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AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
SECTION___ J~ T-ZLN-R-Z7--W
ADDRESS ~'ca l J ~7/'~l ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
X
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
V
,eel
_ c
"Ve n
INDICATE NORTH ARROW
6 Vol
BENCHMARK:Elevation and description:
~
~Ilwe Alternate benchmark
/I Liquid Cap.~~~
SEPTIC TANK:Manufacturer: 1.e~ e j
Final grade elev: Z O 4
As' 7Z _'oZ
Rings ed:Ar Manhole cover elev:-&
Tank inlet elev.:__;fv, -Tank outlet elev.:
No. of feet from nearest road : Front , Side,, Rear Ft . > ~/e'~
From nearest prop. line•Front , Side , Rear Ft. /B DO
1o. of feet from: Well ~ Building:
Include this information in the above plot plan)
2 reference dimensions to septic tank)
SEE REVERSE SIDE
I
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
Bed: X Trench: Seepage Pit:
Width: y K Length Gd Number of Lines:_~_'_Area Builtlf~~0
Exist. Grade Elev.,/&e ~5_Proposed Final Grade Elev.,,-e c>_ 3
Fill depth to top of piper
No. feet from nearest prop line:Front , Side, Rear Ft.~a
No. feet from well: No. feet from building
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:
DATE :
PLUMBER ON JOB:
LICENSE NUMBER:
6/90:cj
~.CATI N: SO~RgET 11.30.19.641A SE SW, 160TH AVE.
"~isconsin 6epartmenfof ~ncTustry, pRIVAfE SWAGE SYSTEM
S County:
Labor Human Relations
Safety fety an d'Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) sanitary Permit No.:
GENERAL INFORMATION 175660
Permit Holder's Name: ❑ City ❑ Village [TTovvn of: State Plan ID No.:
ILSEN JOHN L,& PATRICIA BORD NSOMERSET
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
p~/,GC~ GGl •d q~ 032-2042-70-100
TANK INFORMATION ELEVATION DATA A9200320 I I
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic le- eA~ Gv`, Benchmark
~ / v, °
/
Aeration Bldg. Sewer /
Holding Stjlli Inlet 4,037 96 07'
TANK SETBACK INFORMATION St/ Outlet ,6(0 °
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Septic NA Dt BottoM
Do ' NA Header- /p 97, 0'
Aeration NA Dist. Pipe (o, $
9 97,21
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manuf Demand to °
Model Number GPM
TDH Lift Friction Sys TDH Ft
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width , Lengt} ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION (O~ EN 1 N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA G Manufacturer:
SETBACK CHAMBOr-
INFORMATION TypeO ,v1 um er:
System: OR UNIT
DISTRIBUTION SYSTEM
Header WenKi I / Distribution Pipe(s ) 7 x Hole Size x Hole Spacing Vent To Air Intake
Length _L2~ Dia. Length $ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over , Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center 3 - qOlt
Bed /Trench Edges 31 ~Topsoil ❑ Yes ❑ No ❑ Yes No
COMMENTS: (Include code discrepancies, persons present, etc.) errvn!
6
ell'
Plan revision required? ❑ Yes 2-I~O
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's signature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
9
v
f
~,L R SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
~.a...„„e,...,..,,M,,.,, J/
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. Ch rf revisio to a us 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
(f ~/s C., P14, S T , N, R E (o 14Z jt PROPERTY OWNER'S ADDRESS LOT # BLOCK #
o" .544 J72 7
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
LLAGE
( ) F] State owned WELTAXNUMBER(S)
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms TOWN OF;"
III. BUILDING USE: (If building type is public, check all that apply)
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. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 13. 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
4Z.5~ O !J ~Vj Feet 'fe`et
CAPACITY
VII. TANK Site
in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks oncret structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank -G 71 F1
Lift Pump Tank/Si hon Chamber 11 Ed - CE IL f 1: 1 -LMLf L-1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name (Print): Plumber' nature: (No Stamps) MP/MPRSW No.: Business Phone Number:
01-
dt~
Plum is Address (Street, City, Stat , Zip Cod co~
s
o
IX. COON EPARTMENT USE ONLY
ent Signature (No Stamps)
Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is
Approved El Owner Given Initial Surcharge Fee)
Adverse Determination
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 $ani1ry permit is valid for two (2) years.
2. -Your sanii!ary 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 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.
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 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; Q,soil test data on a 1154orm; 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 a`nd establishment of standards. - -
~..i _ .s+..T. ter' ! v \.I\ 1•...
SBD-6398 (R.11/88)
STC - loo
This application ;Corm is to be completed in full and signed b
the 0 ner(s) of the property being developed. Any inade uacies
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 proper ty_J51- 1/4 .2GZ1/4, Section-'-.,,,/
TN-RW
4-
Township - o w e.,- 5 7
Hailing address
Address of site om s.-
Subdivision name
Lot no.
Other homes on property?
-yes_No
Previous owner of property G c`
Total size of parcel
~Gr-c
Date parcel was created
Are all corners and lot lines identifiable?
___,-~Yes No
Is this property being developed for (spec house)?-yes No
Volume
and Page Number
of Deeds. as recorded. with the Re
is
to
g r
-
INCLUDE WITII TI1js APPLICATION THE FOLLOWING:
A 19ARRA11TY DIED which includes a DOCUMENT
11UMUI; ~ NU 1
R & xltr SEAL of THE 1LC -GIS7 ~ ,GIZ OF iDER, VOLUME AND PAGE
a
certified survey,
DEEDS. In addition, , a
de 1 a if available; ;would be helpful SO as to avoid
Ys of the reviewing process. If the deed description
references to a certified survey map, the certifie
shall also be re
d
survey wired
9 Ma
P
PROPERTY OWNER CERTIFICATION
I(we) certify that all statements on this
best of n form a
y (our knowl re true to
edge t
t he
the that I (we) am (are) the owner(s) of
property described in this information form, by virtue of a
warranty deed recorded in the office of the county Register o
Deeds as Document No. of
Den an
the s d t
pro owed ~ hat I we
s
p ite for t ( ) presently
he
obtained an disposal an easement, to run the above described stem e I (we)
the construction of said system, and the same halobeen duly
recorded in the office of County Register of deeds as Document
No.
sig •ure of ap~l cant
co-appl cant
Date o Signs ure
Date of 3 gnature
.y
AMOW
x
,61
his 6
'i
N
M llnabeer had is rte CC d AL. QMix . Srle d
r OM M of the, Milza d and the NEt of 9* and the 96
1~ei1d J M M" #n the 31% of the So* of section 11,
. Ct+Mttr *wntt. Wiaooetain. Store fully described as iQatha~lmtr'
Cold ct said Section 11:
itg j along the South l ima of the 94 a tit w
172
4Dw oo a point on the North-South Quarter Lira cc maid
1 aloft =W line 1202.00' to the point of beginning.
400 to 160th Street over the southerly poctiga ,
~wmll~ll~litdl of svons, f,
iit 100t cn 11. TXM, R19M1, Town of Somersets St. Croix County,' 11
ss.
t
tll~teldtlaaeF'~Ite r f wrier ttr . implMo neuM. ad apprnnfttnen,
i t.ft i .1 nelin Mink. ctfttain fade, Wrm w-isdasra, store! doofe, .ear. awttit~. ad Y;M
'n4rsl aOw mail! bA ft ad we aesuic iow mad to any ememe tts afficft On brad. < k114~~.
aM surrrlg io iYw A oird rd t%wAy tom. intnals. Senn ad On
iZattd ft* efmoist Fad pier a )awry 22, Oft V or, wilt rtrch aseetn~fa
. r ; , ~IsMii~lifartsee~ney a rs dad! rirbfs. 7La bntSoit~ tadrfios. arofpdas-mud
r~ Mal ad edw nfiuedf of wnhaamm vertu iyft is a ruin late
M Vward 46r dnedt ptadroed wd mmd dtaehost. k is a prrdy traduMed ittt i ,
` °ii."~1 d etieri. a as a it dNe thereto.
WAS . $a it Aw Woo Pocham it. Si y five thau.and
W: d viii tbs eves of ,.1,40 w ho ifs pnid In Siff prior to dte delivery bond, the no* d wti" I&
r,
-~rSdb Willi bwtaf from tke 6" of dtie aoubw on may part toed at air that rttpnid ttt
_ llfioltaeW b rtb dirk. Md d the rue d 12 perveat per aartrs, oarrprfed tt~ttliP
" w ~i pdod d atSr dirk i• paytaat. Strd► additioeal pwdaee utosry asd inutreel lIF
of ter- ThjA_Wjll_b&_bMM"
i OMM ng be edded a the first instdimets if rite initial period is prafef dtan subsegnettt perrodf.) 3wA
` w breuottt 04 to lulasca a priecipal. AN of the purchase matey and iateeest, honsver, ewer be
paid
errasr~r.le: "1996 , anydtittp herein to the coanny
r
Ib 400OW4 d 44W a PWdm r or his am*as. upon payment in full of all sums owing hereon, a limited wrawM" dead
; 915Wd #otekarlergrfifanl ~eatricaor, anemeaatc and to any then unpaid ntatppe or morWW%. brt fm lysftals
dslpt ~trth rs;ttrolr life betris sit belt or sW have warmed or attsched time die dare bered thrwSlt the aces ar ottdnieeltttf
taMfn Sfrf ee We after, `
Ali t es~>> t videsce d title. at. SdW's option, eidter ar owner's pdicy of tide urrreeoe eft
r - a#s bot 1%dlat n den of fire #oft of oadlfedou tee at the abstfacx is In be approunm y the *w4(.,
t x hart tee tbt*sli* Plr"W" of inch avi N of ties *Aft to life of ids ooserrct but upor detnrl tdli
aloft * OVA dVAW
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rA MY comminim awbw '
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ IJO /f'I e ~e4l
ADDRESS: 5__.2.-;;L f FIRE NO:
LOCATION: _1/4~ _sw 1/4, SEC.-// ~ p N-R_,0P W
TOWN of : cam. om 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
a ree
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: _2 x%'07
DATE:
St. Croix County Zoning Office
911 4th St. -
Hudson, WI 54016
DEPART" ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IfVDUSY G DIVISION
'LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/M- Sx ~fY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
SE 1/4 94 1/4 11 /T 30 N/R 19k(or) W Sonerset n/a n/a n/a
COUNTY: OWNER'S B NAME: MAILIN ADDRESS:
St. Croix John Nilsen 15221 Suwamit St White Bear Lake, M. 55110
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: ice, PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
~Etesidence 3 n/aIew ❑Replace
8-10-92 n/a
.
RATING: S= Site suitable for system U= Site unsuitable for system O 3 / /D .
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) US ❑U [as ❑U [A ❑U ❑ S QU ❑ S ®U conventional
DESIGN RATE:
If Percolation Tests are NOT required If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 26 01TC2
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.)
0-7, 10yr4/3, L.; 7-38, 10yr4/4, Is.; 38-84,-
6- 1 84 99.86 none >84 10yr4/4, co.s.
B- 2 86 100.15 none >86 0-7, 10yr4/3, L.; 7-86, 10yr4/4, Is.
3 89 100.35 none >89 0-8, 10yr4/3, L.; 8-41,10yr4/4, Is., 41-89, 10yr-
B- 10yr4/4, stratified ls. & S.
4 82 98.46 none >82 0-L, 10yr4/3, L.; 7-28, 10yr4/4, Is.; 28-42, 7.5-
B4- 5 82 98.50 none >82 0-6, 10yr4/3, L.; 6-48, 10yr4/4, Is.; 48-82,-
__T inyr4/4, star-tified Id-s- &S-
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. -PERIOD 1 PERIOD2 -PERIOET3 PER INCH
P-
P-
P- see design P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96'_50
001
.
jet
-o a= _ a w
(dq= 11134
411
f
3 3
~ E
N
,
3
6 0~
6.5
I, the undersigned, hereby certify that the s 19, s were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded h t n e tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 8-10-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New T:ichmond, Wi. 54017 2298 1 -2 -6200
CST SIGN E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
1 DILHR-SBD-6395 (R. 10/83) - OVER -
v
t _ a> ,t~: 1
z Vie..
i
_ J
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
DIVISION NAME:
LOCATION: SECTION: TOWNSHIP/MAMP : LOT NO.:BLK. NO.7n/a
SE 1/4 SW 1/4 11 /T 30 N/R 1 or) W n r t- I n/a n/a COUNTY: OWNER'S D)ER6gff NAME: rm"
ILIN ADDRESS:
A
t. Croix John Nilsen 221 Slim mit St., White ar Lake, ~W. 55110
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: EIDESCRIPTf-ONS-: S: PERCOLATION TESTS:
QAesidence 3 n/a fie"' Replace I 8-1I-LE 0-92 n/a
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENT ONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
Qs ❑U QS ❑U ~ ❑U ❑ S QU ❑ S ®U conventional
DESIGN RATE:
If Percolation Tests are NOT required I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Class 2 Il Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 26 01TC2
BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, !EVA T ION OBSERVED TGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
0-7, 10yr4 3, L.; 7-38, 10yr4/4, 1s.; 38-84,-
6- 1 84 9.86 none >84 10yr4/4, co.s.
B- 2 86 100.15 none >86 0-7, 10yr4/3, L.; 7-86, 10yr4/49 Is.
100.35 0-8, 10yr4/3, L.; 8-41,10yr4/4, Is., 41-89, 10yr-
B_ 3 89 none >89 10yr4/4, stratified Is. & S.
4 82 98.46 none >82 0-L, 10yr4/3, L.; 7-28, 10yr4/4, Is.; 28-42, 7.5-
B- - 5 82 98.50 none >82 0-6, 10yr4/3, L.; 6-48, 10yr4/4, Is.; 48-82,-
e 6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATPER INCH MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RID
P-
P-
P- se design P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96.50 Q w, ~n s
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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 Wis66nsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM print> TESTS WERE COMPLETED ON:
Gary L. Steel 8-10-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (oPp . na1)6
1554 200th. Ave., New Richmond, i?i. 54017 2298 1 -2,15-6200 >
CST SIGN TURE:
i
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
PLOT PLAN
PRQJECT -,1041,7 ~r- .l ADDRES ~ c 2, Ae-
J~~ 1 /4 ~ 1 /4/$// /T,~ N/R W TOWN ern COUNTYSf G,X ,5 /,r o
MPRS Byron Bird Jr. 3318 DATE BEDROOM_ CLASS PERC. 49NVENTIONAL~CIN-GROUN ESSURE
CONVENTIONAL LIFT MOUND HOLDI G TANK
SEPTIC TANK SIZE ~ LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark T.~ 5=-
0 Borehole Q Well Scale Feet
0 Perc Hole System Elevation
Vent
12"
TYPAR COVERING
2-
12" 3' 4 6' O 3'
1 6 " Sewer Rock
12' /
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A a, /o
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REPT131 SOMERSET ST. CROIX COUNTY ZONING PAGE 1
11/12/92 10:15 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/12/92 AREA: JT
` Activity: A9200320 11/12/92 Type: CONVSEPT Status: PENDING Constr:
Address: SOMERSET 11.30.19.641A,SE,SW, 160TH AVE.
Parcel: 032-2042-70-100 Occ: Use:
Description: 175660
Applicant: HILSEN, JOHN L,& PATRICIA BORDEN Phone:
Owner: HILSEN, JOHN L,& PATRICIA BORDEN Phone:
Contractor: BIRD, BYRON JR. Phone: 268-7616
Inspection Request Information.....
Requestor: BIRD JR., BYRON Phone:
Req Time: 14:11 Comments: a;QO
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I