..(SEAL) sat C CSQ ~
AUTZRNTICATION ACHNOWLEDGK.4 `~.f,
- O
Signature(s) . STATE OF WISCONSIN U t9
I~
ss. c~
ji - St . Croix . - Count '2 La
Y•
- • ~ r
;i antb,atieated this --•--..-day of.__-...----- 19...--. Personally came before me thj v ~.dtl1"....~.day
lamrha---V-.. P_e-texson........•---•----
y
TITLE: 1[EHBER STATE BAR OF WISCONSIN .
(If not, -
authorised b - -
Y 4 706.06, Wia. Stata.) to me known to be the person . who executed the
z forezoir.l; instrument and a owledRe the same.
4 THIS INSTRUMENT WAS DROFT ED eV-/J I / -
11 x1, 4s~_,_.G x.i..4..?:tu_rray_...By.;..Samuel- K. Cari
e -
P.O. Box 229, Hudson, Wisconsin 54016 Marlene M. Peterson
f . Nota P:Ihlic St. Croix r
-County, Wis
(Signatures may he authenticated o* acknowledved. Both 1T:, Commission is permanent. Of not, state expiratiml
are not necessary.) i
date: 4-5- 19 -.92_.)
~a1M OI D.eson{ .Ienlne in Rny t4GacitY r mid be t)'{.ed n- {u ~nd•d b.d.. w' th..ir n'R n"tun•=.
S-:
~aaaAM?T D aTATF. BAR OP wI9CONSIN wisKnuh il~al t
DORY No. I - lf{2 11i1.a>rYw. ♦Y. ' "
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I, do hereby certify that i z mm z w z D
this Certified Survey i ep co N o o N>
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has been approved by the m w w z
Town of St. Joseph this ° m - D.
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,U.tTi~YURS CERTI?ICAT".:
i
I, Gene C. Shaffer, a registered Land Surveyor, hereby certify that by the j
direction of Thomas Seim, I have surveyed, described and mapped the land
parcel which is represented by this Certified Survey Map;
that the exterior boundary.-of the land parcel surveyed and mapped is
described as follows:
•
A past of the SE 1 /4 of the N'i1 1 /4 of Section 33, T-30=N, R-19-W, Town • of
St. Joseph, St. Croix County, 1-isconsin, further described as follows:
Commencing at the South 1/4 corner of said Section 33; thence N 00°-16'-16",.'
(assumed bearing) along the North-South 1/4 line of said Section 33,
2868.24 feet to the point of beginning of,this description; thence f
~`b,-_O~tt-~~ r~L 'ACS` feet to the centerline of` a 66`_LO private read`-
easement; thence IT 220-37'-54" tip' along said centerline, 242.16 feet;
thence , 410-041- 25" W along said centerline, 161-48 feet; thence
133°-22'-34" E, 34.25 feet; thence N 000-141-45" W, 88.99 feet to the
centerline of C.T.H. "E"; thence S 780-27'-05" E along said centerline,
i
391.65 feet to the point of curvature of a curve concave Southwesterly
h-.ving a central angle of 080-181-24" and a radius of 1909.86 feet; thence
Southeasterly, 276.89 feet along the arc of the curve, the chord of which
bears S 740-17'-53" E, 276.65 feet to the end of said curve, said arc
calso being the aforesaid centerline of C.T.H. "E"; thence S 000-161-16" E
along the North-South 1/4 line, 351.03 feet to the point of beginning.
Above described parcel is subject to an easement for C.T.H."E" and said
parcel is together with and subject to a 66 foot private road easement as
shown on this Certified Survey Map and all easements of record.
that this Certified Survey Map is a correct representation of the exterior
boundary surveyed and described;
that I have fully complied with the current provisions of Chapter 236.34
',:7isconsin Revised Statutes in surveying and mapping same. F
Certified this It ~day of , 1979, at Hudson, Wisconsin.
i
Signed:
m~ v•y
Gene C. Shaffer, R.L.S. No. 1325
T Land Surveying GENE C. ~S & r~
108 alnut St. SHAFFE= t '
Hudson, Wisconsin s- 1325
SO SON a ~ f
HUDSON
Wis. n,~ E
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER L titi/~t
1000,
ADDRESS: FIRE NO:
LOCATION: .f 1/4, IVJ,, 1/4, SEC. v~3 T 20 N-R,19,W,
TOWN OF: `r~ ~~osniY 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 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.
