Loading...
HomeMy WebLinkAbout032-1011-70-000 Q y v o I c c~ ou ~ I er 0. 0 c O r, p C © co N E N M O U s, O C p V a) C) O O Lr) Q O m F O co C o '3 ~ U M N W O a x 7 q LL O C N L D ~ L 3 C7 Q) Z y O rn Z 0 O Z y m M w a m U') Z o z ° U a) Z d 2 c UA F- O ill C E Q) a) '0 0) Q) 0- m v c: (D N O O O N _ O CN a- L L co N O C C O O O Q O Z H Z Z O O N E E Ea U ` N U d OI in m 0 a -9C co Q~ LO x FL 0- N A H _ 0- 5 3: 3: R. U O O O ►.a CL IL CL a cn s O N N N O O N to V a rn rn_ a) Q) > r Irv Cl) ro O lb C a N N a " a r C O ~ N N ^ O C od N c _ C LO _O O 0 O F > W V) C CL m 0 0 CL O O N E Y ' N Cn ~ C O a) Cl) a) F- CC) ti M E L co ;d Z+ a) • co Lo O m 8 E m v L O O fn O Z Un O w C E l r a. ~ d V a, m a a a. • a m u m a E ` c c C u a O in U AS BUILT SANITARY SYSTEM REPORT OWNER :n P t C~ ~1 f ~C TOWNSHIP %l1 L;i' o a~ SECTION-,-/I--T-3-(-N-R-/-LW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION_ :2? 6~-o LOT LOT SIZE 7 7 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7ZZ a ~uf t I GIV INDICATE NORTH ARROW BENCHMARK:Elevation and description:,ZCZ( A b,IC iAJ i-l-r Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings used:-~-Manhole cover elev: Final grade elev: ll~ Z Tank inlet elev.: Tank outlet elev.: 99. L? No. of feet from nearest road:Fronv-0-61, Side Rean6Q-OFt. From nearest prop. line:Front__L, Side Y-,, Rear.L_Ft. No. of feet from: Well Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer:_ Liquid Capacity: Pump Model:-4,Lr7 Pump/Siphon Manufact.: V Pump Size Elevation of inlet: ! g, Bottom of tank elevation 1b jo, f Pump on elev.:462LS-pump off elev.: Lb-~_pCtallons/cycle • 3 Alarm: Man.: switch T • ype: Location Distance from nearest prop. line: Front Side,', Rear,g._Ft.z=- Distance from: Well Buildin g=fa i SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width;Z--jgjL% Length Number of Lines: p -,?,_Area Built- ' Exist. Grade Elev. Z Proposed Final Grade Elev. Fill depth to top of pipe:__ No. feet from nearest prop. line: Front -x'~, Side, Rear,4_Ft,l,~ No. feet from well:it~No. feet from building 6 HOLDING TANK i • 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 : 0 r l= PLUMBER ON JOB LICENSE NUMBER: 6/90:cj LOCATION: SOMERSET 5.31.19.69,5,NE,NW, COUNTY LINE RD. VyisconsinDepsrtme&tQJIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division C~ 0" GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermitNo~:'~r 149107 Permit Holder's Name: ❑ City ❑ Village f(I Town of: State Plan ID No.: MAHLE, JOEL W & SUSAN B SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 16)62,1 / U o 4 ...4^.:. , - TANK INFORMATION ELEVATION DATA A9200153 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark b fo~~ I001U Dosing lob on Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 37 Z 2- TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet 7, S Ar Septic IUQ NA Dt Be#em Dosing NA Header / Man. q,87 1015.0 Aeration NA Dist. Pipe j to ioo,-7 Holding Bot. System q ~ I C) O, f PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number J 7 GPM TDH Lift Lriction,4 Syste TDFP!-S Ft oss N11) Forcemain Length 67V Dia. -H' Dist. To Well7)ib SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: i~>160 5do 5710/t/ OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 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 Bed /Trench Edg 6v Topsoil Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepanci , persons present, etc.) ~r CX7 V Yi' ! ~ vv r.,~Ps . t r1ij Pik& Islon required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature . Cert. No. ADDITIONAL COMMENTS AND SKETCH , • ' r SANITARY PERMIT NUMBER: ~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY S TE SANIT PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑L 8% x 11 inches in size. C k l revis n 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 E'/4~ IV%4,S JBL;Z~j PROPERTY OWNER'S MAILIN ADDRESS LOT # 4AA of L. 7 7 c ee_ ITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5 011 II. TYPE OF BUILDING: Check one CITY p NEARS T ROAD II ( ) State Owned VILLAGE : ❑ Public Rl or 2 Fam. Dwelling-# of bedrooms PARCEL TNUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) ©!I ! 