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HomeMy WebLinkAbout032-1039-30-000 o oO 3 o O 6 0. ~ a~M a E c o a~ aU) m c -a 0 x 0 O C C co O' U Co m co CL a)MD C 6~oo y a =~m o0 a E o 0 -CL U O mN G I- co ° cn C 0) N m m w o - F. O U N D .C U .X O C C- U N co N v~ 'a -r- p p -07 j, N O U N U U cz 0- a Z N N L U U 00 C - o) .N+ N Y. C y O C U D N U o 5 O EM (0 0 "a .0 O CL U 61 O 70 E Q ~Z 7-o E»° E U U (9 ~ Q ~ N ~ y rn W O z O z m m Lw a m 'o o z 7t s U z d c N o v `o m E ~ v cg~ C: Lo N O y O o . ~i O L t0 N D 0 z z _ o O n c d m E E NN ~ _ io Y LO 4) 0 ~i O L 05 04 CL 0 La N a d c U I E o ~ F- IL O a~ O O O • na N a a a FL a~ Q O N N N t% ~ U U) rn rn } *Aoki co co o o " E o rn 0- N 00 co ~w CD v O C U N' C Ill i"' p O 3 N O C E LA 00 © L~ O O U L) o C N fw n. a) 0 G M O F- 7 O. C a)0 rn a~ W c a~ C M o) E T i C 1. 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CROIX COUNTY, WISCONSIN Current ' X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - REGER, DIANE M & JAMES E DIANE M & JAMES E REGER 2168 HWY 35 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2168 HWY 35 SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.650 Plat: N/A-NOT AVAILABLE SEC 14 T31 N R1 9W 5.645A IN SE NE N 350' Block/Condo Bldg: OFS1143'OFE687.05'OFSENE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 01/26/2005 785875 2737/564 QC 12/31/2002 704250 2097/352 TI 07/23/1997 1232/378 QC 07/23/1997 946/14 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 76908 247,500 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.640 61,200 138,000 199,200 NO Totals for 2005: General Property 5.640 61,200 138,000 199,200 Woodland 0.000 0 0 Totals for 2004: General Property 5.640 61,200 138,000 199,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 O.OQ . A ' )artmentofIndustry, PRIVATE SEWAGE SYSTEM County: or ana n man Relations INSPECTION REPORT St. Croix 'tv and Buildings Division ~~4TIT~4~C~P3FIRMIT) Sanitary Permit No.: JERAL INFORMATION Se, NE, Se 149299 ermit Holder's Name: ❑ City ❑ Village :k] Town of: State Plan ID No.: Magnum, Eugene Somerset CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA _p►~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV./s Septic ~jtC~- C f Benchmark 6ri Dosi ng / /r Aeration Bldg. Sewer Holding St/ Inlet 910.70 TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet / Air Intake (®r NA Dt Bottom ,5'p ► Septic 114 Dosing >iG~ r (F j ' J , Qa NA iesdef-J Man. 2 7, ' Aer NA Dist. Pipe g/ i Holding Bot. System 651 PUMP kFINFORMATION Final Grade Manufacturer 60"kag Demand Model Number 3RX6_uDiE0311(- GPM TDH Li ,eq/ Friction p~ f Syste ms TDH8,~(t Loss (7 H S/f Forcemain Length Z/ Dia.,a7' Dist. ToWell SOIL ABSORPTION SYSTEM BED/TRENCH Width 8 r Length ► No. Of Trenches PIT 110.0 a4r,. Inside Dia. Liquid Depth DIMENSIONS DI N I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu rer: SETBACK CHAMBER Mode Number: INFORMATION TypeO OR UNIT System: DISTRIBUTION SYSTEM Het►t}er/ M fold ~r Distribution Pipe(s) x Hole Size ► x Hole Spacing Vent To Air Intake Ye ' ii Dia a Length30 Dia. _1~2__ Spacing X ~o I / Length SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx~Seede/d / Sodded xx Mulched Bed /iYenrtii Center f t Bed /Trench Edges /z -/f Topsoil Cp ~iy.~ces ❑ No No COMMENTS: (Include code discrepancies, persons present, etc -6" /G eoscc r ~ 9 715- Plan revision required? ❑ Yes Q~fd~ p p~ Use other side for additional information. l D SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION (MILHM In accord with ILHR 83.05, Wis. Adm. Code COUNTY ` 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. ❑ 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. f / PROPERTY OWNER PROPERTY LOCATION '/4, S T r , No R E (or 1N PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : l ❑Public 1 or 2 Fam. Dwelling-# of bedrooms PAR LTAX N M R( III. BUILDING USE: (If building type is public, check all that apply) - o 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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. El 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 12. 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 i j' Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank F1 El 1-1 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's Sy'gnature: (No Stamps) / MP/MPRSW No.: Business Phone Number: Plumber's dress (Stre , City, tate, Zip Co IX. COON /DEP RTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I 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 Al 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 San:tary Permit Transfer/Renewal Fora} (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 purnpec 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 f:ax 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. Vl. 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 marufac',urer's name. Indicate prefab or site constructed and tank material. Comp-ete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval o/~Iy 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 3% 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 rrains/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. i SBD-6398 (R.11/88) I t'cE / df /o I 4 A) r WORKSHEET - MOUND SYSTEM DESIGN CC 1 PROBLEM: I Design a mound system fora The site characteristics are: Depth to groundwater or bedrock in. - I Landslope I . Percolation rate a4-• min./in. Distance from dose chamber to distribution system ft. Elevation difference between Dump and distribution system ft. ; Step 1. WASTEWATER LOAD o gal' { z Step 2. SIZE THE ABSORPTION AREA A) Area required = ~CCgA/=- /,~~/fir SCE sq. ft. B) Bed or trench length (B) s~ ft. C) Bed or trench width (A) ft. D) Trench spicing (C) . Wastewater load .24 coal/ft2/day B ft. • trF~c ems r i Step 3. MOUND HEIGHT A) Fill depth (D) = Z ft. B) Fill depth (E) - D + slope (A)+P) ft. C) Bed or trench depth (F) ft. D) Cap and topsoil depth (G) _ 44 ft. E) Cap an topsoil depth (H) = ft. Lign: J Licenuc 1`11: Ut~Le Step 4. MOUND LENGTH A) End slope (K) _ (D+ E 1 + F + H x 3 ? ft. 6) Total mound length (L) = B + 2(K) a .3 ft. Step 5. MOUND WIDTH Al) Upslope correction factor A2) U slo a width (J n = p P ) (D + F + G) (3) (factor)_ ft. /.Df, s~~I~(3)(9~)= .795 Bl) Downslope correction factor = fc B2) Downslope width (I) _ (E + F + G)(3)(factor) _ f t.~1 Y ~ C1) Total mound width (W) for bed J + A + I = ft. C2) Total mound width (W) for trenches = J + + (no. trenches -1)(c) + A + I = 4- ft. i t Step 6. BASAL AREA i A) Infiltrative capacity of natural soil gal./ft2/day i I B) Basal area required = wastewater flow natural soil infiltrativecapacity sq. ft. Cl) Basal area available for bed for sloping sites = j B x (A + I) _ sq. ft. 6.42, s_X 0 7.9: 9,60 _ //co C2) Bas are avail le for trench for sloping sites = B W J + A sq. ft. T I ~ C3) Basal area available for trench or bed for level s tes B X W = sq. ft. Sign: License 'Vii:. Date: s- X , i , , y~ Of 1.U. + Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing } in. 3) Distribution pipe length_ i.rr 4) Distribution pipe diameter in. 5) Spacing between distribution pipes = S~ in. 6) Distance from sidewall to distribution pipe in. 7B) DISTRIBUTION PIPE DISCHARGE RATE "qc)- ft. 1) Number of holes per pipe 2) Flow per pipe GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length = ft. li 3) Number of distribution lines i 4) Manifold diameter in. !I II ,y . 7D) SIZE FORCE MAIN 1) Minimum dosing rate GPM 2) Force main diameter in. 3) Friction loss co 4= I'0 9,- ft. k 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = ~"yis=aft. 2) Friction loss = ft. I 3) System head 2.5 ft. _ ft. 4) Total dynamic head L,icer:ne: Date :__i~__ ~L-Z__ i 1F) PUMP SELECTION 1) Pump selected will di schargeGPM at ft. total dynamic head. 2) Pump model and manufacturer 7%~-? co ?111 V? A%z 7G) DOSE VOLUME 1) 10 times void volume of disxribution lines s 2,L-) gal./cycle 'Ieo A, Ile. 2) Daily waste aterr v lumc~ 4 doses/24 hrs. Z:1, gal./cycle 3) Minimum dose volumreeC gal./cycle ~.j C~a3/7~ ~(.r..v' ~ `,Fs1 f~?a`~.f _T ~'l'o,tYrr•a•%r~~7•~~ - ~I I; 7H) DOSE CHAMBER 1) Minimum capacity required R t 7,`~ gal. i; . /~,✓NEp ~LnC lt~~krlf5 ,i Licunsc Date: - f !!v ~9~ t~4,✓ S E"~~ N~,~S; .scG /7 T 4) IL s see-.s' /C TrJ• e~; - i• ~ il~rls E=GG ga/ l~ t A 7T 7-77 C a i N _E I 1 i ° I Z, 70 AM s e' _:3 E SYST A ~NgITESE 3`' t=oRCE MAIN, ' fig' r- v Vol) ~Ep~IONS L oR DEQ~S~~ENT pF ttv9pST T'HE EXISri14G SEPTIC -IWV- MST- QE t SPE TED 1VlStON Fort S F-mxuRE I sewmc NE55 Anlo aAF l.ES~ 400 SE REPAtRED oR Mo~tF1E~ ►F i NEGE554Ry FOR CoN ~oRMO/~KE. vv lc SEE ~HR' e3 , W(.A.c. - - l- - ' _ r _i - l Page ~ Of 2-6 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H G Topsoil = F 3 E ii D 2- % Slope ONSITE SEWAGE SYSTEPII Bed Of - 2,V Force Main Plowed Jitior'&,afif Aggregate Layer D A6 Ft. E Z Ft. %JV AwtoR Fr s Of A Mound System Using my va DEPARTPJIEN OF t ,DUSTRY. LABOR AP10 H1►P, d For The Absorption Area T Ft. tstON OF ) E . D~ Ft. E A 9 Ft. H ZA Ft. Signed: B L Ft. License Number: K Ins Ft. Date: L S._> Ft. J ~7,.o Ft. Alternate Position Z "~7 Ft. of Force Main W 6!~n Ft. L Observation Pipe-,,., B K A I. n I•-.___---------------- ----------------------~I Force Main W J M M Distribution. Bed Of 2 - 2 %2 Pipe Aggregate Observation Pipe Permanent Markers i Plan View Of Mound Using A Bed For The Absorption Area a ' PAge ONSITE SEWAGE SYSTEM m r% Perforated Pipe Detail pvto V rw w REt.~T~OUS LABOR AND • tvt)'JSZRY, Ott. Mpy t RTMOF I 1NG5 I Of nd View CE Perloroted SEE CW* Eadcep PVC Pipe Holes Located On Bottom Are Equally Spaced Q PVC Force Moir Q PVC Manifold Pipe Alternate Position Of Oietri! Ilion Force Main Pipe Lost !lots Should Be Nast To End Cop End Cop Distribution Pipe Layout P Ft i R S J X ~'n Inches Y Inches Hole Diameter Inch Signed. . Lateral p ~j1 Inch(es) License Number: Manifold Inches Date: Force Main " 3 Inches of- holes/pipe+ 13 Invert Elevation of Laterals2 " Ft. i - i 0% ~soNs ell ©Ns~ `tits v r~ ti b AoooQ J I.rq + + + + 14 N As w > 41 d Q W + + U O ~ __----------vim W a N d N a~ w N O U o v U \ N N ~ i~ N 41, N '•3 i i 44 •r1 ~fir% 01 sN Vl d ~ 4 ~ d+ V 41 n a A a rfi " Cl PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOUS VE WT CAP 'ice C.I. V E All PIPE I WEATHER PROOF APPROVED LOCKING ?-!S' FRCM DOOR, JUNCTIOKI BOX MAIJHOLE COVER WINDOW OR FRESH 12"MIU. AIR IAITAKE GRADE I y~ MIN. - I IB' MIN. L I8•nIN. ONSITE SSWAG~ p lh - INLET I v---- AL i ICI ROVED flhlA'I1C1S II APPROVED JOIMT A liu I ( ( APPROVED JOINTS W/C.I. PIPE APP LABOR AND tJILD I I (I W/c.I. PIPE. CPARTI~CiJ7 EXTENDING 3' ALARM EXTEM01UG 3' ONTO SOIL. ONTO SOLID SOIL: I ~ I ON c .I I r I ~VMP OFF II.tiV . , O l __j PUMP OFF D CONCRETE BLOC4( RISER EXIT PERMITTED ONLY IF TAIJK MANUFACTUR6.R HAS SUCH APPROVAL SPECIFICATIOUS EPT•IC AND OSE TANKS MAIJUF'ACTURER: r (JUMBER OF DOSES: PER DAS TAMK JIZE - GALLOAIS DOSE VOLUME: GALLOUS ALARM MAUUFACTURER: 5- _I. r~ti• S<</Lg tn/ CAPACITIES: A=IAICRES OR : • GALLOWS MODEL 1JUMBER: e--'/ !41) B=Q_IUC14ES OR 'It2 GALLONS SWITCH TYPE: ~1;!/~ 1 " C= J -3 INCHES OR.;242-JI/ GALLOIJS PUMP MANUFACTURER: D=~IUCHES OR /,L2M GALLONS i MODEL NUMBER: ~SJ+S~-i•~ MOTE' PUMP AND ALARM ARE TO BE bWI-ICH TYPE: Z-. i.1 INSTALLED ON SEPARATE CIRCUITS PUMP DISC-HARGE. KATE. QGP1h VERTICAL.DIrFERENCE bETWEEN PUMP OFF UnDPISTR16UT110IU PIPE..-.2 FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.5 FEET -1- FEET OF FORCE MAIN Y, F3,00 FxFRICTIOU FACTOR.. FEET TOTAL D9MAMIC HEAD FEET ;r~~2'4e INTERNAL. DIME SIONS OF TAWK: LENGTH ;WIDTH, ;LIQUID DEPTH _12 _ SIGNED: LICE E UM E -S A] S 1J R SAT E. V V4: .'Ri tk., Gq LDS ..SUBMERSIBLE ' I h1j 1 1 i~ 1r t I• SEV P- ANN tFFLUENT PUMPS G 7 I.1 ~ r x 0311 Llsr nlsc. Jt y 4 FQ' 115 V Effluent PurQ 1/2" solids 256.80 172.10 {y+ 6 5~ r ' O~(A'Fp0311 142 W0311 1/3 1 r ~ -Sub' ersible {x:: ,;~,~~,.;y MODEL EP0311 Effluent: Pump A r:I'f vs , tEreas FEET SIZE /e" SOLIDS. n a I Y a + i r`' zs o ~v; J,, ,~e4 , ~,g a k . • . ai ~,Nt~ f a ~ k: • 2 [ t, { 4 ~r-x~t Fi <t o 0. 00 4 s 12 10 20 2t 2• OZ J6 40 ?f 0 2.5 3.0 7.5'mVh ` CAPACITY rG + ..t x • • ~t... Performance • Curve 3885 ~ M~,t" .ttr MODEL 3885 SIZE 1/4o Solid k t AI 70 _ ' 1 < d w i. 10 ~ we t' Zz _T + r f v 't' oe so x 30 a ' 'w w ro' oo :00 no . tb ow F e 3AOWAI 0. to 29 CAPACITY LLir 9 35 t`r~~f 5N5 XP.E031111 142 HE0311L 1/3 HP 115 V La+H 3/4' solids 491.55 ]2 t O ttt r t. rr 3/4" solids 491.55 329.35 '1F?r.a' t OOIR,'EO311N 112 'NEO311M 1/3 1P 115 V Mod H' ,,t ray v'~i fit OCIJ{iT0511H 112 t1E0511H 1/2 1~ 115 V {iiph 14 3/4" ebllds' 700.25 171.85 /~yoti.Ld r ilk ~r'I rdS, F 4 OJUPi,'E011211 112 VE0712H 3/4 HP 230 V High M. 3/4" iolids A43.65 565.25 t~: r'~ {f•~sSEE.1Ci1rC4lING PAL, FM PERFCttt•VS7CE AM SPE)CIFICA7•IOti4. L1E1yT 30 PAGE Vu 'f t1+.4C 10/88 _a' d r OEPA`RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/~tITY: LOT O.:BLK. NO.: SUBDIV SION NAME: 1/ - 1/ /1 / N/Rp It (or f COUNTY: MAILING ADDRESS: s >u dk4Z USE DATES OBSERVATIONS MADE NO. BEDRMG.: COMMERCI L DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence :z_ ❑New ®Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ZS ou as ❑u [AS ❑u oS ou aS Zu I L:2 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1 PROFILE DESCRIPTIONS 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- _ B- - B- B- 7 c r - Zl•S - P B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIO 2 PERIOD 3 PER INCH _ P- i 7 S P- ir 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. 71 1 'i SYSTEM ELEVATION r'l y rc /G 16 - N '-r . I, the undersigned, hereby certify that the soil tests reported on this form were 7madey me in accord with the procedures and methods specified in the Wis nsin Administrative Code, and that the data recorded and the location of the tests are cthe best of my knowledge and belief. NAME pri TESTS WERE COMPLETED ON: ~1 ? / ADD ES I CERTIFICATION NUMBER: PHONE NUMBER (optional): CST S GN E: STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ILHR-SBD-6395 (R. 10/83) - OVER - . INSTRUCTIONS FOR COMPLETING FORM 115 - SBO - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use soction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil S"rates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPAP;TMEN'fOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY„ DIVISION 370 LABOR RAND ELATIONS PERCOLATION TESTS (115) P.O. MADISON, WI BOX 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) (or )TOWNSHIP/MWMetPAtITY: OT O.: BLK. O.: SU DIV SION NAM : LOCATION: , SECTION: ~F//-/ N/R/? It 44 -1.4 CO, TY; MAILIN ADDR S: USE DATES OBSERVATIONS MADE PROFILE DESCRIPTIONS: PERCOLATION 474 I ! 9-'? Residence NO. B~ EDRMS.: COMME L DESCRIPTION: ❑New ®Replace TESTS: ~1 r•.. RATING: S- Site suitable for system U- Site unsuitable for system ONV cNTI NAL: MOUNccD: IN-GROUNCcD S'U STEccM-IN-FILLHOLDIccNG TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: I Floodplain, indicate Floodplain elevation: A114 1A I PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF OIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- • c n _ > . A~Allf- z 0- 1,;2 B- B- c; 2 r B- B- 7 ' _ B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME R I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. 1 RI PER INCH P 7 r 3 2 1, -k P- a P - D- OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tal 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 end slope. 'STELA ELEVATION 9l 9/" . /GP, o a - - - - j. l _ - - - - i - _I. I _ I ' C I I L_ z - i C - ~ 1 .;S Y1 signed, hereby certify that the soil tests reported on this form were made y me in accord with the procedures and methods specified in the Wis nsin ve Code, and that the data recorded and the location of the tests are corre t to the best of my knowledge and belief. TESTS WERE COMPLETED ON: CERTIFICATION NUMBER: PHONE NUMBER (optional): ~J /ef -2 :?,W / i '2 Z CST S GN E: N: Original and one copy to Local Authority, Property Owner and Soil Tester. 95 (R. 10/83) - OVER -