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020-1157-80-000 (3)
CD v ~ O O 6 CO a� 'n a ts r ° `m o qb H Cl, O R N E � c Cc N N cn v ° I o o N rn EN c L N O N O rn U O I � Z C Z O C LL C O LL C O p. 0 o 3 3 @L) I Q v cLi I I I M I z y Z v1 W E O : O LY �> O CON ? am am o C p C �p O Z : c c U 7 a�i Z C m y z E @ a N a ai c a� O *a zmz o z° mz z N = Y Y d d N 9 E N E cc CD L _ LO = N n 3 T 3 a T ° z C •� N a a a N a a a y a �y U) J U CD m o I a) co rn z � 4) C> ° O N O 0 0 7 N cc ml c (D ml N c 4 9 N Q m 'O N N 61 Q z fn 'a d Q } U) w �. � 7 a0+ 7 C O V O E A y E N r- -6 Om m d g I 00 a) c o O co N (D F ° N `m z 0 0) w a '0 'D v N R C_ 0(U) � O N H O N V C 0 O 0 0 0. p N U T O N S U) O Z _ Z Z fn C) Z y z H O e w I � € € a a� R a a m c a c E m 'm c E �1 A c°) IL oaic°� ovici ' f w r PUMP CHAFER Manufacturer: l t/--, _-Liquid Capacity: Pump Model: /hg Pump/Siphon Manufacturer: ,�-Zc,: _ Pump Size Bottom of tank elevation: Elevation of inlet: � c� � d L Pump off switch elevation: g % iG Gallons per cycle: C//-Z- Alarm Manufacturer: 5j L TTZlp Alarm Switch ,Type: '-4 4-a 0CL�t' Number of feet from nearest property line: Front, O Side, 0 Rear,Q Ftt—A 1 Number of feet from well: �p S 4-e-r- Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: SS�•-•-•--- Width: Length: ` Number of Lines: e) Area Built: Fill depth to top of pipe: �, 642 Number of feet from nearest property line: Front, O Side, O Rear, p Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: l i Plumber on job: n License Number: /72 3/84:mj t Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER .J,rf,rr_--.�- rl� � _�-T- TOWNSHIP SEC. T N-R W ADDRESS 7� .h7� a,�� � q, =ST. CROIX COUNTY, WISCONSIN � "J SUBDIVISION SUBDIVISION � ,//j�f- ,�� J LOT ^ �� ` LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM g- kx r � - 7 A , �- ) RED j _ Nov-2 VEEP - �•.��s� �, jONIN6 1987 �' INDICATE NORTH ARROW '� \_ Offl� ,cz,— u..Y BENCHMARK: Descri e e vertical reference point used STV2�-7-4 Elevation of vertical reference point: C Proposed slope at site: - �- SEPTIC TANK: Manufacturer: /? �,,.:� /��, //��Liquid Capacity: Number of rings used: C'i Tank manhole cover elevation: f Tank Inlet Elevation: c„ r � Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, O feet From nearest- property line Front,0 Side 10 Rear,0 - feet Number of feet from: well _ building: I� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE L DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS L,YBOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SWk, SEk, S26,T29N—R19W KRCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number 111 assigned) Town of Hudson F-1 Holding Tank El In-Ground Pressure El Mound Meadow Lane Drive NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: 1 James S rin ett Route 5 Box 17F Hudson WI 54016 1 O - W? BENCH MARK(Permanent reference poet)DESCRIBE IF DIFFERENT FROM PLAN: - REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: T.4z 1 1- T P rq i 6219 St. Croix 102806 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 160/� PROVIDED PROVIDED OYES ONO OYES ONO BEDDING. VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH ALARM FEET FROM LINE _34 f AIR INLET OYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTUR 16'[I:D DING'. lIOUID CAPACITY PUMP M EL PUMP/SIPHON MANUF AC TITRE WARNING LABEL LOCKING COVER 7 PROVIDED PROVIDED YES NO OYES NO OYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER P 0ERTV WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES NO NEAREST Sol L ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER JMATIRIIL AND MARKING Or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE / the soil is dry enough to continue.) MAIN 7 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH- LENGTH NO.OF DISTR.PIPE SPACING COVER E CIA &PITS LIQUID 6�t 1� TNE IN:�ID NC / DIMENSIONS S / MATERIAL: PIT - DEPTH st � 1/ GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL BUILDING VENT TOFHE SH BELOW PIPES. ABOVE COVER ELEV.INLET ELEV.END. PIPES FEET FROM LINE AIR INLET NEAREST—i 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 PERMANENT MARKERS OBSERVATION WE LLS 1:1 YES ONO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES El NO DYES ONO OYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL N DISTR DISTR.PIPE DISTRIBUTION PIPE MATE HIAL&MARKING ELEVATION AND ELEV.. ELEV.. CIA. ELEV.