Loading...
HomeMy WebLinkAbout038-1165-60-000 CD Pj a 0 w C �o - O N a b N 7 f0 0(_) c tY I N �N Q) w E o z :3 m w LL c° N p C M Q N i Z N co r O Q 7 ` Z a m M H Z O O Z c Vr .N. •- CD z C E U N N co •� d � L (Opp o O Q 0 0 z m z o N Z :; N Q i (V d i0 O Al) d O O n a I � 000 z 'N io m a m �i a ° ° N (A .i U ',' U CO rn > ID �l m N m Z m C d O) O O � C ill M 3 N c o ~0 oQ o ° ! r a°i c al r \ tO � O O O c_X = 'O N Lr)V O 00 ° N c = N a� d Cy.y Cr r (9 Q' _ N N O r N ° f0 R ~ O M m(n '. H B O Z U) H fn O O :jj r at a L: a r • a m .2 d y c `N ++ E _ �1 A c°� a � jloinL) v Form - S T C - 104 AS BUILT SANI J,TARY SYSTEM REPORT OWNER Rn'j,k ft�112 1 TOWNSHIP S���' t :,tg SEC. _ T N-R W ADDRESS ►1 ST. CROIX COUNTY, WISCONSIN SUBDIVISION ��1 �^ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•T.HR 83 SHOW EVERYTH1.NG WITHIN 100 FEET OF SYSTEM S 1 � I i 80 INDICATE NORTH ARROW BENCHMARK: De cri4e t e vertical reference point used 4 N a 1 I IV,, vd Elevation of vertical reference point: Proposed slope at site: f b SEPTIC TANK: Manufacturer: &�Cg4,0e3�&iquid Capacity: Number of rings used: Tank manhole cover elevation: �/ 3� Tank Inlet Elevation: Tank Outlet Elevation: 91"e Number of feet from nearest: Road: Front, Side,O Rear, O .��� feet From nearest- property line Front,OSide,�Rear,O �-- feet Number of feet from: -r -� SS , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufact er: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: !Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lennih: Q Number, of Lines: (=4 Area Built:cl4g) Fill depth to top of pipe: ♦ (o Number of feet from nearest property line: Front, Side, (QS Rear,Ort Number of feet from well: Number of feet from building: 37 ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of seepage pit elevation: t Area Built: i Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). 1 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: 6k Dated: � � �T 0 / Plumber on job: �r, I��i ��t y- S' License Number: 3/84:mj r,1p Form - S T C - 106 AS BUILT SANITARY SYSTEM rEPORT OWNER / _ TOWNSHIP , _ SEC. ?6 T ,�ZLN-R�,�W �9d wDDRSSB A4 ST. C1t0IK COU1lTy, WISCONSIN SUBDIVISION �,Y -:,✓ LOT .;: � LOT SIZE PLAN VIEW Distances and dimensions to mer_t requirements of I•L11R 83 SHOW EVERY T11I14G WITHIN 100 FEET OF SYSTEM If ILA E F f f / r _ IINDICATE NORTH ARROW SENClDIMt Describe the verticnl reference roint used x/; . ' Elevation of vertical reference point: e7 _ _ Proposed slope at site: 89FTIC TANK: Manufacturer: ,+ �3'1;vld Capacity: Number of rings used: --'� Tank mnnhut.a cover elevation: Tank Inlet Elevation: ._-_ Tank OuL.1-t. L'.Ls.,vation: Number of feet from ncarr r'''ids Front+0 L ,ICY Rear, O feet • From nearest- PIVJscl. ""a Fr�nt,� ��1. Lu,ORear��_,�[�r1 feet PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.—_ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width:_ .42 Len$th: LIQ Number of Lines:_ Area Built: Fill depth to top of pipe: .I f Number of feet from nearest property line: Fro t, O Side, Rear,O Yt . _ Number of feet from well: ,i, /J 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated! �� Plumber on job: License Number: 3/94:m) L� DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SW 4, SE 4,Sec. 30 ,T31-R18W ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Star Prair LOt 2� Holding Tank ❑ In-Ground Pressure El Mound NAME OF PERMIT HOL ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 1/—/y— 7 X34 BENCH MARK(Permanent reference point)DESCRIBE IF EN REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: 1563 St . Croix 135362 SEPTIC TANK/HOLDING TANK: M CTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 00 /'j �] / ! PRO DED: PROVIDED: � J –I (� YES ❑NO ❑YES LJ'NO BEDDING: VENT IA.: VENT MATL.: IG WATER NUMBER O ROAD: PROPERTY WELL: BUILDING: VENT TO FRESFf ALARM: FEET FROM //,, LIN AIR INLET: ❑YES O 0 ❑YES IG'NU NEAREST 111 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO I I ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUM A D 44ept LS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF S ❑NO NEAREST---* SOIL ABSORPTION SYSTEM. Check the soil mo' re t e f plo wing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, on tr cti n all cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: N0.N F DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES DEPTH: DIMENSIONS J t U / : RIAL: PIT / GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE ISTR.PIP MATERIAL: NO TR. NUMBER OF PROPERTY WELL: 8 DING: VENT TO FRESH BEL W PIPES: ABO COVER: E .'I T ELEV.E 'E PI NEAREST 7d LINE: ^ AIR , v7 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 [__1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO E]YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO E]YES ❑NO NEAREST� % f >� OS maw / - 0Z i o� , t Sketch System on Retain in county file for audit. Reverse Side. sl TURE: TILEf L- SBD-6710(R.06/88) SANITARY PERMIT APPLICATION U ILHR In accord with ILHR 83.05,Wis.Adm.Code 70, STATE SANITARY PERMI # -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ ? 8%x 11 inches in size. � revision o previous application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROP TY OWNER PROPERTY LOCATION :a,-z % ' Y4,S T , N, R (or PR P OWNER'S MAILING ADDRESS LOT# BLOCK CI STATE ZIP CODE PHONE NUMBER SUBD ISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) CITY NE EST ROAD ❑State Owned VILLAGE- ❑ Public C91 or 2 Fam.Dwelling-#of bedrooms AR EL TAX Nu BE ( ) 111. BUILDING USE: (If building type is public,check all that apply) �]CIjQ 1 El 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. V New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ry Seepage Bed 21 El Mound 30 F-1 Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 12.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals day/sq.ft.) (Min./inch) ELEVAT N Feet Feet VII. TANK CAPACITY Site in ciallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank 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. Plu er' ame(P 'nt): PI tier's Signat o Sta MP/MPRSW No.: Business Phone Number: Plum 's A dre (Street,. ' fate,Zip Cod IX.'COUNTYIDEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Date Issued ss in Agent Signature(No Stamps) Approved ❑ Owner Given Initial / / Q 0 Surcharge Fee) /6--7 Adverse D rmination `7 oocc X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS ' •' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 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. II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'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) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------ ------------------------------------------------------ Owner of property Location of property _1/4 .fir Y/9, Section _, T,J/_N-R/__W Township - - Nailing address Address of site Subdivision name Lot number Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes 1 No Volume and Page Number ,(,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 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 dead reco ded in the Office of the County Register of Deeds as Document No. and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If A plicable) Date of Signature Date of Signature ♦, k DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 f 85Q PAGE 15S _ REGISTER'S OFRCE r Sr..CROIX CO., `WI_ Rcd for Record Lo1�x1 e.. ...ha -resice..and De nice...A_...LawrQx ~e,..............husband...and..zife....... ....................................... OCT 171989 . - at _ ... ....................... ........... ............................................................ 8.30 A conveys and warrants to ..RQber�__L••___-Thsll-.aad..Sha oxt_.Ja.... r ;I ' RbQisler of Geed! Th�].1. l�.usbar�d•. ,... .and--zvife, a4axital.--Pxogertv......... , wi.th..x:ighta..17f...sumviyox-.9h. ..... t ................................................................................................................. ................................ _......................... t ................................................................. ......_.. RETURN TO ................................................................................................................. t ................................................................................................................. the following described real estate in .........St.._..Crctix..................County, State of Wisconsin: E Tax Parcel No: ................ ..... . y Lot Twenty-six (26) of Crestview Addition to the Town of Star Prairie. rNSF O in State of Wiscons �' Carty of St. Croix t hereby certify that this instrument is a full, LEE true and corred copy of the document on file and of record in my office and has been compared by me. Attest October 17 19 89 James O'Connell irises (Y Connell Renter e} Deeds X1wi Deputy This .... A._JaPt......... homestead property. (is) (is not) Exception to warranties: Dated this .................................J_3......... day of .............QCtoher........-_._...._...._........._..__... 19._$_9.. .....................................................................(SEAL) A~, ....c .. . ........(SEAL) « « Lonnie G. wrenc ..... .....................................................................