HomeMy WebLinkAbout026-1001-90-401
I
f Form - S T C - 104
s AS BUILT SANITARY SYSTEM REPORT
TN-R -W
~ 'OWNER s TOWNSHIP SEC. _
E
ADDRESS ST. CROIR COUNTY, WISCONSIN
. jrOr 7
SUBDIVISION'' LOT LOT SIZE
r r. PLAN VIEW
3 ~requirements of IL-HR 83 ;
Distances and dimensions to meet
' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
• SEPTIC TANK: Manufacturer:.c•iquid Capacity:
,:.414ftmber of rings usedi Tank manhole cover elevation:
- '.Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side Rear, O feet
From nearest. property lie : Front,OSide,Rear,O %'Q feet
Number of feet from: well , building: r
(Include this information of.t a above plot plan)( 2 reference dimensions to septic tank) 1
SEE RFVERSE SIDE
i
PUMP CHAMBER
Manufacturer: Liquid Capacity:
'.:Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line:. Front, O Side, O Rear, p Ft.
Number of feet from well:
Number of feet from building:_
(Include distances on plot plan).
SOIL ABSORPTION ; SYSTEM
Bed r- Trench:
Width: ~f Lenifh:_ ..-Number of Lines: Area Built: Fill. depth to top of pipe: C~x
Number of feet f om nearest property line: Fr. t, O Side, Q Rear,O It Number of feet from well:
N ber of feet from building:
(Include di Lances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
I
`Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box or distribution box O been used on any of the above soil
absorbtion sytems? (C eck one).
HOLDING TANK a
Manufacturer: Capacity:
Number o V.rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from.nearest road:
Alarm Manufacturer:'
Inspector:..
Dated: :J 2 Plumber ,on job:
License Number:
3/84 :m' j
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Agoz 1-W
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR &41UMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707
NGJ- , SGT 4 , Sec. 1. T30-R18 Sf at s igned) 'Number:
Town of Richmond ~ CONVENTIONAL ❑ ALTERATIVE
Ct 4 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
i
Ronald Shil tz ~732 T
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. EL V.:
Name of Plumber: MP/MPRSW No.: ounty: Sanitary Permit Number:
Calvin Powers Jr. 1563 CSt. Croix 135+51
SEPTIC TANK 'I to VNw,~a(e C K r = 970("./V'-)
MANUFACTURER: LIQUID CAPACITY: TANK INLET TANK O LEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
2.66 / YES ❑ NO ❑ YES NO
BEDDING: "I-' DIA.: V£#T MATL.: HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING: VENT TO FRESH
C.7 C.0, ALARM: FEET FROM LINE: / AIR 71T:
❑ YES NO ❑ YES NO NEAREST o~ 3I
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.
CONVENTIONAL SYSTE ' /A '
BED/TRENCH WIDTH: L NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
TRENCHES: / MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. IPE DISTR. PIPE MATERIAL: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET ELEV. END: r u `n(_- PIPES: FEET FROM LINE: AIR INLET: r
Tnt J NEAREST S S - y5
G 921
MOUND SYSTE :
Mound site plowed perpendicular 0 Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: 4ARESTFROM---- MBER OF PROPERTY LINE: BUILDING:
FEET
r ❑ YES/❑ NO ❑ YES ❑ NO 0-
y
Sketch System on /41-61ain in county file for audit.
Reverse Side. WSIGNAT TITLE,
SBD-6710 (R. 06/88)
D LHR SANITARY PERMIT APPLICATION ou
In accord with ILHR 83.05, Wis. Adm. Code C
STATE SANITARY PER IT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El /hegck
8% x 11 inches in size. i 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.
PR ERTY OWNER PROPERTY LOCATION
c~ C /UOJ/a S T G,N,R S~ or)W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
7 .Z r`e r
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
w Rte sent? 7f s~ S M4.,P
II. TYPE OF BUILDING: (Check one) VITM NEAREST ROAD y
❑ State Owned ~ VILLAGE : M 1
❑ Public 1 or 2 Fam. Dwelling-#of bedrooms & ARE U1Mf 5-
E O ~ _ 100
III. BUILDING USE: (If building type is public, check all that apply) 7v k-ki
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ 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. K New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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)
NoniSeepageTrench e surized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 11 Specify Type 41 ❑ Holding Tank
12 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
~ - -7 3 I55Feet 6, Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
-0 F1 I Li F
Septic Tank or Holding Tank 000
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans,
Plumber's Namerint): Plumber's Si rra re: (No Stamps) /MPRSW No.: Business Phone Number:
I is -:5r
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY EP RTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
_19551A
Adverse Determin tion
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A 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.
1 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:
I. Property o%4ner's narr* 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 81/2 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)
• APPLICATION FOR SANITARY PERMIT
STC - 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 permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property 01411_0 C. SHVun
Location of Property tAw k Section , T ?70 N-R IS W
Township E" A401.10 .
Mailing Address -1 Z 5 HC20 6
t~~w ~.~-t+wtoN~ V41 Soo 1 •1
Address of Site Vo-4 e
mE w -RA (&j M 5+011
-
Subdi~iiiop llaiaa
~ 1 T=WO SM"C V 05 2(0 -151 7
poG 42(0 o-i 4
b r.
.Lot Number
Previous Amer of Property U60 DO 6A ;5:
Total Size of Parcel 3, l S A.C,vt,ES
Data Parcel was Created 4- $'1
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume bc and Page Number U1010 as recorded with the Register of Deeds,
INCLUDE WITH THIS APPLICATION THE FOLLOWINC:
"A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
i Iwe i coit_ti.6y that a.te statemeltu on this oh.m cute .thue to tthe but o6 my (owt)
hncutUdge; that I (wet am (ahe) the OW It (J 06 the pnopeAty dUcAi.bed in t1t a
.iPlWma ion 6oAm, by vi tu¢ o6 a wa~anty deed'
eed AecoAded in the 06 -ice 06 the
Cerint Re-giAteA o6 Deeda ah Document No. 4ZI 0v o ; and that I fwe I PAUentty
oun We ¢ pftopoa ¢d d i t¢ 60~ the s eluage d i~5 poa d ya em (oA I (we) have obtained an
raAC tent, to hun with the above dUcAtbed pnopeA.tr/, bon, the eonatAuctjon o6 eaid
e ya•tvn, and the dame had been duty Aecohded to the O66.lce o6 the County Reg.i,ateA o6
Vetch, ae Poement mo.
,t,j 000
SIGNATURE OL► OWNER SICNATURE OF CO-OWNER (IF APPLICABLE)
3-Zb• -q0
DATE SIGNED DATE SIGNED
w ►.S. COMPANY
M<MOMONKS PALLS. WISCONSIN
422000 poor 765-POE'
STATE OF WISCONSIN ST. CROIX_ COUNTY, CIRCUIT COURT PROBATE BRANCH
SALE OF REAL ESTATE OF PERSONS UNDER
LEGAL DISABILITY-DEED BY GUARDIAN
WHEREAS, On application to the Circuit Court of qt-- ~'rni X County, Wisconsin,
to sell all right, title and interest of Leo T. Domke, also known as Leo Domke
Spendthrift , in and to the real estate hereinafter described, such proceedings were
~ipcast= AAiAer='=er- k+eols~peEe~►t✓-1-
had that the undersigned was duly authorized asgenera 1 guardian to proceed in said matter;
+Irrtert y'9peeia+'ierj 6enerei~'}
and whereas, the undersigned, as such guardian, has done or caused to be done all things necessary and required to be done by law
in such cases made and provided, before conveyance of such real estate may be made; and whereas, the undersigned,
Lois Hanrlrahan, formPrl y Lois Aspl Lnd , as such guardian, was
duly authorized by order of Court herein dated on the 16th day of December ,
19-$6, to execute, acknowledge and deliver to Derrick Construction, Inc.
a deed of conveyance of all the right, title and interest of said Spendthrift in and
0.
tsertr'}olh~or=~'rn-"hrct7rtrp nt=~')
to said real estate:
NOW, THEREFORE, I, the said T.ni S Hanclrahan , fnrmarI V T.ni G Asp 1 unri , by authority of the
Court above named and in my capacity as such guardian, in consideration of the premises and of
S iXt[rThLZUS and ($60., 000 On) Dollars to me in hand paid by the said
Derrick Construction, Inc. do hereby grant and
convey unto the said Derrick Construction, Inc.
all the right, title and interest of the said Leo T. Domke, also known as Leo Domke
Spendthrift , in and to the following described real estate in St- Croix
County, Wisconsin, to-wit:
The Northwest Quarter of the Southwest Quarter (NW4 of SW4) of
Section One (1), Township Thirty (30) North, of Range Eighteen
(18) West.
I ~ :~oiEi1~I5`
I !AEGIS S OF,I'-t Z
ST. CROIX CO., WIS,
`or Reemd 96 2nd
Jan.
J ; o
A. D. 197
:~>1 IL
File No.
No. 75P-SALE OF REAL ESTATE OF PERSONS UNDER LEGAL DISABILITY. DEED BY GUARDIAN. Chapter 296.
i
600K 765na'~~6 fn
• m
WITNESS the hand and seal of said Lois Handrahan, formerly .oi ; fAspluncLardian aforesaid, this
22nd day of December 19 _$6
In Presence of
k (SEAU
Lois Handrahan, formerly Lois Asplu d
General Guardian of
Insert ~aeeie~ =o.~enere a-
Leo T. Domke, also known as Leo
Domke, Spendthrift
i
i I+nserr'#A;ner-_- br +neow~peeen~ '=F
STATE OF WISCONSIN,
ss.
St. Croix County.
Personally came before me this 22nd any of December , A. D. 19 86 ,
the above named Lois Handrahan, formerl W Asplund Ppardian,
s iiiebY
to me known-to be the person who executed the foregoing instrument and a nowledged tha s he e...
xactj t Q00
virtue of the authority aforesaid. { :'••.•o'
Tanya,,/4f. Glaser
_ Notary Public, St. Croix
~ ~ C~ti~r3uY'
My Commission Expires
N
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• STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
0
"~tttztcu., CoN~ZsVK~-1oM~O~L >
OWNER/BUYER RPt~O L•s►~TS
ROUTE/BOX NUMBER ~?7L ~.1• ~71.1Op£ "~~VE Fire Number
CITY/STATE ~1Cw P-1c44Mo"O-, W1 _ZIP 54-017
PROPERTY LOCATION: W\Al k, '5\1V }L, Section I T Jo N, R W,
Town of 7- 14+1kPAv►.10 St. Croix County,
Subdivision -J'tiR^/e Lot number +
~o o s -Zto - ~-t Tito C_ 4Z~ 0`14
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
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. ao
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
r,
the standards set forth, herein, as set by the Wisconsin Depart- •+o
went of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Offkge within 30 days
of the three year expiration date. ~J
SIGNED
?Z%~ Cam'
DATE "A10
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.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
P.O. BOX 76
`I'A90R AWD PERCOLATION TESTS (115) MADIS
ON WI 53707
HUMAN RELATIONS
. (H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP36LRX=ALITY: LOT NO.: BILK. No.: SUBDIVISION NAME:
NW I/cW1/4 1 /T30 N/Pd8 k(or)W Richmond 4 n/a Derrick Consst. Inc.
COUNTY: OWNER'S B1XIAME: MAILING ADDRESS:
St. Croix Derrick Const. Inc. IR.R.#!, New Richmon ,Wi. 54017
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROMLE DES RIPT NS: AT ON TESTS:
®Residence 3 n/a QNew DReplace ( 4-29-87 4-29-87
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENT ONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~x S U ®S ❑ U F] S ❑ U E:] S ®U E] S Q U conventional
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS Page 28 SHA
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTFM. ELEVATION OBSERVED EST. HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 7.16 96.15 none >7.16 .83bl.1. 1.50bn.sil. .58bn.l.s. 4.25bn.c.s.
B. 2 7.00 96.33 none *less thanl.0
2.00 4 n s
B_ 3 7.00 96.05 none >7.00 .75bl.1. 1.83bn.sil. .50bn.c.s.&gr. 3.92bn.c.s.
95.58 2.42 less .75bl.1. 1.67bn.sil. .67bn. mot. sil.
B. 4 7.42 none o
B- 5 6.92 95.72 none *2.25 less .00bl.l. 1.25bn.sil. .67bn. mot. sil.
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D P R PER INCH
P-1 3.60 none 3 6 6 6 <3
p-2 3.7 none 3 6 6 <3
P_ 3.50 none 3 6 6 <
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 92.55
{ ~ v.
. TN
I
17 i ~ ~k 1~f+'
D
i;
f
41
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): TESTS WERE COMPLETED ON:
Gary Steel 4-29-87
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIG U E /
UTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
-
-)-6395 (R. 02/82) --OVER
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G.~ . PAGE OF
3 .s S~rE1~1, o~ A 3r1~ Sys~eesr
Fraeh Air Inlal► And Opeervollon Pipe
Approriad Veal Cop
1.IM4num 12' Adore
Flnol Grade
20- 42' Above Plpp _ 4' Coal lion
To Final Geode Ven$ Pipe
--Nan hot or Srn1M1k Covering
man 2' Aggregole -
Orer Pipo
016UIDullon - Tae a
pipe 0 0 o
d' A"Iolale a Peelwoled Pipe below
beneula Pipe
o -Compling Termineling Al
8ollom 01 STalem
A
i
1
'J
o) l ft e. 1 5 rH Cl<
P~u~eD ~ ~ i
~.IcJ•.~' Ion ~
SOIL FILL
DISTRIBUTIOM PIPE
APPROVED s411tPETIC COVER
r MATfRj&t- OR 4" OF STRAW
2" OF hGGRE4AlE OR t'1ARSN HAy
' (e0 Pl2-212 AGGREGATE eP
ELEV. OF NEST-
60
DIS•T 11151JT10A1 PIPE TO BE A7 LEAST 20 IUCHES BELOW ORIGIIJAL GRADE
AWU AT LEASTLO IIJCHES BUT 1.10 MORE THAI.I 42 INCHES DELOW FINAL GRADC
i
MAXMM DEPTH OF F-)(CAVATIOP FYOM OKI&WAL 69AoF- WILL BE IIJCHES
nNIMVM ®rrr1t OF EXCAVATION FFlOM CR,IGINAL- (jRADV- WILL. 6E 3, INCHES
5161JE0: I
LICEUSC DUMBER:
DATE: °2 / /