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ❑NO ONO COMMENTS: (� PERMANENT MARKERS: OBSERVATIONWELLS: NUMBER 1E P TLL. BUILDING: FEET DYES 0 N ❑Y E]NO NEA FR M �r� SCI 2 Sketch System on y Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710 IR.01/82) I I 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 1, pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 GroundtBr —1 included the creation of surcharges (fees) for a number of regulated practices which Wisco ttl'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur ° 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. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY dpo a- 0;=HR In accord with ILHR 83.05,Wis.Adm.Code ,�„, 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. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES IR No PROPERTY OWNER PROPERTY LOCATION cSPR-ZN0. 7;r �'�'/a '/a, S /o To�9, N, R /4' E (or W PROPERTY OWNER'S MAILING ADDRESS LOT LOT NUMBER IBLOCKNUMBER LNEEARES;L ISION NAME 1 Cl T ,STATE ` ZIP CODE PHONE NUMBER CITY D,LAKE,OR LA MAR K , Z) /_ VILLAGE: �j`�Cvj-� II. TYPE OF BUILDI NG OR USE SERVED: fW c-"- 0Q0- //57- F0--60 (3 Number of Bedrooms if 1 or 2 Family I �r��� 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. ❑ 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## 99a r9 Date Issued 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in##2) 1. a. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. §4 Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Squa Fee PROP SED Square Fe�t): 7" Feet Opriva te ❑Joint ❑ Public VI. TANK CAPACITY V Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 12.0,0 Lift Pump Tank/Siphon Chamber 'v P ❑ ❑ 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 nat :(No St mps) MP/MPRSW No.: Business Phone Number: 3". 1� Plu er's Address(Stre ,City,State,Zip CodeK Name of Designer: VIII. SOIL TEST n9FORMATION Certified Tester(CST)Na CST# r� � CST's ADDRESS(Street,City,State,Zip Code) Phone Number: �- C C � � 2,� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial charge Fee �y PP �l C1. 'p / Adverse Determination t7� 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 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 moeacmn0wca and mxu/'umsoil v""' =p"` "'"A 'Mc^""= 1 Complete legal description; . 2� The use section must dondy indicate whether this is reskonceor nvmmorcia) project; 1 MAX!MUK8 number of bedrooms or commercial use Planned; 4, |athk u new or mp|mnmmont system; � 5� COMplele thO SUit�bllitY ratilIg boxes, A SITE IS SUITABLE FOR A HGLDING TANK ONLY IF ALL D1-HER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE UW the abt)ICViations shown here for writing profile de,,scJptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately |uruhng you, test locations. Drawing to scale is preferred. A separate sheet may be used ifdamirod; 8� K8akwnum your benuhmmrk ond vouioai elevation reference point are clearly shown,and are permanent; g� Complete all appropriate boxes as tudums' nam:a'addmsoes.flood plain data' po,mo|a ion test enomp' don. ifoppropri/te; 10, If the information (such ayf|ood plain,elevation)does not apply, Fducv N,A.if)the appropriutebox; 11, Si0ntho form and Place ypurcu,mm address and Your cmiificabonnumbar; 12 Make legible copies and distribute as require(]. ALL 5Q|L TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 3U DAYS OFCOMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols m — Stone (over 1O^) BR — Bedrock cob — Cobble (3 lU'') SS — Sandstone gr — Gravel (under 3'') LS — Limestone °« — Send HGVV — HighGnmndWmter /o — Coom*8and Peo — Pmxm|otinnRme meds — k8ndiunoSand VV — We 11 fo — Fine Sand Bldg — Buiiding is — Loamy3end > — Gpomo,Than ` °d — Sandy Lnom ( — Less Than °| — Loam 8n — Brown � °ni| — Si!t Loom B| — B/ock � 6y — Gray °d — Clay Lnom Y — YeUmw � � mJ — Samy Clay Loam R — Red � oicl — SU|tvCiovLuarn mm — K"'lonimn SC — Smmdy Clay w/ — vi th sic — Silty Clay Mf — few, fine, faint °u — []ay Cr — omnmun. onamo Pt — Peat mm — Many, mod/um � m — Muck d — diminm p — pnomincnt HVVL — High umtrr{eve|. ^ Sixgonora| soi| toxu/es SW-face wa or 'or liquid wammdisposm| B — Bend` K8ark VRP — Vo/tioa| Reference Point TO THE OWNER: This soil test report bthe first step in securinga sanitary permit. The, county orthe Department may request verification of this soil test in the field cvin, to permit issuance. A complete set of plans for the private sewage system and o permit application must be submitted to the appropriate local authority in n,dm to obtain a permit. The sanitary permit mum be obtained and posted prior to the start of any construction. U T OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS FMW INDUSTRY, ___ ___ ____—__ DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911)& Chapter 145) LOCATION: SECTION: TOWNSHIP/MHPd+6F{�A ": LOT O.:BLK.NO.: SU pIV ION NAME: �� , -�� & / N/R 19E (or N / ftznll�l OUNTY: OWN S/BU ER'S NA M • 110 USE DATES OBSERVATIONS MADE r,�,_�,//' NO.BEDR COMMERCIAL ESCRIPTION: PROFIL DESCRI TIONS: ER O ATION �IESTS: L�)Residence f ew ❑Replace O �� �n RATING:S=Site suitable for system U=Site unsuitable for system / ONVFD�10❑N?L:IMOUNP--�� IN-GROUN URE: SYSTEM-IN-FIL HOLDING TAN ECOMMENDEDSYSbEM:(option )RS ou ES If Percolation Tests are NOT required DESIGN RATE: q If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: AIR 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- 9'7.59 > q s 3 ri s1 B s B-. 0 Off 8nSL, / Q On sL c (o 8n weds B- > &64 BASL y 12 n M e cts B: �v .y 7 n s s B- 6 91,.58` > e7(, 13 - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 REP IOD 2 PER,10D 3 PER INCH P_ 5 /4 P-01 3 !(� P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and th dimens�ns of suitabl 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 a face elevation at all borings and the direction and percent of land slope. J?5 SYSTEM ELEVATION 95a In .� e _ 3 € F 3 , 3 - coca E IN E � E x E F , , , a € € E 3 E F € I ` 0 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and method, specified in the Wis rift Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, d v NAME(print): TESTS;Z6 MPLET ON: ADDRESS: o C CA NUMBER: P NE NUMBER tiol►:1 / & oC � CST TUR d-4j:::2 r DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. i DILHR-SBD-6395(R. 10/83) —OVER — Zvi rl 0 / � s � i C NIS Ci N � . ST. CROIX COUNTY WISCONSIN ZONING OFFICE h � 796-2239 (HAMMOND) 425-8363(RIVER FALLS) - HAMMOND, WI 54015 November 4, 1987 Ms. Vickie Smith Sanitary Permit Program Department of Industry, Labor, and Human Relations 201 East Washington Avenue, Room 141 P.O. Box 7969 Madison, WI 53707 Dear Vickie: The enclosed permit replaces permit No. 99079 that was issued on September 8, 1987. The reason for the new permit is they changed the location of the system and took the actual perc rate instead of design rate. If you should have any questions regarding this matter, please feel free to contact this office. Sincerely, 147 rv\) Roxann Croes Administrative Secretary Enclosure DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR.&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P;O.607969 BUREAU OF PLUMBING *4ADISON,WI 53707 SW�14, SE!,S26,T29N—R19W ®KONVENTIONAL ❑ALTERNATIVE I State Plan l.D.Number: Town of Hudson El Holding Tank ❑ In-Ground Pressure El Mound [if assigned) Meadow Lane Drive NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE: James Springett Route 5, Box 17F, Hudson, WI 54016 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: Lyle J. Myers 6219 St. Croix 99079 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO EYES ON BEDDING: VENT DIA.: VENT MATL: HIGH WATER INLlIYIBEF,I ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: I FEET FROM LINE: LAIR INLET: ❑YES ❑NO DYES ONO NEI�REST ' DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. JF7��MANUIACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF ` PROPERTY WELL: BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FR©M LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORGE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER JINSIDE CIA.. #PITS. JLIQUI BED/TRENCH TRENCHES MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH JFILL DEPTH DISTR.PIPE DISTR,PIPE DISTR.PIPE MATERIAL: NO,DISTR NUMBS R'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 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 ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER ITEXTURE PERMANENT MARKERS: OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED- MULCHED. CENTER: EDGES. DYES ONO I DYES ONO EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BEDITRENCH TRENCHES: DIMEIONS :''. MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. CIA.. ELEV.: PIPES: DIA.: EI_EVATI4'IN AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED tNFORMATII N PLANS: ❑YES ❑NO ❑YES 1-1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF'. PROPERTY WELL BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R.01/82) Zoning Administrator 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 owners name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 :BttBf included the creation of surcharges (fees) for a number of regulated practices which Wisco t1'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried sure 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. o � The monies collected through these surcharges are cred ted to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY TDILHR In accord with ILHR 83.05,Wis.Adm. Code 5T - STATE SANITARY PERMIT## 9gv —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. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES tpJ NO PROPERTY OWNER PROPERTY LOCATION S-Z 4 a, S T , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER UBDIVISIO NAME CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK SO IS21014 ❑ VILLAGE : II. TYPE OF BUILDING OR USE SERVED: /v Number of Bedrooms if 1 or 2 Family Y-56n&&AJOR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. aX New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Xconventional 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. XSee a e Trench c. ❑See a e 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): 98.,O-) 2 2 /1966 >`'7 , 08 ,Feet Private ❑Joint ❑ Public VI. TANK CAPACITY U U Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank 2up Wo 177, ,gL-C ❑ 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' Signat e:(No Stamps) P PRSW No.: Business Phone Number: Plu er's Address(Street,City,State,Zip Cod • Name of Designer: �Z ffICIZ VIII. SOIL TEST INFOAMATION Certifi oil Tester(CST)Name CST## CST's ADDRESS(Street,City,StI Zip Code) Q� 7 Phone Number: 9 S _ 2� s. ( 21 --) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S Hilary Permit Fee Groundwater ate Issui Agent Signature(No Stamp IC Approved ❑ Owner Given Initial S charge Fee Adverse Determination X. C07MENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber s , APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit 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 �71H� S k"_0 Location of Property S W Section Ito , T Z N-R12— W Township 4-v,JS CCU Nailing Address P_7-S rJ�X 7 { tc�5 C1�L W l5<<Ni Sire Address of site 421 Jy► _s,/0 Subdivision Name MPS D016 S Lot Number Previous Owner of Property NE U le , Ou !'c 14 Total Size of Parcel 1 3.04 I IBC 12f_S Date Parcel was Created t° S; 4 Are all corners and lot lines identifiable? yes No Is this property being developed for resale (spec house) ? yes No Volume ?r` and Page Number S= as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 ((ve) CULU6y that &a 4ta.tement�s on .th,4[h 0 hm aAe -tAue to the best o6 my (oun) hnowtedge; that r (we) am (ahe) .the ownerc(,s¢ 06 the pnopeAty de�scAi.bed in .this .in6ohmaLi.on 6o4m, by viAtue o6 a waAAanty �de7edd kecokded in the 066ice o6 the Countyy Reg ustoA 06 Deeds ass Document No. _� a.e S- sun .the pnopoeed zite bon .the sewage di spoe l a y em (ohdl�(we)Ihavel obtained an eaeement, to Run with the above deachibed ptopehttf, bon the eon.ethucCi.on o6 eaid Veeds 4yatem, and the dame hae ¢en . eeohded .in the V .tee o the County Reg.ieteh o6 Deeds, ae flocwnen,= No. �2 7�Y Ste`'1 . 6 6 6 S ATVRE Op SIGN A OF 0-0 ER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1982 THIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT Individual and Corporate �� (T6, 00 USED FOR ALL D TRANSACTIONS NON-CONSUMER OVER $26,000 I3 FINANCED AND IN OTHER NON-CONSUMER ACT TRANSAOTIONS) y REGISTEkS OFVZE Contract, by and between _MarX_ R._ �tusch_ _____ ____ _ ___ _ ST. CAW o+s.W1 - -... . ----------------------•-----...._..........------------------. -------- ---------• ------. ---------...----- Road. for Kecord lhif 2 ... . . ..... ... •- - -- ("Vendor", J.one 987 ©�of Q� whether one or more) and---- _8IC11 4 _.3A ,�13a. r3.. _......... ._. S1?ringett?.husband and wifee_ mar ital__property__with_______ � 2:3 - -- right of survivorship --------------------------------------------- ----------- ("Purchaser", whether one or more). 4 Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- ._ t Dods formance of this contract by Purchaser, the following property,together with the rents,profits,fixtures and other appurtenant interests (all called the"Property"), in....... -------------------------------------------- County, State of Wisconsin: - RETURN TO Lot 25 in the Plat of High Meadows II, a-subdivision located in Section 26, Township 29 North, Range 19 West,_ Town of Hudson. _ Tax Parcel No- ------------------------ i i t i 11' - * If notified of any valid defect(s), vendor shall have at least 60 days to correct such defect(s) , or such longer time as the parties agree. i v This ._ is not homestead property. i4 (is not) her residence or such place, Purchaser agrees to purchase the Property and to pay to Vendor at .as she shall_name•,_,• ____,__ __, ___ the sum of$---22x500.00 ------------------------------ in the following manner: (a) $_2,25A.DA............................... ! at the execution of this Contract; and (b) the balance of $___2Q325Q,Q.0.................. together with interest from date o i hereof on the balance outstanding from time to time at the rate of..._.UN1.11O7A)................... per cent per annum until paid in full, as follows: $177.71 on the first day of August, 1987, and $177.71 monthly payments of principal and interest on the first day of each month. thereafter. Vendor shall not be required to pay second half of 1986 real estate taxes until July .31, 1987. Provided, however, the entire outstanding balance shall be paid in full on or before the..... ............ day of ---------June-----------I............ 19--- ( the maturity date). Following any default in payment, interest shall accrue at the rate of....12._..% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for,payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time xzltcxxxX 88xxxc�[ Ox tk=0xoaXXAMx=2 I )MtNA2wfx=xaixalxwit xixg amxatxY maw& In the event of any prepayment, this contract shall not be treated as in default with respect to payment so lonj Th; �.n:�.;iii h:�l:,,r.� � IMF t�rinci ,.J ,.r;', :.�tr�r,-? I;u:,i it :ov; i.�iz , interc-1 from month to month :4,111 he treated UV Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- .u, tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved i by:Vendor, in the sum of $._.__n!