(SEAL) ,. ..._ . (SEAL) * . « Denise A. Lawrence ........................ - .............. ...................._........_............. ...-.._............. AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN ss. •... ................... ... . ....................---•--•-- Ste...Cx;O1X------•---•---..County. authenticated this ........day of.. ----....__-_•--__, 19...... Personally came before me this I......( .....day of .............October.----------., 19..89. the above named .................................•---------......_............------...--------- Lonnie G L wrence and Denise A ----- -------- ------- ------ --------------------------------•- -......., Lawrence TITLE: MEMBER STATE BAR OF WISCONSIN ................................................................................ (If not, ............................................................ authorized by § 706.06, Wis. Stats.) --••----------•----••....••-----•-------•--•--••.....................-•--•...... to me known to be the person _-5........ who executed the foregoing instr ent and acknowledge the din THIS INSTRUMENT WAS /� Reiinatr_a_,_..VAn.-D.Yk DRAFTED�Aee_dhAM,..._S.._C (L1._._ A-_- V 201 South Knowles Avenue,, Box 127 «.......... ......�.�....._� New._aLahmoad ...W1....a4.02.7................. ---------_ Notary Public .....S.t,_._Cr�.,+, (Signatures may be authenticated or acknowledged. Both My Commission is permane� .(I! state are not necessary.) nn 2 date: ---................. gJt. .yn�. .., 19• Ci I L P U • .Y *Names of persons signing in any capacity should be typed or printed below their signatures. i� y. �� °•r STATE BAR OF WISCONSIN �, 'IF U" 4A ♦`" � ry FORM No. 2— 1882 `.�TViisfw. 3002 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER ,f' FIRE NO. CITY/STATE /. 'KA2' L ZIPS— PROPERTY LOCATION: X1/4 S/ 114 Section -313 , T,SLN, R W, Town of , St. Croix County, Subdivision 1�,fi:s1iJ��'� , 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. SIGNE DATE 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY�t BUILDINGS • INDUSTRY, G DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LIO SECTION: TOW SHIP/MUICIPALITY: LOTNO.:BLK. O.: SU DIVISION AME: 1� 1/ /T jN/ E to COUNTY: OW ER'S BUYER'S NAME: A GAD RESS: USE DA SOBS RVATIO MADE NO.BEDRMS.: COMM R AL DESCRIPTION: PROFILE DESCRIPTIONS: N TESTS: RResidence 3 JZNew ❑Replace RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE:S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) ( ]S EA 110 S DU ®S ❑U I El [ZU I 0S ©U I If Percolation Tests are NOT requir DESIGN RATE- If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: JA PROFILE DESCRIPTIONS BORING TOTAL DEPT H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,C?)LOR7 TEXTURE, AND D TH NUMBER DEPTH Ffq- ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-4 1 9 B- y B- 7 > B- y > ./ / - B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INGI " AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD RIOD3 PER INCH P- P- L5, Ald AZZ ji, 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 tl tN I I i I � � 1 I { : i — — - , 111 I,the undersigned, hereby certify th t 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 d to recorded and the location of the tests are correct to the best of my knowledge and belief. NAME( int) TESTS WERE COMPLETED ON: 1 ADDR S: CERTIFICATION NUMBER: PHONE NUM BE (optional): CST NAT RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — // I I T I -r I � I I i l l l l l la l i I I I I i i — _ I I -- - r ' I I I I i : � I - - }-, II I I Ali --j---j---7----j----fi- ';---f-------i ?----{- -I--�---I- L-�-I� -j----�---I+-- +---- ---t--t-- I --- - -- -- --�- ---I-- I i r i I I i I , ! --- -- - - i I , i l ' I I I I T--- : I r 1 i i r • PAGE .OR C,r� SS S �C � IUf, o � ,q Zito S stems-) y r � Frehh Air Inlela And Obs-errollon Pipe i� Approved Vaal Cap � Minimum 12'ADOVa — Flnel Grade S � 20-42"Above PIpp _4"Cali Iron To Final GN4da Van$ Pipe Maaa Hoe Or SrmMlIc Covering min 2'Aggregole Ora, Plpa 016111b lion ' Plpa �' 0 0 0 --Too - b"Aggragol• 114noolh Pipe a Parforoled Plpa Bale• o —Coping TaminoUng Al Bollam Of Syvlam i �1tJ•.1 son j/i\��%VOW�� 7� SOIL FILL DISTRIBUTIO1.I PIPE ' APPROVED SI1$1PETIC COVER r -e- /1AT�1tll�t OR 4" OF STRAW Z"OFA6GREGATE --�� OR JJARSM HA,-:j LLEV. OF„��LFEET_., b OF12 -21/z AGGREGATE i .. I DISTRIBILITIOAI PIPE TO BE AT LEAST _ INCHES BELOW ORIGINAL GRADE AkIU AT LEASTLO INCHES BUT AIO MORE THAI) 42 IKICNES BELOW FINAL GRADE MAXIMUM ©EPrH OF EXCAVAT100 ROM 0KI& NAL (39ADF- WILL BE :NCHE NCHES IMINIMUM ®EPrH OF EACAVATiON FROM 00KI(AWAL GRApF. WILL BE S I SIGNED: LICENSE AJUMBEI2: - DATE : _�i1� 7—�J ,