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HomeMy WebLinkAbout016-1074-90-100 o 0 00 40 CD 0 ts 6 L) LO tm X L 0- 0 LO O ono 00 U) 0 tm 0 0 Z yY U. .0 :5 E -o 0 E C-4 Lo LLJ CD P CL m chi F— Z .2 0 z dze c(D E Cl) 0) a) ca .N CL r_ (D (D M 4) Co cn U) c • e 0 O Z H z MC v .. 4) q) C*4 F 1 Its 0 E cc LO 0 = 2 1 c U') LO B 0 CL WSJ Z N U 0 0 0 3 FL IL IL IL IL co co 0 o 0 co co CO z CN (D LO f0 O C, C> N Of E ' C (L cD a) fA IA CD O E M 00 O o o o W ~ 0 c c�cm, cD cD 40. U2 0 I y 0 a) zi C t z 75 tn Q) cl E 0 U) (D co O z C j2 g fn IL L: CL Il E k; *a 0 2 0 to 3 02 0 IL 2 0 U) L) Form — STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNED � TOWN SHIP l�r � SEC.' EC TN-R. LS__W ADDRESS C�cr�'F -«i� le. ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ,/ _/'f LOT SIZE 3,,�_ /51C, Ce PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 I SHOW EVERYTHING WITHIN/1 b FEET OF SYSTEM i 5� C C h � ! INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /r Elevation of vertical reference point: Proposed slope at site`)))): r SEPTIC TANK: Manufacturer: ��� CAceg&O iquid Capacity: Z Number of rings used: __ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,(2ySide,O Rear, O feet - From nearest. property line : Front Q Side 10 Rear,0 J� feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) '" - - inn *. •.+nnnn or*..v J . y• L PUMP CHAMBER Manufacturer: ��.��QLiquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: j .� � Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: 5 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: h/ Width: Length: n Number of Lines:_ Area Built: 5_ (11 0 Fill depth to top of pipe: e" Number of feet from nearest property line: Front, O Side, O Rear, Pt . 7� Number of feet from well: Number of feet from building:' (Include distances on plot plan). is i; SEEPAGE PIT `i 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). ..Y HOLDING TANK 1 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: 3/84:mj 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: SE%,SGI 4-,S34,T30N-R15W Pq CONVENTIONAL ❑ ALTERATIVE (If assigned) Town. aj Gtenwcad ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound OIL-10 k n AM ERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Doug Stan,dae t Route 1,GZenwaad City, W1 54013 �- BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Wayne Lanen,z 934 St. Cnak x 119364 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES F-1 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: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAREST-� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavafon. (If soU can be rolled into a wire,construction shall cease until MAIN the soil.is,dry enough to inue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS [__ GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST-- MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: 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 ❑YES ❑NO NEAREST C �0 Sketch System one` Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Admi vwsticatan DI�HR SANITARY PERMIT APPLICATION CO1 C 0/ ' In accord with ILHR 83.05,Wis.Adm.Code-�J_ STATEANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STA/TE PLAN I.D..JwNUMBER 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 n NO PROPERTY OWNER PROPERTY LOCATION �- �-� I-� '/a S''/a,S T , N, R �S E(or) PERTY ER'S MAILING A ESS LOT NUMBER BLOCK NUM ER SUBDIVIS O N ME ('- C-1 CITY,STATE ZIP CODE PHONE NUMBER NEARES R AD,LAKR LANDMARK Glen c� �, U - �S q /.SCE o r_1 TOWN OF: E- Ler oo Lk) loa III. TYPE OF BUILDING OR USE SERVED: AU4.1 Ol —107q_ Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. EgReplacement 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..RrConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ee a e 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): a/ / a Jr rn 0 _7 0 7,5-4s Feet Private El joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank ✓ Q El Lift Pump Tank/Siphon Chamber ��� I 2 C <�� ❑ ❑ ❑ 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 Signature:(N Stamps) MP/MPRSW No.: Business Phone Number: W-N -e U (-( �,, ,,Iumbe 's Add r ss(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMAT ON art i ied Soil Tester( ST)Name CST# CST's A DR SS(Street, ity, tate,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate issuing Agent Signature(No Sta ps) RApproved ❑ Owner Given Initial S,M¢harge Fee 1+� /J►//� ? Adverse Determination 120 'OV I+� w —�� v W� Y 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 a, 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 816 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 afar�- included the creation of surcharges (fees) for a number of regulated practices which Wisconjsil'I'3 can effect groundwater.The surcharge took effect on July 1, 1984. All of the water that buried treasure ° 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. 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) 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 ! ...,._ , Section N-R W Township n ujood Hailing Address +e cOh t 0 © + / 3 Address of Site--p ©q4-e Cm e Subdivision Name Lot Number Previous Amer of Property Total Site of Parcel iv Date Parcel was Created,,, �i Are all corners and lot lines identifiable? Yes �/ No to this property being developed fo male (spec house) ? Yes No Volume ! Band 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 Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I flue) ceAti 6y that at t Statements on thus 6OAM ane tAue to the but o6 my (oun) hnowtedge, that I (we) am (ate) the owneh(b i o6 .the pnopehty deAcAibed in .thiA .i"gov"ati.on 6oAm, by viAtue o6 a wavtanty ed neeonded in the 06 ice 06 the Countyy RegiAteA o6 Deeds ah Document No. ;, ; and that I f We) phehentty avn the phopoded site 6oh the bewage du5pob by em (on I (we) have obtained an eabement, to tun with the above de,�e�.ibed phopehty, bon the conatAucti.on o6 adid eye.tem. and the dame has been duty heeonded to the 066ice 06 the County Reg.Laten o6 Dttdi, cte Ooc men t No. ) SIGNATURE Op OWNE�Ry SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1992 427384 83PAGE X24 REGISTERS OFfiCE ST. CROIX CO., W ISII Howard Sneen and Ruth Ti:.�-Sneen, his wife, and Recd. for Record tt�a 25th &d-61i"i n"h f"s o rlie"r""i ricl'i v i d'u'a I"r'i glif"""""""""" 87 ............................... ............................................................... day of J_,,.-n.,:,....r°►.D. 19_ ............................................._................................................................... t 9:00 ..............•-•---...-•-•--............._....---..................._..---•----.._.._........................... conveys and warrants to ...DOU�las W. Standaert and __._..Ka.blem..IL,... t lls� x. �...hu b id...end•-w -fe.�...... .... s Uw ll ......holdA.rlg...l ... ?�lti�].Y41; klJL ' P...ln r? ta.?�...pr4.I?erty.!......... ........................................_.._..........-••-........................._.... .. ...... ..................................._......._.........._.........................._......_......................_. RETURN TO ......................._.._.._..._.... ..................................................__.. .............. ....................._...._.._............_........... ..._........._...... the following described real estate in... St. Cro1?C Connt I State of Wisconsin: Tax Parcel No: .............................. Part of the North One Half (N2) of the Southeast Quarter (SE4) of Section Thirty-four ( 34) , Township Thirty North (T30N) , Range Fifteen West (R15W) , more particularly described as Lot Two ( 2) of Certified Survey Map filed June 17, 1987 in Volume 7 , Certified Survey Maps, Page 1837, office of the Register of Deeds of St. Croix County, Wisconsin. w , 00 i This ...........s ................. homestead property. (is)XRWI GW Exception to warranties: Easements and restrictions of record. Datedthis ...................2.3...........----••........ day of .................7 U n e.........................,................. , d ----------------- ...................................................(SEAL) .. .......(SEAL) Haw!ar d..Snepan.................................... .....................................................................(SEAL) ....... .... . .............(SEAL' ................................... * Ruth T. Sneen r . .....--•--•------_..... ..................................................... ............. AUTHENTICATION ACHNOWLEDGMRN, ©� G• ter �✓ Signature(a STATE OF WISCONSIN as. ...--•---•-----...;....................•----........---------- --...... . .........S .....0. olx.......County. r�ru�ru authenticated,this ........day of........................... 19....., Personally came before me this ....... 3.....day of ...........June. . ....................... 19-0.7... the above named .. .... . A0Vand..S.11een...?Lj?.d-..Rl4th..'I:: '..••---•••--•--•-•--------•.............................. TITLE: MEMBER STATE BAR OF WISCONSIN i: ..........................................•---•---•---•-- ...................... (If not, .... ................................. ..:. - .......................... .................... ...... ----....... authorized by § ?06.06. Wis. Stats.) r, to me known to be the person S.......... who executed the fore inatrumen acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack 4w.0 ....4............................ II .Baldw.........wl....-54002.................. ....... ........Reuben- Doorn-ink.--- ............ ...., Notary Public ....._....S t . C r o i X County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration Iiare not necessary.) date: ..........Aug_....2.7.............................. 19..89...) *Names of persons signing in any capacity should be typed or printed below their signatures. I� _ _.,._. _._.__ II.C.MilIarconv" STATE BAR OF WISCONSIN FORM No. E— 1 SLACK NO. 3002 952 - - --- x cn • a r STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o x St . Croix County d a H S � OWNER/BUYER � V4 NUMBER 0184 'e ,� `e Fire Number ROUTE/BOX z LP CITY/STATE S 1 e y ! -------�---- S u� � S e c t i o n� + T N , R �,L_W , PROPERTY LOCATION : C, �, + Town of /eg��� , St • Croix County , Subdivision Lot number • use and maintenance of your septic system could result in ` � improper ' ntenance con- sists mai its premature failure to handle wastes . i ears or sooner , of pumping out the septic tank every three y if needed , by a licensed _s�_2tic tank 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, whick� 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 . to submit to St . Croix County Zoning a The property owner agrees 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 H three year expiration. O E I/WE , the undersigned, have read the above requirements and agree x CA to maintain the private sewage disposal system in accordance with the standards yet. lortt► , Ilerei_n , tls ic�L by thc� Wiwcnrtt�xin f)upart- 'd meet of Natural itesourceq . (,ert .if teat Lon form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SICNED 1)ATE 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 . DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.0911)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ LOT O.:BLK.N .: SUBDIVISION A E: S B EN/R . E (o W C, UYCOUNTY: OWNER'S c �( NAME: MAILING ADDRESS: USE I DATES OBSERVATIONS MADE N0.BEDRMS.: COMMERCIAL,DESCRIPTION: I "LE Residence DE R PTIONS: PERCOLATION TESTS: Q ❑New Replace 1© /Q RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MO ND:❑� IN-G®ND• URE:SYSTEM-IN-FILL HO�LDING�NK:RECOMMENDED SYSTEM:(optional) jMQI S U 1AS S U S L'S�jJ U S U ; O Yl If Percolation Tests are NOT required DESIGN A E- I If any portion of the tested area is in the N/4 under s.H63.09(5)(b),indicate: A 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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- Yly D / / P- D "3 P_ 3 9 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 3 j S 1 100 , E {{ IN lo 1 YI ,.,.... �._......... __ - i i , r , E [ 3 t � t 3 A 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. AM (print): TESTS WERE COMPLETED ON: GL q n o (--e> h 09C171 # ESS/ � CERTIF C/A�TION NUMBER: PHONE NUMBER(optional): CST SIGNATURE: J�t Q__4 DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DI LH R-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - S D - 6395 ' To be a complete and accurate soil test,your report must inClude: 1. Complete legal description; S. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a nevv or replacement systern; 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; 0. 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 to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 0- Complete all appropriate faxes as to dates,names,addresses, flood plain data, percolalion test exemp- � .tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A. it) the appropriate box; 11. Sign the form died place your current address acrd your certification number; 12. Make legible copies and distribute as requilod= ALL SOIL TESTS MUST BE FILE[) WITH THE LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St — Stone (aver 10") BR Cie€:frock cob -- Cobble (3- 10") SS — Sandstone gr Gravel ("under 3") LS - Limestone, �s Saand HGW — High Groundwater s Coarse Sand Perc _ Percoiatknri Rate nrrsd ! lediun; Sand W _._ We fs Fine Sand Bldg Building k Lo&rny Sand > -- Grr,xater Than sl Sandy Loam < — Less Cdaarr Loam Bn tBrovvn x . sit Silt Loam Bl Black si - Silt Gy - Gray cl -- Clay Loant y Yellow set &wdy Clay Loam R -- Red sicl - Silty Clay Loam mot Mottles sr; __ Sandy Clay r=i - vvitlt sic - Silty Clay ti; ._ fe , fine, faint 'lay lit flc-at MITI - Many, rntAiuru in -.- Muck d - distinct p - plrorninellt HVv''L -- High water le=vel, Six general soil textures surface°:mater for liquid waste disposal BM - Bench Mark VRP - `vertical Rt.,ference Point TO THE OWNER: This soil test report is tlae first step in securing a sanitary pertnit- The county or,the Departrrtent may request verlficatioll of this sail test ill file hold prior to Permit. issuance, A complete set of plans for the private sF kv& e systent and a perrnit application must be submitted to the appropriate local authority in order to outain a pei rnit. The sar-rowy txarmit must be obtained and post ed prior to the start of;rimy r"csrastructiurr. `L 0 B M O i - SEWAGE EJECTORS - Features and Performance SP40 • Oil-filled ball bearing motor 28 4110 HP—MAX.SOLIDS IW"SPHERE—1750 RPM incorporates automatic reset thermal overload. 24 • Non-clog two-vane impeller. 2U • Reliable diaphragm switch. • 2-inch NPT discharge. o 16 • Stainless steel shaft. ,2 ° - i4 Jam►. • Completely field serviceable. 8 AMPS AT U 11SV. . . 9d.AT 230V t.7 0 0 20 40 60 e0 100 120 US.GALLONS PER MINUTE SP50 IS Oil-filled, heavy-duty ball-bearing 1/2 HP—MAX.SOLIDS IV."SPHERE—1750 RPM motor. • Enclosed, two-vane sewage type ,. impeller. •Oil-isolated level control _ 1 diaphragm swtich. = 1e IS Mechanical shaft seal with carbon „ and ceramic faces. e 1 . •2-inch discharge (3" flange optional). 4 S`°41 ^eV 1 211 AT 23W" FULL L0 O -- -- -- -AMPSAtU •Completely field serviceable. 0 IT 13 0 20 .0 W e0 120 140 ,w 1yy,1 yy,yy,y,yy1y1y1 y USS GALLONS PER yMINUTE y 11 yy1yy11yy1y 1yy 1E 7t )c R� 7[ 7t ii lE 7{ 7E R /t 7t 1t A 7i� 7{ � R X M 7S 1C 1C 7t Si Ti �� 7f R � 7C 7t 7C ➢C R R R )f 7t 7f It R if if SEW50 • Heavy-duty, oil-filled, 1/2 HP motor 1/2 HP—MAX.SOLIDS_1_3h"SPHERE-3000 RPM with built-in thermal overload 24 protection. Z 20 IS Heavy-duty, cast iron motor 15 housing. < t2 "1 • Non-corrosive ABS volute. 5 _ I • Automatic (SEW50A1) features wide-angle switch with piggyback °0 20 40 60 so 100 plug, CAPACITY IN GPM • Manual model (SEW50M1)also available. a PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEN7 CAP I `i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING ,1UNCTIOAI BOX MANHOLE COVER 2.5' FROM DOOR, WIAIDOW OR FRESH 12"MiU. AIR IWTAKE GRADE y"MIN. CONDUIT �`-- --------- \ ----- 18"MfA.I. ' ---- - PROVIDE I ----- IMLE T AIRTIGHT SEAL I I I I III APPROVED JOINT A (I I APPROVED .IOIAITS W/C.2. PIPE I III W/C.I. PIPE EXTENDIUG 3' I I ALARM EXTERIDING 3' ONTO 'SOLID SOIL I II ONTO SOLID SOIL I ow C OFF D COAICRETE. BLOCK RISER EXIT PERMITFED GIJL9 IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC.IFICATIOUS SEPTIC AND SE TANKS MANUFACTURER: '��''Z IJUMBER OF DOSES: PER DAM TAMK rIZE: ,L.(Q d O C� JS DOSE VOLUME: GALLONS ALARM MANUFACTURER: � e-4i/�-�� CAPACITIES: A= IKICHES OR GALLOEIS MODEL 1JUMBER: 0 I B= IIMCNES OR GALLOWS SWITCH TAPE: 1024 C=-IMCHES OR GALLOUS PLOA ' MAKIIIFACT LIKE R: "�=e � D= IAICHES OR GALLOUS MC>n L 'NUMBER: NOTE: PUMP AND ALARM ARE TO BE IMSTALLED ON SEPARATE CIRCUITS :),WITCH TJPE: ...______ PUMP D15C,HARGE. RATE ____GPM VERTICAL DIFhERENCE BETWEEAI PUMP OFF AIJD DISTRIBUTIOM PIPE.. FEET + MiuIMUM NETWORK SUPPL9 PRESSUR7E/. . . . . . . . . 2.5 FEET -} FEET OF FORCE MAIM X FyooFtFRICTION FACTOR.. FEET -r TOTAL DJtJAMIC HEAD = FEET t1dTERA1AL, DIMEMSIONS OF TAIJK: LENGTH ;WIDTH -;LIQUID DEPTH SIGUED: y LICENSE NUMBER: DATE: 9 I I I 11 I I I I�1� . 1. I - I 1� ,,, � ;�, _ , : I I , , 31 1 "i "� I I — 11 I ,�, :I I I 11 ,� I- I , ,:I�7 , • , I I , �: ,': � I I,I— ; I I ,�", I 111,,mow 7� c, �' � . a�a .... x `' mt a ak# ,` x z ." of ,k' { dA'>, , 54 y 7 r h 11 aW ,o S s 11 4 r y_ & .. i t Y 5 -C 1 i s I I"11 1-1 "___ f v�a 6 ��1 t�,w bT r a 6 11 aut ram d '" r �� ° �'� ,, M `k1r 11,III ':� e '7 ;b' spy-Al q 11 I 4 -; tt 4 p_ .,� .�; 4 -- MODEL , f� 78 MODEL 198 4 188 Z 70 r 18 ':�: ' gg ' 30 107138 MOp10 d P r rh MtM�k 4 J ' 4 k at '+ q Iv: .' 1� -.5 `"'r r a n "C w MODEL - ] ...rt' a t a r� r g 93,55, - 57,56 y bhp t 61 r tr . i'sY ^(cs iY s ONO 2�1 30 10` 80 i8 80 66 106 1 �� r t`" 0 0@ 100 $ !11 1 �. 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