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020-1153-10-000
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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: BED/TRENCH WIDTH: LENGTH: NO.OF TRENCHES: DISTR.PIPE SPACING: COVER ERIAL: INSIDEDIA.: #PITS: LIQUID PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLLEE T: NEAREST---'1111" 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 EYES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES [__1 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: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO I ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES [__1 NO ❑YES . 0 NEAREST---- � C, 3 0 I� Retain in county file for audit. Sketch System on TITLE: Reverse Side. SIGNATURE: SBD-6710(R.06/88) ILHR SANITARY PERMIT APPLICATION L2 mmoms In accord with ILHR 83.05,Wis.Adm.Code COUN STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ 8%x 11 inches in size. ch if ev application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY NER PROPERTY LOCATION /j ,e� %4Ci t/4,S..?.5 N, R l E(o 00 PROPERTY MAIYNG ADDFIESS LOT# BLOCK#V CI STATE d� , ZIP CODE7'e. PHONE NUMBER SUBDIVISEgN NAME OR CSM WJMBER A-OX IlAt-4 L512 11. PE OF BUILDING: (Check one) CITY NE REST ROAD ❑State Owned VILLAGE: Z40 ❑ Public 01 or 2 Fam. Dwelling—#of bedrooms AR EL TAX NU&--R( ) III. BUILDING USE: (If building type is public,check all that apply) 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 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. El 3. ❑Replacement of 4. El 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 07Seepage 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 RE/�/IR�EfD(sq.ft.) PRO OSED(sq.ft.) (Gals/day0/sq./ft.) (Min./inch) /,, EL€V�ION r -- Feet 7}e Feet VII. TANK CAPACITY in allons Total #of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 1203 6--16- Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. PI u er's N me(Print): Plumber's nature: o Stamp M61MPRSW No.: Business Phone Number: f .2lJ P um is Address(St t,Ci tate,Zip Code. 4S 72--S IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater a Is Issued 7�ng Agent Signature(No Stamps) D Q Surcharge Fee) VApproved ❑ Owner Given Initial /� �//�� Adverse Determination i n / / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(former) Plb-67)(R.11/88) DISTRIBUTION: Original to County,O n e Copy To:Safe ty&Buildings Division Owner,Plumber r INSTRUCTIONS J►' . 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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. CountyMepartment 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) L APPLICATION FOR SANITARY PERMIT S T C 100 This application form is to be completed in full and signed by the owners) 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 ro ert1 p P Y Location of property � = 1/4 _1/4, Section , ' , T G 9 N-R W Township Mailing address ' -' fr„ . Address of site r Subdivision name Lot number Previous owner of property Total size of parcel o Date parcel was created Are all corners and lot lines Identifiable? Yes No Is this property being developed for resale (spec house)? Yes x o Volume and Page Number 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. - 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 recorded 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. ) Signature t of/Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1912 IITHIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED I 43'723 ' This De9d The First National Bank of Hudso �CROIX ,made between � �. ��X 00.r VA A Wisconsin Banking Corporation__ _ Roe'd fW RllCord Grantor. DEC 4 987 11"o 14 and Ro�inev G. Burton