S I G N E D ~l DATE :
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON, w1570
HUMAN RELATIONS
(1-163.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/1~Y: LOT NO.: BLK. NO.: SUBDIVISION NAME:
1/ / N/R (or) W n /a n a n a
COUNTY: OWNER'S/BUWEAM NAME: MAIL NG ADDRESS:
St. Croix Mike Ottman R.R.~~2, Box 277, Hudson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BE RMS.: COMMER L DESCRIPTION: IPf _ IiSCRIPTIONS: PERCOLATION TESTS:
®Residence n a 91 New ❑Replace Ill 3-31-87
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE (optional)
0 S ❑U ❑ S EU 0 S ❑U ❑ S [E U ❑ S f] U conventional trench
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 If Floodplain, indicate Floodplain elevatinn: n/a
decimal' PROFILE DESCRIPTIONS page 42 BxD2
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPT". ELEVATION OBSERVED EST. HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 7.49 105.67 none >7.49 .00bl.l. 2.58bn.sil. .33bn 0'.1.' 3.58bn.c.s.&gr.
B-2 7,25 105.59 none >7.25 .50bl.1. 1.25bn.sil. .58bn.s.1. 4.92 bn.s.&gr.
B-3 7.25 103.29 none >7.25 .67bl.1. 1.33bn.sil. .42bn.s.1. 4.83bn.c.s.&gr.
B-4 6.92 100.28 none >6.92 .67bl.1. 2.25 bn.sil. .33bn.s.l. 3.67bn.c.s.& gr.
B-5 7.01 100.04 none >7.01 .67bl.1. 1.17bn.sil. .67bn.s.1. 4.50bn.c.s.&gr.
B-
decimal' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD t P RI D2 P PER INCH
P.1 4.00 none 3 24 2
P_ 3.92 none 3 6 6 6 <3
P- 3% 3 3 1
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. upper trench 101.67
SYSTEM ELEVATION lower trench 99.29
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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 3-31-87
ADDRES : CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNA E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
f
asp To 60 Fl T44 '?-r
PLB 67
PLOT & CROSS SECTION PLANS
tAPPA BROS. EXCAVATING INC
PLUMBING UNIT
oosro
uECt PROJECT
L,~ •V ~ / ES
A140 (o4,1VelJLvA,
SL/1 4~0 SEc✓E~ j/NF o~oSE~ w .S OS-9-09 W
1000 COgt SLtfl/ C TANK h~ t ?Fl ~ES~Of~/Cd ~S, 'r G
AtsoErrie~ G.~~Ttf ,7-PD,~o%0 - S~ o
~iPT~ O~uG ~s' \
SOQ 3s ~F~ut,t.vT L,..v~
96' QRnPEPvY
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57'
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DISTPi~BU £FFN4rNr Tn ExS1ST/A/G
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Sok-tN P40ootPTy4,Ajz ~~-,q<T-s9'~4 ~ENr•
NO
A r SCALE
R S
s
FRESH AIR INLET AND OBSERVATION PIPE
APPROVED VENT CAP
MAXIMUM 12'
ABOVE FINAL GRADE
- I .~/---fi- 4' CAST IRON PENT PIPE
MAXIMUM OF 42' ABOVE
PIPE TO FINAL GRADE , I I
SIGNED:
MANSH HAY OR SYNTHETIC COVERING I I i LICENSE: Pi?S .3~ J"S"
/s At?
MINIMUM 2" AGGREGATE _ I I - _ ! 1 I DATE:
OVER PIPE I I
DISTRIBUTION PIPE
TEE SOIL TESTING BY:
C._
C-LEVATIO14 BED W AGGREGATE •
BOTTOM PER SOIL.. BENEATH PIPE PERFORATED PIPE BELOW
TEST IS • COUPLING TERMINATING
A lol. e- '7 ' FT. AT BOTTOM OFSYSTEM
43 -5~1. a 9
REPT131. ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1
08/6/92 14:43 REQUESTS FOR INSPECTION WORK SHEETS FOR: 8/27/92 AREA: JT
Activity: A9200216 8/27/92 Type: CONVSEPT Status: PENDING Constr:
Address: ST. JOSEPH 33.30.19.363I,SE,NW, CO.RD.E
Parcel: 030-2003-50-000 Occ: Use:
Description: 171451
Applicant: LIKES, WAYNE A Phone:
Owner: LIKES, WAYNE A Phone:
. STAHNKE, MARK E. Phone: 715-386-2850
Contractor.
Inspection Request Information.....
Requestor: ZAPPA, GARY Phone:
Req Time: 14:08 Comments: Time Ex
Items requested to be Inspected... Action Comments p
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION