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HomeMy WebLinkAbout032-1065-95-000 c Q) O � I � c t� - O N O @ C C o-. M w (0 N III C � U C i p� a) R, oc c > o �`cin n' E O ? 7 U N C Cc.0 I cu� C(0 O) 7 0 E .2 z E U Ln OU U. o m E `m N 7 E i ` Q w O O.V 3 M o z rn E C a E o I z C M d m cc., H z !a m 0 E C7 a ) o z c •- 0 - o Z c o E -a O m M N 0 .7 CD N N U) ►�' N c •►v a r °- C C O U O z z z I 0) N E r U) c I U) � f0 - CL m O c v lC) N N d Q O z 0 0 O O O d '0 O CN z M > F- F- F- c E w p Q z o - 0 O O �► a '' i I g II a� o m (n J U U) rn CO z N 00 O O O 1� E !I (n O O O � O CD - N N �r M 7 w to O � N F- 0 I'. co U C C 0- 0 0 0 O N N C) tin U C N N C .-- M N N L2 O z C N r O N M E i. O t O y N E ttS L a a I'' a w • a z .2 a c E o II, ; �a o t ;', 0 in V PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: 3,?4? i�C3��,�Pump�6#rhe Manufacturer: Pump Size -7/�� Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: „ ZZ 06 r OAlarm Switch Type: Number of feet from nearest roperty line: Front, © t Side, Rear, Ft. Number. of feet from well: i Number of feet from building: —�- (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Q Number of Lines: Area Built: $"DUp Fill depth to top of pipe: f 'Q,� .34 O✓E+f ,m os% o r T!/�ct Number of feet from nearest property line: Front, S, Side, S® Rear, S� Pt . Number of feet from well: 5-0 14— %A"-X4 Number of feet from building: A (Include distances on plot plan). S Number of pits: Diameter: Liquid the Bottom of seepage pit elevation: Area Built: Has either a drop box O distribution box O be used on any of the above soil absorbtion sytems? (Check one). K Manufacturer: �' apacity: Number of rings used: Elevation of ttom of tank: Elevation of inlet: Number of feet f m nearest property line: Front, ,Side, O Rear, O Ft. e, Number of feet from well: �. Number of feet from building: Number of feet from nearest road: \ Alarm Manufacturer: Inspector: 31161 6 Plumber on job: / �I� �/I� ��J /Ub License Number: 33 O V fee- :yc f"�hr.+► Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1'l�c/I�G�� XOGL TOWNSHIP SEC. T 3 N-RILW I ADDRESS` . ST. CROIX COUNTY, WISCONSIN a.-. /v• SUBDIVISION Z LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -13 "-r IY►'fi x = /$D , r 304d AW ..till y � .•S ' r 9r°h 'p 6 L o f��+ Rom v,` �v /¢dQ Ctf1L, s.T• � tow• 1 s� 6 00 C-AI, G o m �U FFC�I�� 1987 .;� 02 0 ! �0� TICE y R CvY� u l Yt V INDICATE NORTH ARROW ENCHMARK: Describe the vertical reference point used �� a� i1L0 So./iC�P. LZAIE Elevation of vertical reference point: /®D Pr posed slo a at s•te: OZa,*, SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road ,+Front,O Side, Rear, O From nearest property line :!�Front,0 Side 10 Rear,0 Number of feet from: well t (Include this information of the above plot plan) ( 2 reference dimensions to sep SEE REVERSE, SIDE � e�2� S FEATURES 1. m�e I Il e� 2. 'Casing A 41 Mechanical 7 Sevotage Seat 4. Shaft c4 5. Motor --` �'`- �. ` E 6. Bearings — crl �� r Upper & Lower 7. Power Cable 6 8. 0-Ring 5 � 4 3885 3 PERFORMANCE RATINGS In gallons per minute 1 — I WED511H WED511HH Series WED512H WE0712H WE1012H WE1512H WED512HH WE1512HH 2 ® o. El} 1L E0311M WED532H WE0732H WE1032H WE1532H WE0532HH WE1532HH ED312M WE0534H WED734H WE1034H WE15UH WE0534HH WE15MHH HP V, 'ii 34 1 1'4 ''t 1'i MODELS RPM 1750 1750 3500 3500 3500 3500 3500 3500 �-•--- 5 100 70 so 90 106 114 60 — Series HP Dolts Phase RPM Solids Max. Weight 10 80 65 76 87 102 111 55 83 Amps. (Lbs.► 15 60 57 71 83 98 108 52 73 WE0311L 115 9.4 20 as 65 78 94 104 48 77 WE0312L 1/3 230 4.7 1750 2") 26 59 73 89 100 42 68 WE0311 M 115 1 9.4 30 50 67 84 96 39 72 'E0312M 238 4.7 35 40 61 79 91 34 63 _0511H 115 13.0 3 40 26 52 72 86 30 66 WE0512H 230 6.5 s 45 10 43 64 79 23 58 WE0532H 2081230 3 3.4 LL 50 30 54 72 18 60 WE0534H 1/2 460 1.7 60 I 55 17 42 63 12 52 WE0511HH 115 1 13.0 60 6 28 53 3 54 WE0512HH 230 6.5 = fi5 16 40 45 WE0532HH 208/230 3 3.3 70 5 26 47 WE0534HH 460 1.7 3/4" 75 t4 37 WE0712H 230 1 9.0 80 a a0 WE0732H 3/4 208/230 3 5.4 3500 90 33 WE0734H 460 21 70 t00 24 WE1012H 230 1 11.6 110 15 WE1032H 1 208/230 3 6.4 120 4 WE10341-1 460 3.2 WE1512H 230 1 13.3 WE1532H 208/230 3 9.2 DIMENSIONS WE1534H 1-112 460 4.6 80 WE1512HH 230 1 13.3 (All dimensions in inches) T--- -- WE1532HH 208/230 3 9.2 (Do not use for construction purposes.) i WE1534HH 460 4.6 1 121h„_ � a �— —5'/1' EFFLUENT EJECTOR SYSTEM ROTATION --- G 2 Package Includes: Effluent ejector system offers Submersible Effluent Pump, 2”NPT ease of ordering and installa- WE0311L,12L or WE0311M,12M, 81h" tion.A single ordering number WE0511HH,12HH —� ecifies a complete system - Mercury Level Control Switch •igned for most residential A2-5(115 V),A2-6(230 V) I 3'/i' d commercial sump and titi Basin A7-1801S ° effluent pump applications. -So Basin Cover A8-1822 --- Check Valve A9-2P KICK-BACK Order No.:SWE0311L,SWE0312L, p. y3 ,� 3/4 and 1 HP= 15"except for model WE0712H 8 WE1012H=18"; SWE011M,SWE031 'h HP= 18" SWE0511HH,SWE0512 HH. 1 Available Certifications: Sf Canadian Standards Association llelz� VA4 Performance �r Curves METERS FEET 2 - -- -- T - -t-- MODEL 3885 25 80 r SIZE 3/4" Solids WE15H 0 I 70 I W S 0 WE10H -- ------- - — « - — H 60 0 WE07H- 15 50 WE05H j 40 10 WE03M 20 WE03L I 5 10 - - I 0 L 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 1 _ L 0 10 20 30 m'/h CAPACITY HGOULDS PUMPS, INC. 5EPECA RA us FEW Yc)gK 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH i I I 100 30 I 90 I 25 80 w 70 Z 20 H 60 O ~ E05HH I 15 50 W i 40 10 30 I 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I I 0 10 20 30 m'/h DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 ,,.MADISON,WI 53707 NE%, SW , S24,T31N—R19W 000NVENTIONAL ❑ALTERNATIVE IIfaeigned)D.Number: Ilf assigned) Town of Somerse t ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 3 Heimer, Turtle Lake NAME OF PERMIT HOLDER: DRESS OF PERMIT HOLDER: INSPECTION DATE: 76548 Michael R. Kroll Edgewood Avenue N. Brooklyn Park, MN 55428 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: Norman Arndt 3304 St. Croix 92562 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLE;PROPERTY: WARNING JLOCK:NG R OVDED OVER OYES ONO ❑YES ONO BEDDING: VENT DIA.'. VENT MATL.: HIGH WATE NUMBER OF ROAD: WELL: BUILDING: VENT TO FRESH ALARM: AIR INLET'. FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: JPUMP/SIPHON MANUFACTURER. pgOVIDEDLABEL PROVIDED t OYES ❑NO ❑YES ❑NO ❑YES GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VLINE (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH 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 TRENCHES: DISTR.PIPE SPACING !CO V R INSIDE DIA nPITS D PTIH ATERIAL: PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPf DISTR.PIPE DISTR.PIPE MATERIAL: O.DISTR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH ELOW PIPES. ABOVE COVER: ELEV.INLET ELEV.ENO: IPES. FEET FROM LINE: AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1-1 NO PERMANENT MARKERS rg VAT ION WE LLS OIL COVER TEXTURE. ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED CENTER'. EDGES'. ]YES ONO OYES ONO DYES ONO 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 DISTRIBUTION PIPE MATERIAL&MARKING ELEV.'. ELEV.: DIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED RE INFORMATION HOLE SIZE HOLE SPACING DRILLED CORCTLY COVER MATERIAL PLANS ❑YES ❑NO ❑YES ENO EpMq,.�ENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: 1_ p LINE: �./— FEET FROM DYES ENO OYES ❑NO NEAREST Say 21. q �.� c(9 I ® ro G?) I 5 I Sketch System on Retain in county file for audit. Reverse Side. is ITITLE. 2 IV. SIGNATURE'. Zoning Administrator • DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION i TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 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% 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.,pumpmanufacturer; 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 morkp 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 atl3r - incl led the creation of surcharges (fees) for a number of regulated practices which Wisco tfik8f "ict groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T n your building is returned to the groundwater through your soil absorption + t1t13 the disposal site'used by your holding tank pumper. collected through these surcharges are credited to the groundwater fund adminis- ' lepartment of Natural Resources. These funds are used for monitoring ground- t later contamination investigations and establishment of standards. Groundwater, ring. i SANITARY PERMIT APPLICATION COUNTY (�Y DILHR In accord with ILHR 83.05,Wis.Adm.Code 5-7,- OR 0 2 STA�SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system, on paper not less than STATE PLAN I.D.NUMBER '8'h 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 ® NO PROPERTY OWNER J PROPERTY LOCATION Ar 0—R A O L L N6 % SW'/a, S T3/, N, R )((or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME ;r�;,?s-41.2 V6. Al CITY,STATE OD (� PHONE NUMBER CITY NEAREST�9Af3t LAKE OR LANDMARK 4000 L N � 0 / #&S12 TOWN E:SO/rIERSIL 45 L etf— O II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 1.3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. XNew 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. 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. 9—Seepage Trench c. ❑ seepage 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): �J �Q� 99 / Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Fiber- plastic Exper. anuac Con- Steel INFORMATION New xisting Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank Or'3fl CU 77 E17 Lift Pump Tank/Siphon Chamber 600 ❑4 E] VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stam e -MP/MPRSW No.: Business Phone Number: oRMAA) NDT 3 O y 71s 3.53- ,2Q63 Plumber's Address(Street,City,State,Zip Code): Name of Designer: IVV696 /°r6 P6 .-D. A/6 se Z-_5 E VIII. SOIL TEST INFORMATION C 897 S ified Soil Tester(CST)Name /Q 119 P;XinAgentS �i�'rj�9N i9 /U17T i9 s E -L - /9s ,x2 S CST's ADDRESS Str et, it ,State,Zip Cod ber: SE iQ 8♦v ,f- =NrSs A� MA- 9 c✓ �� S�ldrP� TC#A,0N� a b - ado X. COUNTY/DEPARTMENT US ONLY G✓25. S 0 ❑ Disapproved Sa itary Permit Fee Groundwater ate ignature(No Stamps) A pproved ❑ Owner Given Initial 6100 j� Sc arge Fee ��� Adverse Determination .Q© -751. X. COMMENTS/REASONS FOR DISAPPROVAL: d b�3 z .ZQ�,k ns SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber II DOtx1M8♦ ' ;, �T/tT> RIM Of.W180ONi1N FORM 2-19U THIS SPACE RESERVED FOR RECORDING DATA .r !! Thomas J. Heimerl and Julie D. Heimerl, husband and wife ;i conveys and warrants to Michael R. Kroll and Sharon L. Kroll, husband and wife, as Marital Property with rights i of survivorship i RETURN TO iI the following described real estate in St. Croix County, State of Wisconsin: ` !I Tax Parcel No: ! Part of the NE334 of the SW4 and the NW14 of the SE114 of Section 24-31-19 described as follows: Lot 3, Certified Survey Map filed January 23, !! 1984, in Volume "5", Certified Survey Maps, page 1394, as Document j #390706. �I I i; i I �I This is not homestead property. (is) (is not) I Exception to Warranties: Easements of record 21st March 87 (! Dated this day of ,19 _ (SEAL) (SEAL) • Thomas J. Heime 1 j, (SEAL) (SEAL) I� lie D. Heimerl AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 33. St. Croix County. authenticated this day of ,19 Personally came before me this 21st day of March • ,19_87 the above named Thomas J. Heimerl and Julie D. Heimerl TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to 7eg e kno n o be the persons who executed the authorized by§708.118,Wis.State.) f tr ><4r1d1F1t 8 the same. THIS INSTRUMENT WAS DRAFTED BY ACORN REALTY, INC. i' 245 Main Street