1 ❑ Apt/Condo C/ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 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. 9LNeW 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 ❑ 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 LkTo i Feet Feet VII. TANK CAPACITY Site INFORMATION in alIons Total #of Manufacturer's Prefab. Fiber- Exper. New Existing Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank e A Lift Pump Tank/a hon Chamber F-1 Fj VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI mber's Name (Print): Plumber's Signature: (No Sta s) rP/PPIRSW No.: Business Phone Number: Plumber's Address (Street, 'City, State, Zip Code . r ` IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Lary Permit Fee (includes roue water Date Issued issuing gent Sign a (No Sta ps) 7qApproved [3 Owner Given Initial a~ 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 I£ Buildings Division, Owner, Plumber INSTRUCTIONS s 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 (SBD 6399) to be submi~ted.to the county prior to installation, 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped :)y 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 -anks 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/ Hater 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, grou,rld- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ' PUMP CHA.MEER CRuS5 SEC"IOLI AIJG SPECIF'ICA'r10h!S VEQT CAP 4"C.I. VEtJT PIPE WEATHERPROOF APFROVED LOCAMIG 25' ' ROPA DOOR, JUAICTIOu BOX MANHOLE COVER WIIJDOW OR ' RESH 12"MIU. AIR INTAKE I GRADE I • I 4" Aim. ~ I I8" /wIU. 18 MIN, CONDUIT L \ " \ - - Nn UJLET 111 PROVIDE AIRTIGHT SEAL ( i i I I~ APPROVED JOINT A I III W/C.=, PIPE APPROVED JOIAII I' (I I /C.I. PIPE EXTENOtAl6 3' W I II EXTEAIDItJG OUTO SOLID SOIL ALARM B I i I ONTO SOLID SOI i C I I ON ELEV. FT I I PUMP OFF D SO t X, COMCRETE BLOCK RISER EXIT PERM17rED OIJLy IF TAUK MAWUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFIGAT101 DOSE• ~JS TANKS MAIJUFACTURER' - c (DUMBER OF DOSES: PER DAy TAAIK SIZE: d© GA ONS DOSE VOLUME ALARM MAUUFACTURER: INCLUDIWG BACKFLOW: in C) ALLOW MODEL NUMBER:A / CAPACITIES: A IAICAES OR -`(u GALLOu SWITCH TYPE: 41 B = - U•MP MANUFACTURER: IAICHESOR GALLOM C= MODEL NUMBER: IUCHES OR IV60-GALLOU r~/' D= FICHE OR GALLOA SWITCH TYPE: ei $~LQ = $19 i bla) NOTE: PUMP AND LARM RE, TO BE MIUIMUM DISCHARGE RATE 3 GPM INSTALLED Oki SEPARATE CIRCUITS VERTICAL DIFFEFE*UCE OETWEEU PUMP OFF AND DISTRIBUTION PIPE.. FEET -~'(o".J 4 6_~ 4'rcwl 560t~(Zt + MINIMUM NETWORK SUPPLY PRESSURE FEET F-.-wt. $2•✓ + bO FEET OF FORCE MAIIJ X LF~ Ioa rT FRICT1oA1 FACTOR„7 Z FEET TOTAL DyAJAMIC HEAD = FEET IUTERNAL DIMEIJSIONt: OF TALK: LEA. T tl I to L5 ( ;WIDTH ;LIQUID DEPTH SIGUE0: OATE:v LiCE.IJt F. LIUMBER: STC-100 Th is application form is to be completed in full and si' ned the oti liar(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 ?'ouse), then a second form should be retained and completed when tha property is sold and submitted to this office with the appropriate deed recording. Mr- -Y~--Y-l.-_---A.----...-7Y-~---Y--r---- owner of property T0EL td. t S A SA N'- A - MA NNE Location of propertyA&%/4 ae1e1L1/4t Section-I TAU,N-R-aW -Township &-)h Hailing address now 27/90 1=0UA/rA/A/ LI✓ Mo~rH ~!lu SSS/~ 7 . Address of site 337 PoGK - Sr. CROIX ApAi subdivision name NeNe ____Lot ha.`/!MiVC other homes on property? yes-NO Previous owner of property ANWdOD 4.4 V C Q Total size of parcel 34 IM*Oee S ~ Date parcel was created Y 0 Q'Q O Are all corners and lot lines identiti,able? Yes zs thlc property being developed for fapeo house)? Yos XHo Voiume,-2-72and page Number ~ O of Deeds. as recorded, with the Register - -----_r♦r__---r-Y--------------wrw.