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Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP �6— SEC. _ N-R W
ADDRESS CROIX COUNTY, WISCONSIN
I
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
6
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i
V T
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/ = Z
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ��
Elevation of vertical reference point: _441d Proposed slope at site:
SEPTIC TANK: Manufacturer: 4iquid Capacity:
Number of rings used: __,Tank manhole cover elevation: 7
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road:
Front,O Side,O Rear, feet
From nearest property line- : ' Front,0Side,0Rear,0 � feet
Number of feet from: well building: 4;42 7
(Include this information of the above
� P lot P lan)(
2 reference-dim ensi on
s to septic tank)
TT.�.mnll.+ fTTl7 ..
f
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PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: A2M Pump/Siphon Manufacturer: 4,a"ja/c Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: . �(��� Gallons per cycle: 6 �
Alarm Manufacturer: S JA%p 4�glftS4ZjAl arm Switch Type:
Number of feet from nearest property line: Front,/O Side, Rear,O Ft.
Number of feet from well: ,45�2
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width: Len$'th: Number of Lines:_ Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front,/ O Side, ( Rear,O Pt . _
Number of feet from well: d y
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,
0 Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on lob: 444/x'ec
License Number: &:Z S
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
DIVISION
�LA80R&HUMAN RELATIONS
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707 State Plan I.D.Number:
SF%jNE4, S30,T31N-R.18W ® CONVENTIONAL ❑ ALTERATIVE (If assigned)
rBEENCH oiRStar„ airie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound a 1139
PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI ATE:
on Parent Route 1, Box 49A, Somerset,Wl 54025 _ _ 8 9
ARK(Permanen t reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT. LEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 119417
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROVID DLABEL LOCKING
ROVIDED:OVER
❑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----*
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: ARNINU LABEL PROVIDED:OVER
❑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 ❑YES ❑NO NEAREST—�
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDT LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
BED/TRENCH ��� 1 TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS C7
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: 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: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES [__1 NO [:]YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
' I �j ❑YES ❑NO ❑YES E:]NO NEAREST-�
J (�• �0
S
13•
r Retain in county file for audit.
Sketch System on "I TITLE:
Reverse Side. SIGNATURE:
Zoning Administrator
SBD-6710(R.06/88)
E:E:cSANITARY PERMIT APPLICATION COUNTY
1LHR In accord with ILHR 83.05,Wis.Adm.Code U k
STATE SANITARY PERMIT#
—Attach complete plans to the count co /
p p ( y copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 9 No
PROPERTY OWNER PROPERTY LOCATION
Oh t F N. A/ %, S 3o T3 , N, R W(or)W
PROPE Y OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
l 1- ti ,q
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
�J �0 �1 S 2 ❑ VILLAGE: G 7-y 12d �G
II. TYPE OF BUILDING OR USE SERVED: PM K-- QO I 03 l— 0_0
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): YZ-,d
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. �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. ®Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tan k
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. �I See a e Bed b. ❑Seepage Trench c. ❑seepage 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):
J �/,5— Y -,s 7 I/R Feet W Private ❑Joint ❑ Public
CAPACITY
VI. TANK Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New Existing Gallons Tanks Concrete glass App.
Tanks Tanks strutted
/ / ❑ El Se tic Tank or Holding Tank O O 0 �O O c)
Lift Pump Tank/Siphon Chamber .b/(7 /O 1.+e Crc_rh,.n ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plu er's Signatu o Stamps) IA/MPRSW No.: Business Phone Number:
(f of 0L.,, -
Plu ber's Address(Street,Ci ,State,Zip Code: Namy f Designer:
t� .�. IA
VIII. SOIL TEST INFORMATION
CeZfd�So(,T estr,CSI Name CSTZg�
CST's ADDRESS(Street,City,State,Zip Code) y� tt�� Phone Number: /
e, I V 1l�t,v L L� l 1 5- Z —te ZOQ
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial S rchargge Fee Qg
Adverse Determination co u ( F1h H'`J
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
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 permit 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;
II. 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;
III. 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 manufacturer'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% 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 St9T
included the creation of surcharges (fees) for a number of regulated practices which Wisco IFIr$ e
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Teisti#itT
is used in your building is returned to the groundwater through your soil absorption
system or the disposal site used by your holding tank pumper.
a
The monies collected through these surcharges are credited 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)
M
1 ,
• I
APPLICATION FOR SANITARY PERMIT
STC - 100
his application form is to be completed in full and signed by the owner(s) of the
roperty being developed. Any inadequacies will only result in delays of the permit
asuance. Should this development be intended for resale by owner/contractor, ("spec
ouse"), then a second form should be retained and completed when the property is
old and submitted to this office with the appropriate deed recording.
er of Property V/ or)_P4 ri-F
Location of Property F_kl�lk. Section �17 , T__N-R W
Township _�
Mailing Address _ � � uk. L/`�,tf .
Address of Site NlA
Subdivision Base
Lot Number N/q
Previous owner of Property 1\0r0er- IQ-
Total 819e of Parcel 1,00
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes _ X No
Voluse �0 7 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 refer-
ences to a Certified Survey Nap, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
T IWO CvAti.6y that ate ata.temen>ts on thus onm cute hue to Vie best o6 my (out)
hncwteati that , y am (she) ,the own (A o6 the pnopehty de�sehi.bed in tit a
in6onn+aLion do", by viA-tue o6 a waAAanty deed h.eeonded in the 066.ice o6 the
County RegjAten 06 Deeds ah Document No. 2 and that I (we)
c.un tAe p�topoaed bite. 6oh .tile sewage dus oa a a em (oh I nnebentey
P y (we) have obtained an
caaefient, to Run with the above deg cAi.bed pnopenty, bon the con6tAuction o6 aaid
aya.tun, and the name ha.a been duty neeojcded to the 066.tee o6 the County RegiAten o6
Veeds, ae Document No. 1 .
J
SlcNA OY WHiR SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGtiBD DATE SIGNED
I '
wil
•1W�►t �. m , Y l� Ntl•awls�iMlMliris
• STATS BAR or Wt MMU MM I—I� � a
: r
Bakm..R,e.. "grW444.And Doris A. Maitre am 0L �il
.....................................
......... . .... ......... . ............... .. .... . _..
eoareys and wamnts to .Ih!ran Parent, a/k%a_It�rrao b t'aisnt r IM ►M a
Pitsnt.,. husband sad
...... ......................... ....• •--....... ...... . .... .. .
I`
... .... . ...... ......... .... ....... ...... ..
........ . .
•.
the feUowing deeeribd real estate in ...... .ft t..Ctoix........... .. .. ...Gent.
hate of WiaeMin:
Part of the Southeast Quarter of Northeast Quarter 7 `rase✓not
of Section 30-31-18 described as follows: Lot 1 of Certified Surrey Mq f1W
May 22, 1978 in Volume "2", Page 596.
EM4M �
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!t
1 is not
j! Tbis ................. .. property
... Itomastead
(is) (is Mt)
RaaitM to warramiss: Basements of record, if any.
• y
DaNd this _.. . ... ........:� .. ... .....-..- day of ._ . April
(SEAL) ��^!L '-�v < / . / SEAL►
• ROBERT R. MAITRBJEAN
......... . ... ......... . ....
.... ... .. ....... .(SEAL) A (. �.+..
DORIS A. MAITREJEAN
AOliTllfllOAlIOIt AO=IIOWLsDOi XUT
@j@=&mmy Robert R. Naitre� and Doris_ STATE OF WISCONSIN
A. Meltrejeea a,
..................•--..............._.........
.. .Coaaty.
aarsaYerei •[.. .y.... 1l. Personally ease before me this ................4W of
................................. ......... 19........ 0110 above newel
.
.................................................... ............................................... -••--•-----•---••-...._........_
BTATS BAR OF WISCONSIN
:. ......................•-•-•-------.......... .......__.-•---..._........._.._...
.................................................
�i+M►Wis.Stets.) 0o me knewa is be the person ............ Ube enaetlsi I" '
foregoing instrument and aekaewbl•e the sans.
TWOS MMIMAMOW WAS OeASrM ar x
is a Cori i Murray, By: Samuel R. Carl --• •---- ------------- _. ...... .
ING. mot 229, Madson, Wisconsin 54016 ............... ...................
