HomeMy WebLinkAbout038-1064-20-101 (3)
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RECEIVED
IUI IIIII11111 I111~1l11 II{II! IIII ii{I
MAY 1 9 2009
891406
ST. CROIX COUNTY BETH PABST
SURVEYOR'S RECORD REGISTER OF DEEDS
ST. CROIX CO., WI
CERTI FI ECG SURVEY MAP RECEIVED FOR RECORD
LOCATED IN PART OF THE NW1 /4 OF THE NE1 /4 03/23/2009 10:30AM
CERTIFIED SURVEY MAP
OF SECTION 16, T31 N, RI 6W, TOWN OF STAR VOL: 24 PAGE: 5611
PRAIRIE, ST. CROIX COUNTY, WISCONSIN. RECPFEE: 13.00
Exemption verified under Section 13.1 B. 3, a.3) of the St. Croix County Land Division
Ordipance and Section 236.45 (2) (a) (4) of the Wisconsin Statutes.
gY Q~~e ✓"~u`'~~ Date 3._ZO-oti
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C~IOd~ 9 pro 49 ~g DDQ. 60)@0
NORTH LINE OF THE NE1/4
N89°44'00"E N89°44'00"E 656.25' m NE CORNER
656.25' En
N1/4CORNER N89°44100"E 656.34' - -XL 8 , .00' g N "
SECTION 16 8 590.34'
C6 220TH AVENUE
. V7
LOTS MAY BE SUBJECT TO ' ' ' ' ' ' ' ' ' ' " " " "
FUTURE SPECIAL
ASSESSMENTS FOR ANY
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UPGRADES AND
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N "u Z a O 66' ROAD EASEMENT AS SHOWN ON -
Z CERTIFIED SURVEY MAP RECORDED IN W ~I
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LEGEND X
1111"10 U
(0 ALUMINUM COUNTY SECTION u
M CORNER MONUMENT FOUND
1" O.D. IRON PIPE FOUND t /
(p 3/4"X 18" IRON REBAR SET WEIGHING
Q7 1.50 LBS. PER LINEAR FOOT -
. . 50' ROADWAY SETBACK LINE
Q SEPTIC VENT
Z SOUTH LINE OF THE NW1A OF THE NE-I/4 /
S89°44'08"W n659.92' SCALE IN FEET 7" = 150
THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON L1~p~~ LJ 7~~~ NNW
JOB NO. (Y-CV 2 DWG - CSM DATE 01-30-09 SHEET 1 OF 2 SHEETS 1 SO 0 150
Vol. 24 Page 5611
Parcel 038-1064-20-100 02/23/2012 11:59 AM
PAGE 1 OF 1
Alt. Parcel 16.31.18.277A10 038 - TOWN OF STAR PRAIRIE
Current [X] ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
TRUST DEPARTMENT 0 - EASTWOOD BANK
EASTWOOD BANK C - CUSTODIAN FOR JOHN A DUSEK III IRA
CUSTODIAN FOR JOHN A DUSEK III IRA
13504 GOSSAMER CT
APPLE VALLEY MN 55124
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1069 220TH AVE
SC 5432 SCH DIST OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.530 Plat: N/A-NOT AVAILABLE
SEC 16 T31 N R1 8W PT NW NE BEING LOT 1 Block/Condo Bldg:
CSM 812384 3.53ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-31N-18W NW NE
Notes: Parcel History:
Date Doc # Vol/Page Type
06/18/2010 917755 WD
07/13/2006 829586 QC
2011 SUMMARY Bill Fair Market Value: Assessed with:
164367 44,500
Valuations: Last Changed: 09/13/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.530 29,600 14,500 44,100 NO 10
Totals for 2011:
General Property 3.530 29,600 14,500 44,100
Woodland 0.000 0 0
Totals for 2010:
General Property 3.530 39,700 22,000 61,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
'~ECTION _N-Rj_~LW
ADDRESS ST. CROIX COUNTY, WISCONSIN
T /
SUBDIVISION- LOT~„lam LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5 ~
4
i
f~
A
l
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: r: eir/ f~-J' Alternate benchmark
-
jeod
SEPTIC TANK:Manufacturer:, r , Liquid cap-
Rings used:,.,2-Manhole cover elev: /f).S; S-Final grade elev: jet',(
Tank inlet elev.:,/C1~ y/y Tank outlet elev.:
No. of feet from nearest road:Front , Side, Rear Ft./ZQ
From nearest prop. line:Front , Side , Rear_ Ft. l~
No. of feet from: Well , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
t
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: Trench:Seepage Pit:
c; Width:_ Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. ZD+?
Fill depth to top of pipe: ,2/,
No. feet from nearest prop. line:Front , Side_;~., Rear Ft.
No. feet from well: No. feet from building 44/
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:
C~~
LICENSE NUMBER:
6/90:cj
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
La6or and Human Relations NW,NE,16,31,I8WINSPECTION REPORT St. Croix
Safety and Buildings Division
Near CC (ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 149132
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
Dave Springer Star Prairie
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
l 277A
TANK INFORMATION ELEVATION DATA 09 I QD o~~ l
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_
Septic bap Benchmark J6, /06"Al` /00 3
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet 7 /Va, SEq
TANK SETBACK INFORMATION St / Ht outlet / V a , o sr
Vent
ir Ito ntake ROAD Dt Inlet
TANK TO P / L WELL BLDG. A
Air
Septic 6p f ,t,/-v NA Dt Bottom
Dosing NA Header / Man. 7• !U 0?
Aeration NA Dist. Pipe 7.3 5- ov , `13
Holding Bot. System 3
PUMP/ SIPHON INFORMATION Final Grade %a.(o /U
Manufacturer Demander , 7q to y~
Model Number GPM
TDH Lift Friction System TDH Ft
oss Fi
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS > 0 o 02-1.1 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK CHAMBER
/ Mode Number:
INFORMATION Type Of /74va
System: 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 Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
a
7,3~ /
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 1/0 g Y e 4
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
4
SANITARY PERMIT APPLICATION
•{L UILHR In accord with ILHR 83.05, Wis. Adm. Code COUNT
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than O~
8% x 11 inches in size. 1:1 CHeck if rvl l6n previoLs 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
al)A r' t/a ,/a,S ' T N,R E(or
PROPERTY OWNER'S MAILING DRESS LOT # BLOCK #
CI ST TE ZIP CODE PHONE NUMBER SUBDIVISIO NA E OR CSM NUMBER
ITY
LLAGE NEAREST ROAD
II. TYPE OF BUILDING: (Check one) El State Owned ❑ VI
❑ Public ~41 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUM ER( 1. t,
III. BUILDING USE: (If building type is public, check all that apply) 27 7 A - 63 g-' )6 D-l o9 0
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 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. ® 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 N 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 q. tt.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet
Feet
VII. TANK CAPACITY Site
in alIons Total # of Prefab. Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New istin Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Se tic Tank or Holdin Tank fl ~y
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 (Pri PI tier's Si re: (No Sta ps) MP/MPRSW No.: Business Phone Number:
Plum is Addr ss (Str - , City, Sta Zip Code):
l
IX. COUNTY/DEPARTMENT USE ONLY
o Stam )
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag t SignaturtIgN
urcharge Fee)
Approved ❑ Owner Given Initial ~cI p* 07 /
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
a
INSTRUCTIONS ' k
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
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; 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)
r
. APPLICATION FOR SANITARY PERMIT
8TC-100
This application form Is to be complatod in full and signed by the ownet(s) of
the property being developed. Any Inadequacies WL11 only result in delays of
the patmlt Issuance. -Should this development be intended tot tesalt by
owner/contract0t,(spac 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. rw----
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -r - - - - - - - - - - --ww ,
Ownst of property AA41~ S~.e'L
/4 lY~._..l/4r Section Al/
Location of property
Township ~y
Mailing address -04-91.q_ Address of alto .
lvbdivlslon name 1~!
Lot number
Previous owner of property
Total size of parcel
, Date parcel was created
Are all cornets and lot lines identifiable? ^ ~_Yss 0
Is this property being developed tot resale (spec house)? as
Volume and Page Number as recorded with the Register of Deeds.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • - - --w-----
I
INCLUDS WITH THIS APPLICATION THE FOLLOWING?
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUMa AHD PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, 11
avallable, would be helpful so as to avoid delays of the reviewing process. It
the deed description references to a Cestlfled Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (out)
knovledgel that I (we) am (ate) the owner(s) of the property described In
this Infotmation form, by virtue of a warranty~Ared a otded In the Office of
the County Register of Deeds as Document No. !'W 71,~~ f and that I (Ve)
presently own the proposed alto for the sewage disposal system (or I (we) have
obtained an easement, to tun with the above described property, tot the
consttuctlon of sold system, and the same has been duly recorded In the office
of the County Reglat c of Deeds, as Document No. 1.
signature of Or r Signature of Co-owner (if Applicable)
Date of signature Date of Signature
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
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OWNER/BUYER
ROUTE/BOX NUMBER- Fire Number
^
CITY/STATE £,J ZIP 'f
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PROPERTY LOCATION: J~/Nl 14,_14, Section T&/ N, R/,? W,
Town of St. Croix Count
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into li
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% 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 Zoning a
certification form, signed by the owner and by a master 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
0
E
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ~v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
a
SIGNED !l~ 0(-d° ~L -
-2-1 DATE -2-1 A
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
LNDUS
DEPARTMENT Of PORT ON SOIL BORINGS AND SAFETY & BUILDINGS
~NDUSTf1 .RY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS ~
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MUN~ffAt1TY: LOT :BLK. NO.: SUBDIV SION NAME:
/T [ (or) / f Xhr OUNT : OWNER'S BU E: MAILING ADDRESS: 9 O!'
AIXXI
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: I L DESCRIPTION: PROFILE DESCRIPTIONS: R COL ION TESTS:
50FIesidence New Replace ~Zz
RATING: S= Site suitable for system U itable for system
CONVENTIONAL: MOUND: IN RESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDS SYSTEM: (optional)
S ou s ❑u u a s 2 u a s ou
If Percolation Tests are NOT required ATE:
I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
,-Al
PROFILE DESCRIPTIONS
BORING TOTAL D PTH T NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSE EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- > i - -
l
B- - ' 71
B- a. / - -
B- - - 6
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER O 2 PER PER INCH
P-Ale-4 A)Z
P-
P-
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 direc ion and 'percent
of land slope. /
~ ~ ~ /-'-'a',1
SYSTEM ELEVATION 14a 0 - ~ ~
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the undersigned, hereby certify that the soil tests reported on this form were made by in n accord wit -the procedures and methods specified n the Wisconsin
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
C
'Irin TESTS RE COMPLETED ON:
P4 -
C RTIFICATION NUMBER: PHONE NUMBER (optional):
7/J -
C IG AT E:
p`STR,
O`~FR -iginal and one copy to Local Authority, Property Owner and Soil Tester.
10/83) - OVER -
I T-7RUCTIONS FOR COMPLETING FORM 15 - SBD _
To he a cor, a€r~i accurate soil test, yor.v repo€t must include:
1. Complete lega =scription;
2. The use section must ciea her this is residence or- comme€-ci
1 M/ "POUM number c amens=.rcial use planed; 4, never or reolac,rare f
B. Cc ~iqi..t.c the suitabil': ; A SITE IS SUlTA3LE FOR A HOL K ONLY IF ALL
O-, tai: SYSTEN"iS ARE 'eft i") t' 3T BASE[ ON SOIL CONDITIONS; . PLEASE use the abbrevia sns shown here frar vvJting profile de feting the plot plan;
7. MAKE A LEGIBLE accurately locating your test to ~ -,;-ale is preferred. A
separate sheet may be us-, if desired;
8. Make sure your henchniark -'ad vertical eleva ' 1 refe€ence point ~ €:ae r, and are permanent;
9. Complete a" . 'talaria;e boxes as to da- addresses, flood pla' ercola:ion test exemp-
tion;, if:,..
10. if the (such as fit elevation) does riot apply, plat ~ the appropriate box;
11. Sign the .m I place your cu, ddress arid your certification rr
12. Make legible ci :lies and distrib - E as required. ALL SOIL TEST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 20 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Symbols
st _ Stone (over 10") B13 - drock
cola Cobble (3 ' 10' ) S
gr Gravel (under 3") 1 . ~ -t, jli~
s' Sand ')WIdwater
cs Coarse Sand <;'_on Rate
rne:d s Medium, Sane
is - Flrr" San qj
s Lo.l han
;l - F- L ,r€ "7 r1an
n
;i L.€-._
u a 1 E ow
sc t€"Ti R
=ac,! y rra«t ties
:c G'ra y l.~iut a~i VV/
sic - Silty Clay ff€ - few, fine, faint
c - Clay cc _ cimmon, coarse
pt Peat € in Many, mediurn
II - muck d - distinct
p prominent:
HWL Nigh water level,
Six general soil textures surface water
for hquid warm disposal BM - I' ch Mark
VRF al 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 Kermit 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 he obtained and posted prior to the start of any construction.
AN-
f ?L
~j
4
i
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PAGE OF _
CroS JLC~1UIl p~ A Uric STen-)
FrotA Alr Inlole And OD►ervollon Pipe
tV '
G9
Ok ^
1 l:~-Approvid Yom Cap
minimum 12* ADove
f~ final Grod•
sy~i 7
20- 42v Above Plpp _ 1" Cool Iron
To flnel Grodo Von$ Pipe
Mot In Hot O_ Srmnolk Covet Ing
min 2" Aggiepale
Over Pipe
Oloulo,dlon
Pipe 0 0 0 ioo s
6" Agglogat
onU Pipe ssib Pip
e e
B o Perlorelod Pipe below
o -Coyglnp iuminollnp Al
8ouom 01 Syelom
s'X 99
►ne.
~lcJ•.~' ton
SOIL FILL
DISTR1113UT101.1 PIPE
. APPROVED SylAJPETIC COVER
~""-/1AT~RI^~ OR 9" OF STRAW
2"OFAG6RE4AlE OR MARSH HAy
(oOF JZ-Z~/Z AGGREGATE
ELEV. OF FEE 1.
~~~s
DI5-rRIry'JT10M PIPE TO BE AT LEAST --:~Z" INCHES BCLOW ORIGIMAL GRADE
AUU AT LEAST tO INCHES BUT 1.10 MORE THAI,J 42. IMCI{ES BELOW FMA.L GRADE
MAXIMUM MrVi OF EXCAVAT100 FYOM OK16WA . 61 AK WILL BE _ INCHES
nNIMUM 0EPT1i of EACAVATION fAOM 016 JAL GRAPE WILL. 61= INCHES
i
SIGNED:
LICEWSE LiUMBEIZ: LCl, -
DATE: