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AS BUILT SANITARY SYSTEM REPORT
OWNER fF .1,4/rte l TOWNSHIP
SECTION ~1-T~Z N-R /9 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
1
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Houses
%8
~r
~us
Illy
INDICATE NORTH ARROW
BENCIR4ARK:Elevation and description:
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap. l~100~~
Rings used: --Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear_,y Ft.,2 7f~~
From nearest prop. line:Front Side V, Rear Ft. S~
No. of feet from: Well , Building:
(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
Bed: L_Trench: _Seepage Pit:
Width:
Length__ yam'
Number of Lines:~_Area Built1~'~,
Exist. Grade Elev. proposed Final. Grade Elev.
Fill depth to top of pipe:
No. feet from nearest
prop, line:Front~( , side'
No. feet from well:- • Rear-_Ft.42~
-JZ~No, feet from building 3
HOLDING TANK
Manufacturer:
Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest
prop. line.Front Side
No. feet from: Well , Rear Ft.- '
building , nearest road r"
Alarm Manufacturer:
INSPECTOR:
DATE: -
PLUMBER ON JOB:
LICENSE NUMBER:9
6/90:cj
1 Lq~A"VION: SOMERSET 24.31.19.326C,SE,NW,24,205TH AVE.
iscons n Department of Industry, PRIVATE SEWAGE SYSTEM County:
Laborand Human Relations INSPECTION REPORT
Safety~ncl Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.-
INFORMATION 149311
149311
Permit Holder's Name: ❑ City ❑ Village)f7 Town o : State Plan ID No.:
CARLSON JEFF SOMERSET
CST BM Elev• Insp. BM Elev.: BM Description: Parcel Tax No.:
O 032106570100
TANK INFORMATION ELEVATION DATA A9200156 -,F-
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 60 Benchmark 2 O' A.-&D ~
D
Aeration Bldg. Sewer %p
[Holding St/pt inlet 97 (07/
TANK SETBACK INFORMATION St/~K Outlet 3 /2 a
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inl-t_
Septic If NA Dt. Bottom
Dosin NA Headert arr- Y3 5/ K77
Aeration NA Dist. Pipe jd ~
Holding Bot. System 6'2A„
PUMP/ SIPHON INFORMATION Final Grade
Manufa Demand 5,7%
Model Number GPM
TDH Lift Friction Syste TDH Ft
Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width Length s No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~C I N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type of ' c) r1 CHAMBER Moe er:
System: 35 0 ( OR UNIT
DISTRIBUTION SYSTEM
Headers Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _(a~ Dia. Length ~ Dia. _~c 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 Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code iscrepancies, persons present, etc.)
C ic.~C4`~ t X1(/{ l/i~Gc. ?t-l / ~/CF2f ~c-r1 C~/~ ( `1 t2 -c^C°/.f k~ 6,
/'l1 .i -Y1 `_"..f" , l_T..~'..-cG! F? AG /C? ' UA~(1. -•'G1'..-! j~ ~'1 /~Cd%G --C V "t 1
/J a! c~ , S , aid ~l
S, T
Plan revision required? ❑ Yes No
Use other side for additional information. 7 P j--
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH t '
SANITARY PERMIT NUMBER: .
DILHR SANITARY PERMIT APPLICATION couN
In accord with ILHR 83.05, Wis. Adm. Code S7, Q_
rs..~....~.,...,,a.
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than /419311
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
' '/a Y4, S T , N, R E (or)
PROPERTY OWNER'S M LING ADDR LOT # BLOCK #
CITY STATE ZIP CODE PHONE NUMBER SUBDIVISJON NAME OR CSM NUMBER
"r 'Ve
11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD
❑ Public (M 1 or 2 Fam. Dwelling--# of bedrooms PAR L A NUM ER 111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 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. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/d ay/sq. ft.) (Min./inch) ELEVATION 0-157 L - Feet 914. 7 Feet
CAPACITY
VII. TANK Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted _RT_ -TT-1 71
Septic Tank or Holdin Tank 64af = a&2 S
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installati of the onsite sewage stem shown on the attached plans.
Plumbs s Name (Print):, Plumber' Sig tur : ( to s MP/MPRSW No.: Business Phone Number:
2 .1 A P mbe ' /lddress treat, City, Zip IJZ'
IX. CODUNTY/DEPAR MENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agent Signature (No Stamps)
Approved ❑ Owner Given Initial harge Fee)
Adverse Determination Ol
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS E.
