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HomeMy WebLinkAbout020-1127-10-000 `� o ' °�' ° I a•°i o I M O p °� m a a' c I tv I h N w CD p d t? E co ti I� N mod co°O<V J y 00 to O M O C N X O tU ?, E U (YCO N D C p• y J N CO 0 N tOA Goo m m O N 0 p C Z �L c Z y Lo ai U. C f0 S O f0 d 3 o rn w a o �p 0) to (n o v rU rn o m o v Q a E ¢ o�� M M Z N to E E z .. c d € •`o E o m m NW am am o o O z :!t C U C U F- O c O O C O Z Z E 2 c E Q2 co V O1 M : N tU � N D. •7 7 Imo tU 7 N tU •� d CO N CO d o O c O a� o 0) Q o �w I Q Q - z z z m z 0 0 N to Z z m m i0 E :01 N N N W L p a a �l O V N CL O O c 0 O. N l ++ C 1 d tU Q) O r W d G1 O co G G a .a L 0 In a n. 17 V @ N a o o v� to v> E o I N N N E o �►N aaa , aaa IL o u,w co 00 �o t" v1 .° °� U a r-- r, } ao 0o } _ rn rn J N N O co o o Y O E - In in O E I rn C E 0 0 E 'O to 0) 0 tU tU 'O y 0 _m tU Ci Q2 7 w 7 r fn °o O tl! C E v y c E O O l V H Q on I (v n M.- m z O c a� C�to d �� C) _ o c � rn7 o ~ A C � d o O c) :3 7 N N N O yZ 40 7 yU U UN V O c N d I 2 U) w o z c I- g cn p Cd r E ` d dt a `m € a 'c v L: a- dad r A c°� a 2 ! o vii c°� o vii 0 % Form - STC - 104 ' r AS BUILT SANITARY SYSTEM REPORT �ARa(&L C'UANS OWNER TOWNSHIP ��DSa,� SEC. T Z� N-R � � W ADDRESS 40 y �'P£� //(// ST. CROIX COUNTY, WISCONSIN SUBDIVISION RfeeUi,�t L./ LOT 62 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used AS j�PF d-A-r&- Silk ,fL� Elevation of vertical reference point: 0 D' 0 Proposed slope at site: 0- :;?- ,P" Errs riv(� %,},K .t'F 2i.f�o SEPTIC TANK: Manufacturer: L0 4 SE/2 r1!7L Liquid Capacity: d -- ' Number of rings used: Tank manhole cover elevation: X001 ' Tank Inlet Elevation: f5' Tank Outlet Elevation: Number of feet from nearest Road: Front, Side ,Q Rear, O L' feet t2LE N M i 11 4V' WEST From nearest property line Front,0 Side,O Rear,O 7 S feet Number of feet from: well l96 , building: 15 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE_REVERSE i PUMP CHAMBER l` Manufacturer. Liquid q id Capacity: Pump Model: Pump/Siphon Manufacturer: ZC>t(l�� Pump Size y2 � Elevation of inlet: / / ' Bottom of tank elevation: 90' Q i Pump off switch elevation:/ 2 ' 0 Gallons per cycle: 130 Alarm Manufacturer: L ( 14 141 M Alarm Switch Type: "k, ER�e� (0"k T— Number of feet from nearest property line: Front, Side, O Rear, Ft. G Number of feet from well: /03 Number of feet from building: `S Y / (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: 3- 3 2 Width: s Length: Coo Number of Lines: Area Built: Fill depth to top of pipe: 2 y "40 3 & " Number of feet from nearest property line: Front, ©Side, O Rear,O Ft . 3'3 Number of feet from well: 1 2�PD Number of feet from building: �a / (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: XDmeter: Liquid depth: Bottom of seepa pit elevation: Area Built: Has either a drop box O or distribut box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings use Elevation of bottom of tank: Elevation of in t: Number of fe 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: 2,12 Inspector: Dated: 116� Plumber on job: License Number: HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ' ROBERT ULBRIGHT 3/84:m WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. P"NN.INSTALLER&DESIGNER LIC.NO.00663 wcl LT- REPORT' Z /{o M E7" � -• ` CASE ffAeOLD � U#kO S t xgostD —zo 'ISI1y �K r v.h.er - -- ,PE "WISED • ��H� stir so-14 P8 _f1 ��of �ki'ST/Aj aAFFLeJ �fA�ST�ass,paD i s � N � • PUMP • �3, ��G 'j'� dpi S- z &Z � sYsrtM �G•S Af r 3 0-�- N - - - _ _ - - - - - --- - ----- 32 f 3' (' � r 5'x bG �u p or ' 11 . 9R Sy� ' C&DAR Toy i,,y ToplP'Px sys�e�+ GS fA j2 C ro of.)P I'A3 46-60ATt C3/y'' f , �,P��.✓ iii// 4AI HOMESITE SEPTIC PLUMBING 5. 655 O'NEIL RD.,HUDSON, Ale ROBERT ULBRIGHT NIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. A�` ? '.