~r--------r-rr.rrrs.rwr-r~r-wr.ar INCLUDE WITH THIS APPLxCATION THE FOLLOWING: A WARIUUt;['Y DUED which includes a DOCU1 ZHT NU]1B8R, VOLUME AND PAGI; HUME31M & 7111; SEAL OF THIS IMMSTilt oy DEEDS. In addition, a car L•ified survey, if available; would be helpful so as to avoid delays of the previewing process, If the dead description references to a certified survey Happ the Certified survey map 8I1all € lso be required. PROPERTY OWNER CWTYPICATION 1(wa) certify that all statements on this form are true to tho best .of ny (our) knowledge that I the (we) am (are) the owner(s) of proporty described in this information form, by virtue of a warranty dQatl recorded s as Document !to . btile i f oe of the Cohn oo: the r and that 1 we gister of propvsad site fox lie sewage disposal sy ( orr es shwa) 4i'leld an easement, to run the above described ( ) Wthe Construction of said system, and the same haso beertr n duly recorded n the vLfiae of Gou21t xO' Y Register of deeds as Document W 8 ure f'a CQt1 'V Co-appl cant ~0 q+Z Date Q S gn tutu PC.S 14a 40 Date o a qne u MAA Es w o (2.) -a4 Acle. -PARC.ELN sr akow cry. V-1 -,~W, AN W57 • i.xY j Yi'Ma t i ~9!"a - xl.._! .K •Yy .u TAat the "M Grantor. Ift a vain" eonaldwatbn...... .r tie fotiawtos,deseribed "a astate in .....St, ..Cl aix. Rea lty"World` Dowd''"Reliance fr ' ti4 Matt ! ~Yisoonsiu: Oaiowla .WIr'` 54020 ~ f` V Tax Pared No: _tional On of the NW4 of Section 5, Township 31 North, Range `19 A of,-Somerset, St. Croix County, Wisconsin. m r ~r •g ~E.d Tn'.l • tF L. ~4P v:r~ ..f.- _ t. Th4t`' ist homestead property. ) (is noLj T ~tth~$rta}~ll} a}n1d sinVlar the hereditaments and appurtenances thereunto belonging. XJ\lflf-YQl.•• • ` tills is =ood, indefeasible in fee simple and free and clear of encumbrances except w~< > x ta, restrictions and ordinances of record zant.and defend t e Same. s."a... day of _ a . (SEAL) c (SLID. " ; f . BY:. David H. Preus, Presiden_ t• • ' r~ k~ (SEAL) ........!a 'c r 1 ATTEST:. Roderic Shearer,.Secretary............ ' AUTSSNTICATION ACBNOWLSDGMBNT (s) STATE OF WISCONSIN ss. , POLK County. 19 Pe ally came before me this day of authe6tkated this .........day of............ Jy~ t r 19.*).. the go" nawA h deric David H PrPus Ro S `ITLE: DdEMBER STATE BAR OF WISCONSIN " I: z . . (If not. . .....authorised by 1706.06. Wis. Slats.) to a known to be the persons.. i foe in -ins me n ackn yy t e me. i THIS INSTRUMENT WAS DRAFTED BY °1,.AUX..&..~AMHRR~1..._5~~--t..~~S..Cascade •St.,.,--. J' Qhn R-.. Letch -f . I P~O....Bax..45 S?.gS:PQh Nota•V P,Ibtic -polk :~M(~►. ~1 ilx Commission is permanent. (If not. { (Signatures may he `authenticated or acknowled6 aed.Both a f.: are note necessary.) date: _ 19.33...) WMAO of Perron. ehrnlnK In nnY rwPecltf •honld be tYUCI ..r urintrvl h0o.w• their Rixn.turm ! STATIC. BAR OF WISCONSIN wivAemy 04/20.92 09:36 FAX 612 223 4666 MN MUTUAL-IS 444 S.C. CO CRTHOUSE 11004 8TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Z-OE L W• Sk S N 8. M A H LE ROUTE/BOX NUMBER_ _ _ 337 PO C-14- ST. C RO I K RhA D FIRE N0. 33 7 CITY/STATE a NX ZIP S"'(10 2 D PROPERTY' LOCATION: 41f,.1/4 i/4, Section ,I, T,31_N, R__.If!?,,,rW, 'down OfA ~~/ry~ , St. Croix county, subdivision _ ~QQ--e- IT f:7-, , Lot No. N/A.- Improper use and maintenance of your septic system could result in ita premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a NAXIMlN of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County 2oninq a certification farm, 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. Certificativn form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office wi hin 30 days of the three year expiration date. SIGNER Wl7 DATE a AOAZ- --00, 9t. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, tai $4016 (715) 385-4680 Sign, Date, and Return to above address 4441^ can Cr CF i re 20 'd Lb6-1 tgO30SO d0 ANOE WE36A 9996 RZZ Z19 01 90:01 261 0z Ndd r ; n / y $ c ~ z 11 nj T S N G I i r I o~ P~ 1 ~ O i TOO RSIlOHIHD 00 '0'S FFF Si-lvfl flw NN 999V £ZZ ZT9 XHd 6£:60 Z6/OZ/V0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO": BLK. NO.: SUBDIVISION NAME: N~ 1/ t/4,)1/4 _ /T31 N/R /9E (or► , _ , s,, 7-/,.- COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: y#1614111 -S Q.) z a 4w t 715- USE ATES BSE ATI NS MA E NO. BEDRMS.: COMMERCIAL DESCRIPTION: r~-. (PROFILE DES RIPTIONS: PERGOLA ION TESTS: 1 Residence LdWew ❑Replace Il C d ~c f L- I~2 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1 N-FI LL HOLDI NG TANK! RECOMMEND ED SYSTEM: (optional) ©s ❑u o s [3U I ES ❑u EIS au ❑ s ou T/4 ,,rc, I-DESIGN RATE: _71 If Percolation Tests are NOT required If any portion of the tested area is in the / under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS J BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, jELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / • t~F ~ . ,33' 5,9 t~• 7-33' s~Tsr f /`C:, 1./7` Btis (7Bti 3,5' ` J_o3.._< Ss 3 ov 7, c. C, Ls Ts 33 F ,Zs B- j of j 7' a~ 7 6-51 ' f ' is '6 vE ( f,,t/ ~ 9. 67 B-.S 7,5 joz 83` 7,5b`, .s~C s3 C. ,Z } j B- G' 6,17' 9:3, tsTs X33' C, Fti'cs . 1 GT)'ti, c 7' B-7 x,1.7' c'Ts s,,,, t_ B 7d7 .3.' C >h s` <T73 S ~•2 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ -3q A~,v i P_ 3 P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of s ble soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot ,orn. Show the surface elevation at all borings and the direction and percent of land slope. _ v,~4 SYSTEM ELEVATION 5114 • Z" Y ` - 4 y 7_ ► 00 - 57 TA ,Al a /z E t Pbl crr1~2%y -Z~~~~~~~fiG<•~fir, a Ixr r / ~ i to c 9^ _ . F7 / `v p O N I, the undersigned, hereby certify that the it stsei obis form w de by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recor thtl,~ocation ~&e test r rrect to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN T E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - . TIONS FOR COMPLETING FORM 115 SBD - 6595 To be a corx::Mete and accurate soil test, your report must: Include: 1. Complete [ ; -escription; , The use set !on must clearly indit ate ."]h r this is a 3or commercial project; 3. IViAKIMU: ^ number of bedrooms or ~,~m t, ; Cial use f.al_ 4, Is this a new or replacement system; , Complet=e the suitability rating boxes. A SITE 15 SUITABLE FOR A HOLDING TANK ONLY !F ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6i PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; I, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scab: is preferred. A separate sheet may be used if desired; B- Make,, sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- bon, if appropriate; 10, If the information (such as flood plain, elevation) doer; not apply, place N .A. it) the appropriate box; 11. Sign the form and place your current address and your 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 IL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR Bedrock cob - Cobl.)le (3 - 10") SS - Sandstone gr Cray=el kmder 3"} LS - Limestone *s Sarni HGW High Groundwater cs - Coarse Sand Pere - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is Loamy Sand > Greater Thai) "sl Sandy Loam < - Less Than 'I Loam Bn - Brown .sil Silt Loam BI Black Si Silt Gy - Gray " cl Clay Loam Y Yellow scl dy Clay Loam R - Red sit! y Clay Loam mot Mottles Se ..,y Clay vv/ - with sic _i Clay fff few, fine, faint ~c C y cc - common, coarse pt - Feat mm - Many, Medium m Muck d - distinct p - prominent HWL - High water level, Sax general Soil textures Slat€'face water for liquid waste disposal BM Bench Mark 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. REPT131, SOMERSET ST. CROIX COUNTY ZONING PAGE 1 08/11/92 ff9:00- REQUESTS FOR INSPECTION WORK SHEETS FOR: 8/11/92 AREA: MJ -Activity: A9200153 8/11/92 Type: CONVSEPT Status: PENDING Constr: Address: SOMERSET 5.31.19.69,5,NE,NW, COUNTY LINE RD. Parcel: 032-1011-70-000 Occ: Use: Description: 149307 Applicant: MAHLE, JOEL W & SUSAN B Phone: Owner: MAHLE, JOEL W & SUSAN B Phone: Contractor: PFANNES, WILLIAM Phone: 715-755-3962 Inspection Request Information..... Requestor: WM. PFANNES Phone: Req Time: 13:08 Comments: 1!36 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION ory 4 P ep /let, CTS ~i VA c' F 4\ _I fs *6 I~I