1. A sanitary permit is valid for two (2) years.
2. Ydur 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 p"umber 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 5y 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 adm nislrator 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 tolal 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 ,eceived
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(sl, 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 elevatior, reference points;
C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
9TC-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 parmlt Issuance. -Should this development be intended for resale by
owner/contractot,(spec house), then a second form should be retalned and
completed when the property is sold and submitted to this office with the
appropriate deed recording.'
Ownsr of property JEFF CARLSON
Location of property SE 1/4 NW 1/4, Section 24 T 31 H-R 19 V
Township SOMERSET
Mailing address 736 NORTH SHORE DRIVE
NEW RICHMOND WI 54017
Address of site XXX 205TH AVE.
Subdivision name NONE
Let number LOT 1
Previous owner of property JOHN BUEGE
Total six* of parcel _ 5 ACRES
Date parcel was created 8-30-88
Are 411 cctners and lot lines Identifiable? X as
_ No
Is this ptopetty being developed for resale (spec house)? Yes X No
Volume 7 and Page Number 2032 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWINCr
A WARRANTY DECD which includes a DOCUMENT NUMBER, VOLUM2 AND PAOt NLrMBZR, and
the SEAL OF THE RSOIST-BR OF DEEDS. In addition, a certified survey, if
avallable, would be helpful so as to avoid delays of the reviewing process. if
the deed description references to a Certltled Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(ve) certlty that all statements on this form are true to the best of sky (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 Reglstet of Deeds as Document No. 481740 ' 1 and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of sold system, and the same has been duly recorded In the Office
of the County Reg-stet of Deeds, as Document No. -
signature 0 or Signature of Co-owner (If Applicable)
Date of Signature Date of Signature
is
.L.Ame ..e _An9.he .oars.
I
M. 311
a vep ow warraets to .._.s1R~~R'~f..
bysbssd..end .riifs.._as..~n~nt .tenants
. . .
aeruass ,e
•
tM twlowias dascriw raw aatato in St._..Crnix ........................County, 4
State of Wisconsin:
Tar Pared No:...........
t
Part of the SE 1/4 of NW 1/4 of Section 24, Township 31 North, Range 19 West,
St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Nap
filed September 30, 1988 in Vol. "7", Page 2032, Doc. No. 441876.
i
f_
TL i, is not homy,toad pro Pert S.
(girl (is- not I
Fxception to warranties:
Dated this 8 day of April 19 92.
• (SEAL) (SEAL)
Jo G. Bue e
F! 9
C _ (SEAL)
(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
as.
- St. Croix
County.
authenticated this ........day of 19. _ Personally came before me this 8 . ......day of
Apri.)-..-... 19-92... the above n,,mw
~l- ,hn G. Bui~gP, a single person
(If not,
authorized hS $ 7"41.1W, Wi,
,0. ,•x.ratcd the
i INSTRUMFNT WAS DRAF-FD il. l
w.... . s. 1nia Public /St. Cray r fig x+
(Signatures may be authenticated or aeknowleds-ed. Both My Cnirmissinn is pertnanont.(If not, f
area nwessary.)
dat,
K
161101111M, F,
•Nameo of penoM sisnUm IA aoy crps.:u 'hi -1 b, tyJ-d d K,,,, Neoglr;'Pu~AiS!~Mol F
4
My (~~li1wA ~M '
.
- STATE. BAR OF W SCONSIN
FONM Na. 8 - IusY - ,
t L"16~IS.Y of St,
1 h r~r °by z fuit,
and of record in try e,H r cirri ~-cs u a,
4ompored by me.
Apri1 27 92
James O'Connell
C~,4((6Deputy
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-19821;
.John.. G...6uege.~..a single..Ae)°_S°n•-
conveys and warrants to 0-effrey..S.L..Gal.1 Oj1,
.husband..and..wJfe.,..aS..Jn.int..tenan-ts......................
RETURN TO
the following described real estate in ......S.t....r-rOj.X ........................County,
State of Wisconsin:
Tax Parcel No:
Part of the SE 1/4 of NW 1/4 of Section 24, Township 31 North, Range 19 West,
St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map
filed September 30, 1988 in Vol. "711, Page 2032, Doc. No. 441876.
0Cc0rZ~~;,~5 z~i=o y- - `lZ cy~~~yo
This ....is. n.ot homestead property.
Q (is not)
Exception to warranties:
Dated this ...........8 day of Ap.r.i.l...., 19....92..
(SEAL) ......................(SEAL)
G. e
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Croix
.....................................County.
authenticated this ........day of 19...... Personally carne before me this 8 .day of
Apri.l....... 19.92... the above named
John G. Bueg............... a s i ngl e..Person...........
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
ATTORNEY'S l..
"ta3S'NORTHW QF .YLLWATM
1'EAN AVENUE J~~9...l e yy....C.:...!X°l!!~ ~
. Croix
8TILlWAR,••~N X82 Notary Public / St
County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19.........)
Sl'A1i1.>:Y •f'' Ham'
-Names of persons signing. in any capacity should be typed or printed below ttleir signatures. Notary Pubis-State of WIscmin
Wry ConNmion Exp w 6
STATE BAR OF WISCONSIN
".C.MyI,arCon+oeny~ FORM No. 2- 1'982 Stock No. 13002
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-19821;
..John..G....Bue9e.,..a single..Ae1".Son
.
conveys and warrants to
hUSband..a9nd..w.1.fE.,..as..j ojnt.. tenants........................................
_
. RETURN TO
.
the following described real estate in ......S.t....CrQi.X ........................County,
State of Wisconsin:
Tax Parcel No: - la's-?O -LUd lb
Part of the SE 1/4 of NW 1/4 of Section 24, Township 31 North, Range 19 West,
St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map
filed September 30, 1988 in Vol. 11711, Page 2032, Doc. No. 441876.
This S nOt homestead property.
Q (is not)
Exception to warranties:
hated this _ $ - day of Anri l 19 C)2-
SEPTIC TANK MAINTENANCE AGREEMENT w
St. Croix County
OWNER/BUYER JEFF 'C'ARbSON
0
ROUTE/:$'dX NUMBER 'UX' 205TWAVE: Fire dumber ? :J
CITY/STATE SOMERSET; WI ZIP 54025 Cr
PROPERTY LOCATION:'.' SE NW Section 24 T 31 N, R 19 W,
Town of SOMERSET St. Croix County,
Subdivision NONE Lot number -I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.' Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a l'ic'en's'ed' um er. What you put into
the system can affect the- motion o, t e •s~ep:tic tank as a treat-
ment'stage in the waste disposal system.
St. Croix County residents,- may 'be eligible to recieve a grant for
a maximum of 607. 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 'sys't'ems agree to keep their system properly
maintained.
The property owner agrees to. submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or..a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2).after inspection and pumping (if nec-
essary), the septic-.tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year-expiration.
H
I/WE, the undersigned have read the above requirements and agree °
to maintain the private sewage disposal system in accordance with y
the standards set forth, herein, as-set by the Wisconsin Depart- .7
ment of Natural Resources. Certification form must be completed U'
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration-date. L
SIGNED M
a
DATE (7
1~%
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
.INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069
HUMAN RELATIONS
L 83.09(1) & Chapter 145)
LOCATION: SECTION: r RS HI UNICIPALITY: LOTNO.:BLK.NO.:SUBDIVISION NAME:
Ste!/a ~/4 AR/ N/R E ( Sa
COUNTY: OWN-E 'S BUYER'S NAME: MAILI G ADDRESS:
Z
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence xNew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVEcNTIONAL: MOUND: Vuj IN-GROUNND-PRESSURE: SYSTEM-INFILLHOLDIING TANRECOMMENDED SYSTEM:(optional)
J Elu 0J J F]U I DS F]J
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: 0
I ly-
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST_ TO BEDROCK IF OBSERVED (SE ABBRV. ON BACK.)
O-/d / rl 511,10 ' ~D.lc !O
B- ya 6
awe ~y~ j)p
r - 7
B- ~2_ 1 761
B- 3 _ a6 -yam ~s
>C
Z7,; .50!
Ili 0.17 _5
of.1w
B- >
B-
PERCOLATION TESTS
TEST EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTE SWELLING INTERVAL-MIN. PERIO 1 PERIOD P R D 3 PER INCH
P_ L 40 .2 - 4~
P- oZ L 02
P- dA 4s-
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 5ys7E`ti~ r
o
7 ~
P
1' 41-
IN gem
ay 2- N
~f ohs
V
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
All" 0 TESTS WERE COMPLETED ON:
Je? ,w
ADDRE S _ CERTIFICATION NUMBER: PHONE NUMBER (optional):
/1100, CST SIGNATURE:
r
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
INSTRUCTIONS FOR COMPUTING FORM 115 SBD - 6395
To be a complete and accurate soil test, your report must: inclucde-
1. Complete legal description;
2. The use see.tio~'= lust clearly indicate whether this is a residence or commercial project;
3. MAXIMUM €ak- ,,er of bedrooms or commercial use l:alannd;
4. Is this a ne , ;)!'ice€nent system;
S. Complete the ability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY !F ALL
OTHER SYSTE" 1S ARE RULED OUT BASED ON SOIL. CONDITIONS;
6. PLEASE use t ` reviations shown here for writing profiles descriptions and completing the plot plan;
7. MAKE A LEGI _E diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet y be used if desired;
S. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9, Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, 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 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 SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR Bedrock
cat) - Cobble (3 - 10") SS - Sandstone
gl Gravel (under 3") LS - Limestone
res Sand HGW - High Groundwater
cs Coarse Sand Per c; - Percolation Rate
med s Medium Sand W Well
fs Fine Sand Bldg - Building
Is - Loamy Sand > Greater Thai)
sI Sanely Loam < - Less Than
h l - Loarn Bn - Brown
sil Silt Loam BI - Black
si - Silt Gy Gray
ycl Clay Loam Y Yellow
sci Sanely Clay Loan? R - Red
sicl Silty Clay Loam mot Mottles
sc Sal Idy Clay t vit/ - with
sic - Silty Clay fff - few, fine, faint
*c Clay cc - common, coarse
pt - Peat rram - Many, medium
m Muck d distinct
1`r prominent
HWL - High water level,
Six general soil textures Surface water
for liquid Waste disposal BM Bench Mark
VIP - Vertical Reference Point
t '
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request 1
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.
s
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H gearings are referenced to the
East - Hest 1/4 Line of section 24, o w K w 30 nl
assuaeJ to bear 1,1890180124 . l L k
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Unplatted Lands N v• a 12,
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= N00009'40"E 466.52'
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433...~52' °
S0001011611W 466.52'
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PALE OF
MUSS S~C~IUr1 p~ A 3r1~ S~'ST~n'~
` c ~-~~O SLiblf FeeM Ale Inial+ And OD►eevallon Pipe
1
/~C1c 1/.,R~Jp Gti~ r\
1 ApprorU Yeel Cep
Mtnlmuiw 12'ADOre
Finel Geed.
• I
1
1
20- 42' Above Plp' 4' Coal Iron
To final Goalie Venl Pipe
++u en 110" t Synlnella Co.erlnp
UJA 2" l1St Yoiepale
1 0.•r Pipe
Oielrlbollon
e o 0 0 Teo +
Pip
C 6' Agog stale
j Beneale Pipe o perlofeled PIPe Belo.
1 o -Co.pllno T«minellnq, Al
Bottom 01 STelem
e 19e 1".
• Pro PoSeD Finn' c~rF.c~t ~P' .
SOIL FILL
OISTRI6UTIOLI PIPE
• APPP.UVEu $`1!1 lurk COVC
r.
cep-
`~-I'IATE}ZII~L OR 9" OF STRAW
2" OF hISGREWE OR 10IAr SN HA`.i
a '~'&Q 1. OF AGGRCGATE ~•P .~/i~
t:L E V. OF_94_1 FEET--•-
DISTRIyUTIC~ W PIPE: TO INC AT LEAST C+Y-~ IMCHES BELOW ORIGIWAL GRADE
A►JU AT LLASTtO MCHE-e BUT LIO MORE THAI) 42 IMC-4ES BELOW FINAL GRADE
i
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AVIMUM DSPTH OF EXCAVATIoIJ ri(OM OR16NAL 61 w wl'_'. 5L IUCHES
1'VNIF'1UM OEFni.oF EXCAVATImN ,61W L
rF~OM ~ A GRAPE WILL Bt ItJCHC S
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SIGEJED: /
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,vow R,cLn /Mu^td w= ~Yv
n/M teaml realty
„Y 103 Main St., Box 68
Somerset, Wisconsin 54025
®.M~s (715) 247-5900
246-7125
Each Office Independently Owned and Operated
REPT131 SOMERSET ST. CROIX COUNTY ZONING PAGE 1
06/0$/92 09:26 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 9/92 AREA: JT
Activity: A9200156 6/ 9/92 Type: CONVSEPT Status: PENDING Constr:
Address: SOMERSET 24.31.19.326C,SE,NW,24,205TH AVE.
Parcel: 032-1065-70-100 Occ: Use:
Description: 149311
Applicant: CARLSON, JEFF Phone: (715)246-2977
Owner: CARLSON, JEFF Phone: (715)246-2977
Phone:
Contractor. O CONNELL, KIM A.
Inspection Request Information.....
Requestor: KIM O'CONNELL Phone:
Req Time: 13:06 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION Mx'
Inspection History.....
Item: 00012 FINAL INSPECTION