^'N.INSTALLER&DESIGNER LIC.NO.0001 +r DEPARTNA NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING AQADISON,W l 53707 SE4,NW4, S17,T29N—RI 9W MtONVENTIONAL ❑ALTERNATIVE jtatePa.I.C.Nr,mber: Town of Hudson El Holding Tank El In-Ground Pressure ❑Mound Lot 6 Parkview Estates Mvcm NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Harold Evans 474 Green Mill Lane Hudson WI 5401 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumb— MP/MPRSW No.: County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 106128 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUyD TANK INLET .:G TANK OUTLET ELEV.. WARN(NG LABEL LOCKING COVER `/ f PRO IDED: PROVIDED. YES ONO OYES NO BEDDING. VENT DW I VENT MATL.. HIGH WAT UMBER ROAD: PROPERTY WELL BUILDING. VENT TO FRESH ALARM LIN �� I (AIR INLET ��{{ EET F R �,^❑YES LINO ❑YE EARES \ �% DOSING CHAMBER: MANUFACTURER G'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MAN F CTURER WARNING LABEL LOCKING COVER , / �/ P OV DED PROVIDED: �rJ 17YES NO vV ! 7 _zd Z C YES ONO YES ❑No GALLONS PER CYCLE: PUMP AND CONTROLS OPERA710NA L: NUMBER OF PROPERTY 1111-1- BUILDING jVENTTC11E1H (DIFFERENCE BETWEEN ? FEET FROM LINE / so AI r PUMP ON AND OFF) /^ YES ❑NO NEAREST (y L) �V SOIL ABSORPTION SYSTEM.Check thesoilmoistur eat the depth ofplowing LENGTH DIAMETER M or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE �LZ 3 the soil is dry enough to continue.) � MAIN CONVENTIONAL SYSTEM: WIDTH: L NO.OF DISTR.PIPE SPACING COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCHES MA IAL: PIT - DEPTH DIMENSIONS : 3 �j l f GRAVEL DEPTH FILL DEPTH US�TR PIPF DISTR.PIPE DISTR.PIPE MA gIAL. NO.DI NUMBER OF PROPERTY 7:_Z�BUILDING VENT TO FRESH BELOW(ES,ES. ABOVE COVER 'V INLET ELEV.EN�D1 PIPES LINE 2p AI L 1 �e7 Z_ 7 2''T NEARESTO U �� M OUND 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 ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS JOIISIHVATION WE LLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES El YES OYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA. ELEV.' PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. [� FEET FROM LINE ❑YES ❑NO DYES ❑NO NEAREST v Sketch System on w"� fain in county file for audit. Reverse Side. i� SIGNS« DILHR SBD 6710 (R.01/82) TITLE Zoning Administrator SANITARY PERMIT APPLICATION COUNTY ^ _ ,, DIL.HR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# w —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D. UMBER 8%x 11 inches in size. y —See reverse side for instructions for completing this application. PETITION �— 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE 1:1 YESOE NO PROPERTY OW�NE f j PROPERTY LOCATION C L_& rm,,� 5C—%IV W'/4, S /7 T , N, R 7 E( r) PRO ERTY OWNER'S MAILING ADDRESP LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME J C STATE /�,r IP CODE PHONE PHONE NUMBER CITY NEAREST ROAD K Uf»l0�/ ^'! �tP <O VILLAGE; #041 AI /'� 11. TYPE OF BUILDING OR USE SERVED: ©,D — A,2 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.�Replacement c. El 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./SjConventional 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) Z 414) 1. a. ❑ seepage Bed b.*-See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): � e' 5'0 �� f00 v Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in al Ions Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank x o/ev-0 aKwo w ❑ El 0 El F Lift Pump Tank/ er t UIE6e5 - ❑ ❑ ❑ Ej 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:(No Stamps) 'WP7MPRSW No.: Business Phone Number: 21 b1Q r'C kT 33a 7 K Plumber's Address(street,City,State,Zip Code): Name of Designer: (S'S 6 `A)jr-i #Vl so'." Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name ie-MESITE CST# 655 O'NEIL AD;,HUDSON,WI&54016 Z y 11 RRij3NI CST's ADDRESS(Street,City,State,Zip Code) "NIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. Phone Number: '' NN:rNSTALL"ER&DESIGNER LIC.NO. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Is MingAgent Signature(No Stam s) Approved ❑ Owner Given Initial � (ems rg�e^Fee /t Adverse Determination I�J (�• �" ^ lJ►-�.1r�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 sewageaystems 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. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 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 gallcns 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 81/2 x 11 inches must be submitted to the county. The plans must include the following.--A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and-pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data'on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE:: On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This-legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate.*The groundwater bill Ground �ttgT included the creation of surcharges (fees) for a number of regulated practices which Wisco tbrS ' •t e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r fire. 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(8.03/86) ! APPLICATION FOR SANITARY PERMIT S T C - 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 Y/00/k 4F61111� � / Location of property E 1/9 W 1/9, Section , T N-R W Township #_VPSCA,1 Mailing address �� � '✓ ���� G'y Address of site U/ Subdivision name �" -17e'R- S Lot number 6 Previous owner of property 1�ON Total size size of parcel Acit f Date parcel was created Are all corners and lot lines identifiable? / \ Yes No Is this property being developed for resale (spec house)? Yes o Volume 119 and Page Number YLS as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposa system (or I (we) have obtained an easement, to run with the above described property, for the construction of said qystem, and the same has been duly recorded in the Office o=/t ty eg' r o Deeds, as Document No. ) . Si nature of Owner Signature of Co-Owner (If Applicable) 0 Date of Signature Date of Signature F aS ....... 14 � Tax ' Lot 6, Park View Estates, Township of AWson, St. Croix k " County, Yscemsin. z 40 of - .. UgUS .. ..... .. ... .. Spit "� T VW .+ +l i$'• ♦������� g 4. �e-a� ' AktkoP WISCONSIN .......... € # to mR k of(* OW 4 Q it d JlAindeen ,. POO AK p3r*Adw • . v # m V7 elf A.. h•�xt' x •�'. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT H" St . Croix County OWNER/BUYER �� ROUTE/BOX NUMBER 7 -f-f xl` 1,v Fire Number { �; CITY/STATE i6�yPS(N 4�)/S ZIP• S-7 O h l� �•r �� PROPERTY LOCATION : 5c fit, N Section I / , T N, R Town of y pfo St . Croix County,` Subdivision /fie &e&) , 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 putt 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 i maintained. • 1.''. 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 4 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 Depart- ►~q l ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning ff�pe wit in 30 days of the three year expiration date. � I SIGNED Gam' I DATE St . Croix County Zoning Office "? P.O. Box 98: Hammond, WI 54015 j 715-796-2239 or 715-425-8363 g Si n date and return to above address . '�► � I 1fPP&-vU­tt 70 Refldet- of c T /vT- 377APF-507 17F77 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 3707 `..HUMAN RELATIONS 1 � MADISON,WI 53707 (1-163.090)&Chapter 145.045) tMATION:- SECTION: TOWNSHIR0M1JA"IPAj:l1rY: OT NO]BLK.NO.: SUBDIVISION NAME: s�- '/ �/ 17 /77-111/1111 E( ► U DJ0 A3 (, Pr4P lF u I&Lo COUNTY- : MAILING ADDRESS: tmpoLv �'� N S 41g /"//// G.v . l�vLZ1 a-v Gv�S USE DATES OBSERVATIONS MADE ( Resider>ce O S: y SSTc--- "'t ❑New Replace 7 N f 2- RATING:S•Oka suitable for system U-Site unsuitable for system ICONV M U D: N-G -FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U S ❑U ®S ❑U ❑S ❑S ®U CO 0 UE13166,JAL - TRck)C,L,Q S If Percolation Tests are NOT required JDESIGN RATE: If any portion of the tested area is in the under s,H63.09(5)(b),indicate: G(+rS S Floodplain,indicate Floodplain elevation: '"o PROFILE DESCRIPTIONS BORING AL P R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELJEVATION OBSERVED E GHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B- i =7 h a fi o r 3,0e4CE'" Ae5ec ' PERCOLATION TESTS 7 /v Lrs C� �Q 5'1,71}'f,f S TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERT D2 PER INCH P. 3. `1'i.�l' � L r• P. P.40 3, p P.. i P. *LOT PLAN: Show locations of percolation tests, mil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tontal 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, i SYSTEM ELEVATION - - -- -- --d ta 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 ,r Administrative Code,and that the date recorded and the location of the testa are correct to the best of my knowledge and belief. f,. A print : TESTS WERE COMPLETED ON: HOMESITE 9lP11C PLUMBING CO. c 8%O'NEIL NWSON,WIS.54016 3 — I Z Ad ROBWULBRIGHT CERTIFICATION NUMBER: PHO NUMBE loptional): WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. Z y Z— 3 MINN. CST S GNATUR ISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. b1LHR-SBD-6395(R.02/82) —OVER — �G- o F Z REPORT ON SOIL 13ORIN&S i PERCOLATION TESTS IIS' Poor PLAN PRo3-EC r. D. NARoLv 6'11.4.05 - ?4RKVlEw DA rE D� . 6 19 JP 7 s f�" HOMESITE TESTING CO. AT-3, O'NEIL ROAD BOB ULBRIU, AI, DSON, WIS.. 54016 CST sY-02 yez PROPOSED MOUSE mosr LIE ZS- Fr. o f Atote APOM . iu- TEST #,PEgs. Pft POSED WELL M o6r LIE 5o FT. a� �yp,PE- FiPOy fit[ TEST ,�j,PE/j s, • " 8�4�' Plrs #AVP Ad9E,PE0 o,Q S,4,wj-,t S • ` //oe%Z . 8 M ® = vrpr%G*t RCAFPZA14E PO%,JT T°P OF x p o s c o S �fl E E/El�ilT/ON A/ffE�fiE /Ro✓i s.'vEt��9/k �T s, W rip LEGEND t/al. ofro . �pr io o .o ' w 1N -%+A1Lsok- a Y.Ve 14--11700 I 3 'BtovM5. J,4446- I I wiuD�'J S,DE wAcK" r�J Dy}LET th(STN►y \VERT 0 REF Pr /ovv f PR���' • y'9.yo' (OAJO SO rK, 611 TAA)k= 95.IS -- 4 ' �T f EA i6r)A)(r C.r. U. 2 GSA Py 3z ?7 x 55'-t0 CEAJTER Of G REE,V Mill W. DEPARTMENT OF INDUSTRY, REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS LABOR DIVISION HUMAN REDLATIONS PERCOLATION TESTS 115) P5,1 of Z P.O. BOX 7969 (H63.09(1)&Chapter.145.045) MADISON,WI 53707 ' EOCATION: SECTION: TOWNSHIP/iOfCfpfCTr-PVC-1-i Y: OT NO.:BLK,NO.: SUBDIVISION NAME: 1/ 1/ 17 /T29 N/R/9 E(o W NuDSON:' OWN R'S B:'-Ye^�;NAME: MAILING ADDRESS: EaA 4AROLD �'v.4✓vS 474. 64"EU 14111 1w. 171& ro�, USE NEDRMS : COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE N- �1 ❑New Replace DZC S 1110? NS: 19.4-- 6 /TESTS: RATING:S=Site suitable for system U=Site unsuitable for system .5; 5 WA MT,,�­— 10.4,t 1 — G 5 6-R, SV C3-$'?. 1- ONVENTI NAL: MOUNccD IN_ -GROUN�c`DPRES''SIIURE:SYSTEccM-IN-FILLHOLDIIcNG TANK:RECOMMENDED SYSTEM:(optional) ®S �� ©J ❑� �J ❑V ❑J E]U ❑J ©� t^o X EA.)±I•av44_ T Ter-ckjjf W itL. PtPPROUAL- OF � T. If Percolation Tests are NOT required DESIGN RATE: -- I under s.1-163.09(5)(b),indicate: C/ItS S =� If any portion of the tested area is in the - Floodplain, cate Floodplain elevation: i PROFILE DESCRIPTIONS tN DEGiMh' fr BORING TOTAL PTH TOGROUNDWATER-I NUMBER DEPTH IN, ELEVATION NCHES CHARACTER OF SOIL.WITH THICKNESS,COLOR,TEXTURE,AND DEPTH OBSERVED ST. GHES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 1-33 ' Rik. iO4 M' 1.08' -Die. -6y. Si ,2.0� oiuG'B- o.0 9y, Gy � > /o, o ' GZ.Ys,t, 6, TAN S.v-iv7asEv'vy�iR�y/ocs� 4e',/v o l g. C-5 2- /0,D t �9 �0' 1. m,-. ,a l 3 w,�l Gs B- � p gr 4 . 75' 31k. laa.y I.z 9 B- 3 0.O 9 05 c5 T4.v 7 ✓ B- / Q •� ./9�b� Ale 3, 0� 1.33 3{k. /o�1M 1.0�' Dk. R.j• -It T/3 1,0�' o/ru£ R? 5// wi CrJMMON 7iSTivcr /-4 . CSR-6. . 401%5 B- ;RoM 3.5 ' ♦e 70' , IIgvDS of 9RTf `Fiat 140t1i D N X �O a.✓ DIS'r%.vC7- nQ-GR• Hp'1F SI B- V0 re of E I'srW6- S Prfc ToiaIC ovfte-7- = 95•/S I,v 0ee.r-r• PERCOLATION TESTS TEST NUMBER DFA►6+Eg AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD 1 P E RI Z05 D PER INCH P- P- 2 � L P_ 3 P- P_�_ x& o 0 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 30-rT0M Of- T REAje 49 F0 ' 4 C G.gAc1z0 D F OI VE —g y PJLOT JUL- N '• 50iL E1/,41,0,+r14,1 OF �— `04V&J AD S4 C Ca'r 'T D O GIB N el?'S rS T'y,Li U��Fi<v fiELD i T E�4SOw�l// S+Tv04Tfp sr� -/D�}MS MQ ff�ta BgvDED 7 ✓''�E SA x I 5ET i v LUE// D0w;Ve'a S vi/,S -Y//./r ZE _G_ x/'t i I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): HOMESITE SEF I IC PLUMBINe eeo TESTS WERE COMPLETED ON: 655 O'NEIL RD.,HUDSON,WIS.54016 ` b ')DRESS: D WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. CERTIFICATION NUMBER: PHONE NUMBE (optional►: SIGNER LIC.N0.00663 2 I f L 3�(0 -. ��s CST'i1GN �nal and one copy to Local Authority,Propel ty Owner and Soil Tester. -.02/82) --OVER— yy` PG.. Z a F Z REPORT ON SOIL BORiN&S T PERCOLATION TESTS 115— PLoT PLAN PRo3-EC-r _'. D. 4A Po L O C UhAJS - �r4le W01E w DA rE 7 HOMESITE TESTING CO. RT.3, O'NEIL ROAD BOB U1 BRJ(;j.i A AUDSON, WIS._- 54016 CST SS-02 yez PROPOSED House Mosr LIE 2� Fr. O� MDRE "o-of ,gLt TEfT ^er.4s. PRO POSED wi LL M VSr LIE ,So Fr. 4� /"lO�PE Fi oAl , tl TEST �y'er • ' eAG�'/y(O�E I�lT,f 0 = 47d UAI(r W ELL X ` AEQG /o Armes �{ a //ANB 4919EQE0 10 54Wft �G1�ES • _ //oriz . BM ,PEFERW4r Poiar I-°P of -x Poscv A ' fPW E'leOAriow Ay�C�y�rE /RO�i s:vEwq/k , ,t T- c, w . -r P LE GE N p e/fv,►ron/ of 1/Of. #PEi io o - o ' w �� ��Crs r►a s (r ►/S Tfw1 1N 3♦A1L#49- vtie- 14- if 7'r 3 SeoRHs. r i 2, 0 1 1, : 6iDEiuAcK ' „}LET On" \PERT O , ReF. Pr pareAs r ff.fa to.o40E SEP�"`� GS' TnaK= 95.i5 - EXeg AV, C.r. ° a "0 1 'B - GS • Py P, � lep 3 3Z" N d Imp o 55"+o CEaTeR of Mill W. i /+Qzr.1 Mail 1 .� DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS . INDUSTRY, .HUMAN AND PERCOLATION TESTS 115 P of 2 DIVISION HUMAN RELATIONS CC P.O. BOX 7969 LOCATION:llv'190k�' (H63.0911)&Chapter 145.045) d MADISON,WI 53707 TOWNSHIP/ OT NO BLK.NO.: SUBDIVISION NAME: SE :- V 17 /T29 N/R 17 E(o MupSoN Ps�pt��ii6w �sr�t>�s COUNTY:- OWN A_M A LIN ADD SS: sf coax RAROLD �iIIIII s 17 4' G-��>�,,/ �%// �. /��9.10-✓ Gc%c.t USE BE DATES OBSERVATIONS MADE fit OMM S I!f ON: S. Residence 3 ❑New ®Replace DESC LA N �Jcc s 1�tP7 Jet C iP 7 RATING:S•Site suitable fors 5 GS 5 g 9A leOTA-- 104H - C$ �(rR,system U Site unsuitable for system ONVEN ffju MOUND: IN-GRnOUNc YSTEMM- N-F ILL DED SYSTEM:(optional) ®S ©S ❑� a] ❑� r--1 �V ❑J ©� C�,X ft'ev�C.. + TQEvCI.Cf r a �iUEs W ffk 4PPROU^L of: is T. Iolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s,H63.0 9(51(bl,indicate: C/.y,SS r Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS tN �EZiMti� Fr BORING TOTAL UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION!!!D HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-/ /0.0, 99.Gy ' 1> /O.Q 1-33 '.R1k IvIiI I•oR' "Dr-DAIII Si 2.0e-r- .0e o/U Y S�11 5 T,Iu c 5 S.0 ' TAA.J CS 3 Gr . B.Z /O,D' y900' 7co ' /a p ! '7j' 13/r, ImAi . 7S' -Dk,13 - /,� 1,0 0 II 51 w gr., Irs Tav vERy c5 ­0 ' B- 3 O•o• 99005 > io.o . 75' Blk. loa1 , I.zs ' �a. sl w� gle. , �o• T4V J 10, Ry B- ./9�0 !'�0 3, O 1.33 Ik. 10AIII r I.OP' D& 13.1 fy. S1 I,of o//Or p2z 51/ Wiflk C VA4,40,v 7i STi.v eT- C>R-6 . A40-f_4 B- ;ROM 3.6 ' +e, 70' ' BAODS OF 9RI*r Mo+iL 0 r AI Co ,.w a A.J D1:5 ri.v C T OP-6-R. )40+5 S I . N07`I ele u+'o,J af' E I'STi,3 6- S PTrc -rAoK Ovf LET = '75-15 ' Ili DEarr. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-IN HES NUMBER •IAd6�N" AFTERSWELLING INTERVAL-MIN. RATE MINUTES p I p t p R PER INCH P- P- 2 < L G P- . 3 P- .2 O - - 0 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- klintal 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 bf land slope. SYSTEM ELEVATION V oTro m of- T Ise NC�s = q 2. PO P�FcoD of d l,h�TldN S sr tEoI'E y P0 i k) -fioc C0"'►.Pi{_��O� See SEPER�1 r PLOT- PLAo, PA i i— i .. .. ....h•-- f --t----t_-.y.._._. No1W7 8'4560 ca Soil EvgGUPtTiov OF 130,PF //- -r-4keou A•D r4ceaT T O O WN t k S Ex is l"Itii(-1 1.-- tN e`4ovuyTi&"AL �OUPQLy Dc-ep SE�fSON�'//1Y SN T 0,047 p ,410 - S%�7f--/Oq�►S S M0 f��lA B'�oEO 7i'�%t'E S �t'tow�►E•v �tp��t��E,,,r srrTr,�, s�l'v�sv 8�- d�crc _,�9d,��o.-__.�.;`�_ D�!rroN S�r i,✓ 6lJF// D.r�/in+1EG S vi/S - zf�i/r ZE �'X_/;�ji jv G-__.i__,.L----�.._�. 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. AME(print): H 655 O'NEIL RD.,HUDSON,WIS.54016 TESTS WERE COMPLETED ON: R S: WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. CERTIFICATION NUMBER: PHONE NUMBER(optionail: MINN lbIS:[AI I FR P. SIGNER I.C.NO.00663 2 L 3 t'p — laD S CST'iIGN DISTRIBUTION: Original and one copy to Local Authority,Pope,iy Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER – F Z REPORT ON SOIL BORINGS Pt PERCOLATION TESTS IIS PLOT PL.AM P ROTECr r. p. IAA OLD �11AJ5 - T'gRKVJEw DA rE, apc - 6 19 ol> 7 HOMESITE TESTING CO. RT.3, O'NEIL ROAD BOB ufxRlci HUDSON, WIS.— 5,4016 C5 SS-aZ yeZ PROPOSED moose MOST LiF Z,.,!r Fr of Mote FiQOM qLL TEST fl�PE�9S, PRo POSED WL a M osr LIE So Fr. &joer F,POy ,�cc TEST ��E�S, • = SA&eh6kF P/Ts 0 =E.r'�fT/.11(r LCIELL X s PEQG lcelfr/oN/f A f #AvP *4014AM of s4owEL 134eE5 r ` owit . BM ® = VF,pticrt �PEFERtwcF Poi�T rod oF Pos�o _ �f E�E V i}T/O N A y f L�j�j s E /Ro✓i s;v E u i q/k if T S Gc! j'j P LE GE N p e/EVhroA/ o,p 11 r E,o /00 , o ' w 1� �xi'STIIJ G. S IBS TfN1 iN S+111-Q uNt 14- If 7,p I 3 Sed'RM 5. I X", I J�/«AbE �- s�oFwa�,r ou+l.t1' OF cF+srwf \VEaT /ors 9�• O ReF.Pr pKCC�s r. � y9.yo' �oaG�t•F� sEpn, GS' I I + EXiSn� C.r. 4" I " GSA $y I z (p, 1p 83 y 1 3 I 32' GAlp z . t 55 40 CEOTE{Z OF G REEV Mill W• 6REEa Mill La • i ,9U1/ttiII-44 70 IrkfaX 0/-- u Lac "r ft f INDUS TMENT,OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSi'RY; DIVISION HUMAN RELATIONS PERCOLATION TESTS `115) MADISON WI 53707 (1-163.090)& Chapter 145.045) TOWNSHI�Y: OT NO.:BLK.NO.: SUBDIVISION NAME: sF �� �/ ►7 %Tz�N/R 19 E( 1 U,0j0 AJ C, Pr4P I`U I'&uj COUNTY:NTYPa% V 4 ADDRESS: /11 Lift � U,Qf e-c� W� � 1( P0 Lo � �N S 'lg �R,&e.,.) /y � S USE DATES OBSERVATIONS-MADE NO.BE lkssidence 113 N, ,/,� _DESCRIPTION: ❑New Replace I 3irc Cl S' — �!1 P / Nh 1 Q RAtINQ:S•Site suitable for system U-She unsuitable for system Q _ Q�: MOUND:❑� 1_ Z S aU S FILL O�LDING®NK:RECOMMENDED SYSTEM:(optional) UC-�.Q S IW/I Jc S U CO S U E�i('a,uA L If Percolation Tests are NOT required JDESIGN RATE: [if,any portion of the tested area is in the s.H63.09I51(b),indicate: C(�S S oodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING AL 70181SERVED R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION ES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 2- Z 121= PoRf- OR D A< G / � g2 ' s. Sv, f q c-, 16 C-1, or- /O�cr PERCOLATION TESTS /(j s TEST DEPTH-. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D2 PFRIOD 3 PER INCH i P. P- 212 S •G P- *LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tontal end 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, i SYSTEM ELEVATION t_ I I I y , - - -t 7 A 1 1�: - tot, I II i I t i I 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 vsAdminlstrative Code,and that the date recorded and the location of the testl are correct to the best of my knowledge and belief. A (print): TESTS WERE COMPLETED ON: HOMESITE 8lFTIC PLUMBING CO. �^ p 655 O'NEIL W HUDSON WIS.54016 ROSEMlTWRIGHT CERTIFICA ION NUMBER: IPHO NUMBE (optionall: WIS.MASTER PLUMI�JER LIC.NO.3307 M.P.R.S. 2 -/ MINN. CST SILGNATUR K: i� { I !bISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. L 'OILHR-SBO-6395 (R.02/82) —OVER — P6'. OF i l R soi� BoR�N �s PERCO�ATIoN TESTS II`Y� REPORT o N PLo r P L.AM Ros EC i r• O. 4A OO c.u P s�� pA rf- �� l 9 of, 7 .00 HOMES,ITE TESTING CO. AT.3, 0-NEIL ROAD BOB ULL'RIC!, iUDSON, WIS._- 5"16 C i 5 r SS-02$ee Z PROPOSED HOUSE MOST LIE 2s Fr• opt MDSE "m ,qLt rESr Aor.4S. PRo poSE o WC a MUST we- So FT of /bogs' j;eom ,etc rEST i9 oz.-45, • #Oe;z . BM ,QEFERENCF I-°P of Zxpos&;o your E&illfrlvm A ffzapiE GRO✓i 5:vEw4Ik r j 1_ LEGEND e/EVhroN of !/Mt �PEi. io o ,o w t2� �K�'ST�a6- SyST£�1 i !N 3+A A# � vNt 1`t- �4 7,p 3 Seol?MS- I y,44A6-E 1 w lu v� 1p 'SIDEwA��e" i" o�{LET Of EhISTwf 0 VERT 3j RtF �r PACCAS r y9 yo' (oa"ile SeP r1c �S' 1AaK= 95,►5 - -- A 10 ;I i d , y vp 83 3z� ��5 D x �2 0t�� �2 • G� 55Ito CEaTflR Of GREEN Mil) LA, Mill P#o f- V ?4)e Fs s PROPOSED moose MUST LIE 2. Fr. p,� MD.tE F OM LL r \ �P A EsT �9,PEAS, PRo POSE 0 WEU. M VST LIE ,SQ FT ap ttO�PE FiPO�I �L L rEsT 1,pE�s. • = B,QC / p�rS 0 = EXifTI.A!6- WELL X t �EQG /D�CgT/A,vf � $ f/A�tJ� Ad9E�PE0 o,Q S�q�IEL �ES • ` /�o,�iZ . 8 M ® _ VrPT%CAL �EF,rp,rAJIE poijr To P OF ex p os c o S yi�9pE E/E!/r}T/ON A yff�f��E /Ro✓i s:vE '1/�(' ,�T- mac, W , rrp LE GE N p W 3 'BeoI?M$. I $A,Pg6E to J / i I !`SiDfwAcK' HOMESITE SEPTIC PLUMBING CO. 655 0-NEIL RD.,HUDSON,WIS.54016 o�+�E of ep(sTN►y \VERT ROBERT ULBRIGHT REF ITT P¢oP�S e� WIS.MABTER PLUMBER LIC.NO. 3307 M.P.R.S. /ovo N�w MINN.INSTALLER&DESIGNER LIC.NO.00663 PRgGA31 �� l9.yo tAiE coaGe#�-sePrr _� hPPPoo 95,15 �. _ ono •Q � , 0 �. P h S'0 i 4 iw w i a T� 3 a «` _ By S-1444- S'A(00/ TRFNC4 F1eVAr-oa OF 55'-to CENTER of G REEu Mill W• G R EE�1 ­rpc j e4— 4 resh Air Inlets And Observation Pipe C�.--- Approved Vent Cap Minimum 12" Above Final Grade F1'Q iS 1+Ev �� r 5 PA-D E 9 4" Cast Iron 30 " Above Pipe_ 'TO Final Grade Vent =P ipe' M-a h N^;Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe �'' 0 0 0 0 0 , 6lEv, - 1 7.� " Aggregate 0 Perforated Pipe Below 0 Beneath Pipe Coupling Terminating At Bottom Of System .G. S o l t TEST- 2- —goo � C Y V vFresh Air Inlets And Observation Pipe h 0 aA- Approved Vent Cap Minimum 12" Above t=,'ti, I'S ttct� Final Grade ,,r 5a�L9 t ,OWN 4" Cost Iron 30 Above Pipe — Vent Pipe -To Final Grade Mersh-Hu -Or Synthetic Covering Min. 2" Aggregate Over Pipe V, Distribution Tee Pipe —' 0 0 0 0 0 , " Aggregate 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At G� �0► i' Bottom Of System T�s� .5 0 X114 Z'g y /,tea I"r YeA • 3O Vo v Polo,-,e- oreds "0 .V PAGE:. CF PUMP CHAMBER CROSS SECTIOIJ ANG SPECIFICATIOUS VEUT CAP 4"r-.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUUCTIOU BOX MAWHOLE COVER � WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I 40 MIA]. � boo a `__ �. IB"/'K►AI. COWDUIT 180 MIAI. \ \� -------- y� � 1 PROVIDE INLET I AIRTIGHT SEAL I III V I I APPROVED JOINT A ( III APPROVED JOINTS W/C.T. PIPE I III W/C.I. PIPE EXTENDIIJfs 3' I II ALARM EXTENDING 3' ONTO SOLID SOIL d 4� I 11 ONTO SOLID SOIL C I j ON , I ELEVV, FT. PUMP- � OFF 0 g E-0014&- ; 7 CONCRETE BLOCK RISER EXJT PERMITTED ODLy IF TANK MANIUFACTURER HAS SUCH APPROVAL TON O TE h( r wRs SEPTIC E SPEGIFICAI'IOA1S DOSE �EE�S eo TA AI KS MAMU FACT URER. IJUMBER OF DOSES: PER DAU TAWK SIZE: po y GALLOWS DOSE VOLUME II2+ I - ALARM MAIJUFACTUR,ER: Lt-00 A I A Q.r-k INCLUDING BACKFLOW: 130-1 L GALLONS MODEL DUMBER: D. V' L CAPACITIES: A= i.5 CAPACITIES: OR .L—_ GALLONS SWITCH TSPE: MERL"= Fl0,4 T B° Z INCHES OR 36 GALLONS PUMP MAMUFACTURER: 70 CII�`�� C= 07 INCHES OR 1130 CALLOUS MODEL NUMBER: -� 1 ���— P D- I Z INCHES OR O ' GALLOUS Pro�-4y l34c% SWITCH TYPE: M CyR 10,1 r-A( 2-) NOTE: PUMP AWD ALARM AR[ TO BE MINIMUM DISCHARGE RATE 30 GPM /IINSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF ARID DISTRIBUTIOIJ PIPE.. S. 2' FEET -4Ne fop4FG,S ' + MINIMUM NETWORK SUPPLY PKESSURT,E�. . . . . . . . . . :��-FEET �'I = /fj�Q �- � FEET OF FORCE MAIN X , Z3 F/ �� FEET o O loo FtFRICTIOW FACTOR. TOTAL DyWAMIC, HEAD = S' 3 FEET INTERNAL DIMENSIONS OF TANK.: LENGTH ;WIDTH --;LIQUID DEPTH 51GKJED: LICENSE, DUMBER: DATE: Aip i 4 l 3inNINI V3d M01:1 lb'1Z'8LL (ZOSi� Oct on 09S Oer 001, We ova Of 09 0 SM31n amp kpn1uox vpxino1 06t 001 Olt 09l osl Ovl Otl ozl 011 OOl 06 Oe OL a9 OS Ov os 0a 0L SNOIWD LiE9l "a 'O d O OM smile NO 0eac . 99a'Loa S a 1300" Ot 17719Z -- — �— a0Z — Oa 9 1300" 9Z 0 I — – vea OE O 1300" I E0Z 01 E- 4 se — 1300" -� at v6a Z 1300" eL 09 n 9L x — I-- -- S9 D Sot 91 v 13(1ow s9 at OL at 3inNIW dad M01d st oft Oat Ott OR oe 0 SU3111 ►a Olt o0/ 061-!g OL Oe OS ov OC Oa OL SNOIIYO 0 'SS'CS S a a 1300" OL 9 � "i tot 13(10" 1300" oz 9 rJNIt1311�M3Q 9a a pue 3JdM3S Sot 66t'LC1 OC 1300"= 1300" OL SC -Ot at 904. e/ C l3oow Cot 1300 9L v r SS v et Z a Oi n OL m rJNIb131dM30 at 601 1300" SL p pue 13(10" ve LNgn73mf3 I I 9. 9a 66 t ez OOl Ot 3A uno Ott VdV3 - -Ott All3� . Olt ICIV3H `� -� Vd . �, AS BUILT SANITARY SYSTEM REPORT OWNER S r I r TOWNSHIP SEC A 7 TI f N, R/'7W P.O. ADDRESS ' •-r' 0 � ST. CROIX COUNTY, WISCONSIN SUBDIVISION . ^ /r V " w , LOT 4� LOT SIZE �i Gi C P. P ii PLAN VIEW Distances & dimensions to meet requirements of H62. 20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM s ' /ns9 Y 7 SEPTIC TANKS) t (;0 CONCRETE W > n CONCRETE G� STEEL N-07—of rings on cover Depth_ DRY WELL TRENCHES No. of width length area BED no. of lines Ant I wi tai — _ length area f, 1 22 depth to top of pipe AGGREGATE PERK RATE AREA REQUIRED AREA AS BUILT CY DISCLAIMER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation,. However, if failure is noted the County will make every effort to dete mine cause f failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUG A THI SYS INSPECTOR DATED T PLUMBER ON JOB LICENSE # REPORT OF ITTSPECTION--INDIJIDUAL SEWAGE DISPOSAL SYSTEM Sanitary Permit r St to Septic 17 _ "•�'IE T&INSHIP St. Croixu County SEPTIC TATT: Size gallons. `dumber of Compartments ! ,: Distance From: Well ft. 12% or greater slope ft. c Building `r- _,; ft. Wetlands f Itighwater — ft. DISPOSAL SYSTEM Tile Field or Seepage Pit(s) Distance From: i1ell 4- ft. 12°/0 ,or greater slope* ft Building $J ft. �'—` Wetlands f.: FIELD Highwater ft. Total length of lines .' ft. Humber of lines ­2' Length of each line ft. Distance between lines ft. Width of the trench ft. Total absorption area (rr ' -- sq, ft. Depth of rock below tile in. Depth of rock over tile min. Cover nver.rock ,h;. .'1' Depth of tile below grade 37 (o in. Slope of trench, in' , ier �fn ft. Depth to Bedrock ft. Depth to ground water ft. PITS Number of wits Outside diameter ft. Depth below inlet ft. Gravel around pit : _`yes no. .Total absorption area sq. ft. Square feet of seepage trench bottom area required :square feet of s epap nit a ea equired ' Inspected by / , Title: Approved Date w '/ 197• ! Rejected Date 197 .r EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH ` P.O. BOX 309 MADISON,WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS / LOCATION ' ,4E%,Section a,T4N, R-,qE (or) W,Township or Municipality Lot No. –C._, Block No. /- //1 'r 1, County !'c \,4� Subdivision Name Owner's Name: - ' �� �� e x Mailing Address: Ale- TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: ZS�OIL BORINGS � � PE CE�O,,LA//TI ESTS SOIL MAP SHEET a(- ,qq SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 134-1 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B 7 X21 iV W -7 - s �j ;7A 4: j d' 7 PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location andsquare feet of Suitable areas. In irate number f sUyare feet of absor o area needed for building type and occupancy. le or distances. Give horizontal and vertical reference points.indlcate slope. tN 0 T, I } ti� 01 1 0 �' 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 location of test holes are correct to the best of my knowledge and belief. Name (print) e- Certification No. Address �7 - � "!- Name of installer if known CST Signature "4C -;2= COPY A—LOCAL AUTHORITY _ ` v State Permit # 30 PL867 State and County Permit Application County Per for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: SA LLE 50X A62- B. LOCATION: 4 '/4�F Y4, Section , T_Q�_ N, RJj— E (or) W Lot# _1�—City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township ^ V 0156 N V IF— W � STAT—f 5 C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family V"' Duplex No. of Bedrooms 3 No. of Persons D. TYPE OF APPLIANCES: Dishwasher V YES NO Food Waste Grinder_YES NO # of Bathrooms--L Automatic Washer VYES NO Other (specify) E. SEPTIC TANK CAPACITY 1 aDp Total gallons No. of tanks _ t _ *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) . 5 2) 3) 5 Total Absorb Area_ S sq. ft. New Addition Replacement *Fill System See age Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches_ Seepage Bed: Length_�__LWidth�Depth Tile Depth 3° No. of Lines _ Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 4�_ Distance from critical slope 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME t?IG` h A R O W N 6 P kI IV C.S.T. # ► 3 / and other information obtained from (owner/builder). Plumber's Signature MP/ PRSW# 14 N ? � hone #2 Plumber's Address a 1- t PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). v L P&4 U 3 y V' / d 5 ti G- RFLN MILLS ROA. Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application Fees aid: State /0,100 County Dat Permit Issued/R4*4od ( ate) _Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (whi copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76