Notary Pahiie ._WIL
a It en/be saNmadee d or mkaewfd *L Both my Commission is permanent.(If ask stww a -1i
date
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
DV1-&W/BUYER Ir ` V r 0 t Pa( e_ J
ROUTE/BOX NUMBER , ' 6 Ll Fire Number /V/,¢
CITY/STATE 5omerscj_ c,on5ltj ZIP SYVZS
PROPERTY LOCATION: ,SF- k, NE it, Section30 T� N , R J. y W,
Town of Pr a n& ,e St . Croix County ,
Subdivision / Lot numberly
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 m- y 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 N
to maintain the private sewage disposal system in accordance with x
the standards set forth , herein, as set by the Wisconsin Depart- b
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 .
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 .
RY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUS TRY,
INDUS c DIVISION BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 537907 9 53707
(H63.090)& Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ CITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SE 1/4 NE/ 30 /T 31 H/R 18fxor)W Star Prarie n/a n/a n/a
COUNTY: BUYER'S NAME: MAILING ADDRESS:
St. Croix Myron Parent R.R.#l, Box 49A, Somerset, Wi. 54025
USE DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TES TS:
®Residence 2 n/a ;gdNew ❑Replace 10-24-87 10-24-87
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
El S ❑U El S ❑U x)x]S ❑U 1E1Sx9010S9Q1 conventional trench
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: n/a Floodplain, indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS page 19 BrB
BORINGI TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER IDEPTH XX ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-1 6.83 101.28 none 5.58 1.08bl.1. 1.25bn.s.l. 3.25bn.c.s. 1.25bn.mot.sil.
B-2 7.17 100.15 none 5.67 1.00bl.s.l. 1.33bn.s.l. 3.34bnc.s. 1.50bn.mot.sil.
B-3 6.80 100.24 none 5.80 1.00bl.1. 1.17bn.s.l. 3.63bn.c.s. 1.00bn.mot.sil.
B-4 6.39 101.24 none 5.22 .50bl.s.l. 1.50bn.s.l. 3.25bn.c.s. 1.1.7bn.mot.s' .
B-5 .6.92 100.15 none 5.75 .58bl.s.l. 1.50bn.s.1. 3.67bn.c.s.1.17bn.mot.sil.
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 PERIOD3 PER PER INCH
p_ none
P none 3 - 6 6 <3
P-3 2.76 none 3 6 •6 6 <3
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 97.48
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1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME(print): TESTS WERE COMPLETED ON:
Gary L. Steel 10-24-87
ADDRESS: CERTIFICATION N BER: PHONE NUMBER(optional):
988 N. Shore Dr. , New Richmond, Wi. 54017 2298 715- 4200
CST SIGNAT
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
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5om er5 z a L...l PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
S`tu 2,S
VENT CAP
4"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
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B I I ONTO SOLID SOIL
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DOSS TANKS MANUFACTURER: �Ow�rS ���^e.-TTs� i A WUMBER OF DOSES: _PER DA`J
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ALARM MANUFACTURER: INICLUD!�!:, ZAC!,FLOW: - Ll / .-3 GALLONS
MODEL NUMBER: j-Q-! CAPACITIES: A=2-'INCHES OR -302-,`GALLONS
SWITCH TYPE: B= rL INCHES OR -�Llt l g GALLONS
PUMP MANUFACTURER: &o vi . C- INCHES OR 2,0L GALLONS
MODEL NUMBER. 2930 #1403'434_ 10uaIrS D- INCHES OR 51 GALLONS
SWITCH TYPE: W* NOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHAR4,E RATE ��^ GPM /I�N,STALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE B�WEEN PUMP OFF AND DISTRIBUTION PIPE..-/0&0 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . , , , :a FEET
♦ ...ELSE.- FEET OF FORCE MAIN X J�F/
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TOTAL ObWAMIC. HEAD FEET
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INTERNAL AIMEWSIGN OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH
BIG UED: LICEWE NUMBER: - / 5-6 3 DATE:3
—117—
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20-42"Above Pipe _4"Cost Iron
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Marsh May Or Synthetic Covering
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AQU AT LEAS'r20 IMCHES BUT AIO MORE THAI) 42 INCHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVAT1m►.D FROM oKit A.L bgADF. WILL BE �_ IMCHES
PUI41MUM ®F-PrM OF EACAVATION ROM 0IK1I;1WPjL 6849E WILL BE INCHES
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