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PUMP CHAMBER
Manufacturer: `� �l�s Liquid Capacity: (90 0 �J,
m (0'f-0,3
Pump Model: (12.) AA Pump/Siphon Manufacturer: D-,t (::�_ Pump Size
Elevation of inlet: 91 0? Bottom of tank elevation: �-_ o
Pump off switch elevation: � � Gallons per cycle:
Alarm Manufacturer: 4,4— Alarm Switch Type: 02 ri✓ z�
Number of feet from nearest property line: Front, O Side, ®Rear,6 Ft.
Number of feet from well: Zcq
Number of feet from building: ��
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Z) Width: Lenith:�� Number of Lines: >-- Area Built: 96-0
Fill depth to top of pipe:
Number of feet from nearest property line: Front, , O Side,Rear,0 Vt .��
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: N er of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Bu'
Has eit r a drop box O or distribution box been used on any of the above soil
abs tion sytems? (Check one) . r '
HOLDING TANK
Manufacturer: Capacity:
Number of rings used* Elevation of bottom of tank:
Elevation of in t:
Number of et from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well: -
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated - � � - g•� � Plumber on job:
License Number: �' 5
3/84:mj
I�
z Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. :?_-7_ T -3o N-R ZU W
ADDRESS. � 4 ,,� ,` ST. CROIX COUNTY, WISCONSIN
r
rtf Plot-
SUBDIVISION LOT � qLOT SIZE
I
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
i
3 J o e
da /a 3'
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used K"-
Elevation of vertical reference point: In e) ` Proposed slope at site: 0
SEPTIC TANK: Manufacturer: cC (Liquid Capacity: 1,0[ -� c J
�S
Number of rings used: Tank manhole cover elevation:
[�
Tank Inlet Elevation: �� Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side, Rear, /0� feet
From nearest property line Front,0 Side,0 Rear,0 feet
Number of feet from: well , building: 3&
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
t
DEPARTME0 OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LA�itOR&WMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
P.O.BOX 7969
MADISON,WI 53707
State Plan I.D.Number:
IN CONVENTIONAL ALTERNATIVE (lf as.igned)
NW14, NE%, S27,T30N—R20W
TT i ��TT hh ❑Holding Tank ❑In-Ground Pressure ❑Mound
Loor29f hcko9epHoulton
NAME OF PERMIT HOLDER: ADDRESS Of PERMIT HOLDER: INSPECTION DATE:
Elmer Crawford Rural Route 1, St. Joseph, WI 54082 S—/9`— 8 '7
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 1,.,REF.PT.ELEV.:
Name of Plumber: MPIMPRSW No.: County: Sanitary Permit Number:
Gary L. Steel 3254 St. Croix 92540
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROVIDED: L PROVIDED OVER
OYES ONO DYES ONO
PROPERTY WELL: BUILDING: VENT TO FRESH
BEDDING: VENT DIA.: VENT MATL.: HIGH WA R NUMBER OF ROAD: LINE: AIR INLET.
JALARM: FEET FROM
El YES ❑NO ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODE L. PUMP/SIPHON MA NU FACTLI RE R. PROVIDED,LABEL PROVIDED OVER
❑YES NO
ED ❑NO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: AIR ENT TO INLET
FRESH
FEET FROM LINE
(DIFFERENCE BETWEEN OYES ❑NO NEAREST
PUMP ON AND OFF)
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL 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:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE CIA SPITS D OTID
TRENCHES: NIATERIALt PIT
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTR.PI PF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING. V NT 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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
PERMANENT MARKERS. OBSERVATION WELLS
SOIL COVER TEXTURE
❑YES E-1 NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER. EDGES:
1:1 YES ONO ❑YES 0 m ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL- NO DISTR. DISTR.PIPE UISTHIBUTION PIPE MATERIAL&MARKING
ELEV.: ELEV.: DIA.. ELEV.: PIPES DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORR ECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
❑YES 0 N El YES El NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE:
[1)YES 0 N ❑YES El NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side. sICNATURE TITLE'
DILHR SBD 6710(R.01/82) Zoning Administ
}
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'/z 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 at9�
included the creation of surcharges (fees) for a number of regulated practices which WiSCO €17}5
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TeasttC6'
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.
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- f
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
e
SANITARY PERMIT APPLICATION COUNTYY C 0/
�' fflLHR In accord with ILHR 83.05,Wis.Adm.Code STA SANITARY PERMIT/
9 s 4lo
—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 (y�
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES ONO
PROPERTY OWNER PROPERTY LOCATION
Elmer Crawford NW % NE %, S 27 T 30 , N, R 20 )V_ (or)W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME
R,R. 27 7 Houlton
CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK
St. Joseph, Wi. 54082 1 (n/a EjTv ILLAGE: St. Joseph St./W. #35
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 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
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. 0 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. ❑lSee 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):
class 2 750 750 94.80 Feet [�]Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in ga ons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank X 1000 1 Weeks Concrete ❑ ❑ El
Lift Pump Tank/Siphon Chamber X 800 1 Weeks Concrete ❑ ❑
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 ature:(No Stapp I&/MPRSW No.: Business Phone Number:
Gary L. Steel "Z�� 3254 (715 )246-6200
Plumber's Address(Street,City,State,Zip C&d&K Name of Designer:
988 N. Shore Dr. , New Richmond Wi. 54017
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
Ga L. Steel
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
88 N. shore Dr. New Richmond, 715-246-6200 Wt 546t�IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved F-1 owner Given Initial Surcharge Fee 7
Adverse Determination 16v'� •C -�S�g`
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
i
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 Elmer Crawford
Location of Property NW 36 NE ' , Section 27 , T 30 N-R 20 W
Township St. Joseph
Mailing Address R.R. . St. Joseph. W; . 54082k,.
Address of Site —_Same
Subdivision Name _gniil tnn
: Lot Number 27
Previous Owner of Property George Holcomb
Total Size of Parcel n/a
Date Parcel was Created 4-13-55
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for resale (spec house) ? Yes x No
Volume -j?0-. and Page Number 304&309 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) eenti6y that a t A tatement6 on this onm ape true to the best 06 my (oun)
hnowtedge; that I (we) am (ahe) the owneh.(.61 o6 the pnopeh ty dens cA i.bed in thiA
in o�cmati.on onm b v
6 6 y i .tue o6 a wcvAa►tity deed neconded in the 066zce o6 the
County Reg.c.6ten o6 Veed�s ass Voeument No. 243030 ; and that 1 (we) ptuentty
xun the pnopoaed zite bon the sewage dibpob Ty-,s em (on I (we) have obtained an
Uement, to nun with the above d6cAi.bed pnopehty, bon the conbtnucti.on o6 .6atd
item, and .the same ha6 been duty neconded in the 066ice o6 the County Re9.i6ten o6.
44, ab Document No. ) .
9 OIL OWNER SIGNAT F CO-0
(IF APPLICABLE)
4-7-87
TED DATE SIGNED
a..
WISCONSIN
Otate of rap
Countyof..........St.*...Grobc..........................
...............-...................day...................day of......My..................
OX Od,.............4/ ............................... 19..54-..., before me,
a.........................Notar-y-publin--------------------------------------------within and for said County,personally appeared
---------------------------------------------------------------Georger-46—Holcomb--and--GI-adys---Fv--H6I-emby--hj:ff--vi-f-eri..................
........... ............................................. ...................................................................................................... ----------------------------- .... .
to me known to be the perso?P.............described in, and who executed the foregoing' instrument,
.................................... ...(-See Now------------------ and acknowledged that............the-V.........executed
the same as— ------------free act and deed...............................................................
--------------------------- -------4............... ........................................
-wise.
Notary Public........................
'County, Jfhm
NORty Public, St. (-,Mi, (,�,Mty,
MY commission 0!�
iff6i a
NOTE:The blank lines marked"See Note"we for use when the Instrument Is executed by an attorney in fact.
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2005—Warranty Deed. individual to Joint Tenant.. Form No. S. Minnesota Uniform Conveyancing Blanks (1931).
W�LI[....00iM.,OM• a1M11YgY.
� • 1
Tjigkbenture, Made th.is............................:77=:.......day/of........May............................................... 1.154........
between .....................GeLorge...G.a...Hol.eomb...and-Gladys... ...w ifs .............................
.
of the d lounty of.......St....Croiix..........................................._..and State of......Wisc ionsin....................................... part:.4e8
of the first part, and...................Ewer...CrAwf.9r..!LD.Qr.Q.t.bY...GEC?Ryfwd l,...h1o...wif m—r.....................................
...........................................................................................................................................................................................................I of the County of
St....Croix......................................................and State of.li[iaconsin.........................................., lKirties of the second lnirt,
WitntISOCtfj, That the said part eg.........of the first part, in consideration of the suns of..................
Onv...D.Ql ar..jmd...Qthar...valdelb e...c.S?mileratim.......................................................................................... /1OLL.11M.
to.them..............in, htind paid by the said parties of the second Dart, the receipt whereof in hereby acknowl=
edged, do..................hereby Grant, Bargain, Sell, and Convey unto the said parties of the second Bart as joint
tenants and not as tenants in common, their assigns, tie survivor of said parties, rind the heirs and as-
signs of the survivor, Forever, fill the tract...... el........of land lying and being in the County of
Stia....rrnIx................ ....................and State of . desrrilxd as folloias, to- •it:
Lot Twenty—seven •(27 Fre
n Bfoek Number Seven (77 in the plat
of Houlton, St. Croix County, Wisconsin.
To *abe atib to *ofb the Oame, Together with all the heredittrni.ents rind appurtenances there-
unto lvlonging or in anywise appertaining, to the said parties of the second peri•t, their assigns, fire sur-
vivor of said parties, and the heirs and assigns of the suxviror, Forever, the said parties of the second part
Lakin o (is joint fenants and not as tenants in common.
.1nd the scud...Gegrgd...9.4.... Ei.....H01CS?0b.0....hio...wif.a.,.................................................
.......................................................................I............................................................................................................................................................
part.1.09.......of the first Dart, foithem.9 sa ygm...and...thetir......heirs, executors mill administrators do...........
(Wrenant with the said pni•fies of the second part, their assigns, the surriror of said ptirtic•s, and the heirs
mud assignx of the surric•or, thattllley....are........well seized in fee of the lands and premises aforesaid and
ha_.ve....good right to sell and convey the sarn-e in manner and form aforesaid, and that the sanie are
free from all ineicinbrances,
,1nd the rebore bar_c%ained and granted lands and premises, in the quiet and peaceable possession of the
said parties of the second part, their assigns, the survivor of said liarties, and the heirs and assigns of the
Survivor, agtiinsf all persons lawfully clainting or to claini the whole or any part thereof, subject to in-
eunibrances, if an.y. hercinbefore nientioned, the said part...1Q.0......of the first part will it'cirr(int and De-
fend.
$n leatunonr Obtreof, The said pa,rtAll!.......o of fhe first part ha..:....hereunto set..their......
hand..$.the dale and year first above utritten.
• w
lit Presence of 'Z` '+
vog
Gladys . . Holcomb
............... ....... ................
Annette DeWitt. ................................
H
• a
• STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
i d
a
OWNERAWR Elmer Crawford
ROUTE/BOX NUMBER Fire Number
CITY/STATE St. Joseph, Wi. ZIP 54082
Section T N , R2 W,
PROPERTY LOCATION : NW NE 27 30 0
Town of St. Joseph St . Croix County ,
Subdivision Houlton Lot number 27
I
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 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 . Ho
F
I/WE, the undersigned,, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with 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 ,/ r"I LAI,
D AT E 4-7-87 '
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 .
INSTRUCTIONS FOR COMPLETING FORM 115 - SRI - 6595
To be a complete and accurate soil test,your report must include:
1. Complete legal description;
2. The use section rnust clearly indicate>vhether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or eorxartrereial use planned;
4, Is thk a new or rep€acernent system;
a. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL.CONDITIONS;
6. PLEASE use the abbreviations shown here for vvriting profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
seperate sheet may bt, used if desired;
S. i tal<e srare your benchrrtark and vertical elevation reference point are clearly shown,and are permanent;
9. Complete all app!opriate boxes as to dates, names,addresses, flood plain data, percolation test exernp-
t4-,n,if approptia*e;
10, if iha information (such as flood plain,elevation) does riot apply, place N.A_in the aprarow iate box;
-1 e. Sirs)the form and place your current address ar,d your certification number;
12, Make e leg4fle, copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL fiUJI-I'DRITY VVITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIES) SOIL TESTERS
Soil Separates and TextGrres Other Symbols
st — SlOnc "over 10"j FAR — Bedrock
Cobh;7 r (3- 10") SS — Sandstone
9i — Otavel ;under:3" LS Limestone
's S=�nri HGVV — High G,oundwater
C.- C'<)ars=' statatI l't'ri:; .._ Pt'ICi)lat;iaF? Rat:E'
Ivilri,liumi &nd VV : . r
�' tics -� I :h tC�tr"i rj
�ePiC L L
Ct)umy San(, ThcarT
Sttr>.dy Loarn Lcfis Than
t 3, rrr f>rr - Et o�rkrs
Silt Loam Bi — Black
Sil y
Siff[ — Salty Dfay Loam irtot _._ IV!ntries
Ai.dv Clay ?' ritia
Si !y C:lriy ttl few, lirs:r f.<airt
t�Izay tnsora o a!se;
>r prtat r,rx ?vlany, rne( ir) ;
nT
__ lJi"C)!1"t4ne#"Pt
HVvL — High grater level,
Six ricn:ral soil texttares surface water
fw liw_�id v„,raste disposal UM - Bench Mark
VRP Vertical Reference Point
TO THE OWNER:
1 hit:seat! test re por( is tie first strap in securir)(I a sanitary perInit.The county or the,Depart rnent may request
i#icaitoo rtf lryis soil test in the, field Friar to pear iss9_r<,rrcr.. A complete set of plans for the private=
".Vd0e syslerit anc," a pe rnrt %pq)hcation must be suhmit-ted to the app;opriate local tr€?t.horrty i1) i)t'(jef to
],> SEri 2 ;7Crrsait, t;1e n ust I")P. QliE3i€5#ad and posted prior 10 the start of any construction,
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, - c DIVISION
LAB•dR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATION: SECTION: T : LOT NO.:BLK.NO.: SUBDIVISION NAME:
NW �/NEB/ 27 /T 30 N/R20 rX(or)w St. Jose h
COUNTY: OWNER' ER'S NAME: MAILING ADDRESS:
Croix Elmer Crawford St. Joseph, Wi. 54082
USE DATES OBSERVATIONS MADE
NO.BEDRMS.:ICOMMER91AL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
C19nesidence 3 n a New ❑Peplace 4-7-87 n./a
RATING:S=Site suitable for system U=Site unsuitable for system
rQS ONVENTIONAL: MOOUnUND: IN-GROUND-PRESSURE S STEM-IAN--FIILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
❑U FX S ❑U ]JS ❑U S ]U EIS R conventional
If Percolation Tests are NOT required DESIGN RATE: I 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
decimal' PROFILE DESCRIPTIONS page 41 BRR
BORING TOTAL. DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITIT THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTHC ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 6.92 98.59 none >6.92 .75bl.1. 6.17 bn.c. cob. gr.
B_ 2 7.00 97.80 none >7.00 .75bl.1. .83bn.sil. 5.42bn.c.cob.gr.
B- 3 16.75 ' 98,06 none >6.75 .83 bl.l. 1.00bn.sil. 4.92bn.c. cob.gr.
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PER( PERINCH
P-
P-
P-
P see design rate
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 94.80
(E �
- ._
I
t l/ II
E Y 1 w t
A, 1_ t 2 `
E
___ _
E �
E . ! jil - - ` t
lea
� I E
t
k E
— 7
) i
[[
G'1� l _� .... -i-._..-.-�---......... _�. t,.. _{_...... i �..,,.. ......_ ' ...,........�,...,.. ;Mir-�.. ..�.�..�...�......._ �,........�.g....,,, ;�.�.(�......e-...,_...._x
V�
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 4-7-87
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
988 N. shore Dr. , New Richmond, Wi. 54017 2298 715-246-6200
CST SIGNAT
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
Elmer Crawford
NWIW4 S.27 T30N R20W
• town of St. Joseph
vi
3
9oo
60 A-A b
� Tl 7'
3t (
t V't vyl
9 3, 10
+ c9c)
-7 D c7 P
Iq
Gary L. Steel
1988 N. Shore Dr.
New Richmond, Wi. 54P17
MPRSW 3254
PAGE: CF
PUMP CHAMBER CROSS SECTION AKJO SPECIFICATIOkJS
VEWT CAP
4"C.I. VENT PIPE APPROVED LOCK1
WEATHER PROOF
JUNCTIOKI BOX MAIJNOLE COVER
25' FROM DOOR, 12"M►U.
WINDOW OR FRESH ���/`> ti5�
AIR INTAKE I
GRADE I
I 4"MIKJ.
COWDUIT _---------
t8'MIN. �� ----------
PROVIDE I ----
IKILET AIRTIGHT SEAL APPROVED
JOINTS
APPROVED JOINT A
W/C.I. PIPE I I(I W/C.X. PIPE
EXTENDINGi 3' I I ALARM EXTENDING 3'
OWTO SOLID SOIL I II ONTO SOLID TOIL
a I
I Ow
p � C
ELEV._....7._ FT-- PUMP-� --�
OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED OWLS IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPEC FI TI M
DOSE
TANKS MANUFACTURER: I��Et�S 12 F iJUMBER OF DOSES: PER DAy
TALIK SIZE: goo GALLOWS DOSE VOLUME
ALARM PANUFACTURER'=Uv '7- INCLUDIKJG OACKFLOW: ' �3 fsALLONS
MODEL LIUMBER CAPACITIES: A= ' ' INCHES OR 8 GALLONS
SWITCH Tort: �0 B= INCHES OR �GALLONS
PUMP MANUFACTURER: l nr) LL d- C=INCHES OR .J 7'8 CALLOUS
rr••,,�
MODEL WUMB[R: D=—(=—INC RESOR 2507 GALLONS
Lc� Q
SWITCH T»PE: ` /I L,�,s NOTE: PUMP A1JD ALARM ARE TO BE
MILIIMUM DISCHARGE RATE 6P INSTALLED ON SEPARATE CIRCUITS
M
s sa
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND 013TRIbUTION PIPE.. FEET
-alai FEET Z Z. r 29 G $l9
+ MIKIIMUM NETWORK SUPPLY PRESSURT,E/. . . . . . . . . . . R:x 40
FEET OF FORCE MAIN X '3o Fiioo rtFRICTIOU FACTOR. '�7 FEET (���
TOTAL DyWAMIC. HEAD = FEET
INTERNAL. DIME SIOWS OF TALIK: LEW&TH _;WIDTH It �r *,LIQUID DEPTH
LICE E LIUMBER:�/7S�J' � KTE:
N .�.-..'3_8
91GE • O
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