Loading...
HomeMy WebLinkAbout022-1069-10-000 I o d 0c~0 d c1 c O K CD 0 (D 3 . - v at M (D (D I m m I m I ~ O 3 Z O m n N• 01 B 3 W w O al OD CD ,3.. CD N N -'c n eo p CO 0) CD w (n cn cn a) (D K3 i~3 7 CL 2 w CD O O- p 7 7 (D CD a' 00 p o 0 UOi N C O O O ^r 3 a in N 00 ~ O in N C) a+ m o I d to Z D F ~ CD t0 O Cn C. fD o = W c CL O ~ Q! 7 V N 3 CD Po N Z a w co < n r ui 4 -4 3 fT Q - Z Z tv y 0) ~E cc Ch CD aq cr C, m 3 m N 0 Z o D D c v O 0 EP (D a Z• CD vQ w ' n m s -4 cn z O A Z N s ;a C I I II Z ~ N CD (D m 00 cn a z c Z X m 00 H A D CD D 3 CD a) 0 a CD = ~3 a x O. y Q 2 O O 3 c ~mv o z > j Cp a O ~c- CO aCD co a ~oN•5 -cc 2 O' Co y x * N 7 Al Z-0 N n CD v 2J O Z EL CC, j a C O (DD= N C N a CD O op °w A fA O ti N ti 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISOI~,Al 53707 NN,NE1~,S25,T28N-R19W El CONVENTIONAL XXI A LTE R NATI VE State Plan I.D.Numbec of asses ~f) Town of Kinnickinnic ❑ Holding Tank 1:1 In-Ground Pressure XXI Mound 05814 Evergreen DRive NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Daniel Clark Route 2, River Falls, WI 54022 ) Q, 6EV.: _ g1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 96012 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH 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 ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) DYES ONO NEAREST- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I IN(.TH DIAMETER JMATERIAL 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 CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF JDISTR. PIPE SPACING. COVER INSIDE DIA.. #PITS: LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. JELEV. INLET. ELEV. END. PIPES. FEET FROM LINE: AIR INLET: NEAREST--s 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- D meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS. OYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED = F TOPSOIL. SODDED. SEEDED. MULCHED: CENTER. EDGES. DYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.. PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ONO NEAREST TL L L{ S -rt_ & 41 $ L M 722 ,>n P I s, 40 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 approyed 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 jn 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: 11, 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'/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 nrLains/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 v 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 GroundwateC- included the creation of surcharges (fees) for a number of regulated practices which Wiscorisin's cart effect groundwater The surcharge took effect on July 1, 1984. All of the water that burled treasure is used it your building is returned tc; the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. -he rr,onies collecte' through these surcharges are credited to the groundwater fund adminis- te e ; by the Departme.nf of Natural Resources. These funds are used for monitoring ground- T v~atE r, gr ur :iw 'er contamination investigations and establishment of standards. Groundwat(:!, s - crti; protecting. 