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HomeMy WebLinkAbout036-1099-60-000 \ 0 \© \ � � � /r � � (D % §d 2 �2 � �2 t »_ E � E 2 � \ m I § J2] � « E R § I a ■ § � ) B 2 \ ) [ 4) ° ° -� ƒ f f b k ) k \ ) % \ e ' 2 ■ , CL o \ \ \ 2 0 � ) « / 8 Lo co k ) \ z0 -� 4 ' ) a a a t0U tic 2 � v \ § § (D E § k 6 ) 0 k 0 \ : R � ' / ƒ ■ 7 ■ 7 ° $ Q § n K ) c G } 2 § © S \ » 8 § § 2 = > o k ® a / ) (D z z _ 2 § R . \ ) \R f c o m § § - § CD c) m : m = o z W e R s « ® ! � C40 � 2 k ) — � _ . , " ate E' § a § k v a 0 3 � , - I PUMP CHAMBER a Manufacturer: Liquid Capacity: Pump Model: Pdmp�/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed S Trench: Width: 2 Lengjth: 7 Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line:• Front, O Side, Rear,O Pt .1�_ Number of feet from well. / --- - - '�� Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: II� Number of .feet from nearest road: Alarm Manufacturer: Inspector• Dated: �/ 7 Plumber on job: License Number: / 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT • OWNER TOWNSHIP SEC. T ?N-R2_2_W ADDRESS �" ST. CROIX COUNTY, WISCONSIN t SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET.OF SYSTEM /w c � = /S 17 r.�:�s fir,�-� yS'•�� � ° 3 � INDICATE NORTH ARROW "41" BENCHMARK: Describe the vertical reference point used Z'. Pro Elevation of vertical reference point: Proposed slope P P e at site: SEPTIC TANK: Manufacturer: 6 f4r." i •Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,. Side,O Rear, O %�J) feet From nearest property line Front,O Side,M Rear,O SY " feet l Number of feet from: well _, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 7 BUREAU OF PLUMBING MAiDIS SW1" T blN-R17W -MADISON NEli, 1' CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: Town of Stanton ❑ (If a-greed) Holding Tank ❑ In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Vicky Schurke Route 5, New Richmond, WI 54017 `7 r-14-9 7 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.: CST REF,PT,ELEV.-. Name of Plumber: MP/MPRSW No County: Sanl y Permit Number: Calvin Powers Jr. 1563 St. Croix 96044 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER � PROVIDED: PROVIDED: � I S. 3 �p YES ENO EYES LKNO BEDDING: VENT DIA.: I VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: I LINEi ' AIR INLET. C FEET FROM d DYES NO ` C ❑YES NO NEAREST ` O DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO 1:1 YES ENO EYES ONO GALLONS PER CYCLE: PUMP IN O C N O O ERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) YES ENO N€AREST" SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING: COVER =INSIDE DIA. #PITS. LIQUID E�H 1� TRENCHES MTIAL: DEPTH. .119f� 1q pL �� GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR_PIPE DISTR.PIPE MATERIAL. NO.D R NUMBER OF -.PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES- ABOVE COVER. EL IN T ELEX EwO PIP ES. LINE Q G� AIR INLET EET FROM€YSr��0 7 2 �l NEAREST l9 IC) /U Z S Z s 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 SOIL COVER ITEXTURE PERMANENT MARKERS JOBSE WELLS 1:1 YES NO DYES NO DEPTH OVER TRENCH/RED DEPTH OVER TRENCHiBED =OF TOPSOIL SODDED. SEEDED. MULCHED. CENTER. EDGES. DYES 1-1 NO 1 ❑YES ONO ❑YES 1-1 NO PRESSURIZED DISTRIBUTION SYSTEM: "�yCiJTRFIGI'i WIDTH. LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. Y�ME1��,r�f♦IS I MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.: ELEV.: PIPES. DIA.: LOV�I T71Oki AND HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED iNFtRT}ON PLANS DY ES 0 N ❑YES NO COMMENTS: PERMANENT MARKER OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: j FEET FROM LINE: L ❑YE ❑NO YES ❑NO NEAREST � ,Co 5 Sketch System on Ret in in county file for audit. ,a- Reverse Side. ^� S ATURE: TITLE: DILHR SBD 6710 (R.01/82) Zoning Admen' U 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 Iodation, 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 septic4ank(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. Prcperty 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'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; wefts; 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 Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco in S; can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea5urel ° is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05,Wis.Adm.Code C�d� STATE�A�TTARP PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLCAlCNJN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROP RTY OWNER PROPERTY LOCATION '/4 '/4, S T , N, R fit(or PRO R WNER`S MAILING ADDRESS LOT NU BER BLOCK NUMBER SUBDIVI 10 NAME CITY,ST ZIP CODE PHONE NUMBER C NEAIjES OAD,LYE OR LANDMARK JZ. % ❑ VILLAGE: I I I 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.X Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. M 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. ❑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): Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in allons Total ##of INFORMATION New xistin structed Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank ' ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of private sewage system shown on the attached plans. Plumber's Name(Print): ?Plujer's St mps) MP/MPRSW No.: Business Phone Number: um r s Address Street,City State,Zip Co e: Name of De gner: VIII. SOIL TEST INFORMATION :Certi'ed S it Tester(C )Name CST# _ S C T's A DRESS(Street,Ci ,State, ip Code). Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) S charge Fee Approved ❑ Owner Given Initial 4D/`O r��. /vim Adverse Determination (J V) X. COMMENTS/REASONS FOR DISAPPROVAL: b y 7 �i-acts . /Ile/T&x R.0 /86 DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber SBD-6398(formerly Plb-67)( 3 ) 9 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 Property Section T_31 N-R_ r'`/ W Township ���.,,� Mailing Address �u�..P S Address of Site .n. Subdivision flame Lot Number �� Yells C��l (A-Y`- IQ-e� _ 3�c) Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is th operty being developed for resale (spec house) ? Yes t-,� No Voles► s_ � and Page Number PIL as recorded with the Register of Deeds. 7 Y 7. (fa(,urnt 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) centi.6y that att statements on thi,6 onm cute tAue to the best 06 my (M) hnowt.edge; that 1 (we) am (ahe) the owner o e phopenty descAi.bed in this .in6o4mation 6ohm, by v.ihtue o6 a wahAc d ed n c ded in the 066.ice 06 the count ReglAten o6 Veed�s ass Vocument N s _? "g • and that I (We) phesentty own •the phoposed site bon the sewage os s s (on. I (we) have obtained an eaeement, to nun with the above deAchibe nop bon the con,6tAucLion o6 sa.id eydtem, and the same ha.e been duty neconded a 066.ice o6 the County Regi.6ten o6 Veeda, da Voeament No. ) . SIGNATURE 01 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) LGNED DATE SIGNED i ,, . : G�' / �� � �� � ��� ,: i �� W.P.D.COMF^NV Mf NOMONt■FALLS.WIfCONfIN � Lq A67 a STATE OF WISCONSIN, CIRCUIT COURT, ST. CROIX COUNTY IN PROBATE IN THE MATTER OF THE ESTATE OF nn MARK E. SCHURKE FINAL JUDGMENT Deceased File No. PETITION for the final settlement of this estate having been heard,and the petitioner having appeared in person and by attorney, lc7d On all evidence, records and proceedings herein,the Court finds that: 1. The petition came on for hearing upon-Inokok* (waiver) as provided by law ()** (by) all persons entitled to notice; 2. Notice has been published for determination of the heirs of the decedent; 3. The expenses of administration,funeral,last sicknesses,and the claims against the estate have been paid;the Closing Certificate for Fiduciaries of the Department of Revenue is on file and there is no unpaid income tax;and the CERTIFICATE DETERMINING INHERITANCE TAX of the Department of Revenue is on file. 4. The decedent died seized of the following real property in joint tenancy with Victoria I. Schurke who survived decedent: Lot Six (6) , Hook' s Addition to Township of Stanton, St. Croix County, WI Parts of Lot Twelve (12) and Thirteen (13) , Original Plat of the City of New Richmond, St. Croix County, WI, further described as commencing 2 rods South of Northeast corner of said Lot 12; thenc West parallel with North line of said Lot 12 to Easterly line of lan of Richard W. Williams and Bernard Greeley as in "115, " page 316; **continued below 5. The decedent at the time of death owned personal property in joint tenancy as set forth irXtl[oemvcMf40LM2t&X On the final page of this judgment 6. The decedent at the time of death had yp(life estate in tkodQkogvb property: no any **thence Northeasterly on said Easterly line to a point 24 rods North of South line of said Lot 13; thence East parallel with South line of said Lot 13 to East line of said Lot 13 South to place of beginning. *Strike as appropriate. No.29-A(1980) FINAL JUDGMENT �� z ' H Y r ST C - 105 v H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 OWNER/BUYER �'% 4v S H ROUTE/BOX NUMBER e4.]]�Q Fire Number 1 c .CITY/STATE N �;��vy�o,�c� �Q9 .SC ZIPS of PROPERTY LOCATION: _ nR�_W, Town of Sor-, , 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. H 0 E z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein , as set by the Wisconsin Depart- ru 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 ;7 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 - 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 commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. 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 rise 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 sci-mrate sheet may be used if desired; 8. Make sure your benchnnark and vertical elevation reference point are clearly shown,and are permanent; 0. Complete all appropriate boxes as to dates, names,addresses, flood plain data,percolation test exemp- tion, 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 current address and your certification number; 12. Make legible copiers and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st -- Stone (over 10") BR Bedrock cob Cobble; (3- 10") SS -- Sandstone g{. Gravel (under 3") LS — Limestone *s -- Sand HGW — High Groundwater cs wars--Sand Perc — Percolahon Bate mad s -- Medium Sand t,"11 -__ ktV+, 3'; f:s F-;ne Saa n Bldg -- Buikfinq is Lo:imy San! ,> — Greater Than `sl - Sandy LoYarn Less Than Loam Bra -- Brown Silt Loarn ,'I' Mack si ._.. Sill Gy Gca, cl — Clay Loam Y Ytalco/ scl -- Sandy Clay Lraarn R _ Red sic; — Silty Clay Loam mot _ Mota es sc — Sandy Clay �rrr,' -- with sirs' — Silty Clay fff -- foo," Fine, faint c Clay ce — comrrons coarse of __ Peal mm — Many, nnedium n. --- Muck d distinct p — prominent HWL — High avatar level, Six yenerai soil textures surface uvater for ligcrid 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 play request verification of this soil test in the field prior to permit issuance. A complete seat of plans for the private sewage system and a permit application must he submitted to the appropriate local 31.1010rity in order to obtain a permit. The sanitary permit must: l�)e obtained and posted prior to the start of any construction. cr DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&' t11IVIS S DIVISION INDUSTRY, P.O. 9,,OX.7960 LABOR,AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RkLATIONS (1-163.090) &Chapter 145.045) LOCATION: , SECTION: TOWNSHIP/M ITY: LOT 0.:BLK. O.: SUBDI ISION NAME: /a / IAN/R//-1(or C OU rjrT Y: OWNER'S BUYE 'S NAME: M ILING ADDR SS: g 1 > '7 USE DATES OBSERVATIONS MADE NO.BED MS.:1COMMERCAL DESCRIPTIO I ES IPTIONS: A I TESTS: Residence ❑New ��77II Ia�Replace L PROF/ RATING:S=Site suitable for system U=Site unsuitable for system CONVEccNTIONAL: MOUNccD: IN-GROUNccDPRESSUR_E: SY TEWN-FIIL' OLDIIc G TANK:RECOMMENDED SYSTE :(optional) ®J EIU ®J OU ®J OU �J MY �J U lIf Percolation Tests are NOT require DESI RATE: If any portion of the tested area is in the unders.H63.09(5)(b),indicate: J Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS e BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, 11`5 OLOR,TEXTURE,AND DEPTH NUMBER DEPTH 114, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 0 AD B- _ .r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH MINUTES NUMBER M4CFIES AFTERSWELLING INTERVAL-MIN. PERT D1 PERI0132 P R I P- i: P-1 P- P-_ P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of s as. In Fdistances. Describe what are the horn zontal and vertical elevation reference points and show their location o of plan. Show the surface elevatio at II borings and the direction and perce nt of land slope. SYSTEM ELEVATION / . r � 4-- �+ _. tN l E [ W _. e t _ E � I i I,the undersigned, hereby certify that the soil tests r ported on this form were made by me in accord with th and methods specified in the Wi onsin Administrative Code,and that the data recorded and t e location of the tests are correct to the best of my knowledge and&lief. Avi. NAME int) TESTS WERE COMPLETED ON: I AD S: CERTIFICATION NUMBER: PHONE NUMBER(optional): CS N TU E: I DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 5017 i ° 64 q Jam. J f I w PAGE OF ' f CrUSS S �c � lon Or �'i �Jel� S S �en-� y xl ✓ '/ J Roch Al, Inlolc And Obcorvatlon Pips Approved Vent Cap Minimum 12"Above 's*7 7 Final Grade 20-42"Above Pipe _4"Cast Iron To Final Grade Vent Pipe Mash May Or Stint heik Covering Min. 2"Aggregate Over Pipe Dletrlbutlon pipe — 0 0 0 0 0 --Tee 6"All Beneo gregate o Perforated Pipe Below tA Plpo o —Coupling Terminating At Bottom Of System � ��eJ•.T tart 2 R�� / SOIL FILL DISTRIBUTIOVI PIPE APPROVED S4WPETIC COVER ~"MAT 9 Pj0\l- OR 9" OF STRAW 2"OF g6GRE4AlE — OR MARSU HA"J ° 4o OF 1Z -ZI/p AGGREGATE tLEV. OF FEET _. DIS-rRIFPUTIrDM PIPE TU BE AT LEAST WCHES BELOW ORIGIUAL GRADE AQU AT LEASTZO INCHES BUT AIO MORE THAI) HZ WCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXCRVAT100 FROM OKI&WJA.L 6KAI)F- WILL BE X22 INCHES MINIMUM! WrM of EXCAVATION FROM_ CA141WINL 6RAPE WILL BE INCHES SIGMEO: LICCUSE AJUMBER: DATE : _[,t �