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HomeMy WebLinkAbout040-1213-10-000 �. 03 Ofin� h d 0o ao a) ^n c 0 I w � I h O N I', I q I I CL m 3 9 Z 4 c _ w o m LL C v 1 O (0 y Q C 3 M i a y Z � E Z ' 00 LLJ v co U) am o O+ Z v c N O Z I c � v N M � I N N 7 C N N CL y 4) � C •N a m L app O O O N Q 4U-- . z m z 0 N _ Z d N � � £ L I U V C H d c O LO O m ° C G a .a -'Me (0 N N � L' _ ° 2 Zoe •N � aaa a o I G U) N V II = rn rn Z _ v `n I O N w CO 00 m O a N N r r C. N O O C 7 a fA 7 1V N E co r '•� O F O C N N N CD V c%> aj 3o E o 5 c ? a � r w F- Cl, �, tZ 2 - tea 0l 00 H O N O v 0) O N O io U 1 t -6• ' o o 1� Y rn 0 z r F- O t • a m .� I'' d a = o rr `1�v �+ E 5 `�1 A vat 0 I � s PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/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). 44"Pe R 1 1 O•G 6 Skol. 101VI Euv 110—so - 1 10. 5 V SOIL ABSORPTION SYSTEM i00 00 �o.�g g,}�o►^� 64 Bed: XZ Trlela�l•Y Width: ( � Length: Number of Lines:�Q Area Built: Fill depth to top of pipe; �30,, 1 Number of feet from nearest property line: Front, O Side, (0'\ Rear,O P't . 30 1 `� Number of feet from well: �y Number of feet from building: 39 (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: L 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: Plumber on job: License Number: �_ R_�OEO 3/84:mj ti r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER J 1- /l TOWNSHIP... `. RQT_ .. SEC. ADDRESS �OW(�}_ b� 2 �L ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM rax sa BF-P 3 BEDROarn ty' ° a3' d I DICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used B �` a Elevation of vertical reference point: Iy U.U Proposed slope at site: o SEPTIC TANK: Manufacturer W e 5 Liquid Capacity: 0( Q 9AJ Number of rings used: —! Tank manhole cover elevation: to 1 Tank Inlet Elevation: 101R0 Tank Outlet Elevation: �Ua•'iS Number of feet from nearest Road: Front,O Side kV Rear, O I �p� feet From nearest property line Front,0 Side,O Rear,(D S5 feet Number of feet from: well _75 , , building: „ 31 (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 P ABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 53707 P.O. SON BUREAU OF PLUMBING , SE�4,NW�4,S8,T28N—R19W iki CONVENTIONAL El ALTERNATIVE IState Plan l.)D.Number: (lf assigned Town of Troy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 5 Red Brick Addition NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Tim Kidd 1601 Redwood Drive, Hudson, WI 54016 7 O?• (JCS 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: Richard Hopkins 1059 St. Croix 99043 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OQ,�L I SYES ❑NO I ❑YES j4N O BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH f� ALARM FEET FRO I�O LINE: AIR INLET: ❑YES �NO �Z ❑YES NO NEAREST!!--*] DOSING CHAMBER: MANUFACTURER T�YE NG: LIQUID CAPACITY. PUMP MODE L. P . WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: S ❑NO ❑YES ONO 10YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF -'PROPERTY WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE JDIAMFTER 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: p WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER (-INSIDE DIA.. #PITS. IL IQUID BEDITRENCH TRENCHES �I MATERIAL: PIT DEPTH DIMENSIONS + GRAVEL DEPTH FILL DEPTH DIS P F DISTR.PIPE DISTR.PIPE MATERIAL: NO S R NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES- ABOVE COVER. ELEV.INLET.ELEV.END PIP LINE: AIR INLET: `'A- o- a Ial.q 4 WI.-43 a7? NEARES°M 30 IBS 35 JiM -A- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED —7 0F TOPSOIL: SODDED SEEDED. MULCHED. CENTER. EDGES. ❑YES ❑NO I DYES El NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING:JGRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: 0E©/TRrzNCH '' TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEVATION AND ELEV. ELEV. DIA. ELEV. PIPES DIA: I�ISTRIOUTIOW INF4IRIPMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ION PLANS. ❑YES 0 N EYES El NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BVILDING: FEET FROM LINE: ❑YE "° ONO DYES ENO NEARES d-, Sketch System on Retain in county file for audit. Reverse Side. S NATURE: TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) ��, APPLICATION FOR SANITARY PERMIT S T C - 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 p'- w %�bl�C iQQ at birr,Y f457 XY of Tyt yvcs7/'y Location of Property Saaswrt55r �wf Lf , Section , T Z N-R�- W Township ill-eoy Hailing Address 1601 ew va. &T/02 .�- . Address of Site f (,JiJe Is YIO/Ci Subdivision Name . Lot Number Previous Owner of Property 7- Total Size of Parcel Z.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 and Page Number D d .as recorded with the Register of Deeds. t INCLUDE WITH THIS APPLICATION THE FOLLOWING: 4 A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Resister of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (toe) ceAti.6y that aCQ statements on this 60hm ahe tAue to the best o6 my (oun) knowledge; that 1 (we) am (ane) the owneA(z ) o6 the pnopenty desc4ibed in this in6o"ati.on 6on.m, by vi&tue o6 a waAAanty deed %ecotded in the 0h6ice o6 the County Reg.csteA o6 Veed6 as Vocument No. ; and that I (we) ptesentty own the pnoposed site bon the sewage di,spos sys em (on I (we) have obtained an easement, to nun with the above deAcAibed pnopeAty, bon the constAucti.on 06 said system, and the same has been duty Aeconded in the 066ice o6 the County Regi6ten o6 Deedb, as Document No ) , I ATURE It OWNER SIGNATURE OF CO-0 ER (IF APPLICABLE) 3L3� /7 1,3) DATE SIGNED DATE SIGNED i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed 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: 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: 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; 111. 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'/2 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. -------------I----------------------------------------------------------------------------------------------------------------------------------------------- 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 . Grounater included the creation of surcharges (tees) for a number of regulated practices which Wisco n.s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that ° CaUriedrea5ure i 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. 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- . f w ter g ro uni wat e r contamination tian ir�esti ations and est ablishmen t of standards. GroundwatE.1, _.._ `.;'s worth protecting. SBD-6338(R.03/86) I DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code ' STATE SANITARY PER IT# 9'o flu —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES � NO I IM Ki dd !S f fj PROPERTY WNER PROPERTY LO,CGy�ATION %, Q%, S Tag , N, R 9 E (orls PROPERTY OWNER'S MAILING A DRESS LOT NIJ�QBER BLOCK NUMBER SUBDIVISIA NAME I W 0 .L�J N /AV►N CITY,ST TE ZIP CODE PHONE NU BER CITY EST ROAD,L OR LA MARK W / VILLAGE : -'Q� I W TOWN OF: 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): C Mt]CJNAI 3ed III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. � New b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## 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. Wonventional 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. 9 Seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUf RED Square Feet): PROPOSE (Square Feet): V� (� Feet X Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ 1 ❑ ❑ 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 Stamps) MP/MPRSW No.: Business Phone Number: i m o59 1 (715- M 110 c o � w Plu is Address( treet City tate, ip Code): N of D igner:'KICKMNI4 (�Isc . Vlll. SOIL TEST INFORMATION Certified Soil Tester ST)WANWe LA e CST# 1 (I ster 003M CST's ADDRESS(Street,City,State,Zip C ) Phone Number: 8oi 0o S \Ad o sc • S46 1S L- W IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Age/it Signature(No Stamps) Approved ❑ Owner Given Initial charge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: e fV SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber i I �t . F� rt R , x. t 1 IJI�e 3 X41 i.S k pPl i3T,1 9f�k�4� 1' t 1 MYL U nDt fM II �1M 24vdw T*b an and obgvjw as bps Sad �'. .� .. aAM Oat.tip We is 6084 i�iiliiMiiANj,ii in rl o* and iris ay.Nir'i[�i4es oil wijt..•'• ,� r Iltilictias and I l! E of "Mr1 w� �MRirMI tM ssM. i' ; } '' MNwr�MMM�+».» ».w.►..»w. .. _d" . «,M. ..»» ».... w.M...»}.w-6...Nry,TM+ Of�.• .............(SZAL) w....».«.......».««.».�SaIw4� .... ...........»......«.. . • Y . ...... w.,.N.w. wk'M♦ww,,.,�.�I„.,.......nw.r+!«r.w►.,..�.«.« w....«.,.»....+...... w .*... .,r�.*,..»...+.7p�L...r I n , ,f _ i � k Y�t '•'yi'It � tl s I fj Op -. ,i iAII M I I i 1 �¢ I �1 1 y.. i'. ♦�� ,,M....w M.N.•I�..M..MRI�•1 .. I, •� i 'Y.�•p�'1'.A"1 y� +tt�.: V�'i9,q I' "iMrw.wr........y.+.+w...rr.w«w.,....www.«.«.: .... ..wgi.�n.w. +r..r...w..+•,*MY.f•Iw+w+....wrr�..i1Y*+Mw.+ rMd i r « by i'IOdft'�i►�w�taM1.l to aM haowa to to so iNs�.. w6a r`' a �I, Two INaTM"aw wAa,011 I go'�Y . rTM -..»»........-......... ....................»».»..... Nota Public ............... �(� M M7 be•aothmUcatsd w adLw,$*dj d Both MY s t.(ii 00% �C 7•) dato: . .................. {. .f lwMww Mpi�It wV M1waV ehm*M M Up”w primm bdow*.&s ftWara. - w,A>A M"ssso NTATR BAR 4w wwcoxuN whwwsNw Iowa sot 4 ha R �Y YrlNLT�Q.1J�lID! ��� wa — NEW i 8•N x /� —� 8 � U t ai + S••a•r ._� �_ _ NN Zt W EY`--95•.6W_— _ —_A�p___.. _ _.__-_. �� RS•TR SOIITR 'A LWA d SECTOR • •1.00'1'• N19 N' t �JNP�AT T�Q�\\ANCS �t • i i:� ■ rE iii�v• �> f �_ _ •EIMM P� V .is = ! �•. • = 'y i e _6 Lit: •t� y•M : fI ! i 8 8 [ rri;r • =1 't. � 1 r.' •w •r N° �F��itia � r � w R _ inai:11N lit SO : f �•M N r STC - 105 SEP'T'IC 'TANK MAINTENANCE AGI(EEMEN'1' H St . Croix County ° v 0WNER/BUYE[: rn .- ROUTE/BOX NUMBER /� / 3 Fire Number 7d CITY/S1'ATEu�J� Uv�SC . —ZIP SYb�(D pdaD*��s'��( pfrrfl N +ts7yY --- Y IZ O i'L'It'1'Y L U C A 1'I O N JltRSr 4 , Sec t i on_ 1' Z ii , R_L _W , i T own of St . Croix Count Subdivisi0nZ1J iL7�/ ��r. Lot number S' s i Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- silts of pumping out the septic tank every three years or sooner , r if needed , by a licensed se12 tic ta«k LwLer . What , you put into ?. the system can affect the function of tlle svlltic Conk as a treat- ment stage In the waste disposal system . St . Croix . County -residents maw' be eligible to receive a !;rant for. a maximum of 60%. of the cost of replacement of a failing system, h whic was in. operation,' pr3or to July 1 , L978 . St Gruix County accepted this ?prubram in "Au g,ust of .1980 , with the- requirement that owners of all n -H systems; agree to "keep their systems properly p "La intainud .-- -- The property owner agrees to submit to 5t . Croix County Zoning a ` certification form, signed by the owner and by a master !dumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-;site wastewater disposal system is in° pruper 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 I/WE , the undersigned , have read the above requirements and agree f to maintain the private sewage disposal system in accordance with x the- standards set forth , herein , as set by the Wisconsin Depart- b 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 . SICNED C DATE 66 St . Ciloix C .)unty Zoning Office P- 0 . f•o x 98 Hammond , W1 54015 715-7S6-2239 or 715-425-8363 Sign ,' date and return to above address . f • V i 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; 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 separate sheet may be used if desired; 8. 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- 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 copies 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 gr - Gravel {under 3"} LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs -- Fine Sand Bldg - Building Is - Loarny Sand > - Greater Than 4-sl Sandy Loam < - Less Than *1 - Loarn Bn - Brown *sil - Silt Loam BI Black si - Silt Gy - Gray *cl Clay Loam Y -- Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc Sandy Clay wr' - with sic - Silty Clay fff few,fine,faint *c - Clay cc - common, coarse pt - Peat rnm - Many, medium rn Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP -- Vertical Reference Point s TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage systern and a permit application must be subrnitted to the appropriate local authority in orde=r to � obtain a permit. The sanitary permit must be obtained and posted prior to the start of any constructi€ui, J DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUST�iY, C DIVISION LABOR'AND PERCOLATION TESTS (115) MADISON W1 7969 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LOCATION: (ill SECTION: O /MUNICIPALITY: OTO. BLK.NO]SUBDIVISION NAME: ; COU T OWNER'S BUYER'S NAME: M LING ADDRE S: 0�� - 1111 «� eGi(.v�c9Gj P/7 USE DATES OBSERVATIONS MADE / NO.BEDRMS.: COMMERCIA DESCRIPTION: [.7,11 ROF D TIONS: E I TESTS: ILYResidence � New ❑Replace 3 Z 3 cy RATING:S=Site suitable for system U=Site unsuitable for system 3 r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTE opti nal) os ❑u Es ❑u �s ❑u ❑s 2u ❑s au rQ, h �" �. 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: 3 /►y� I I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.H GHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) ! i '5`611''s'Bn � •yL 'B'!a 5, ,67 Bns' . ,1 Bats 7, 33 B- /� 33 /�%9� �. 3? 0151, jr! G . `t2'dH s411(gr w Vyl#*t Fir B- Z 7, /0 5, 75"131s/�q 17 gk i✓Xdl we AFIC, �e y X3 W1, 7S Q�aI Z S f3H /S�g r, �,N2' S 9r.✓l y ¢F,c' B s" /0'/,Z/Z 11D, L , B- ! ' .5-F R/ 2. Afn C S 3," t.! -e Co . 83?Si+S�'d r 4 f S B_ PERCOLATION TESTS EST DEPTH&CTWATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 11~3 AFTER WELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ 7.01 WA 2 P- ! Z.. P- ' L 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 f dD Sys F-11 it : E � i l I iZ3 p . TN ►' � � T 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)Ood ''// TEST772,,E CO PLETED ON: C� I� VGh 31g, 7 ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optional): 0► �" sf G�{NQ�rSD41 1as� � �/� Q�3YY G 6�-3/ CST SI RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — ED BsL 6 7 P � OT A f � C I 0 EC f�l a S TIC PROJECT PLUMRE I_� ` NAME Tires N AM E - ickA d r s l_ I NS = 6 L 0 C AT 10 n�.__��,, � -E -- ( �� TE '1 PL h/1 A h Q= 6r. StEF-1 Pi pF- 'IN q ROUND At 5W GRA)CR O� (ot 5 CL: 100-0 N�� �E- SE CORNER lot StAKE, • = BoRehole S Ife.5 ( I Fee,c.hoIE 51tu th "0 $ W � `: = We.11 Is mvR� ' 50 ft. fRQfn Both JRAlrof(e a +5tPCc —ir i _ 1 6a > Ln Xpa Id x5d Off) Prx 3 P3 °- 40 yp- es � for - BY 10' y3 u s IO * VA C.AIUi I Ot _ FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION Approved Vent Cap (05,08 Minimum 12" Above Final Or rilvA I GKRne ya'` MAY I 4" Cast Iron Above Pipe Vent Pipe To Final Grade— Marsh Hay Or Synthetic Covering Min. '2 1 Aggreg�_lI c Over Pipe Distribution rR �- Tee Pipe - ---1 _ Aggregate _-_ Perforated Pipe Below Beneath Pipe < Coupling Terminating At Bottom of System