3D-5398 8.03/36) SANITARY PERMIT APPLICATION COUNTY T DILHR In accord with ILHR 83.05, Wis. Adm. Code -sa STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUM ER 8% x 11 inches in size. S77 tX41K -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROPERT WNER PROPERTY LOCATION 1A i y k Z''/4, S P5 T0,, N, R/Q E ( r) :E4K O ER S MAILING ADDRESS OT NUMBER BLOCK NUMBER SUBDIVISION NAME PROC CITY, STATE ZIP CODE [PHONE NUMBER CITY NE EST ROA LAKE OR LANDMARK F- l aa ❑ VILLAGE : t II. TYPE OF BUILDING OR USE SERVED: 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. r Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an ,ter System System Septic Ta Only , an Existing System Existing System 2. D4 A Sanitary Permit was previously issued. Permit (`D' 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.,RConventional b. ❑ Alternative c. ❑ Experimental 2. a. El System- b. El Holding c. ❑ Pit Privy d. E1 Vault Privy eV oew-" Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PER 0LATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSE (Square Fe Feet RPrivate ❑ Joint ❑ Public CAPACITY VI. TANK i all2ns Total of Prefab. Site Fiber- Exper. INFORMATION n xi: Manufacturer's Name Con- Steel Plastic New isting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank ~OO T4:x 5 ❑ El Lift Pump Tank/Si hon Chamber Q ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plu r' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 9,A klia,; X ~a•~ r 71.5 s- 95y Pt tier's Addre s (Stree , City, S te, Zi Code). Na signer: F Vlll. SOIL EST INFORM TION Certifie - ester (CST) Name CST e CST's A DR SS treet, City, State, Zip e) Phone Number: p, Is 7 ?"s IX. COUNTY/DEP RTM T USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination I 0 • w X. C MENTS/REASONS FOR DISAPPROVAL: Perly~,'t c~Pclcc,~ d~ {~c~c,~n«ll.. SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 1 i l APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of PropertyA (q--%, ^_'6, Section 2 5 , T o2 N-R-L2- W Township Mailing Address Address of Site Subdivision Name .Lot Number Previous Owner of Property 44L A"e Lt-%e-a,,^ Total Size of Parcel O af-i - Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume -5-7 7 and Page Number as recorded with the Register of Deeds. ~I INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq Deed which includes a Document number, volume and page number, and; the Seal of:the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (cue) centti6y that aU statements on this 04m ane tAue to the best o6 my (ouk) knowtedge; that I (we) am ( aAe ) the owneA (s ~ o6 the phopent y dens eh i.bed in this t.n 6o"at i.on 6o4m, by viA tue o6 a wa Aanty deed teconded in the 0 6 6ice o6 the Countyy Registeh o6 Deedsah Document No. and that I (We) phesentty own ,the pnoposed site bon the sewage dispos system (on I (we) have obtained an easement, to nun with the above de cA bed phopeh.ty, bon the eons tAuc Lion o6 said system, and the sane ha.6 been d y hecohded t.n the 066.ice o6 the County Reg.ie.teA o6 Veedb, as Poement No. SIGNATURE Op OWNEvR~ SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED F r - yy`` _ KS . tbo du ab **a y i y 1 16 s'~,~ ay r ii[ j l %NjR* W" Ot e Ord. AMY, +4 / yr uw ,ft _ _ - y SIM { . }ga i7l as * .....,e:, ham* am* ' v H z H 9 ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z d 9 OWNER/BUYER 6 r f ROUTE/BOX NUMBER Fire Number CITY/STATE rj,)fV ZIP .5,5/ i~ /V :F 4r PROPERTY LOCATION:Section ..Z ,S T N, R I~ W, Town of 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 I` 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 approximately 30 days prior to three year expiration. yo E I/WE, the undersigned, have read the above requirements and agree 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 DATE 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. State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 THOMAS WANG Owner: DANIEL CLARK 1009 1/2 WEST MAPLE ROUTE 2 RIVER FALLS WI 54022 RIVER FALLS WI 54022 RE: Plan Number: 87-05814-S Date Approved: July 30, 1987 Gallons Per Day: 450 Date Received: July 27, 1987 Project Name: CLARK, DANIEL - RESIDENCE Location: NE,NE,25,28,18W Town of KINNICKINNIC County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for private sewage system, code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPL PET'IT'ION - REPL MOUND Inquiries concerning this approval may be made by calling (608) 266-8230. XE rel y, TH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 5 cc: DANIEL CLARK Private Sewage Consultant ----County __-UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health DILHR-SBD-6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor and Human Relations ` W k(l V l , i .`t SAFETytk BUILDINGS DIVISION ,Office of Li vi si on Codes +nc; 1icat'i an 2cl East 0,as1:i ngtorl Avenue 1r;iFl Glum P01)tf . -ceti ti or t;c•. Ear il.. '`farm: Vie: Daniel .;lar?:: Pcsiucroc£ , < i'r1VatE; SPwa!~f~ Tom-i of 'iw,ickirwic, St. r.:roix t~;sit;y, I jEctior! 1`{ (1), iscrosiri StEt.Vj i=s, ILII4; £ L{ ( ) ?'isconsin CuC le, ail l ov! the (:3' ner to pi,tit i on the Gepertm(-r.-r foi- a variance to t6,Ei nstd i i ati uji for is rsri Vite sei Jade sy%v,ni tv replace an exi sti rq private 5ilti`t.tE s stet, at a site v{1+ich is not in fall C0r-11P1iiariCE: e iti the SitinC standards in the adr,"i ni strati vE.'. rule. Tte system (?v. i qn r ruposed should prozect ti.e sN;aters of f:I,tt state frog, contpriinatiorr. If t;lis system F;~ecorrFps a failing .syster, or cot, tar~'iirates tEe {ct -~,ers ff the state:, tftis. VciriarrCE' Skill he resci ncer. The pE'titlcn fcr a voriaiicc, rt.queste6 tt' s. II-14 <a3 3 (l ~ f tho 110 i-'dm ~47t'k ,sas ccrsiterE'd co Jul, -'!i, l`'li. i1'E' 1Ftitivrl :.r5 ~E?E'.'ns Conpitioru-sl'ly approved. Ti,e ccintlition :•eing 1;f,,at ire Cie evE rt of failure, the r"iounC system stall 1'e rep'Icacoc vitf': 6 olriinq tank (':r otFx.-r cif -lot system. Tile rule. requires that a f oifne systee ` ve a ? J r:`ir;iun rf Lr i riches of suitable natural Gcil. The vari a:t:cc rcgi st oe ,.,,as tc., install a rnpl cer<7nt r wi(i s ..stem on a site of si.:itaole notk!r•al soil. ! 