Dennis Fleischauer Somerset, WI 54025 Notary Public St Croix County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission Is permanent. (if not, state expiration are not necessary.) date: September 30 19 87 I i 'Names of persons signing In any capacity should be typed or printed below thN►stpnstures. NTF 2M WARRANTY DEED STATE BAR OF WISCONSIN m Form No.2—1982 Nelco Fors,P.O.Box 10208,Green Bay,WI 54307-0208 :G H ' a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o ' St . Croix County z d OWNER/BUYER ROUTE/BOX NUMBER '-R,Q+ Fire Number CITY/STATE Smozsc Wi ZIP PROPERTY LOCATION : NE ���C Section_�#-3�4 N , R W, Town o St . Croix County , Subdivision Lot number_. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system . St . Croix County residents 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 . 0 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- ro ment of Natural Resources . Certification form most be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . Q SICNEU /� el ' 20�e -- DA'rE ZE 7 n S t . Croix County Zoning Office /l/ /jl_7 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- SBD - 6395 • • To be a complete and accurate soil test,your report must include: r ` 1. Complete legal description; 2. The use section Must clearly indicate whether this €vs a residence or c6mmercial project; 3" MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; . 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; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7- MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale Is preferred. A sepaai ate.sl-feet rnay'b� used it desired";, S, Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9 Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- t io n, if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and place your cr.arrent address and your certification number; 12. Make legible copies and distribute as requi ed. ALL SOIL.TESTS MOST BE WITH JHE LOCAL AUTHORITY WI-THIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERT.I.FIED SOIL TESTERS Soil Separates and Textures Other Symbols st -- S�t:onp (aver 10") BR — .Bedrock cob - Cobble (3- 10") SS — Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand NGW — Nigh Groclndwatef" cs — Coarse. Sand Perc — Percolation Elate coed s — Medium Saritt W — Well is - Fine Sand Bldg _-- Building is — Loamy Sand > — Greater Than 'sl Sandy Loam < -- Less Than *( -- Loarn Bn Brown *sit Silt Loarn BI Black si — Silt Cry — Gray *cl - Clay Loam Y - Yellow scl -- Sandy Clay Loam R — Red sicl — Silty Clay Loarn mot — Mottles sc Sandy Clay w/ with I sic — Silty Cl'jy fff few,fine, faint �G _... Clay CG --- C(7rTlrtit3C1, coarse pt - Peat inrn — Many,rnediurn n! -- Muck d — distinct p — prominent i J HWL — High water level, Six general soil textures surface water for liquid waste disposal BM Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit, The county or the Department may rerluest w"Jfication of this soil test ill the field prior to permit issuance. A complete set of plans for the private sevvage system and a permit application must be submitted to the appropriate local aauilresrity in order to tatair, a The sa'mtary ilerrnit must be obtained and roosted prior to the start Of arsyt Corrstruction. DEPARTMENT OP REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ MADISON,WI 53707 . . (H63.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M"1ftCtP*t+T-V: OT NO.:BLK.NP.:j NP.: SUBDIVISION NAME: NF /a ?,q /T3/ N/R ( 15 s E %3/ COUNTY: 0iltl1d'ER'5 BUYER'S NAME: MAILING ADDRESS: T. C 01 X /WrC A OG L 5 8 E DG6tjooD Avk.N. A-004 YAI 199* 2N . .S.�y�B USE DATES OBSERVATIONS M E NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DE CRIPTIONS: PERCOLATION TESTS: Residence `.� New ❑Replace I _ �// _ O� 13— RATING:S=Site suitable for system U=Site unsuitable for system 7 Q 7 O CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) WS ❑u [Ts au s ❑u ins ou as u CoNVENT.ZoNA4, G. If Percolation Tests are NOT re uired DESIGN RATE: Q ` If any portion of the tested area is in the /Y under s.H63.09(5)(b),indicate: 4 1 1 Floodplain,indicate Floodplain elevation: /¢ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) DK• soK. ED. Jr. W;v- . B- 5L. 7-,S. SAND d GRAVEC B- 7Sr� /oa.�g 111oNE > 8,,, /►�E D 8.u. B- B- � aNE S/9 AI D i V 1' 03.3$ �VoNE /V/1 B- r'/ / SAND /V 6 L f. B- /Q 11 /w•�b' 8`i / Q �/ Q C/ O // 2140, (p PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IW6AQsS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER IOD2 PERIOD PER INCH P- P_ ,O p S 3 P_ P- 3-G6 0 Z P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what a 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 directio and percent of land slope. YSTE ELEVATION 99'72' .._ (3/ -?.�3 IS 1 # l i ;m�] ,C,L. ;/4D!;� oP aA /y, ti I ED _ _ 5 _ ;_�.�_ _. ... -- 7 — - -- - _ S E. �L 1 alg 5 .'``_i — _ _._ a_.,.._ ...... .... _ _ I i t ( 1 € aa1JJ I € z r j 3 ly kk ( j s ouTN PRBp�R�y �. ti I,the undersigned, hereby certify that the s tests reported on this form were made by me in accord with the procedures and methods speci 'ed in the Wisconsin Administrative Code,and that the data record d and the locati n of the tests are correct to the best of my knowledge and belief. FA L Ale-E z,,,E - CORN& Ra S T NAME(print): I TESTS WERE COMPLETED ON: 0 3 — IV S1 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): N46% RZE P6 • 1/I/�y�/P/y14Eus� s s�S= /9s8 7!S- 353 ` S , CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 'IMPARTMENT OF - REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 'INDUSTRY, DIVISION i lug RATI�(le5 PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(i)&Chapter 145.045) LO A I SECTION: TOWNSHIP OT NO.:BLK.NO.: SUBDIVISION NAME: NE '.. '1 /T 1 111/1112 �(o, Somerset 3 n/a Heimer COUNTY: . St. Croix Michael g. Kroll 6548 Ed ewood Brooklyn Park Minn. 55428 USE DATES OBSERVATIONS MADE B O ESTS: j3JResidence 3 — 3-9-87 RATING:S=Site suitable for system Um Site unsuitable for system ONV NTI : MOUND: IN-GROUND N-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) ,'0 S ❑U ©� ❑U 0 S ❑U ❑S Du ❑S ©U n/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: n/a I Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 10 CON BORING TOTAL P 10 QROW A ER-INCHES H RA TER OF OI WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER I, ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.34 100.62 none >7.34 , .67 bl.l. 1.50 bn. s.l. 5.17 bn.c.s.&g. IB_ 2 6.91 101.08 none 3.66 less .75 bl.l. 1.08 bn.l.s. 1.50 bn.s.sil. ' _Mnt_ gil _ '1_75 bn- t _g_ 'B_ 103.31 none 1.00 bl.l. 1.17bn.l.s. 4.83 bn.l.s.&g. B- 4 6.83 102.89 none >6.83 7 I'B- g, 102.72 3.00 less .50bl.1. 2.25bn.l.s. .25bn.mot.sil. 5.83bn.c.s.none �hnn 1 -00' IB- decima 1' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. 1 I PER INCH P. 1 3.50 none 3 6 6 6 <3 P-2 3.33 none 3 22:6 2:1� 1 P. P- P- P 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale ocribe what are the hori- 3ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at and percent f land slope. ;YSTEM ELEVATION 99.39 \\� j ; tN C� 4�n ,�r � j �C = i '—....1���u�!-h /Jr cam' ,si'^{T_•�-�i_�,i C. f r ...� �. 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 dministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TAME print : TESTS WERE COMPLETED ON: Gary L. Steel 3-9-87 DDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. , New Richmond 14i.54017 2298 CST SIGNATUR' • ' ISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. - iILHR-SBD-6395 (R.02/82) —OVER — Ii a � 1 t44 t3 of °U � `a• ►�'•+ �, `dn •� W �ta-s �- o � � J- �C;V I" i x m E+ w A N . u LL�U w W p00 W V x N W 0 w a v v A `k- Q w a i w a w m W W x i W H T 0 CD a >+ H A H 641 D >J � m to >H A H vi to 4 a A � � v V) V %41 W 4j - �h n S r4 K H v) N \ C) IL 3 o F