Grantee. ,wwwr e�pw+ t Witnesseth,That the said Grantor,for a valuable consideration- — Eight thousand dollars and 00/100's-------------------- --- -._ RE TURN TO conveys to Grantee the following described real estate:in St. Croix The First National Bank County,State of Wisconsin: 307 Second Street Hudson, WI 54016 Lot 11, Plat of Fox Valley in the Town of Hudson. Tax Parcel No: 20-1153-10 kANSFEh SAG FEE This IS NOT homestead property. (is) Its not) Together with all arid singular the hereditaments and appurtenances thereunto belonging; And The First National Bank of Hudson, A Wisconsin Banking Corporation warrants that the title is good,indefeasible in fee simple and free and clear of encumbrances except easement, rights of way, and restrictions of record. 4 I and will warrant and defend the same. Dated this 3rd day of December e 1987 _. —(SEAL) 't 'LL�' c —(SEAL) i Kenn th A. Heiser_ pr sia rI i (SEAL) _ —(SEAL) Susan K. Gilbert Cashier AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN �unty. ss. authenticated this_ ._day of_ St. Croix Co_ 19 Personally came before me this 3rd day of December tg 87 the above named Kenneth A. Heiser. President and _ Susan K. Gilbert, Cashier TITLE:MEMBER STATE BAR OF WISCONSIN to me known to be the per on S --who excuted the authorized t,y§706 06 Wls Slats I for oing Instrument and a Howl THIS INSTRUMEN I :Ja',(,NG{T, ;,I1v edge the same The First National Bank of Hudso!� --- -- - - t--- .alai I Finn tur — ----- _ . ,-_. IYptaryPufNic- _ St. Croix -- — 1 Iqn riw�s may be authr•nhr atr 11 or acMnowled er1 Both M ! County WIS I, ./n not nry,ns;ary I � y ommisslon �5 permanent 111 not. state expiration dart - �iJ�.. ._.._-- _ 19 i 'fl.,r ..ti rl I r„) ...1'� .,! I'iiy•.I r r..i iii •rrrr.rl ,r Iirrrliril trr•i H r,.r.il Sii�r.,Iir r. _ WARRAKi:4EED SfA1{f 4If All Of WISONSIN I I l . i.. i • 1,''AM N. ru.•n11q d.11 11 "N I L ' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYERr ROUTE/BOX NUMBER r / FIRE NO. CITY/STATE�L e�)11J ,!/(1r`; ,`/ _`_. ZIP "�✓ .9 �� �. PROPERTY LOCATION: , 1/4 a,:' 1/4, Section , T�N, R W, Town of !?` C./z:>.S c:2A,1 , St. Croix County, Subdivision 1'. , Lot No. �. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department 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. SIGNED DATEr1� 7 � St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address 7-1e) 14 OC p-3 EPAI.TMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INWSTRY, DIVISION TABOR AND PERCOLATION TESTS (115) MADISON WI 7969 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: Q TOWNSHIP/AAWQ6FPAt4-T�Y: [OT NO.:BLK .: S IVISION �VA1�AE: S G'/SE '/ pZ3/Tog?N/R 1q E (or 1 UNTY: MAILING ADDRESS. e USE DATES OBSERVATIONS MADE �- NO.BEDRMS.: A EST UK. idence 'New ❑Replace � �C/ ' (% e RATING:S=Site suitable for system U=Site unsuitable'for system d o CONVE�T'IOaNAL: M ❑� IN-GROUND-PRESSU1iE: SSTEM-IN-FILL O�LDING TANK: REC�OM�ND�T • optional) ���Lj�JJ�'��J`` UU �LJy�(7` S L�J1rY( S L��J}�J� S If Percolation Tests are NOT required DES ATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: 1 Floodplain, indicate Floodplain elevation: fy A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HIGHEST TO BEDROCK IF OBSERVED SEE ABBRV.ON BA W.) B- l �(p . a� ? � n sit� 5 �� s � Ian� s OX nsi J, V 15 n I On rn ea s pK 6 rt sll, a6 n s- l'7 1'C me s 171 Q'lo.I7 j� 7 OK ski, 3 5'�n rt �e s IN.1fa F Y3 131Z nst , ns / Berne s nt`14311 > Wa PERCOLATION TEST TEST DEPTH . WATER IN HOLE TEST TIME DROP I W TER L VEL-IN HES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 22- PERIOD PER INCH P 0 / Y' 1 10 P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate s or distances ribe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevati at a rings and the lion and percent of land slope. - � Ol Q SYSTEM ELEVATION piI t in � I a . I � . - ( [ S C t � : z � Ff1�1 1 , 'L�1) G i j N mm f I I Q 1 - a a ._. _ ----- --4--- + s� _ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with t Le procedures and ethods 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 WE COM LETED ON: r C c�t J e e- /� 8f?, ADDRESS: 14 , CERTIF CATION NUMBER: PFiO�I,E UMB�R(pg_tion 11: CS DIATU E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•SBD-6395(R. 10/83) -OVER - t � r INSTRUCTIONS FOR COMPLETING FORM 115- SBD -6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; -,��,_� 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations.Drawing scale is prefered.A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all apropriate boxes as to dates,names,addresses,flood plain data,percolation test exemption,if appropriate; 10. If the information (such as flood plain,elevation)does not apply,place N.A.in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3 - 10") SS — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl -- Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance.A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit.The sanitary permit must be obtained and posted prior to the start of any construction. 4 L DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, LABOR AND PERCOLATION TESTS (115) MADISON,W 53707 HUMAN RELATIONS (ILHR 83.09(1)& Chapter 1451 O ATION: SECTION: P/ U#f TY: OT NO. .: SN M N/R/qE to )W UNT MAI�NC�ADORESS: 11 44�� v USE, DATES OBSERVATIONS MADE NO.B JMS.: "MM I TION: � Residence �dNew ❑Replace RATING:S-Site suitable for system U-Site unsuitable for system ONVJ-iNTIO�NAL: M ❑� IN-G�ND•PRE: SY�TEM-IN-F11,L OL�DING TAN .RECOMMENDED SYST M;joptional) If Percolation Tests are NOT required DESIGN R T If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: 1 1 Floodplain,indicate Floodplain elevation: A14- PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED TO BEDROCK IF OBSERVED( E A BRV.ON BA K.) B- d70 A�3 s I, ? 6n 1 s �i a in e c s B-a 7(� 9 � > ��O /d 17 s, /o n me s Is B-3 . 3 3 ? �� 7 oa s', t 36 V� n 5/1 y/ n In e S _a B- 6 176 6 nffyu 7 0?�/1�s 5 PERCOLATION TESTS �} TEST DEPTH , WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES + NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PEPAOD 1 P RI P PER INCH P cg /6 Y/<v P- j P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describ at are the hori- zontal and vertical elevation reference points and show their location on the plot plan. elevation tngs an t e direction and percent of land slope. Q- SYSTEM ELEVATION ��O . 7 `��r r a , rE ____ . . _ _ �_. 10 \ ' I 4 i ti ♦ '.._ - i I i � 111 l- ii ` - _ /specified_. L13I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and�etpo the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best�I myQknoowledge and belief..30 O NAME print : d TESTS WERE MPLET N: ol ADDR � CERTIFICATION NUMBFy PHONE NUMBERIoptionall: CST SI TURE: b i DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. Jr11sNR�R���Q�(R 1f11AV -n\/PR - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADI P.O. BOX SON,WI 533707 707 HUMAN RELATIONS 0LHR 83.09(1)& Chapter 145) FFATION: I OT N0. BL N mALN' % N/R/ E tW d M '5410p, U E I DATES OBSERVATIONS MADE �,� • Residence 6d'IVew ❑Replace ^1 (�..,..] I27 RATING:S-Site suitable for system U-Site unsuitable for system C�TU&IS OaNAL:JMOUN&� ❑� IN-GROUND S [:]S E -IML OQLDING TAN�fr R OMMENDEO SYST M;Joptional)Eeo If Percolation Tests are NOT required DESIGN R If any portion of the tested area is in the under s.ILHR 83.09115)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEP R WATER-INCH CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN ELEVATION OBSERVED GHEST TO BEDROCK IF OBSERVED (SEE A BRV.ON BA K.1 B- �, 33 � `�� to O, f'.s l r� 3 n 5 / /i G' '6 817 7 I 16 s t� i n d»e ( s B-a 9 d � s a�Q e B-3 . 33 > `1CP 7 oians/ r , 38n Io nee s r7 ru o l'r7 's 7 s, :s5 .� .�e s PERCOLATION TESTS DEPTH . WATER IN HOLE TEST TIME WATER LEVEL-INCHES RATE MINUTES ii NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER40D/ t _p I PERINCH P- Igo l p. 7141 lto /CO P_ P_ P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descri at are the hori- zontal and vertical elevation reference points and show their location on the plot plan. elevation rags an t e direction and percent of land slope. . Q. SYSTEM ELEVATION % . I7 q 0 Q !� r j - - © o � 13. 1� b Pr qi e Ii I I I r 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures andlivlethod specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the bestf my knowledge and belief.30 0 0 NAME Iprint): ITESTS WERE 9OMPLET N: AODR CERTIFICATION NUMBED PHONE NUMBERloptional): f ('0 3 t 2:sa aC CST SI TURE: b DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. � i LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020-1153-10-000 Parcel Number 23.29.19.839 OWNER NAME: First RODNEY G Last BURTON PROPERTY ADDRESS: Hse# 1/2 PD--Street Name-- Type SD Apartment 850 BRADLEY DR SECTION 23 TOWN 29N RANGE 19W %160 1/440 Line Description Line Description TOTAL ACREAGE 3.140 PLAT LOT BLK 01 SEC 23 T29N R19W 15 02 PLAT OF FOX VALLEY 16 03 LOT 11 17 04 18 05 19 06 20 64— 7/ 07 21 08 22 09 23 J77�X�Cl 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit x ^ ST. CROIX COUNTY i WISCONSIN ZONING OFFICE 796-2239(HAMMOND) 425-8363(RIVER FALLS) HAMMOND, WI 54015 May 6, 1988 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Rodney Burton property, located at the SE 1/4 of the SE 1/4 of Section 23, T29N-R19W9 Town of Hudson, Lot 11 Fox Valley Addition, St. Croix County, revealed suitable soils at a depth of 25 inches, below which bedrock was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN/rc Y t DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING Jl6o;sODI,WJ,53A0f29N-R19(U CONVENTIONAL El ALTERNATIVE IS1,11P11"LD,Number: Town o� Hudson ❑Holding ank ❑In-Ground Pressure (lf aasl neo) Lot 11 Fox VaUey Addition 9 MOUnd 5 8-01427 NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Rodney Button 314 Pte"ant StAeet, Robe, wI 54023 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber-. jMP/MPRSW No.: County: Sanitary Permit Number: Henbe/ct Petke 6327 St. Ct oix 112699 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED. DYES ONO OYES ONO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING. VENT TO FRESH ALARM FEET FROM LINE AIR INLET EYES ❑NO EYE S — NO NEAREST DOSING CHAMBER: MANUFACTURER 7ING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED. ES ONO ❑YES ONO ❑YES ONO 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) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING, Or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER I DIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTFI DIMENSIONS GRAVEL DEPTH FILL DEPTH JUISTII,P IPF DISTR PIPE DISTR PIPE MATERIAL. NO.DISTR. NUMBER OF PR OPERTV WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER ELEV. NLET ELEV.END'. PIPES FEET FROM LINE AIR INLET NEAREST--► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS 10111111VATION WE LIS 1:1 YES NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ❑NO ❑YES 11 NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE JMANIIOILDMATIRIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MARKING ELEVATION AND ELEV.'. ELEV.. CIA. ELEV. PIPES OIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO F-1 YES El NO COMMENTS: PERMANENT MARKERS: JOBSERVATIO WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE 1:1 YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. Zoning Adrninis�trato& � DILHR SBD 6710(R.01/821 f , DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm. Code , ckQ STATE SANITARY PERMIT# /i a Ir 9 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. S 88-- a/ r� wee reverse side for instructions for completing this application. O oc PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES N NO PROPERTY OW ER PROPERTY LOCATION 0D,✓ r /J IA s-ow ,SE '/4 SF %, S X23 ToT F , N, R /j X(ora PROPERTY OWNER'S MAILING ADDRESS / LOT NUMBER BLOCK NUMBER SUBDIVISION NAME •✓T J O G L/7' .O/T/o.✓ CITY,ST TE ZIP CODE PHONE NUMBER NEAREST ROAD,t*KE OR LANDMAR 0 LJ S't�0e7 /S f f- -amt' �: D_s .J II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. Z New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. gConventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.X Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. C<See a e Bed b. ❑See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): .375 37` ,/7 Feet 0 Private El Joint El Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New rxisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Sept ic Tank or Hekhm Tirrk 000 Z000 l p f Lift Pump Tank/ n Chember 7_570 — K �i Q ❑ ❑ ❑ El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Sign ture: No Stamps) MP/IdE9t3W No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Desi ner: 0 0 T VIII. SOIL TEST1NFORMATION Certified Soil Tester(CS?T Name / CST# f L/' L AiID L� SSG CST's ADDRESS(Street,City,State,Zip Code) Phone Number: mss. Y- IX. COUNTY/DEPARTMENT USE ONL �yy ❑ Disapproved Sanitar Permit Fee Groundwater L;ate Issuing Agent Signature(No Stamps)/"I LgApproved ❑ Owner Given Initial Surcharge Fee /�/Adverse Determination 22�"� �KJ��r fSd f Y, Q!�/wJ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION ` TO THE APPLICANT: 1. This 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 perm.it.must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be'properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in #1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacUlrer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result--of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ste[ -�- included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur.6 is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. .Q The monies collected through these surcharges are cred ted to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 1 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 —2 Al-,64N, Location of Property .�. ,' , Section , T N-R_ W Township U Mailing Address Address of Site D CG' Subdivision Name (�k Lot Number Previous Owner of Property L Cti G �Z Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _ and Page Number,d S 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ee a6y that aP.2 .statements on this 404m ake tAue to the but o6 my (oun) knowledge; that I (we) am (cute) the ownea(d) 04 the pnopeAty des n bed in this s .injonmation 6onm, by viAtue 06 a wa4tanty.deed %eco&ded in the 066.iee o6 the County Regis.ten 06 Deeds as Document No. 14V 7� and that I (we) pees enemy own the proposed site bon the .sewage dispod .byes em (on I (we) have obtained an easement, to nun with the above descAibed pnop¢Aty, bon the constcucti,on o6 said bye#em, and .the .name has been duty neeonded in the 046ice o6 the County Register o6 Deeds, as Document No. ) , SIGNAT OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) tcv v� DAT SIGNED DATE SIGNED FV z W 4z g C s. IQS = �¢' Gt° „yMZy 4 i,te tr.. r��-'. PT C AN ��MAINTENANCE AGREEMENT 4 �� St. Croix CauntYt z V a r NER/BUY'8R „ k �� k M ROUTE BOX' DUMBER J r 4 � � Fire Numb y, .. er , CITY/STATE 1 r ZIP PROPERTY LOCATION: s Section T M� !, RW, 'Mcd(Town of ©/t/ St . , Croix County, Subdivision Vdl6tl Lot number_. ft Improper .use and maintenance`of your septicsystsm could resVult in its premature failure to handle wastes, Proper maintenomce .con sists' of pumping out the septic tank every three years or sooner , . ,if needed, by ,a licensed septic tank pumper. What you ' ptit into f the system can affect the function of the, septic` tank as` a treat- ment stage in the waste disposal system. Sf.. Croix. County residents may be eligible to receive a grant for a maximum of 60% of the coat 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 ` agreas to submit to St Croix` Gountt oning a certification form si ned b the owner and be as"teu�mt�er, :gyp r , ce, s h.. Y ,fy n�trnaytnan plumber, k estricted plumber . oi� a ;'licensecuise iii Eying that (1); the ` on=site''wastewater disposal �s�ystem ,i`s trr proper operating wcand tion and (2) after inspection and pumping (if nec- essary) , tfie septic tank is less than 1/3 full a£ sludge and 'scum. Certification form will be sent approximately 30' days' prior to three year expiration. o 0 the ,undersigned have read the above requirements and,,agree z to maintain th private sewage disposal system in arcard'ance `w th the standards set :-forth, herein, as set by the Wisconsin'` Depart- mant of,, Natural Resources. Certification form must be .eompl.eted and returned to the St . Croix County Zoning Off:ce within 30 '`days of the three }dear,-.expira,tion,,data , k SIGNED DATE R '� � 9�t. GrctiX county Zoning Office .: Q �M � r Rammond, 411 S4 tti e1' ^ `a i or"715442$-836 9'� � '`fie , and`,retUtni. to above address., ° °` , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, PERCOLATION TESTS (115) DIVISION LABOR AND P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION:-] / TOWNSHIP/ LOT NO.:BLK.NO.: SUBDIVISION NAME: UNfTy: 1 OW_N�R'S B MAILING ADDRESS: USE DATES OBSERVATIONS M DE [VResidence NO.BEDRMS.: OMMERCIAL DES RIPTION: ��__,�—" DATES ES Rj'PTIONS: PER OL ION T STS: 3 r2 New ❑Replace I RATING:S=Site suitable for system U=Site unsuitable for system D O 7 Q lJ ONaVENTIONF�.' MO�❑� IN-GRaOUNO�PRESSyRE: SYSTEM-IN-FILL HOLDING TA : RECOMMENDED SYS EM:(optional) If Percolation Tests are NOT required DESIGN RATE: I If an p...y portion of the tested area is in the //'�, under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OB ERVED (SEE ABBRV.ON BACK.) "7'531 r hS --7 r m C S B- Om 3 oG B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN, PERT D 1 PERIOD IOD 2 r1=H1L)Uj PER INCH P- izle /O P-a P- /LD 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 direction and percent of land slope. SYSTEM ELEVATION ' i E • - 3 E 03 9 _0 _ F ©' N 7 - _ I Y E t E e _ 3 C1 6 3 E t 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 l: TESTS WERE COM ETED . /� ADDRE a 7 7 CERTIFICATI N UMBER: PHONE NUMBER(optional): CST S TUBE: � cs DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 1 - SIT - 6595 soar! 