HomeMy WebLinkAbout028-1017-95-100 / 0 7 2
\ \ o _
k �
o �
b \
; 2 �
�
e % �
$ / \
@
n
E I
� \ (
�.
2 } \ \ IL ra
g
B z \ )
m �
� } �
\ &
-� 2 =
Q kzz j
.. z
Q
» E, ~
) ,
CD 2
/ ( @ L $ § CD
< \ � 2 2 $ k / }
Z > � e E 2 (
. � 3 t � .
5 2 a a
CL
0 C ; m ®c co
] v z / @ z I
CD
0
\ f / Cl) _ \ K
2 ! � \ § �
\ k 5 k J ƒ f . I
% \ $ ; 3
/ \ \ § $ / 0 E �
LO Of
� { O C j ƒ k N
/ 3 \ ) \ D S . f ) k 5 k § / 2
, - \ \ § E S a s c ° a OD
@ 2 2 \ 7 / o z $ z k \
Aj
2 § k a
a a : .
E ) ) \ §
0 . �
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER / alnXe TOWNSHIP �� �jiV�?y SEC. /Z T ZS N-R W
ADDRESS . ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT /yx LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/�'founcl
30
Sy S-te In
—9
gyp' o e $�, O to' New?
C o
g,M, l 1ouSe R
6ofage E 79 5 —� ,
E/ec/.,L- C
� t
Pad
�arr s tm r me r \ \ J 1
J
Np.
INDICATE NORTH ARROW
I
BENCF.h'.P_Fu: Describe th ._ V
e ve. tica.'.. refer e«ce point used ink OT ����rl qr` for
Elevation of vertical reference point: /on-C) Proposed slope as�itedr �r
• o
SEPTIC TANK: Manufacturer: f 4s Liquid Capacity: /ZOO'
s used:
Number of rings 2�'W _ Tank manhole cover elevation: A00 --?Z
Tank Inlet Elevation:—ter ' Tank Outlet Elevation: 9�,0/'60/
Number of feet from nearest Road: Front,0 Side,' Rear, 0 300 �
feet
From nearest property like Front,�Side,ORear,O /,�7 / feet
i
Number of feet from: well building:
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE STNF•.
PUMP CHAMBER
Manufacturer: Liquid Capacity: ADO �'la/i
Pump Model: Pump/Siphon Manufacturer: �O�/ (�l Pump Size
Elevation of inlet: 7& Bottom of tank elevation:
Pump off switch elevation: C��� �7 / Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type: /fil ,-fir'y
Number of feet from nearest property line: Front, O Side, O Rear,.
Ft./35
i
Number of feet from well: 9�
Number of feet from building: 1�15'
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Xes Trench:
/ i
Width: � Length:- �T
Number of Lines: CO Area Built: 3 7t/,,
Fill depth to top of pipe: �-
� J
Number of feet from nearest property line: Front, O Side, O Rear, Ft
i
Number of feet from well:
Number of feet from building: S"'
(Include distances on plot plan) .
SEEPAGE PIT
Size: Number of pi a eter:
Liquid depth: Bott of s page p el vation:
Area Built:
Has either a drop box O or distr buti n ox O t, : n use on any of the above soil
absorbtion sytems? (Check one).
1'
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: evation /of botto o tank:
Elevation of inlet:
Number of feet from nearest p ope ty lin nt, Side, O Rear, O Ft.
Number of eet f om w 11:
Number of fe from ui ing:
Number of feet f-oir. nearest road:
Alarm Manufacturer:
/ p
Inspector:
Dated• �! r ` " ,�( Plumber on job:
License Number: /q' '0�Z
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS PLUMBING
P.O. BOX 7969 BUREAU OF UM
MtADISO1N,WI 53707
SD —,,SW MCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
Ill a„ n
Town of Rush River ed)
❑Holding Tank ❑In-Ground Pressure [Mound --(,
County Trunk N
NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECT N DA E: —
Paul Ramberg Route 2, Baldwin, WI 54002 _aa_88 S,
BENCH MARK(Permanent reference pomt)DESCRIBE IF DIFFERENT FROM PLAN: FEET-.PT.ELEV.: CST REF.Pr.ELEV.
Name of Plumber: MP/MPRSW No.'. Coun,V: Sanitary Permit Number:
Dale E. Hudson 6629 St. Croix 106050
SEPTIC TANK/HOLDING TANK:
MANUF ACTUR LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED'.
DYES ONO I ❑YES ONO
BEDDING. Y VENT DIA.' VENT MAT(. HIGH WA ER NUMBER OF ROAD PROPERTY WELL. BUILDING.IVENTTOF
RESH
ALARM FEET FROM LINE. AIR INLET
DYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED'.
DYES ❑NO E]YES ❑NO I DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING IVENTTOF
RESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) E YES ENO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. l if soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH-. LENGTH. NO.OF DISTR.PIPE SPACING COVER INSIDE DIA -PITS LIQUID
BED/TRENCH TRENCHES MATERIAL PIT DEPTH
DIMENSIONS _j
GRAVEL DEPTH FILL DEPTH IDISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO F HESH
BELOW PIPES ABOVE COVER. ELEV INLET ELEV.END. PIPES FEET FROM LINE AIR INLET
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES 1:1 NO
SOIL COVER TEXTURE JPIRMANINT MARKERS OBSEHVATION WELLS
El YES ❑NO 1:1 YES ❑NO
DEPTH OVER TRENCH/BED IDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED IMULCHID
CENTER EDGES.
❑YES E1 NO 1:1 YES 1:1 NO 1:1 YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO,OF LATERAL SPACING GRAVEL DEPTH BELOW Pit FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR JDISTR.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
❑YES ❑NO 1:1 YES NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER ERTY WELL BUILDING.
FEET FRO
❑YES ONO DYES ONO N
.t }
y �
I
i � y
Sketch System on �'��
v G 1) t Retain in county file for audit.
Reverse Side.
I SIGNATURE ITITLE
.
DI LHR SBD 6710(R.01/82) ZOnino�
-- SANITARY PERMIT APPLICATION COUNTY
DILHR In accord with ILHR 83.05,Wis.Adm.Code 5y- ' ✓-o�X
STATE SANITARY PERMIT#
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size. '7_0
—See reverse side for instructions for completing this application. PETITION ((��
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES IM NO
PROPERTY OWNER // PROPERTY LOCATION
2u �/l�QeY' .5�r '/a %, S /Z T Ze, N, R .*(or)2
PROPERTY OWNER'S MAILING ADDRESS LOT NU R BLOCK UMBER SUBDIVISION NAME AIX &24
CITY,STAT ZIP CODE PHONE NUMBER CITY NEAREST ROAD,L E OR LAN MARK
_5,��OOZJ ❑ VILLAGE : /ER TOWN OF,
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): N/�
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. ❑ New b.,X Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a.�Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.X Mound f. ❑ IGP
In-Fill Tan k
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. N seepage Bed b. ❑Seepage Trench c. ❑ seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Mi !9/-/es per inch): REQUIRED �are Feet): PROPOSED(Square Feet): a� Feet
� ' , Jo/ 1 1XPrivate ❑Joint ❑ Public
VI. TANK CAPACITY # Site
in allons Total of er.
Manufacturer's Name Prefab. Con- Steel Plastic Fiber- Ex per.
INFORMATION New xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks B e S
Septic Tank or Holding Tank /000 1:1 ❑
Lift Pump Tank/Siphon Chamber ❑
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) MP/MPRSW No.: Business Phone Number:
-Dale Oak
Plumber's Address(Street,City,State,Zip Code): ae Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
e
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
o 1#1-,4 14J1'. S Z
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved I S nitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial 135 �) rSgrch�arrg^e Fee
� fY C�jy�
Adverse Determination v`�� `="c�C.D.CX) �U ► l r
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every-2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
Vlll. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over,2 years of steady negotiation and public debate. The groundwater bill Ground at�r
included the creation of surcharges (fees) for a number of regulated practices which Wisco iiCl'$ a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried i'>QC'ISl1YQ'
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
0
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)
t-,
z
H
Y
ST C - 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT
St . Croix County z
d
OWNER/BUYER 1pa 7S QIZ
ROUTE/BOX NUMBER 04, Fire Number
CITY/STATE __J�/(��yi� , Gt/iS ZIP Sy0�2
PROPERTY LOCATION : .5� it, SZZ) 14, Section /Z T�?. _ N , R12w,
Town of If;w 4 ;4�1'Ve r St . Croix County ,
Subdivision Lot number_.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix . County residents m_ y be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SIGNED (�
DATE Ae I) ZD , 2
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 .
t
DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
I
432801, f WOL
79SPAGE437
`
REGISTER'S OFFICE I
... ___Harold___Bar-, ._.a_._singl_e_- person ST. CROIX CO., Wi I
Recd for Record
---------------------------------------------------------------------------------------------------------------- `
DES 8 1987
-
---------------------------------------------------------------------------------------------------------------
-
conveys and warrants to --.-Paul Ramber0- and Barbara I /0: 30 1
I, }lalttbexq�.._Ylusband and•-wife, holding as
............
�u>;V7.VQ .SYIl.p..?Ilar.l-to .................................... R am
y
----------------------------•------••--••--
I
------
.......... ........ .... ...._................ RETURN TO
...------.----------'----------------------------------------
I' •---------------------•••---------------------------------•-----------------------•----•.----------•-------
the following described real estate in St. Croix
•------- -
•-••-•--•---------•--•-•--••---•--------County,
State of Wisconsin:
�! Tax Parcel No: .....................
That certain parcel of land located in the Southeast Quarter of
Southwest Quarter (SE4 of SW4) of Section Twelve ( 12 ) , Township Twenty-
eight North (T28N) , Range Seventeen West (R17W) , Town of Rush River,
St . Croix County, Wisconsin, more fully described as follows : Commencing
at the South Quarter (S4 ) corner of said Section Twelve ( 12 ) ; thence
N90 00 ' 0011W (assumed bearing on the South line of the Southwest Quarter
j!. (SW4 ) of said Section Twelve ( 12) a distance of 437 .00 feet to the
point of beginning,ginning, of the parcel to be herein described; thence continue
!! N90°00 ' 00"6 275 .00 feet on said line; thence N00 00710411 469. 74 feet;
I,
thence N90 00 ' 0011E 275 . 00 feet; thence S00 °071 0411E 469. 74 feet to the
point of beginning, said parcel also described as Lot One of Certified
Survey Maps filed November 30, 1987, in Volume 7 of Certified Survey
Maps, Page 1918 , as Document No. 432513 , Office of the Register of Deeds
for St. Croix County, Wisconsin.
TRANSi ate]
.00
This ....i s...n
_ot__________ homestead property.
7 1W is not)
Exception to warranties: Easements and restrictions of record.
I
!
I
fDated this ----- -----•' day of -----4ac,........r.1
-----,
(SEAL) SEAL
j rg ..-...
II
.............................................................. Harold Ba
...
l ................................._.. •-------..(SEAL) ----- - ----------...------------------------------------(SEAL)
li
i
I
i
AUTHENTICATION ACKNOWLEDGMENT
II Si ( ) ------------------------------------------------------------ STATE OF WISCONSIN I
'! ---•------------•--------•-•---------•---------- ------ SS. �I
----•-----5- %_Q0iX------County
authenticated this --------day of-------------------- 19------ Personally came before me this -_ 2' ..day of
-- ___-___, 19__87__ the above named
+ _-Harold-_Barg.................................................. it
-------------------------------------------------------------------------------
j TITLE: MEMBER STATE BAR OF WISCONSIN
----------------- ---------
(If not- ---------------------
R r
authorized by § 706.06, Wis. State.) ------ --------- ---
to me known to be the person ___ _ _-_ who exee'� d tl�
foregoing .instrument and ackn dge the sa eZ','.:
THIS INSTRUMENT WAS DRAFTED BY tV�dr • -J
Thomas A. McCormack -----------------------------------------------------....
-------------------------------------- j
Baldwin, WI 54002 '-------- ' --- ' -- /h4 �<,.wtL�� �f Q i
- --•-
----------------------------------------------- Notary Public
Coulity;Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.) i
date: 19 )
*Names of persona signing in any capacity should be typed or printed below their signatures. I+
_ ..._
H GM/llercompany M STATE BAR OF WISCONSIN
FORM No. 2— 1982 Stock No. 13002
THOMAS A. McCORMACK
Attorney at Law
990 Hillcrest Street
Baldwin, Wisconsin 54002
715-684-2644
December 22 , 1987
Mr . and Paul Ramberg
Route 1
Baldwin, WI 54002
Re: Barg, Harold; Sale to Ramberg, Paul
Dear Mr . and Mrs. Ramberg :
Please find enclosed the original Warranty Deed from Harold
Barg in the above matter. This has been recorded with the
St. Croix County Register of Deeds. The recording
information is noted at the top of the document.
By copy of this letter, I am forwarding the same to Boldt ' s
Plumbing and Heating, Inc.
Thank you.
Very truly yours,
,p/THOMAS A.MaCORMACK
Thomas A. McCormack
TAM:mjh
Enclosure
cc: Boldt 's Plumbing;. and Heating, Inc.. w/copy, oft° deed t
Harold Barg
P. S. Also enclosed is a copy of the Partial Release of
Mortgage from Durand Federal releasing the property.
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 inadequaoies 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 1?7c� 4
C
Location of Property �Cr k Si 14, Section T ZY N - R W
Township e', Z'Fl ve
Mailing Address 1f 2
Subdivision Name NA
Lot Number _ &14
Previous Owner of Property za!fI
Total Size of Parcel _ �P
Date Parcel was. Created jy(' dek6c de �9 7
Are all corners and lot lines identifiable? �� Yes No
Is this property being developed for resale (spec house) ? Yes \� No
Volume 7 Tg and Page Number 21?7 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
'P' ENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
IND TRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 537907 9 53707
HUMAN,RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATION:S E N: TOW SHIP/MUNICI 41TY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
Sr '/aW/4 /a /TN/R�9'4(or)W Us/ WA aYA
a NT OWNER'S BUYERAm NAME: MAILING ADDRESS:
o� v b e R . Ac2 91144 d Wj,.1 USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DE R TI NS: PERCOLATION TESTS:
Residence 3 XNew ❑Replace 1 /0 _020 _ P 7 /D
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
os [a lzs ou as ®u os ®u os ®u �o L)Nc/
If Percolation Tests are NOT required DESIGN RATE: lFloodplain,If any portion of the tested area is in the
7 Y under s.H63.09(5)(b),indicate: 14 /� 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 1 �i.0 9 ;35' d,vt, > 117„ S,L - it w �-S FS
B- 0 9433 NdNe, > a ? " /� S; 16`f/, d l/
B- 3 16,0 90-/7 /Vd ,)e, " �aS;� -
B-
B-
PERCOLATION TESTS
TEST DEPTH•, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER10111 PER o2 P R PER INCH
P_ I .o oAj d / o
P . O o a e
{ P-
P_ -
i
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
t
--+
— j
(
I
IN
-T_
1
. r
--1
1
..1.__ _..i..__.._1_..___l. ......_!._.__..._.1.�-.L..__i.___..�.._.........;. .___!.___. i.-........ .-1..........._1._.rL— J------L__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.
NAME(print): / TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
J . #/ /W -A Eme,9AIA LJf �s�i_3 7is-6��
CST S NATURE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD.6395(R.02/82) —OVER —
C�wne
Pawl Rom b a r9
Rt. 2 •
13a/c�win� GJi-
Syooz.
,23• �8-5 43
B,M,-/00,0'
-l- 9535 s o�z p► °
BZ- 9y-33 F--�q-- -�
,
B3- 90,17 32 3s'
11
Mound Sy s e M 27 pl-
io'
�o P3 8O06a 7 'O
B-3 /0% P'C /000
oat,sePt"C'
p $,M. -l7�nofeS' �enc{�mor�
e3 -'J)enos Bore loo/%S
0- Deno►ll'aes perc Role! ;
�� ..
? 7
Sec. /2
36
, e
CtY. --rrx. N
SE�� SW%
�'z8N R
. z�s
No,
,KP 66 z 9
3y13
CT Y ,
NDUS iRY,,M OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
I NDUST DIVISION
LABbR
HUMAN -RELATIONS PERCOLATION TESTS (11J) MADISON W 53707
(H63.09(1)&Chapter 145.045)
LOCATION:Je SECTION: TORosd SHIP/MUNICI LITY: LOT NO]BL NO.: SUBDIVISION NAME:
s� '/a �4 /a /T��N/R/�+ (or)W tie n/A �A R
COUNT X: OWNER'S BUYER' NAME: MAILING ADDRESS:
o v,L Am be R a 9R4 c/r.,vi..l w,s2 6' 40 o z
USE DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS:rERC O A ION TESTS:
Residence XNew ❑Replace /D _o2d _ (� 7 +cZ/_ �j 7
RATING:S=Site suitable for system U=Site unsuitable for system d o
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional)
�S [�U ®S ❑U DS ®U HOS ®U DS ®U I mn L)N�
If Percolation Tests are NOT required DESIGN RATE:
4�/n If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: f y /4 IV 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- IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- / .0 9�;3 5' Nom �. > / C S�L- l7 SQL .S'.� ° �s
B- 33 1 dA) e-, > a ? " /� � 5�� - 16 9dS;L _
B-3 6.0 90.i7 /Vd Av } S-,. '' S;c. - /6 A 9,0 S,
B-
B-
ex
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO 1 PERT D2 PERIOD3 PER INCH
P_ / .O OAj d
/1Y--
. / ` O
P. a . o Aj e. o 5 /�,. ' o
P- O d a e 36 t 3�1 ,.
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 9�•
+ E i
I I _
I
,
+
E
E
+ I
I � 1 � y �
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): TESTS WERE COMPLETED ON:
IDAL C. 14ocl 5 oA.J 0 - 02.E- R7
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
�. #/ Ha x 111 -A Ernemu'l Li f �5�13 7/-f,-6* -3606
CST S NATUR E:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
Y e►
OWnL��
�Ctt<r Rom 6 a rr9
130/c�wi✓�, G�J,:
SyDoZ
23.5 3
A4,—100.6' 13" 47� ��, d B.M,
A- 95.35" s-z o�Z Pt o
B2- 9y-33
B3- 9o,17�
32 as'
Mound SysTem ��p•
10 P3 BoOGa,�� 7'00 ion Rowse �
']0
B-3 /p%6 P.C 1000
. A B,M. -l7�nofeS° bend,mar1�
c3 -17cno--es Bore I, 6/c.5 f
d- De„ofe5 PC.,c- tYo le-S
VJEI..� ? �o To MovtiO
Sec. 12
0 2 0
36
t
;fe
Cf.-/. Try• N "
SF 4 Stdlyy
<28N R i� w sEw ASE sYSTEM
p�iVASE 2951
A
El.AS10NS
.r-
�,pAR�ME�pryiS
ENGE
gEE G�AR�S
No.
yY-OW P7
e.
Mp66Z4
_CST 3y13 _
cry , - N
>QN/ ��rq: ,. Page L Of 3
11
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
H G
Topsoil -=- -----,.�=- F
3 E
tsitio D
B `(D 2– 2 2 Force Main Plowed
gregate From Pump Layer
• D O
Qt��Nt O ection Of A Mound System Using F ,
O R�Sp A Bed For The Absorption Area
G /D
A g Ft. H S•
Signed: B 17 Ft.
License Number: ����29 I /7 Ft.
Date: %/ - 3 – 7 J 7 Ft
K _�L Ft.
Alternate Position L (09 Ft.
of
Force Main W 3Z. Ft.
L
d - Observation Pipe-�
�---- B K
i -
A !•---- --------------- --___— ------------ .I Force Main
From Pump
Distribution _ Bed Of -'-2"– 2
2 2
Pipe Aggregate
l
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
Sw �S
,* ._
t, ti
x : Y, t`� � .�.
>'
��,
,,.—y�� .
...�'.
• e�,
s;�.�.
'�� +.� :�
�.
;r:
�:.
/�dral �1rn,De,r' Page Z Of3
C
Perforated Pipe Detail
0
End View
Perforated `
End Cop) e�' PVC Pipe
0.%,o
�og
Ogg Holes Located On Bottom,
S Are Equally Spaced
S
PVC Force Main
y x From Pump
/ PVC
Manifold Pipe
Distribution r. Alternate Position Of
Pipe Force Main From Pump
Last Hole Should Be
Next To End Cap
End Cap /
Distribution Pipe Layout P
R
S 2-d7
--- x -,2,,5'
Y /5'
Signed: Hole Diameter Inch
/
License Number: /�'lP"26 Lateral Inches)
Manifold Z Inches
Date:
3 P 7 SYSZEA Force Main 3 Inches
A
°
v
p
0
A
Slee
t
• �au� �Carl�6G'r"Q
cUJ PAGE 3 OF 2
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
---VENT CAP
4"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
� 25' FRCM DOOR,
JUNCTION BOX MANHOLE COVER
WINDOW OR FRESH 12'MIU.
AIR INTAKE
GRADE I
I `"MIN.
COKJDUIT -- _
�\ ----
WMIN. v --------- —3
INLET WArrp0/1'o I - ---
P��VAjE SE AIRT�iT SEAL
7
APPROVED JOINT A Co, �t� I (I I APPROVED J011J i
W/C.'E. PIPE I I I( WIC.I. PIPE
EXTENDING 3' II ALARM EXTENDING 3'
ONTO SOLID SOIL- � P♦G� I I ONTO SOLID SOI
s � M
p
C I ON
DEVI���E�Z
D �RaES N � �. oFF
5E
CONCRETE BLOCK
RISER EXIT PERMITTED GNLy IF TANK MANUFACTURER HAS SUCH AP 0 2 0
SEPTIC AND SPECIFICATIOUS
DOSE TANKS MANUFACTURER: s NUMBER OF DOSES:-PER DAy
TAUK :,IZE : SOO _ GALLOIJS DOSE VOLUME: 1'14,0 d GALLONS
ALARM MANUFACTURER: . -0 y L `/ C(
- CAPACITIES: A=�`w INCHES OR -4/ GAL L0U5
MODEL klUMBER: _ Oq'� �. B= Z INCHES OR -f2/'49YGALLONS
SWITCH TYPE: �_,^CG/®r 1/ C=INCHES OR �JGALLCNS
T'UMP MANUFACTURER: INCHES OR ZD`�'Z IGALLOIJS
MODEL NUMBER: wEOShf NOTE: PUMP AND ALARM ARE TO BE
SWITCH TYPE: e,^�G/,- INSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE RATE 7o2/ GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. AU FEET
+ MIAIIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET
-� -ZS- FEET OF FORCE MAIN X //000 F� FRICTIOAI FAC70R..r=CL!_ FEET
loo FL
TOTAL DJNAMIC HEAD FEET
INTF-K?JAL. DIMENSIONS OF TAWK: LENGTH /
� ------_;WIDTH 2i—; LIQUID DEPTH � 7
SIGNED:_ &� /Y c LICENSE NUMBS A� *'
R•-- �� 9 DATE:
Y s �
1
.,, i�`Y,� � A•
` ,.� `�
t�.
.� ...
C■!�o■\■■■■■■\■■\■\\■■■■■
, ■■■■■■■■■■■■■■■■■■■■■■■■■■
MODEL 3885
■■■■■■■■■■■■MEN:
SIZE 3/4" Solidsl'
\\■■■■■■■■■■■■■N■■■■ NONE
■■■■\■M■M■■EMM■■■ ■E■■E■■■
■■■■ \■■■■■■■■■■■■■®■■■■■■
. ■■■■ ■■■■■■■■■■■■■■■■■■■
■M■■■■\■■■■■■■■■■■■■■■■■■■
MEN■■ONE■■■■■■■MEMO■■E■MMM :� 4
■■■■■■ M■■■■■■■■■■■■■■■■
■■ ■■■■■ ■EE■EEME■
., M■■■■■■■■��■■■■■■■■■■■■■■■
• ���■ i'll■■■■■■■■■■■■■■
�164■■■■■■■\■MEN■■■■MEMO
■■
■ \■■■■■
ENE MENEM
■■��■■■■■■■■■■■■■
ONE M M ENE
No ENE
■■■■■■ME■\■■MMM\\MM■MM■MMEN
No
' ■■■■■■■■■■
ME
■INP, ■■■■■■■■■
!111PI c ME ONE
Pau/ Rambar9
Ba/c�win� GJi-
G8.5 -}3 01 //0'
of
d Q.M.
BI- 95.35 s-2
oPz Pi
,
12 9y-33
B3 90.17 32 3s'
J z7
mound Sys 4 em Prof.
o, 7�,o
°P3 8o06a N�USf. x_701
B-3 /0% P'c /000
Hof.SePi;c
,p $.M. -l7enofeS �enc�,mar1�
C7 -lena1-'es Bore- Igo%S
o- Denotes Ferc
IL - 4- ? 7
Sec. !2
36
atv. Tr A• N
SE kM -S 4d-
w
295
No.
Af 6-1 Z 9
_
CT Y _._/V.___ 3y13
, �.
Pool Rambar''d
• Rt2
Bo/cf wing lcJ�:
r'J Od Z
,23.5 G8.5 ' 43� Rio'
�f- 95. 5 s'2 47
3 OIL p► o 13-1
i
?2- 9 y-33 F -----q -�
B3- 90'1"1 32 35'
II 27
Mouru� Sys7e»� P''°P•
io' �,o io'
10 P3 8oOGa <- --70'
B-3 /0% P'C' /000
col,sePi�c.
p $,M. -17�nofe5 �enc{i mar
C7 -'J)ciWt-es Bore Igo%S
p- De l es Per C ilo%S
Sec. /2
36
to
CtY. Tr�i� N
SE�•t SW�
7z8N R «w
295'
i
No,
e.
AtPGGZ9
cam 34113
cry , N
DEP—A—rT111 ENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
DIVISION
INDUSTRY, G P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707
HUMAN RELATIONS (H63.090)& Chapter 145.045)
LOCATI , C EZ`TTON-TqQ //J TOW SHIP/MUNICI4ITY: LO-T/NO.:BLK.NO.: SUBDIVISION NAME:
sC /4,U1 /a /T N/R /4,(or)W usd ,1 r ✓e 2 /YA NA IY,4
COUNT(: OWNER'S BUYER' G NAME: MAILIN ADDRESS:
DATES OBSERVATIONS MADE
USE PROFILE DE§UR IPTIONS: ER CATION TESTS:
,� NO.BEDRMS.: COMMERCIAL DESCRIPTION: I
ldJf3esidence 2 New ❑Replace /D _ .2o - R 7 /O _��- F
IRA—TING:S=Site suitable for•Jsystem U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
El Mu ®S ❑U ❑S ®U ❑S ®U ❑S ®U /�o 0,�'�
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: A/A Floodplain indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BODING TOTAL D PTH 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- 3 .0 90 i7 /NdA)e > C2 5",, " �aS; -
B-
B-
B-
PERCOLATION TESTS
TISf DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES, AFTER SWELLING INTERVAL-MIN. PERIO t PERIOD 2 P R D PER INCH
P. / .O Otit D
P- e2 . O nJe O l/yr b
P- O oae Z5 3
P- I
Lr-- -
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
1
i V
I
r
f i
i I
ITN
I I I I I
4-- --
!
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): TESTS WERE COMPLETED ON:
ADDRESS: it ' CERTIFICATION� UMBER: PHONE NUMBER
(optional):
/ CT -A t'd I d TG �L 6
CST SIG TURE:
,17
,
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) -OVER -
Owner;
Poor i Ram 6 e rr9
Rt./Z
�c�/d�GV/✓1/ /mac//'
SyDAZ
23. 00-5 43 O'
B,M, /oo,o'
A- 95.35
a-I
12- q A1,33
B3- 90,17 32 35'
Moot SyS7em 27 Plop.
7
10P3 800Ga ; 70' �
B-3 /0% P'C' /000
seFrr C.
A B.M. -1"��nofeS I�enc�,rnA�'
O -'janofas $ore
O- 17enofes pferC IYO�CS
I l ` 4 b' 7
Sec. /2
36
CtY.
S E�•� SW'/y -
�'z8N R1*71J
295"
i
i
No,
,lJrown �'
MPGGZ9
csf 3y13
Cry , /V