1 of Cite data ciii(` s r`.i+tei)A(-: nits subli n t.tE:'c`, on "yE'rc;l f of tf:,e petitioner vlere considere,. THs vuriirnce is spcci'fic to tb(- slltjf, ,ct: f:etitiori aric cannot be u":e 1 fc+ any d0CJ ti w!t'l riec f f iciati ons. I 1,1C e YT d lie 19, Ntersoon, C'i'J"f ec i E;r c:9 (~l ((P ri vatc Sr s:a,~ 4 ! ~'"F:kS:' 7 4v cc: Leroy! Jarisi:y°, Private St'wdS t Coi sus,ti;:rit - Pi str"`i ctr Chippewa 1'i~lj s _ Tf C~r!raS 3iE'l Sftir9, 2onl oq AdrA ni c:trzltor Ste '(,,'roi C I , CSGf; 4~/ DILHR-3BD-6423 (N. 04/81) n ~'I~ S ~.5 i ag N 8 n n t C~ (u.J S~ 1 `slot Cp. S o~ c I5~ 51Ott., o SP i s !Z2 too' r Fr-, 4A • J~J r oo 15 wQ L1 CJ' gYOJn tX rtc Cl eo . i 15 pntoo9 S .oo 17' ck 3JO 60 r A C-j C\ T, torn l r Page - Of • - Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil F G f1• 3 E o 1} Of: 2 %Z Force Main Plowed w e From Pump Layer r}~°S Z Cross Section Of A Mound System Using F A Bed For The Absorption Area G A Ft. H I S Signed: B Ft. 0 License Number: I Ft. 1 3+ Date: J Ft. U K Ft. 1 43 Alternate Position L Ft.73ry~~8 of Force Main W Ft. ,31 , q _X L Observation Pipe 8 K 1 A •I Force Main W ~ From Pump ~,Dislribulion Bed Of 2~- 2 Pipe 2 t Aggregate Observation Pipe Permanent Markers LL Plan View Of Mound Using A Bed For The Absorption Area Page Of _ Perforated Pipe Delall Aai e> ~~pN5 s 1"~ . t t ~j~~~r: t3'A End ~Perfotoled~~t~~ V End Cep i1 PVC Pipe of, Holes Located On Bottom, S Are EquoUl Spaced X\~ /Q S PVC Force Main \ 4 From Pump .7 /Q PVC Manifold Pipe Alternate Position of O1tlnbulson PIps Force Main From Pump Lott Mole Should Be Neel To End Cop End Cop Distribution Pipe Loyoul P 2 3 R S 3 p i(A~ X / Y Signed: Vd hole Diameter Inch Lateral of Inch(es) License Number: Manifold Z Inches Date: Force Main S Inches Bulletin C 1A July 8, 1983 ;t! a V714' For Homes r ~ fr! Farms OUL Trailer Qourt Modell r' 0 Motels " (supersedes Model 30 r~ - • Schools • Submersibl I Hospitals etaWuewm Effluent P * Industry .0 Effluent S ste s Y m Pump Speck patio anywhere effluent Solids Handling qt1, ! f w NFarge or drainage must be 2" disposed f quickly z" NP7 letlSemi-open Impeller -x quietly i3n efficiently, 3 vane design, thteade}J'pnp►aasi~'~ qtr` u(1i,ts use I peller Ic?p t4lp,Wdr erl}aGC~derik~►';,. for protegtton 9f mi I t casing _r ft`P I volute type for /nax11~4tf~i [1~1 back oil. Pump out vac s on'bac } impo { ILA y Stainless Steel Faslflrt~tlE I,~s';s~~ Heavy-Duty Solids Handling - series 300 sta~nle t; tP~a L~l . f Dependable Capability to 3/4" ~►d~ Mechanical Seal't. t 1 Ceramic vs. Carbons lJ 1 spring and Buna N elat~~116r~ _ Maximum T@mparalw° H R 60 Hz :160° F. , Capable of Running Single Phase 115, 230 Volt without damage to qo~ 4 Motor S t 3/4s 1 1t/ H.P 60 Z M for Y g~ , ' l in high, grade 1tu binq ~ for P~(jnt [1 Single Phase 230 Volt. Three tion of bearings and mWanir.#jseaf gpa,, ' . 'Phase 208-230, 460 Volt. efficient heat disslpaticlo' f~lolgrsealed fro environment py fugq it #9' 1 Bear Ing Heavy-duty all ball J Stainless Steel S alt t , L~►, - i series 300 stainless stQql for pgrroSlorl ; Y reslstanc Three ded ft 1 v# ~a r iqy +t.-, itri i M ' Single P a Llnlty~ All single phase units h@Y k+4lll*Jn ihs[mf 90 overload prot4ctign al! 49 r C jt 'r ' Three Phaie Llnils 14 r, ~r W2111 .00 Overload protection lr #it"rJO~ .201" 460 volts. Threag§q 70 P°Wer Cord U. GoWater and oil resistant,a boxy Wl 9,q fpotor ang o H„ acts as a secondary mq tµre iarrler,,(n.A4 Df t° damage to outer iacket p-Co[fRSlop[esistartl yr x54` s.glend nut. Single Phase Units a~ z Q 40 '%f H.P. models equipped with 15 W j' > I<'. SJTO with 3-prong grp~nAing plug **y T,;;_,t'~ , 4 i G ,3Q. ~ models equipPed with 3 T r kvr h• Fr ~ cord, ° 1~a;ht ` Y r} O 20 SPECIFICATIONS ,$U T~w 1Q WITHOUT NOTICE' t ' f 0 10 zo 30 40 00 60 io eo 90 100 110 120 CqGOULDS PUMPS, INC. GALLONS PER MINUTE - SeNECa F#4$, t,EW tpRlc 13148 ? PACK' PUMP CHAMBER CROSS SCCTIOM AAID SPECIFICATIOUS a r' 77 VEAIT CA!'7-p , VIE A IT PIPC APPROVED L OCK (p i WCATHCR PROOP , ~ r a JuMCTIOM 001t h1ANHQLC trOVLR, ! f< , lI;OM DOORS W OR FRCSH I>r MIU. ( ' "x I •`I r" b t I K E 1K GRAD N r{ 7~g' d IA1l.C T PR I 1 N T 1, Poo OVER joluT ~~^ti,::' /~~t w I I ~1 APPRPM~D .I I T1F pirg E PIPE l3~ :p6Tc4cluce ` Q41Q ~oIL . h+•,+ ,rte `~tt'} y L`~1,~" 41 ow r ;t ri ,x. ~k pump Orr s D 64 CONCRETE OLacrc K15CK CXIT pC.RM17rrD OWLS IF TANK MAMUFACTURCR HAtS SUGM APPPLOY . h►PpRcvt ~ r SPEC. IFICATIOKIS z . ` 3 err MANUFACTURCRI kiUmIsER OP 004ci: K ~J TAWK 51ZE GA OATS OOSC VOLUME ISOt2~.~b s IMCLUp11tICA. bAGKPAOW:' AR MAWViACTU0.fjr,R: 77 2.10Qfa1 MOP91. ChPAC171ES• Ag IAICH[ ~ ►k~r,~;Rli AIUMIlCR. . n 4 + SWITCH TZIPEi Qs..,. Z_IIJCMCi 0 - "RkAQR1 IMP MAIJUFACT1JaCR~o I I C. w10 IIJLHEi Iaf~ . 7 (~A1.40y'~ MODf~1. 1JUMOER:.....~..•.j~. ! ` ' r ~,J it Do ......C, INCHES 09 *WITCH TaP, PIMP AMD AI_AP.M ARi tO SIC ~t", r • INSTA4~•I:Q ON SEPARA ! T a R MIIJIMUM DISCHARGE' RATE GPM CAL DIFFEKE14CE BETWEC PUMP OFF' A OISTR1 .P✓ ~ U ND OUTIOIJ pIPC.. "w FCCT . 11.IIML1lr1 NETWORK SUPpI.y E>;1;uRC/ ~ 2 5 FCCT ~.lrccT OF iO1tcc MAIN X~ FR " J' f Twolc ICTIOAI iACTO FEET 4 TOTAL OU)JAMIC. HEAD ,'ll, j, / Fi:ET' +z 1 { i~ ry 0 Mz. ;R1JAI. DIMC K: S101JZ Of TAN I.E1JvTH I l~ ;WIDTH LIQUID DEPT GMEW LICEk1SE MUMBERf 3w DATE. ~ y ro ~ n ~ 3 03 (D FJ- a (n d z N rt k H J b z W (D Z(ED' o d rt ~ 0 w --I j Z O CO (7 N O • Q ft N t 01 O CA O O O N ~~11 ul (D 3 3 CD 7Z 7 pNp 1~1 4--$y O v CL N z n. y N O w~+f lAl OC 1 N co Ow N N C 7 O O 00 rn N' Ic~°n8~ ' 00 b 0 7 N O C ~p to r co OD j L. o co m ° Ct Oo m fn D P vS9 v I ~ ~ co N W C. ~ W N 3 O 0 0 170 N ~ p ~ A f0 ~ ' O Z N z ro 00 n r ur .d z ° wo- D~ 3 p Q 00 r (D =;i 0 OIQ 0) CO) CO) CA p Cr A N N• O p ~►1 N W QO ' N N> CL N• n o 0 D D c m a ~ ~ !mil I C.0 z CD Z o ~ l ~ A p~ A z 0 o° ~J z N wM ma, CL z Z p m ~ I v ~ W m I ~ n j CD rXC;D: ? o d c z a N 0 ~p OD I o4 6 N y -46 e m 3. o~ a fD so b Z CD 1 3 Q o 10 N N I o ti 0 o I ~ A N 4'Q EA Q ~v Op ~ ~ C a O ~1 i State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 01 ice of Division Codes ew6 Application Pox 7~i'q V, -3707 Varliel Clark Pive,r F~Jk, f"J LeAr 1%r. Clark: Pri vatC sf~2i'7£:' Sy C r" r°ti )i C'v K'ir+riGl;irPliiC, St. Crui, (ill,;:'7a.',•,, 1 Scc:;.ioo 11' ).`(1', 4,iscor. I :.rj:.ct1:::tes, ;+r;( :s. ~i«'i' (i) lE 1'11"-consir`t C;'iIE'i" 1'.(> !•E;'tsiti+i3r; tilt <;'pc3rt!!1E"s3$. 'st'ar a `'af"iFt!!G£' to tt; i r}si':. 1 l zt i C'n for rt r'r'i ` ato S)" te-g; 'C:C) r°q)aCC° c?ri CXi sti r't' pr`i vjtp sf.adfaj( 511Stea; iii t} s'te 01cGr Fs 11M, Ir; i I'll C!.'vq)i'ir'cC -'1 w" Vne siting stand(i ros i c, t hc'. ~'c;r',i ri Str" L-A v r";.1l 'i "-i' S-Stel r e C i Gi°t F?S"oposeo sboul r' protect the waters ft' li>t< "t.a$£, f ror} C QSf'wdli i diriUr±. 4 t"'.i s syster; t' ecorn s u f di i i ng S.' :r v• ' or, cor?tari n%ites tlk v,a..'Lers of t!-;E' Sine i..•`, irlii s variance shAl 1 i:~V. re sr Tae peti t i cl, i'(.;r a w ri ance P'~ t:Ki f S tG'~ to, I Lh" ' f t . ` ~ 0) (d) of t1ve Wis. A ',.,i f ~t:G r` t~ i~' o l 't> C' i C^'. ""!F! f.'r $ l.Clii ; if±:a R!eer} f t;1).e i ti ( l I r' ts}'jsY"C''JC?tI, T ~e Cr)r 6i ti £ i tern s,i'Ei'4 i ri tl' f` rzVt-r}t of ftli ~ t+r c' ~ Vie r'1L°un,,'4 byt,.'(er, t(- rc-ot +CtyG` ',J $;j!~ cC° syst:tr, Tile rulF requires if,at, ei r"t?i1r syste!:~ Y'2'`q 3. FAY'i1"u ; t; '24; iric ;es of suitable rat.taral scil. T v'f, variance r€ quest:¢~% );<tS to install ii Y"f'()I ~CEf?r^tit r, of:i';rll S!'::t er or, a site v:~iv,, 12' it°ciie's of s i at:+t: ratrur,ah sciii. ill t: 1' t`t... : c,•:ts3. (.r}C' 4tat(rlell s s;th lttr:'.r ,.,&,;alt' of ii t: 1'l''t;it:1Q11`er ,,,(,re covi-:i?e'rt'.'.'.. IrA ; AriAnce is S«:)f'(JfiC tC: t;l„a SU'J, ',Ct: l>e it:icoi and cannot b el a SC.f+ t t r ',rr!r i )'l' 1 9.1 CidiG. i I t+ti°f37 f Iti ()rrS. Si is rt:'1 ~ertiori of A ' C"W I ii ~'JaC S:t 7e:1)v CG: l_t'.C'C" Private lC)'aX('? 1.<.~ rit; - f) i i.r' Ct i13("su,,al F al s oS, S i e'lstar:, i.or;i) r, e`tcf,ji;istretoi `i...4 rc,IT: Ivt DILHRSBD-6423 (N. 04/81) State of Wisconsin ` department of Industry, Labor and Human Relations 1 PR?tiFlTE .raEWAtiE 1)1_FlN AFtF)Rf?'JAI SAFETY & BUILDINGS DIVISION 0f'f i c f' Ili u'i • i cm Cod en ,anc;i )pp] i ro.t ion ~ )..t'lf)fui(i tiff 1~,4C:i i'AWa Y' : i 1 t)'N I iJ C:I M', W9 1;'2 wi -r r1f [11 I.: i; )Et It RTvF, I AI l 4i 1 VI I Fi`1Lt 1x401) t ftE:.: F)'I.at", rttta]t1kJt~Y : H/ ()":~S'1.Q I:)<:it {1Fi()t"C.v 'Ef: (ti1 j '0, 1.9I)~' C:;tal i i?w~ I'r'r E},ay ° 41a4`I E: tr t c, t va(; it t! 2, 1, 13,)1 1)rojec:t, 1'j<anw (J; ARK, I7r")CS11I RE!:"IMNIC1. I.cwat.ior): NV Rif. 1:i ,20,1814 I.t- wn (if t;:I iiIN F C::K I'IVN C:: t;'c,lst':1 y : i C..Q0I ; ho pl.(.tFflbirig pi<ans and ,ip(-':if! it Jti()()r~.r. thi )p 1 i)oc't F)fave 44o11 t'ot1:i.eve c.'t.fcer, t:Ce]f1F) 7 i arlcc:' taJ"!'I.I) ~a~~1J l a <':vh I.P <+JCie? t`+'f:(t,t 9, t"r~lt)t~i S%, . , }i L f t ~::Pf~ on f;{LYOAk?1". 145, Wisconsin .`i);itui'os iarvi the W'Srt_%nsin ow.;r:E1"11. tt'-'].a.UE> E.;Ci;'i4i!. iho pliwls 13.1`k? a't'tati113t?!,t ci:7nc.1:l'I: 1.(:)tYi1.l..t V :4;J,,,1''f)',jCzt{ r i i'! i )t;Jt.'Ji' ti'.f:.+, i; ('racit:7 n,1(7,n I: upf wn Comp I 1 +tiC n w 1 r~l'1tF `.>'t;i.i)tE.E~at:"I (:tri (,hoWri on t) i I t h:it: or-c- t'lC7i:od, fAunt bra (':;JY'rf,(, t'.(+c A~1 t. F~car'tr,1_t,:) i-ocil,i i r,od 1')% c:1 t tii : 'i i 1, .I [ c1i.,.i3'u:;tF71"s ccf' Ci)M1r1{,~ _,i1~,1-i i)<? CitJI; a.i1d Ct prior- to r:owJrur.'t'inn, rho t4ii , i_nntatlation zF):~. t 1, i J at'7t7t r'itI!a j .Aiti . 1 i17? i>ru 5a?(: <>F: 1: !--1 i. i i {.;t;hrtf>f:l"t,if't`.l.C7Yl 04:r., I..1? 'It"1 `3)':.1f !`ii`9' bit"rtJr^f)1,')t'i~Af.e7 r,5 1JG,--C:t'.f?h kl("Ifi{'1 i'xf)IiN'CrtP;~;t1 iaF1.r J r`.;"(fllt"f=' 't,~ini ',/E?;117 a-y..,;i:p 1,"1e° i.i,;'4':i, .:}idt'iltaaf°1/ tYF:`l1111.1 i. CiJI:V~ijG'lir {'t' 1l.1 !'X 171i'~: It')~? Y'w!j inil).:il ;~)FM11IiaJ"'?) jJ't`fi17t (1Xpir't'$. 1`i"IS E+t1t°F!r".tt! Cif E7~1.t,iiltl;)7t)`:I tlia:'s 1"'vr)ti'!,x].~C] ;~I<.'`;f• t.rli}{t'; 1i1," I'it i;'+it-f :44.vl~~S1t'~ :':V.;t.CtG C,:i7r'„IF? re`C)i.I tt^LaiNC3itt `i ~iY'4t 1/ the r? ;:r1 -aids i"l d'tE' ;'c:rl_ ~')i~(.•t{ i"F i ~.,7«sr,te ho t clcto r,ook.il.i`~ S !'t: fC71"~h a. r) Fri.: .l on Ct HP 8 [;onc.'I-ol )7ttJUtt`i]w"I ca lr? t:11 zp!.oi tJ i 4 oV t,hi,- yr Id1.1:)1. 1)I..1...1, f j JAl PFP!, MOUND ~rYC{Gl1t a EIS CCN"It:F'r'rll r'1t~ this 7kpI:'irciva iwky t")o rR,:.`ac' t;)y el, Oh t'wi J)08) 4166 -8?30. i hf nl FM I:1 FMKE: E;t.ti l.cf i r)ct Division of !iiafot:v and F)PPOI fi/0009n/ PArkl[FL, (A-ARV I'~K~lilF~'tf! ~:G'!%.&Jt:jF' f.iarl`.>i.~t.l"C1 t'i't". (,t'ftlili:Aj Z4tJvE.Ih1P~1I' _I'.LI,U"i1171r1C`((:C}rl(ii#t.'tliari'L S I]wr- i.. I:. r)47 i'1:2]ltlont,a 1. DILHR-SBD-6423 (N. 04/81) ST. CROIX COUNTY WISCONSIN LYE e ,Tra+r+~It„~:^•t t} tir ~ r°' " , ZONING OFFICE rr 795-2239 (HAMMOND) 1 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 7, 1987 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Daniel Clark property located in the NE 1/4 of the NE 1/4 of Section 25, T28N-R18W, Town of Kinnickinnic, revealed suitable soils at a depth of 1.00 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, - koMa--) 0 dLr~,Cac~~7//"G Thomas C. Nelson Zoning Administrator rc STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township iiM4XMY: NE Ne i4 JS 25 T 28 N/R 18 gf4& Kinnickinnic Street Address: Subdivision: County: Route 2, River Falls, WI 54022 N/A St. Croix Landowners Name: Mailing Address: Daniel Clark Route 2, River Falls, WI 54022 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19~ Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/49 NE 1/4, Sec. 25 T 28 N, R 18 MXW" W Town =Xftn"Id tyX Kinnickinnic Street Address Route 2, River Falls, WI 54022 Lot No. N/A Block N/A Subdivision N/A Landowner's Name: Daniel Clark The application for this site is for: ❑ new construction use. ® replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers issued to ou.) L l one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑ for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑ for an application on file prior to February 1, 1980. ❑ for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: E la failing conventionalxsoil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here.n I certify that the above information is true and accurate to the b t f my knowledge. Name Thomas C. Nelson Signature L County Official Title St. Croix County Zoning Administrator Date July 7, 1987 DILHR-SBD-6158 (R 12/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTPN: =NSH MU ICIPALITY: OT NO_:BLK. NO.: SUBDIVISION NAME: COUNTY: O ,ER BUY R'S N ME: IVIAI ADDRESS: lrf4 ' X it 'v ?//s C_) . 6 Ing a 1 r . USE DATES OBSERVATIONS MADE NO. BEDR : COMMERCIAL DESCRIPTIO ROFI E NS: I N T S: ~Fiesidence ' ❑New Replace Y RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S au o s au o s au ❑ s ®u o s ©u A44, h a 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWAT R-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / '1/. CA 1, -5c Ise" r B- 5 B- -1 17 s h;1 e /5' B- B- 3 Z' e-1 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RIOD 1 PE RI D 2 P R PER INCH P- .sly' s s 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 ~ ~ t I i ~~Z{r'{ (S~"'Qb~ W 5~w~er?~NhK►~r,~ U~ 0e, la'' Ole xOb,O all le `t jyf rc r. i Jc' ~'GtTh Frpsp„y~ _ - X INV x Ertl SA n~__t~ Qt%~_C nj ' o 90 t 1.0.4W tC Lt EPICd a~._.- ! 5'a' I: Pala jc~N < - 1 ~o d ~ i a I fOG~. 0 _ { P 3 l I 6 I ,FLFw ~eeh 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in acco 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 ( i TESTS WERE COM LETED ON: ADDRE S: CERTIFI ApTIIO NU BER: PHONE NUMBER (optional): ~a CST SIG E: ~J 1 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ` DILHR-SBD-6395 (R. 02/82) - OVER - r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or cornmercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is th'_, a rv r, placement system; 5. Cc f.ability rating boxes. A SITE S SUITABLE FOR A HOLDING TANK ONLY IF ALL t 31 RE RULED OUT BASED ON SOIL CONDITIONS; 6. PL .a e ibbreviat:ions shown here for writing profile descriptions and completing the plot plan; 7. M/'"E A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sheet: may be used it desired; si , your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. C IE all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- t appropriate; rtion (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 1. rrr and place your current address and your certification number; I( -ible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE AL AUTHORITY WITHIN 30 DAYS OF COMPLETIQN. , ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols (oven 10") BR -Bedrock _ +i, (3 - 10") SS - Sandstone gr - rave€ (under 3") LS - Limestone Sand HGW - High Groul,dwater Coarse Sand ,Perc - Percolation Rate .,E.. Medium Sand W WeI1 . - Fine Sand Bldg - Building Loamy Sand > - Greater Than ~ Sandy Loam < - Less Than Loam Bn - Brown :hilt Loarn BI Black Si - Silt Gy - Gray ~cl C` y Loam Y - Yellow scl I r Loam R- f d sic[ mot - r Ill - SC - W'/ sic y C-'y fft faint y cc arse - rn in - 'M r Eck d - c ° p pt HWL - Hi.,` level, x so'i textures water waste disposal BM - Bi VRP - V t Terence Point TO THE O • report is tl fir; i a ritar y p Writy or fie; it ry request f tl :private a _ is a ler to T` Y t it r id pc DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, i~"I DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS ' (H63.09(1) & Chapter 145.045) LOCATION: SECTaON: gtWNSHl 7MUN ICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:-- COUNTY: O ER BUY R'S N ME: AILI,Iy ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE E CIP' NS: ERCOL N T TS: hiliesidence ❑ New ~eplace `/7 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ou ®s au ❑ s ou ❑ s ❑u ❑ s ®ur~ h a 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, JAT OBSERVED EST. IGTO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 3,6G~ 7` B- 5>~ Z' /s B- B- 3 3-6e P. 50 oc~ I tle,_15'J' ,2. eO A,,4 s ~_I J B_ PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER I D2 PERI D PER INCH P_ _76 _ $:/7 P_ d -3 Ly r - f/V 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 96.w Z UIC'_r~1~6 f' 1 ~S rU~~ L~ _ ~~1~;er ~~LhK t hq _ j u i I F t-- ~ yell t d ale v,a~± - 7 _ Ira Qa 50 _ - B Iipl ~ pa N!r N 1 _ E "Irk t ~ ~ 11 F I ( ~ I i m~ I j i 3 7 F ~i; f w~-e e h ID r. I, the undersigned, hereby certify that the soil tests reported on this form were made by me in acco 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( i TESTS WERE COM LETED ON: A ✓t S P ADDRESS: CERTIFI ATIO NU BER: PHONE NUMBER (optional): CST SIG E: A q DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER -