HomeMy WebLinkAbout020-1116-40-000
ry o (D CD
o ~ ~ I
N a o I
e ~ I
o '3 w
N N C
N a~ I
c
ro
0
~ o I
CO
a
a
m I
o -0
N I
C
U
Ol f6
N
E
w X ,i
N
-0
CD O
°
Z c c
c E m I
LL CO O m
U y
a 0
3 3E
Q a a3
I
3 v
z y
Z (D 4)
w
Z
a m
to o
C
c
o
2 c
N H CD ZO
N O
C a
• N d L
0 z m z
a ~ N I
>
~~t a o
v 3 ca N m
O p G o a -
3 3 z I
S: X000
o 'caaIL
N
CL o
N ~ rn rn
'1 N J U S rn rn Z
a~ 2 rn rn
~1 U v r~ ° E
3 0 0
N m a
a y T
in m I
C O O Q N C
0 ~ O E N LO
N C C U d p~j 0
rO W
cc)
` l m N On N f0 y N
v C 1 N O 0 0) 0)
W O N Z Z 'O n
E E s
7 G) O
• ~I w~ S S O Z N Fes- H (n I
V
• cC fl-
`IV E c c
t a O vii v
A V
`on
V ' .
Parcel 020-1116-40-000 02/21/2006 12:04 PM
PAGE 1 OF 1
Alt. Parcel 19.29.19.482 020 - TOWN OF HUDSON
Current X! ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MARES, JESSE & VICKI M
JESSE & VICKI M MARES
887 ASPEN VIEW CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
,
Type Dist # Description * 887 ASPEN VIEW CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.200 Plat: 2626-WILLOW RIDGE ADDITION
SEC 19 T29N R19W WILLOW RIDGE ADDITION Block/Condo Bldg: LOT 7
LOT 7
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 985/328 WD
07/23/1997 833/189
07/23/1997 763/444
07/23/1997 729/311
2005 SUMMARY Bill M Fair Market Value: Assessed with:
92352 266,900
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.200 38,700 233,500 272,200 NO 05
Totals for 2005:
General Property 1.200 38,700 233,500 272,200
Woodland 0.000 0 0
Totals for 2004:
General Property 1.200 19,800 205,200 225,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 112
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
,COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
i
ST. CROIX ZONING REPORT NO.: 30572/01 PAGE 1
o-' ST. CRMIX C"TY REPORT DATEI 10/12/92
C"TH0i1SE DATE RECEIVED- 10/08/92
HUDSON, WI 54016 l
ATTN: THOMAS C. NELSON
f
Otr1NER2 (fWIliam ;He lwig
LOCATION: 897 Aspen View Circle, Hudson
i
COLLECTOR*# M. Jenkins
P DATE COLLECTED: 10-06-92
TIME COLLECTED: 10:45am
j SOURCE OF SAWLE Outside faucet
DATE ANALYZMUO-05-92
TIME ANALYZE13S2400Pm
COLIFORM++ 0 /100 m i
INTERPRETATIONt Bacteriologically SAFE
NITRATE=N2 3 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Conform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
N
(
tD COG
N: '
JF'
0Z C
•
LAB TECHNICIAN! Pam Gaw
WI Approved Lab No. 19 ...,r..~-~`~;..
Means "LESS THAN" Detectable Level Approved byi
s
,Y ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
I\D 911 4th Street
`ten Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at , time of
inspection) J////~ i~~G✓~~~~
PROPERTY OWNERS NAME:
PROP. ADDRESS: CITY
Legal Descr pti n /Y l f4 of the A 1/4 of Section T N-R1jf
Town of Lt6~! Lot Number Subdivision: /
FIRE NUMBER C SOX NUMBER ~~S//! 7 ~Frm~: Color of house / -Realty sign by house?_ -If so, list PLEA
SE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PL&T BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:eg~-
Telephone Number
RE ORTT TO ENT O: Ll~ / z° /'~GL -
ZV 0 - O /
CLOSING DATE:
Signature
~ c%r~~~~ay
o° rre~ ~o~~ ~o ~~~`s
3~
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
` - 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
October 6, 1992
Lucy Gearhart
Century 21 Premier Group
706 - 19th St. S
Hudson, WI 54016
Dear Ms. Gearhart:
An inspection of the septic system on the property of William
Helwig located at 887 Aspen View Circle, Hudson, WI was conducted
on Oct. 6, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Sincerely,
Mary Jenkins
Assistant Zoning Administrator
cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & & DING
VABOR WHUMAN RELATIONS DIVISION
.0. BOX 7961 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON. WI 53707 State Plan I.D. Number:
NE 4wE 4j S19 `29N-F1914 ~ CONVENTIONAL El ALTERATIVE (ifassigned)
T,8F7q-Yyds ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
J_ OR
OF PERMIT
NAME
1
HelwigER. A1401 Laurel,LDHudson, Wa 54016 IN r~Q - 9 QJ.3®
Bill
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
David B. Fogerty 3289 St. Croix. 119442
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. FEET FROM LINE: AIR INLET:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST 111,
DOSING CHAMBER:
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 El YES ED NO NAREST -11110-
I
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 SYSTEM:
BEDITRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER PIT INSIDE DIA.: # PITS: LIQUID
TRENCHES: MATERIAL:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to 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:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: R MATERIAL: VERTICAL LIFT CORRESPONDS TO
APPROVED PLANS
INFORMATION ❑ YES E] NO COVE ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side. sIGNAruRE: TITLE:
Zoning Administrator
SBD-6710 (R. 06/88)
DILH> SANITARY PERMIT APPLICATION
7.a..,~.~a...~HL In accord with ILHR 83.05, Wis. Adm. Code couNY
STATE SANITARY PERMIT #
-Atta-:h complete plans (to the county copy only) for the system, on paper not less than jg r,~S/a
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
Z-a t/a - %4,S / TZ,N,R E(o
PROPERTY OWNER'S MAILI ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR eft"!:IVIOM
0 6 Z w 7
11. TYPE OF BUILDIN~G:: (Check one) ❑ State Owned 0 C LLWE NEAREST ROAD
❑ Public LJ1 or 2 Fam. Dwelling-# of bedrooms . P EL TAX NUMBER(
111. BUILDING USE: (If building type is public, check all that apply) Z152 oaa - 6 qU - cr6
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
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. ❑ 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/day/sq. ft.) (Min./inch) rt. / /,V& S- ELEVATION_
y3 0 9S St90 D . L lvq. W/ Feet o Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New Existing Gallons Tanks Concrete structed glass App.
Tanks Tanks
Se tic Tank or Holdin Tank B d
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 Signature: (No S mps) -MP/MPRSW No.: Business Phone Number:
A. t2gf e.114 3; 2-p
lum er's Add (Street, City, Stat , Zip Code):
-.1 zz_ AZ 41101 ?A r O.Z
775"u /DEPARTMENT U 8E ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I suing Agent Signature (No mps)
Approved ❑ Owner Given Initial --`\surcharge Fee)
Adv a et rmin lion 6//S• QU 14-fi-P
U
l~~hh
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6396 (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.
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 property 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 on8ite 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. - -
SBD4M8 (R.11/88)
i ,
t
t `
^ I
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 A, c, /,n ~ An q e 4-1c f l e / w, j
Location of property lU 1/4 A) 1/4, Section T'Z~j N-R_1_~ W
Township -rd c,J N d4 4 L-A- 15 c) n
Mailing address L 6- V,0- Y7 JV i ew ,n i Uc i-1son w
5 6
Address of site / cdf4ri UiP(J Gi('C oaf 7 No'A~ e,ssf laf in ct, ~f
Subdivision name )44 de" I' di-A
Lot number '7
Previous owner of property /V IJ {~q e-A, d1s C h u V, C/\ 64 /7 vt ds d
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? ---X_Yes No
Is this property being developed for resale (spec house)? Yes _ X_No
Volume 2)~and Page Number M as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
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 references to a Certified Survey Map, the Certified Survey
Map shall also be required.
--------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed reco ded in the Office of
the County Register of Deeds as Document No.+ 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 said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.*
ignature of Owner Signature of Co- wner (If App cable)
y - / 9Y iv-- _ / 98~
"Date of Signature Date of Signature
r r,
Y
.4
.~E~ r y ~ ~ err c
L
4AW OR,
n y " _
" ...............t..........
:
«
•
464#0
AP -01
H
z
H
a
ST C- 105 r
r
9
• H
SEPTIC TANK MAINTENANCE AGREEMENT ri
0
St. Croix County z
d
9
OWNER/BUYER Ct/ 9,;/ 1)e 1 7~P /7E q
ROUTE/BOX NUMBER 0 -3 6- Fire Number
/ C
CITY /STATE 0- ~l S' r~ y1 Ltil Z I P 1/0
PROPERTY LOCATION: JE k, U !4, Section , T N, R/_W,
Town of 14 K 15 uK\ , St. Croix County,
Subdivision 6J,'//,)W Lot' number
adiIiU-k
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.
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
r-i
the standards set forth, herein, as set by the Wisconsin Depart- ►u
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.
SIGNEJ.~~ - l ,
ow
~DATE ~
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.
r
• ~ n
d-= l6f
t `may
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY DIVISION
HUMAN R
LABOR S PERCOLATION TESTS (115
EATIONS ) P.O. BOX 7969
MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: ESECTION: OWNSHIP/}p,~{I:y: LOT NO.: BLK. NO.: SUBDI VISION NAME:
~ ~/a #7 COUNTTV: /BUYER'S NAME: MAILING ADDRESS:
Ale /
Zz-,e_t461 M
USE ewe 3~ g4 X t / DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER O AT ON TESTS:
[ErResidence ETNew El Replace
2 0 8 o
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: Mom 1: IN-GROUND-(P-REFS-SURE:S STEM-I(NN-FFIILLH(OIL'~D,IINGTANK:RECOMMENDEDSYSTEM:(optional)
CaS ❑ S ❑ S LJ Y L_J V lla S ❑ .2 0 ~r ► r S ~'q~
[under Percolation Tests are NOT required DESIGN RATE:
[Floodplain, f any portion of the tested area is in the
s.H63.09(5)(b), indicate: N indicate Floodplain elevation:
y
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 o
/ I 6if 7 8 , to l 8
B- 2- >Es 'az~sl
niS
B- 7 l pf, r 78 7 tf/ S, 8 •rrr w
s /Z s
B- > 55- 51
B- S- Gg . > ~S
B- 7 AKS -r, 2. n 1"S 7 '&d S . ~ % ~Bn • n5
7 ? ~6 PERCOLATIO TESTS
7 C/
z ` w d cob
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES mS
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODI PERI002 PERIOD RAPER INCHES
P- 2 t
P LL
rc~
P- 3 dW e
P i ,7 c
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. /bL. f
SYSTEM ELEVATION Z y' 3
E
t i
E
t
e a
t 3
t
i I
i
- . _ 3
N
l ,
33
f-
i I
L
11 l (
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my k-
ME (print):
DAVE FOGERT'Y PLUM" TESTS
Ljoensed Perk Test & Piumber
R Ess:
#3233 03 CERTIFIC:
Fog" Heights Road
. 2 022
Phone 749-3656 CST GNA
1
DfSTRIBdTIMU: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82)
- OVER - f
t
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 ~
To be cninplete and accurate soil test, your report must include:
1. Co- - logal description;
2. T9. :pion must clearly indicate whether this is a residence or commercial project;
3. M,. "1 number of bedrooms or commercial use planned;
4. Is 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 sl`,~ uvn here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram ~rtely locating your test locations. Drawing to scale is preferred. A
~a r jy be used if desi - d;
--chmark and v_.tical elevation reference point are clearly shown, and are permanent;
riate boxes as to slates, names, addresses, flood plain data, percolation test exemp-
te;
10, nation (such as fl( =ievation) does riot apply, place N.A. in the appropriate box;
91. <A form and place your Cl- :;,dress and your certification number;
12. copies and distrii required. ALL SOIL TESTS MUST BE FILED WITH THE
LOC.^ L AUTHORITY WITHIN GAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
and Te Other Symbols
(over 10") BR - Be('-ock
co- (3 - 10") SS - one
sl (under 3") LS - L" ,17e
g r
HGW - Hign urorm
Sand Perc Per I.-
.im Sand W We;'.'.
Sand Bldg Bu-
- ny Sand > - G lao
y Loam < 1
Bn E
oarn BI
Gv
Loam Y
y Clay Loatn R
Clay Loarn mot
ly Clay tNr
s;c - Silty Clay f f f - irt
a: - e
~r _ Clay
pl Peat Imn -
n - Nfh,ick d - di
p - pr i
H W L - I-
. >oil textures
waste disposa! Bit! - Br Icl-
VRP Vertic l"o Point
r securinq a coun`; *w rn.-, rent, q
rr rr~~rn,. A cn pti
h
> ~r o
t plJor t r_ f3R:
r
Y i
PAGE OF
PUMP CHAMBER CROSS SECTION AIJD SPECIFICATIONS~~
VENT CAP
s 4" C. I. VENT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MAWHOLE COVER
25- FROM DOOR,
WINDOW OR FRESH 12"MIIJ.
AIR INTAKE I
GRADE
4" MIN.
18" MIA1.
CONDUIT
PROVIDE I
I~I I E AIRTIGHT SEAL I III J/
I III
APPROVED JOINT/ A I III APPROVED JOINTS
( III W/C.I. PIPE
W/C.2. PIPE
EXTENDIAIC- 3' I II ALARM EXTEWDING 3'
ONTO SOLID SC':. I I e ONTO SOLID SOIL
I I
I ON
C
PUMP
~ OFF
0
CONCRETE BLOCK
RISER EXIT PERMIIfED ONLY IF TANK MANUFACTURCR HAS SUCH APPROVAL
SPECIFICATIOI~lS
SEPTIC AND
DOSE DA-4
DOSE TANKS MANUFACTURER: NUMBER OF DOSES: 2 -
TAWK SIZE: fezD GALLOKIS DOSE VOLUME
ALARM MANUFACTURER: 141-111 AM INCLUO!~!' Y..1.! FLOW: ~3~ GALLONS
MODEL NUMBER: ~dL CAPACITIES: A=YIMCHES OR SDy GALLONS
B z INCHES OR _31= GALLONS
SWITCH TYPE:
444
PUMP MANUFACTURER- C=-L _IAILHES OR GALLOWS
MODEL NUMBER: D--CINCHES OR .3- GALLONS
SWITCH TYPE: -"J MOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENC[ B?1 WCCA1 PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . FLET
♦ . FEET OF FORCE MAIN X F/IOO it FRICTION FACTOR..-as/ FEET
TOTAL DtJWAMIC HEAD = 1 L_ FEET
INTERNAL DIMENSIOLIS OF TANK: LENGTH ;WIDTH ~Z ;LIQUID DEPTH y~
51GQED: LICEMSE NUMBER: DATE:
-11~-
HEAD CAPACITY CURVE
` T D•H 4
N Pon
W
W ul
W
2 ta
10
TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
30 EFFLUENT AND DEWATERING
95' SERIES 53-55-57-59 97 137-139 163 165
77 77 M L LTRS G?'_ LTRS i^.AL LTRS '_'AL LTRS CAL LTRS
28 90 152 +3 163 n5 248 134 394 231 :1 231
EFFLUENT AND DEWATERING 3.05 1129_ 7 216 791 300 231 231
!5 4.57 '9- 72 41 163 64 242 F,0 227 'i0 227
SEWAGE AND DEWATERING 6.10 27 104 36 136 _5 223 227
\ 7.62 8 30 ~ 7 216 _ 223
26- % 5
sn 1 914 - 55 206 ? 220
24 V 1219 46 172 206
\ 50 15.24 33 125 191
f77 1829 15 57 43 161
~ 2 % 70 21.34 30 114
L \ 80: 24.38 - tq, 53
MODEL\` MODEL Lock Valve 19 245 26 66' 87
20 163 1__\4 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SElNAGE AND DEWATERING
i8 SERIES 267 268 282 284 - 293
% FT M GAL. LTRS GAL LTRS GAL LTRS GAL LTRS •:'..1L' LTRS
`
- _ - -
5. 152 'S8 408 102 386 130 492 16 681
55 \ ` 10 3.05 70 227 -72 273 95~. 360 15 598
J \ I j 4.57 76 t3 163 h 238 1 511
16- 50 \ 20 6.10 8 30 3 125 10 401
\ <5 7 62 7 288
30 9.14 4 163 , 7 292
14
45 "5 10.67 60 227
40 12.19 4ti 174
fy \ , 45 13.72 28 106 z4j . 12 +r V 15 24 1 45
1 MODEL Lock. Valve. 18 2 t 26 35' 53
10 35 1 293
30 MODELS 1
8 25 137 139
6 20 MODEL
~ 284
4 15 MODEL MODEL
10 268 282
- -7t
2 MODELS
C
53, 55, MODEL MODEL
57, 59 97 267
l.S.GALS. 10 20 30 40 50 60 TO 80 90 100 1Q 120 30 140 150 160 170 180 190
.
10i bedlAd"wig LITERS 80 160 240 320 400 480 560 640rf 650
FLOW PER MINUTE?
3280 Old Millers Lane Manufacturers of .
Z ZZ71-ZZ1,-f ZZ7. Louisville, Box 16347
~ Kentucky 40218
(502) 778-2731 Q711wrr PUMPS SNCE S M9
8
( -rl
w
n i
f'
1 ~
~~T I
r1 u ,l" T H ~ t.
T
' li I ~ ~ , z I
~I s
N !
u v T*1 ~n o. ,4 FT
1 l
~ i
1
f
t