'Pleb'WIG acCui'ate soil esl.,adf3ul repot" n"lust i chid 1_ Complete iegal desc:-iptiori; 2, The use section must clearly indicate whether this is a reNsielence of commercial project; 3. MAX IMUMI number of tiecirooms or commercial use planned; 4, Is this a new or teplaCernent system; Co rtpiet� to s=pit .ail ty rating boxes, A S11 IS SUITABLE FOR, A HOLDING TASK ONLY IF ALL 'HER SYSTEMS ARE RULED OUT BASED ON SOiL CONDITIONS; 0_ PLEASE use the alibieviaticans shown here for writing profile cl>scriptions and completing the Plot plan; 7, MAKE A LEGIBLE diagrarn accurately locating your test locations. Drawing to scale is preferred, A u,ep,i a vi. sh e, may be used if desired; 8, Mok, sul-?your 1:7 r.nhrnaik zanta Vertical elevation €,eference, point are clear?y shown,and are permanent; 9. Connplete all appropriate boxes as to dates;nai les,addresses,flood plain data,percolation test exeia7p- ticn, ;f appropriate; 10, if the information (such as flood plain, elevation)aloes of;apt�h/, place N.A.in the apps opriate box; 11, Sign "he, form and "1Ia e your current address and your ceitificaiitcM nUmbpr; 12, Make legible collies and distribLite as required, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETIONS ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st — Stone (over 10") BR Bedrock cob Cobble (3- 10") SS Sandstone gr — Gravel (under 3") LS — Limestone 's Santa HGW High Ground water 4,s Co arse Sand Perc — Percolation Rate reed s- — Medium Sand W - Well ?s Fine Sand Bldg Building is ..._ Loarny Sand > Than f "�l Sandy L.t ara < Less Than - Bii Brown ( -j iaari's v ¢ B' -- Biack S ...... `lilt Loam &ay 1 L"7£1 rY3 Y — fsift.3L`4` Clay: Loam B Red Clay ir..oam trt f>E`, _. M0� tir:S sc .. Sindy Clay sic; — Silty Clay ff.l: _ few, hne, faint *c ... Clay cc .... ccaMMon, coarse pZ .._ Pea t min ._ p0any, rrieai 3n? } _.. S Iuc'k d distinct p -__ 1-lronlinerai_ l-WL _ I-digh „aur i.wed "a r surface, Y ,a a t ti si:?XO:r BIVI Bench M1�4, VRP ..__ Vertical c.ference Point TO THE OWNER. This soil test report is the first step in securing a sanitary permit.The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit, The sanitary permit must be obtained and posted prior to the start of any construction, o cc LLI cj LLJ h� ' U) �o � Z m oo Z uj CP CL 4 p�e �• J i tt LU c aCC n A Q � 4. ° I _' U 'V cr a w �"` n y CLI 5; ND CO \J cc CL 0♦ 1 g w• a ♦ a v O V �3 I a v H . 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F' = = z z r7 W W H 41 41 ai W a d Qwwww ti z w wwHC� h P4 P4 vHi Q x .QI W P4 vn >6 ;. + „�„ •. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VE1JT GAP y"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE COV JUCTIOIJ BOY, R 25' FROM DOOR, 12"MiU. I WINDOW OR FRESH I ,.: I;JTAKE GRADE I 40 MIN.. COQDUIT -- ---____-- 18"MIN. PROVIDE I WLET AIRTIGHT SEAL PRIVATE SEWAGE SYSTEM I I I I�-�, APPROVED JOINTS APPROVED JOINT A I I I is W/C.M. PIPE W�C.=. PIPE Co(- i/iortRl I (I ALARM EXTEUDING 3' ONTO SOLID SOIL ONTO SOLID SOIL s APPROVED C DEPARTMENT OF INDUSTRY LABOR AND HUMAN RELtLij I DIVISION OF SAFETY AND 6U ELEV.-- F'f: g�'� OFF ° �- E RE COlC1CR'ET��P.3 CK RISER •EXIT PERMITTED OIJLH IF TA1JK MANUFACTURER HAS SUCH APPROVAL SEPTIC SPEGIF N I•CATIOS _ E UMBER OF DOSES: 7` y PER DAB DOSE ►.L TA�JKS ^ANUFACTURER: ! � :��' 7Sb GALLOWS DOSE VOLUME TANK SIZE: INCLUDING BACKFI.OW: /7S GALLONS L�ARM • MANUFACTURER M / ,� GALLONS MODEL 1.IUMBER CAPACITIES: A=mss INCNE5=OR SWITCH TYPE: /��k"A r r�' �•r.tart B=-- — INCHES OR �GALLONS =_INCHES OR /7 . GALLONS PUMP MANUFACTURER: �b'yo�o.�,iric. 1 MODEL NUMBER : D= M 11CHES OR GALLONS SWITCH TYPE' //��rH�y `der ��irc.✓ NOTE: PUMP AND ALARM ARE TO 8E • .7.?.S GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE- -y VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.-- '� FEET z -{- M11,11MUM NETWORK SUPPLY PRESSURE . . . . . • • • • . • Q F.T. FA . .3 FEET f y- + �Q_ FEET OF FORCE MAIN X /-S'�-�oFtFRICTION CTOR..TOTAL 13y1JAMIC, HEAD = �•3 FEET �—�i TH INTERNAL DIMEMSIOMS OF TA UK: LEIJGTH 7 7 ;WIDTH LIQUID DEP W-40;'�V" LICENSE 1JuMBER: [)ATE: ` 5fGWED: