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Parcel #: 034-1004-70-000 02/12/2007 02:22 PM
PAGE 1 OF 1
Alt. Parcel#: 03.29.15.38B 034-TOWN OF SPRINGFIELD
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
RANDALL A&CAROL J HAGEN O-HAGEN, RANDALL A&CAROL J
3013 CTY RD DD
GLENWOOD CITY WI 54013
Districts: SC = School SP=Special Property Address(es): '=Primary
Type Dist# Description *3013 CTY RD DD
SC 2198 GLENWOOD CITY
SP 1700 WITC
I
Legal Description: Acres: 1.850 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R1 5W NW NW LOT 1 CSM 3/611 & Block/Condo Bldg:
EXC NSP& INC THE W 30 FT OF N 397 FT OF
CSM 3/753 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-29N-15W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1004/503 WD
07/23/1997 728/160
07/23/1997 724/464
07/23/1997 636/515
more...
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.850 11,950 127,650 139,600 NO
Totals for 2007:
General Property 1.850 11,950 127,650 139,600
Woodland 0.000 0 0
Totals for 2006:
General Property 1.850 11,950 127,650 139,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 129
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP �� SEC.—.,-" T ' N-R/ -- W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1
Aso
lcra `
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used. 1�.d<.� `LI,
Elevation of vertical reference point: 16 .2 Proposed slope at site:
SEPTIC TANK: Manufacturer: Alm iquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, l Side,O Rear, O / , feet
From nearest property line Front,01side10 Rear,0 E� S J feet
Number of feet from: well g0 / , building: /
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
` SEE REVERSE SIDE J
PUMP CHAMBER , �c
Manufacturer: �yjLQ!I Liquid-Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size / O
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle: l
Alarm Manufacturer: -5- ` 'e& Alarm Switch Type:
�_ J f
Number of feet from nearest property line: Front, O Side, (0 0 Ft.
Number of feet from well: '7 C
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Length: � Number of Lines: Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front,> O Side, O Rear,0 Ft .
Number of ,feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems. (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
z2 yyLicense NumberilP 4
3/84:mj
1 e .
CERTIFIED SURVEY N0.
611 is
Part of the Northwest 1/4 of the Northwest 1/4 of Section 3, Town 29 North, Range 15
West, Town of Springfield, County of St. Croix, State of Wisconsin, described in
Volume - of Certified Survey Maps, page__611__as Certified Survey No. 611
349382
8 9 �
ST.CROIX COUNTY m m m
3/4" IRON Roo SURVEYOR'S RECOR
0'�„ONPlELL N W. COR. SEC.3, T 29 N, R 15 W
E6 u+' m
m"
in ADO of Deeds n
0-4 z !?:
S87°18'42 E Nm" z
6r Cr 0 y/ ` 474. 33 S 87° 18'42"E m W Z 0
2 28.oo _ - D Z* ,
T o
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A z.f
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NORTH LINE NW 1/4 z i
SEC. 3, T 29 N, R 15 W = EXISTI �TOUSE _
'� y GAR.
NEO
S 87°18'42" E
N 228. 00' 0
a o o LOT I +
0
V— 2.08 ACRES
LEGEND TGW —o w "" NOT INCL. ROAD 0
ti
o 3/4"x 30" ROUND IRON ROD
°j \0 19 WEIGHING 1.502 LBS./LF.
9ti
228,00- 9'0'' SCALE
SCALE N 87°18' 42" W
I" zoo'
I" = 100,
100 50 0 100 200
I , THOMAS G. KUESTER,Registe red land surveyor, hereby certify that I have surveyed,
divided and mapped a part of the NW-14 of the NW-14- of Section 3, T29N, R15W, Town of
Springfield, County of St. Croix, State of Wisconsin, more particularly described as
follows:
Commencing at the Northwest corner of said Section;
Thence S. 870 18' 42" E. , 474.33 feet to the point of beginning;
AlOIM�l
Thence continuing S. 870 18' 42" E. , 228.00 feet;
Thence South 456.00 feet; O
Thence N. 870 18' 42" W. , 228.00 feet; �Q ou
Thence North 456.00 feet to the point of beginning. M�
Said parcel contains 2.08 acres, more or less.
That I have made such survey, land division and plat by the direction of Allen and
Edith Hagen.
That such plat is a correct representation of all exterior boundaries of the land
surveyed and the subdivision thereof made.
That I have fully complied with the provisions of Chapter 236 of the Wisconsin
Statutes and the subdivision regulations of the Town of Springfield and the County of
St. Croix in surveying, dividing and mapping the same.
DATED THIS � DAY OF 1978.
1
NOTE: Chapter 5.1 .4(2)(c) , St. Croix County Zoning Ordinance, adopted November 15, 1974,)J
and as revised. (Sale or exchange of parcels of land between owners of adjoining ^
property are exempt from Township and County review).
6- 12- 78 V etc.ijied ass compty.ing to Ckapterc 5. 1 . 4 ( 2 ) (c) , St. Ct o ix
County Zoning Oxd.inance. rah
v ,
Volume 3 Page 611
AROLD C. BARBER
Zoning Adm.in.id tn.ata x
o= a
i
'.QEPAR:+I`*Ef T OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
I S, J,ER N6, 3 T29N-R19
1TOwn oof Springfield 1:1 CONVENTIONAL 1:1 ALTERNATIVE State Plan I D.Number:
Double D El Holding Tank ❑ In Ground Pressure ❑Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO D T
Randy Hagen' IRt. 1 , Glenwood City,Wi 54013 436
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV..
11-1 of Plumber. MP/MPRSW Nn.. Cnunty Sanitary Permit Number:
Wa ne Lorenz 934 ST. Croix 135403
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER li
PROVIDED. PROVIDED:
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.: VENT MATT HIGH W ATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. JVENT TO FRESH
ROM LINE. AIR INLETYES ❑NO ❑ ES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING JLIQU15 CAPACITY PUMP MODE I. PUMP;SIPHON MANUF ACTUHEH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
❑YES ❑NO 1 DYES ❑NO ❑YES ONO
GALLONS PER CYCLE: JPUVP AND CONTROLS OPERATIONAL NUMBER OF JPHOPIHTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) 1:1 YES NO NEAREST jo
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing t F N(,TH JOIAMF TER MATE HIAL 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 '10 OF WITH PIPE SPACIN1, COVER IN511]E DIA -PITS LIQUID
BED/TRENCH THE NC ES MATERIAL' PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UI PIPE UISTH PIPE DISTR.PIPE MATERIAL NO DISTH NUMBER OF - Pq OPERTY WELL BUILDING: VENT TO.FRESH
BELOW PIPES ABOVE COVER .INLF f ELEV ENU PIPES L NE AIR INLET:
L FEET FROM '
NEAREST----=-tt-
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 ❑
meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE 11111111ANINT MAHKIHS OBSERVATION WELLS
_ ❑YES ❑NO _❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH TED DEPTH OF TOPSOIL SOIIOFO SEEUFD MULCHED
CENTER EDGES
EY E S. : NO EYES ONO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMEN,sioNS ,
ji�O MANIFOLD PUMP MANIFOLD DI ELEVATIQN AND STR.PIPE JMANIIOLD MATERIAL DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.. ELEV. DIA. ELEV. PIPES DIA
DISTRIBUTION INFORMATION ST B HOLE SIZE HOLE SPACING CHILLED CORRECT L COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES ONO ❑YES El NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NLIIIBERF�LINEROPERTY WELL: BUILDING:
:
I DYES ONO 1:1 YES 1:1 NO NIwA�iEST
10.30
d
/iff"i 3
Sketch System on Retain in county file kaudit.
Reverse Side.
SIGNATURE TITLE:
DILHR SBD 6710 (R.01/82)
{�, ��. SANITARY PERMIT APPLICATION
LJ �ILHR In accord with ILHR 83.05,Wis.Adm.Code Cou
STATE SANITARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than ❑ Jif J'(163
8�z X 11 IrtCh @S In size. 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 OWNE PROPERTY LO ATION.
10/a, S J TOW, N, R 15-E(or)
I PER OWNER'S MAI ING ADDRESS LOT# BLOCK#
CITY,STAT I I I ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
A O�L-u c;iVib I il(
II. TYPE OF BOIL IIN-G: (Check one) El State Owned g — NEAREST ROAD
El Public E 1 Gor 2 Fam.Dwelling-#of bedrooms PAR EL TAX NUMBER( )
III. BUILDING USE: (If building type is public,check all that apply) s� 18 c7"4 6
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 ash
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. X 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 Fir 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 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) Gals/day/sp.ft.) (Min./inch) G� �j( � r ELEVATION
ek 3d O 5 y� v (� /� 7 Feet Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks-1 strutted
Septic Tank or Holdin Tank
Lift Pump Tank/Siphon Chamber I t
Vlll. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
PI mb is Name(Pri t): PI ber' Signature:(No mps) MP/MPRSW No.: Business Phone Number:
ore � OZ/S_6s� 3a�3
mber'A A dre (Str ,State,Zip Code):
IX. COUNTY/DEPARTM USE ONLY
❑ Disapproved Sanitary Permit Fee(includes Groundwater as-Issued Issuing Agent Signature(No Stamps)
Approved ❑ owner Given Initial 06 Surcharge Fee)/ /f\ / p_�
Adverse D termin tin `Z J / L
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: y
SBD-8398(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 rnust 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:
y
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.
11. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling.
111. 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'f 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) so(t 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.
i
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
T t-
Location of property. 1/4_1/4. Section , N-R
Township
Mailing address
C z,
Address of site
=ubdlvlsion name
Lot number
Previous owner of property :
Total also of parcel
Date parcel was Acreated
Ace all corners and lot lines identifiable? Yes _
is this property being developed for resale (spec house)?_Yes No
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.
------------------------------------m--------------m------ ----------------------
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 sald system, and the same has been duly recorded in the Office
of 1the County Register of Deeds, as Document No. 1 .
C ,7ir/C
3lgnatut Tof Owne T Signature of Co-Owner (If Applicable)
Date of Signature Date of Signature
avow
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to me knows to df the pereea ............ wbe srmnisf ;
foreaoba Instrument and sel:nnrledae the eamsa,,.'
....... ......... Notary._Pnblh .,. ......:...... . ..u. .. ,
t>Iil�aat s.a>Iq►he ftftowi a"or adgw.bomt 30th Nr C.e;mission. i,
ere act la 0 as j. e
r saz h..�ar Nrslt M ns.t err►•+•w date: .� . R
5 .... ..-........ ...........
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,fate of Wisconsin
county of St. Croix
I hereby certify that this instrument is a full
true and correct copy of the document on file
and of record in ssy office and has been
;ompared by MO
fittest
NovembeY . 19 89
James 0'
lama A' �vnnell Regbw of Deets;
deputy
cn
H
ST C - 105 r'
r
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SEPTIC TANK MAINTENANCE AGREEMENT H
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St . Croix County z
d
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OWNER/BUYER
ROUTE/BOX NUMBER T -� r�� r _ Fire Number
CITY/STATE
PROPERTY LOCATION : , _, Section TN , R
Town of St . Croix County ,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper. What you put into
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 V)
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- 10
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 . J
SIGNED
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 .
1
"DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON W BOX 53707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: Q TOW HIP/ OT .:BLK SUBDIVISI N E:
/ H/„/,5E A0 �OEOZZW rNq IM
C UNTY MAI ADDRESS:USE DATES OBSERVATIONS MADE
N .: COMMERCIAL ESCRIPTION: jPERCULATI9DN, ES TS:
Residence ❑New place G � (fC7 7 Q
RATING:S=Site suitable for system U=Site unsuitable for system a
NTS V�tT10❑NAl_: MOUly,B"�� IN-GRQOUND-PRE: SYSTEM-IN-FI O�LDING TAN COMMENDED SYST :Optiona UU �L�JT SS SS SS
If Percolation Tests are NOT required DESIGN R� If any portion of the tested area is in the /
under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEETH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF BSERVE (SEE ABBRV.ON BACK
B- O T 1D ,0
a l / ns'1 / ,
s
70 7 9 VH 8/2 s , 3 rr s
s
3 D > 90 /a /7s 30 rtsi 1 , �5
B-
B-
B-
?,(G PERCOLATION TESTS
} TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
f NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIQQ 1 PE l0 M 2 P PER INCH
P X34 r6 6 i
P-
P-
P-
P-
PLOT PLAN: Show locations o percoLe
borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and verticar levation re rence" their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope { � Q
l/
SYSTEM ELEVAT ON �r 90� ___� _ �� _ l 4/0
yea_
i rt
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1, the undersigned, hereby certify that the soilitest eported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data record*n te3�,ation of the tests are correct to the best of my knowledge and belief.
•3
NAME print): TESTS W E C MPLETED ON:
ADDRESS: CER I (CATION-NUMBER: PHONE NUMBER(optional):
CST ATUR
DISTRIBUTION:Original and one copy to Local Authority, Property Owner and Soil Tester.
LHR-SBD-6395(R. 10/83) —OVER —
i
INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395
I
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
liquid for li id waste disposal
VRP — Vertical Reference Point
p
I
I
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.
3
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, PAGE OF.�.�
PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS
VENT CAP
4"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING
JUNCTIOW BOX MANHOLE COVER
25' FROM ODOR, IZ"MILI.
wIN1DOW OR FRESH I
AIR INTAKE I
GRADE G I y'MIN.
I
10"MIAI.
CONDUIT --
10"MINI. \\��
PROVIDE I
INLET AIRTIGHT SEAL
-7
I III \/
APPROVED JOINTS
APPROVED JOINT A I I( W/C.T. PIPE
W/C.I. PIPE I I I( ALARM I<XTEWOIN6 3'
CXTCNDIWG 3' I I ONTO SOLID 6016
ONTO 60610 6011- is ( I
I ( ON
C
LL CV, FT. PUMP-� __�
OFF
0
CONCRETE 6LOCK
3"APPAL WOD
• RISER EXIT PERMITTED ONLY IF TANK MANUFACTURCR HAS SUCH APPROVAL. %soolmfi
SEPTIC
SPECIFICATIONS
E
OOSE PR.e.cas —. NUMBER OF DOSES: I PER DAy
TA N!% MAWUFACTURCR:
TANK 5IZE: S o GALLONS DOSE VOLUME _
S 7 INCLUOINTa OACKFLOW- ZZS GALLONS
AL_ARM MMJUFACTUKCR:
MODCL NUMBCR: CAPACITIES: A= 13 INCHES OR 2+�3. ?S GALLONS
SWITCH TyPC: --�"`r`'`-� ^-----'— 5= �' INCHES OR ��G�►LLONS
PUMP MAWUFACTURCR: F_ M'fects C: I ►NLHES OR 22--5' GALLONS
MODEL NUM9LR: 5 �''� y D= 14 INCHES OR 262-So GALLOWS
SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO 5L
' 0 GPM INSTALLED ON SEPARATE CIRCUITS
MINJIMUM DISCHARGE RATE_—_-1
VERTICAL DIFFERENCE BETWEEN PUMP OFF ALID..DISTR►DUTIOW PIPE.. t2 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE ' FEET L11,T S'lSrem
+ `"I FEET OF FORCE MAIN X 3.2'1 FYo FtFKICTIOU FACTOR.. I•`irl FEET
TOTAL DyNAMiC HEAD = 13."-11 FEET
INITERWAL DIMEWSIOWji OF TANK: LEW&TH �3` - IWIDTH 1-7" -iLIQUID DEPTH LA 3
• ti-`
E D 1 LICEIJSE NUMBER: DATE:r �
SIGN •_,.-,
SECTION 500
PAGE 5
1/30/83
Myers
Tornado Series
•
SRM4 SUBMERSIBLE SEWAGE PUMP
•
• SRM4M (manual) SRM4A (automatic)
500/6
Features
Pump Impeller is recessed Powerful 4/10 HP Motor is oil filled Rotary Shaft Seal has carbon and Mercury Switch 20 AMP rating,
"Tornado"type—operates com- for good insulation and lubrication of ceramic faces for positive seal. 3"cylinder,wide angle 120° oper-
pletely out of volute passage giving bearings and seal. Overload protec- Body is stationary, prevents string or ation, polypropylene material.
full opening for flow of liquids and tion built-in. No starting switch or trash from winding on seal. Recommended Tether length is •
solids up to 2 inch dia. relay mechanism. Switch Housing (SRM4A) is com- 4"from cord clip to switch case
Motor Housing is heavy cast iron, Thrust Washers and Sleeve Bear- pletely sealed from pump liquid, (Pump Down 9").`Pump Down'
epoxy coated. Stator is pressed in ings are oil lubricated for smooth easily removed for replacement if can be increased by increasing
for perfect alignment, best heat operation, long pump life. needed. the Tether length.
transfer.
Dimensions
ON
Mug
tai I �
�e t11"
�. -� �� 5
� � m� mamma cI1.
�'r '3 aw -�g
Performance Curve
e
��
'' p
�r
4= o
Accessories Performance Table
2 4 6 8 10 12 14 16 18 20 22
®�� Total
Head Meters .61 1.22 1.83 2.44 3.05 3.66 4.27 4.88 5.49 6.10 6.71
Gallons Per Hour 6,000 5,500 4,900 4,300 3,600 2,800 2,100 1,200 420
�! ® � Liters Per Hour 22,710 20,818 18,547 16,276 13,626 10,598 1 7,949 4,542 1,590
Performance Capabilities
p ❑ ❑ Capacities to 95 GPM 360 LPM
� 1W Heads to 19 feet 5.19 meters
Pump Down Range* 7 to 14 inches 177.8 to 355.6 mm
� E Solid Handling Capability 2 inch dia. solids 50.8 mm dia. solids
1 NN Liquids Handled Fresh, drainage effluent waste water
Intermittent Liquid Temp. 150°F 66°C
. _ Motor 4/�o HP
Electrical 115/230 V., 12.0 A/6.0 A, 1 (�, 60 Hertz
Discharge 2 inch 50.8 mm
� � Automatic Model,(manual pump variable with switch).
DIVISION OF
F. E. MYERS CO. McNEIL
ASHLANNGESTR48 CORPORATION
ASHLAND, OH1044805-2285
� _ ' � 419/289-1144 TELEX 98-7443 Q