-a-------_------------------------- but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall }� contain the standard clause in favor of the Vendor's interest and,unless Vendor otherwise agrees in w notice a original j of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly g writing, insurance insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in nce proceeds shall ion or repair to be be applied to restoration or repair of the Property damaged, provided the Vendor deems the restorat economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, eencu and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: ... Protectiye coyenants __ > d_restrictions of record and easements of record�__if__any. _ _________________________________ •-----------------------------------------------------------------------------------------------------------------••-------------------------- ----------------------- -•--•----- •---- ----- - --- -----------------_-----------------•--------------------Y- ---------__-------------------------------------- - — — deed toe made ip !ul$ltment hereof 1 �Wr, June .................... 19.87... Datedthis - - ------• -----•------••-_. day of •-•---•------••--------•------------•-••-•....-. (SEAL) ---- (SEAL) Julia P. $pringett Mary Rusch --•------•--._(SEAL) --• ............(SEAL) e;. * * James E. S ingett •---•------- --•--------------•----•--•---•-•----------•--•----------••--•••-- r'P AUTHENTICATION ACKNOWLEDGEMENT Signature(s) - -------------------------------------------- STATE OF WISCONSIN ---•-•-------------------------•--------- --------------------------------------- St. Croix County. . 7 r,t authenticated this --------day of___________________________ 19.-_... Personally came before me this .._-..-_•-._._ day o� June -------•-----� 19.87.-- the above named -----•-._...----- ......._..--••-•-----.....--•------•-------------------------------•----•---_... Mar R. Rusch James E. S rin ett and . Julia P.._Springett----------- ________________________________________________________•---------•----------- ------------------ -- ---- -# t�, ••N ' TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------- ____________________________ ________________________ (If not- -----------------------------------------a ----------------------------------- -- ._...-.._..._.....�,r' to me known to be the person _ ., ' authorized by § 706.06, Wis. Stats.) s____-__-_: ,����1> the foregoing instrume4 and acknowledgti the salYle. THIS INSTRUMENT WAS DRAFTED BY �• (J - •� - /� .. Lois A. Murray, HEYWOOD, CARI & 14URRAY /` . r --------------------------------------•'----------------•_...-------- ---• t .. C� P.O. Box 229, Hudson WI 54016 _-ys ix --•------ ------------------------------------------- Notary Public ------ --- --------•-....L-FCIi(1kl`tyC��Kis ��yy i�natures may be,authenticated or acknowledged.Both My Commission is permanent.(If not, state.,expil'stlon '4«9 Anot necessary.) date: ............................... *Names of persons signing in any capacity should be typed or printed below their sign#tures. LAND CONTRACT—Individual and Corporate—State Bar of Wisconsin, Form No.11_1982 y a.. SONV� 0111VIdNO w ' T 0 s t♦\ 9/9'4 f d �: •b` � FA n`� oil t1- We .� J7j� F,��,FS 4 6j M CIJ uj� • } w: w.o•9ti yiw w , r X-T 'tn' N ; dun e v i9•t9ZY �,,.4�,BIAN ,. fw ...a^l +ure a.s +a. z n ° °W r•7i $ 7$�•d� �Itt I I ' n° N Jet p r r r r t L `•� c, o V X w Q O i ws bglt3�ikY's YY�t4kbi:Ri $ Z° W °� ; a � w• r.•wls• .• r,",� Z z v I =« :�°ul.l•OIL L i t I.r IL iye��; O ^ y ~• tt : # ; E y • Sgt � •` III �I :3,9� S � s '« •, .�� • Y = o G sasts •nw.e......•w,wruxtr, SONVI 0311Vld Nf1 n O V raroa+aiw•u ua aw•sawN ss ww I � °•� i�i `�J s-n ssa r sw•asn su.swnwew • r - NU^a 01).)bnY .•Www ewnr• • O i o y a rill Im U- aaaa Ell= f OL J121 - r $ a E _ a I;r it i ` a f 61 Ir a ! 3 a Ill!, • .�. =fir � � E � � ` H z W H ' a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z c7 a OWNER/BUYER 6tiS� , �2t� �U �/k Q SPY2JN I7 Lc)�4s l/TO ROUTE/BOX NUMBER 121 (7F Fire Number 'a-xt-c CITY/STATE U, J5C'014Si/y ZIP 54o16 fi PROPERTY LOCATION : G V Z, SE 14, Section, T 2 N , R Iq W, Town of 4l't��$'�l� St . Croix County , 1 � Subdivision 1r� �Po) _Su --Lot number ate. I� Improper use and maintenance of your septic system could result in v� 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 may 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 approxi ately 30 days prior to three year expiration. o 0 Y�� �9�y��-jhlecvF�i plea-„6p2� I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- �v 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 2. DATE l Z- 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 . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (1151 P.°. BOX 7969 HUMAN RELATIONS 1 / MADISON,WI 53707 `4 (H63.09(1)& Chapter 145,045) LOCATION: TION: TOWNSHIP/1110011103MCKW: LOT NO.:BLK.NO.: SUBDIVISION NAME: �� �� 26 /T29 N/R 19f (or)W Hudson 25 I n/a I High Meadows COUNTY: s O B S NAME: MAI LINZ AD—DR . St. Croix James Springett R.R.#5, Box17F, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE ©Residence NO.B DRMS.: COMM R D S R O New Replace PERCOLATION A n/a 6-15-87 77 n ET RATING:S=Site suitable for system U'Site unsuitable for system ONVE T : MOUND: IN-GROUND-PRESS -FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) F S U IDS ❑ ®S ❑� ❑S ®� ❑S ©u conventional step down trench 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: Class 2 Floodplain,indicate Floodplain elevation: n/a a , PROFILE DESCRIPTIONS a e 66 BrCZ BORING TOT H T R UNOWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH NUMBER DEPTHiN, ELEVATION OBSERVED E TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 6.88 98.40 none >6.88 1.00bl.l. 1.00bn.s.1. 5.03 bn.m.s. B. 2 7.50 101.90 none >7.50 1.25bl.1. .75bn.sil. .58bn.l.s. 4.92bn.m.s. 3 6.91 101.57 none >6.91 1.08bl.1. .58bn.sil. .92bn.l.s. 4.33 bn.m.s. B_ 4 6.86 99.10 none >6.86 2.00bl.1. 1.67bn.sil. 1;86bn.m.s. .33bn.s.1.1.00m s. B- 5 7.41 98.08 none >7.41 1.08bl.1. .83bn.sil. .75bn.l.s. 1.33 bn.m.s. B- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER10133 PER INCH P- P- see esi rate P- 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. Lipper trench=98.07 SYSTEM ELEVATION lower trench=95.08 - T , i tN t t } ► _� J.'I — 1 _'_11 _ _ L_._ ___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: Gary L. Steel _ _ 6-15-87 ADDRESS: — CERTIFICATION NUMBER: PHONE NUMBER(optionall: 988 N. shore DR. New Richmond CST SIGN RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — i Imo_ ri h IeD q z ,al: I --I� rc ti a Q a V) IS Page _ Of_ Perforated Pipe Detail 0 End View )Perforated End Cap \e PVC Pipe 1 � e o �.• Q�s Holes Located On Bottom, S Are Equally Spaced S P 1 PVC Force Main .7 Q PVC Manifold Pipe Alternate Position Of �r Distribution Force Main Pipe Last Hole Should Be Next To End Cap End Cap� Distribution Pipe Layout P Ft. R S X Inches Y Inches Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold Inches Date: Force Main Inches # of holes/pipe Invert Elevation of Laterals Ft. n PAGE OF PLiMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 'I"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING �: 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE 4"MIN. I CONDUIT -- _ --___--__ -- -- - -- --- INLET PROVIDE I - --- AIRTIGHT SEAL II v APPROVED JOINT A I I I APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3' ONTO SOLID SOIL B I i( ONTO SOLID SOIL I ON ELEV. FT. PUMP-�, '-� pFF D CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC F SPECIFICATIOUS DOSE -� 1 TANKS MANUFACTURER: ^111' &V Z ;Wd4e -/fS7�IJUMBER OF DOSES: PER DAy TANK SIZE : 7.'�-y GALLONS DOSE VOLUME ALARM MANUFACTURER: SJ �2�C°TX� INCLUDING BACKFLOW: /�� GALLONS MODEL NUMBER: CAPACITIES: A=��I1JCHE,5 OR ellre L GALLOUS SWITCH TYPE: B INCHES OR -311- GALLONS PUMP MANUFACTURER: m �Z�5/ C= j Z INCHES OR 1 c GALLONS I MODEL NUMBER: - S-,-) /V7 I/ D=INCHES OR GALLONS SWITCH TYPE: - _1'�I�2G�G/!��/ NOTE: PUMP AND ALARM ARE TO 5E MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET + © am�v FEET OF FORCE MAIN X d 23,/., FTF9ICTIOkI FACTOR.. -. L=_ FEET TOTAL DYNAMIC HEAD = ,3 FEET r IAITERNAL DIMEWSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: LICENSE MUMBER' n��ZL DATE: t