HomeMy WebLinkAbout012-1022-40-000
St. Croix County Planning and Zoning Thursday, September 07,2006 at 4:05.09 PM
Detail Sanitary Information Page I of 1
Computer 012-1022-40-000 Sub/Plat: metes & bounds Section: 8
Parcel 08.30.17.119b Lot: TNIRNG: T30N R17W
Municipality: Erin Prairie, Town of CSM: 114114: SW 114 SW 114
Owner: Sededund, Galen 1603 Cty. Rd. GG New Richmond, WI 54017
State Permit: 79159 Issued: 0512211986 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement
County Permit: 0 Installed: 0512811986 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed
Harold Barber Yes Powers, Calvin data from notecard only $0.00
Tom Nelson Signed Off: No
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
512812005
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-
SEDERLUND GALEN
~ SW SW, Sectiot-_$
Rt. Box 41_ T3 =R17W
New Richmond, WI_ 54017 Town of-Erin- Prairie
San.Permit#79159 5-22-86 C. Powers
Conventional, REp cement
NSTALLED - 5-28-86
• 'Parcel 012-1022-40-000 09/07/2006 03:36 PM
PAGE I OF 1
Alt. Parcel 08.30.17.119B 012 - TOWN OF ERIN PRAIRIE
Current )Xj ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - CURTIS, DALLAS E
DALLAS E CURTIS C - PEITE, KATHY J
KATHY J PEITE
1603 CTY RD GG
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1603 CTY RD GG
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.990 Plat: N/A-NOT AVAILABLE
SEC 08 T30N R1 7W 1.99 AC PARCEL IN SW SW Block/Condo Bldg:
S 269 FT OF W 321.74 FT
9 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
c
. &W v n 08-30N-17W SW SW
73' (Its
Notes: Parcel History:
p~ L) Date Doc # Vol/Page Type
/ ~°yy-1 r 3 tr l y -73 08/26/2004 772637 2644/046 WD
Vl / 06/28/2000 625524 1522/343 WD
L t` 11/03/1999 613217 1468/190 WD
7 7 07/23/1997 980/61D
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/0712005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.990 29,900 111,300 141,200 NO
Totals for 2006:
General Property 1.990 29,900 111,300 141,200
Woodland 0.000 0 0
Totals for 2005:
General Property 1.990 29,900 111,300 141,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 519
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. _ T~M N-R,~Z-W
ADDRESS ST. CROIX COUNTY, WISCONSIN
T
SUBDIVISION X .14 LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IL.HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
Ion
9q'
a'
r ~
z
INDICATE NORTH
-ARRO
BENCHMARK: Describe the vertical reference point used /A
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
za-
Number of feet from nearest Road: (Q~ _ Qy '~O
Front
,O Side Rear, V -LLf feet
From nearest property line Front ,O Side,O Rear,@
feet
Number of feet from: well =
building: j~
(Include this information of the above
- Plot plan)( 2
reference dimensions to septic tank)
r -
PUMP CHAMBER
Manufacturer: C9 Liquid Capacity ?vA
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: ,rte Bottom of tank elevation: &,%!Z
Pump off switch elevation: 8fa 7 Gallons per cycle: J3 Z
Alarm Manufacturer: ~C, 5 Alarm Switch Type:
i
Number of feet from nearest property line: Front, O Side, O Rear, Ft.~
~
Number of feet from well: /
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width a Leng kh: Number of Lines: Area Built:,& ~
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side ide, Rear, it
Number of feet from well: I-Z~
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:
Number of feet from nearest road:
Alarm Manufacturer:
a 477
Inspector: e ,
Dated : Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & HUMAN RELATIONS SAFETY & BUILDINGS
P.O. BOX 79,69 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
7f~7CONVENTIONAL DALTERNATIVE n7:71
Holding Tank ❑ In-Ground Pressure Mound ❑
NAME OF PERMIT HOLDER: El Galen SederlUrid ADDRESS OF PERMIT HOLDER T'7
Rt . 1, Box 41, New Richmond, I INSPECTION DATE: /Y]
BENCH
T~7M]A'RK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN 5 ~ 4 P -Q 6 r `
SW's SWk, Section 81 T30N-R17W, Town of Erin Prairie REF. PT. ELEV.: CST REF. PT. ELEV
Name of Plumber
MP/MPRSW No.. County:
Cal Powers, Jr. Samtarv Permit Number:
1563 St. Croix 79159
SEPTIC TANK/HOLDING TANK:
MANUFACTURER:
P LIOUID CAPACITY TANK INLET ELEV TANK ~LEV WARNING LABEL LOCKING COVER
V PROVIDEDPROVIDED: BEDDING: VENTDIA.VENTMATt HIGH VYES ONO DYES NO
ALARM NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
OYES NO L r I FEET FROM LINJ~ AIR INLET:
DYES ONO NEAREST
DOSING CHAMBER:
MA FACTURER. BEDDING: LIOUIO CAPACI TY Pt1MP M()12EL PUMP; IPHON MANUF CTDHEH
t\ ~n~ WARNING LABEL LOCKING COVER
DYES NO PROVIDED. P OVI ED:
GALLONS PER CYCLE: PUMP AND corvrRO s oPERgnoNAL YES ONO ES ONO
(DIFFERENCE BETWEEN NUMBER OF PHOPERTV WELL BUILD NG VENT TO FRESH
PUMP ON AND OFF) J FEET FROM LINE /7 l AIR INLET
SOIL ABSORPTION SYSTEM. Check the soil moisture at the dep~h of plowinO NO NEAREST
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE DInMF rER MATE HIAL AND MARKING
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH N01 UISTR PIPE SPACING COVER
DIMENSIONS THE NCrHFS MMf HIA L: PIT INSIDE UTA st PI TS DEPTH
+ \ DEPTH:
I- LL UC i. FILL DEPTH DISTH. PIP S'
BELOWPIPES ~ ABOV COVER E EV IN f f DLSTH F~ NPE DISTR. PIPE MA 7ERIAL NO DI ~j.t NUMBER OF PROPERTY WELL BUILDING: V NT TO FRESH
~ I 2 7 J G PIPES,t FEET FROM
AIR INL
~ NEAREST--.~.
MOUND SYSTEM LINE.
:
Mound site plowed perpendicular to slope
and furrows thrown e
upslope: rpe Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES O NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE
PEHMANI NT MARKFHS OBSERVATION WELLS
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED 'DYES ONO DYES ONO
CENTER EDGES. DEPTH OF TOPSOIL SODDED SEE O1"F'-] MULCHED
DYES. ONO YE
S ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE
TRENCHES. FILL DEPTH ABOVE COVER.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.: ELEV.. DIA. ELEV. PIPES DIA:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT Lv
COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
COMMENTS. DYES ONO _ DYES ONO
PERMANENT MARKERS: OBSERVATION WELLS:
NUMBER OF I LINE:
TV WELL: BUILDING:
FEET FROM LINE:
YES ONO DYES ONO NEAREST-
Sketch System on
Reverse Side. Retain in county file for audit.
SIGNATURE. TITLE:
DILHR SBD 6710 (R. 01/82)
®rr. wisconsin APPLICATION FOR SANITARY PERMIT
ILHR OUNTY
-•OE(PLB 67)
InoUSTiW,LgBOq 6MUTgn gELFTIOnS UNIFORM SANITARY PERMIT #
il9/S9
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PRO RTY OWNER MAI NG ADDRESS
PROPERTY LOCATIO 'C +T-Y:
V-;_:
1/ 1/4, S , , N, R (or TOWN OF:
LOT N MBER BLOC NUMBER SUBDI ISIO NAME NEARES ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
91 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): e/ 1,4
THIS PERMIT IS FOR A:
❑ New System fZ Tank Replacement ❑ Repair
X Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Dd Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity O ,
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of ivate sewage system shown on the attached plans.
Na f P umber (P"): Sign u MP/MPRSW No.: Phone Number:
Plumb 's Address:
Name of Desig r:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
❑ Owner Given initial
A&Qv a 7
Approved Adverse Determination
Reason for a rov
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
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 _3y Section
T-dk2-N-R 17 W
Township s it^;
Mailing Address
Address of Site
Subdivision Name
Lot Number
Previous Owner of Property -z.annzs- aY,,J arA
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes
Is this property being developed for resale (spec house) ? Yes i~
No
Volume and Page Number __I 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 att 6tatement6 on this 6onm aAe,.thue to the bet-t a my )
knowtedge; that 1 (we) am (ahe) the owneh(d) o6 the pnopehty desehibed "n this
.in6onmation 6onm, by vi tue o6 a wahAanty deed neeonded in the 066ice o6 the
County RegiAteA o6 Deeds a6 Document Na. ; and that I (We) pneaenzty
own the pnopoded 4ite bon the ,sewage dispod .sys em (on I (we) have obtained an
easement, to nun with the above de.6ct bed pnopeAty, Got the constcue.#,i,on o6 baid
eyatem, and the same had been duty seconded in the 046iee o6 the County Regi6ten o6
Deeds, Document o.
SIGNATURE OF OWNER SIGNATURE 0 CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
z
Cn
H
STC - 105 r
r
• a
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County zz
d
9
OWNER/BUYER f--IU n
ROUTE/BOX NUMBER
Zf / I~Ok Fire Number
CITY/STATE- ~/°_cv / i hn7 ~c~~ (,cJi SG> > ZIP J` ` 6 7
PROPERTY LOCATION:,, ,Ca7 ~L, Section___(~'TN, R~7 W,
` Town of E,-I.; St. Croix County,
Subdivision
Lot numbe
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,
ti 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
I/WE, the undersigned, have read the above requirements and agree W
z
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.
SIGNED
DATE_~D
St. Croix County Zoning Office
P. 0. ' Box '981k'
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
SANITARY PERMIT
~-DILHR County
~.,a„GROUNDWATER SURCHARGE NA 0"'
Sanitary Permit No.
99/59
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com-
monly 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 included the creation of
surcharges (fees) for a number of regulated practices which can effect groundwater. The
surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to
the groundwater through your soil absorption system or the disposal site used by your holding
tank pumper.
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-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
Ground ttt+er -
Signature of leauin Ag 11 C Groundwater Fee: Date: WISco in'sr
7,7-;W buried irt~uiure
DILNa SBD-7 0 J
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY„ DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS 1 / MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNS HIP/Mb'NtCTP'RM1TY: LOT NO.: BLK. O.: SUBDIV ON NAME:
1v 1/a /T N/Ri !r (o
COUNTY: OWN S BUYER'S NAME: AILING-ADDRESS:
USE
DATES OBSERVATIONS MADE
NO. BEDRMS: COMMERC AL DESCRIPTION: PROFI E DES RIPTIONS: E LA I N TESTS:
®Residence ? ❑New Replace
ACI
RATING: S= Site suitable for systeWN = Site unsuitable for system
ONVENTIONAL: MOUND =GROUND-PR=ESSURE: SYSTEM-I -FILLHOLDIN A : REC MMEN s E❑s~u ❑s u
[lf Pe rcolation Tests are NOT required DESIGN ATE: If an
y portion of the tested area is in the
der s.H63.09(51(b1, indicate: Floodplain, indicate Floodplain elevation:
A /A10
PROFILE DESCRIPTIONS
BORING TAL DEPTH TO GRMEST.IGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVETO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Q_
B-
B s - 9-
B-
B_
PERCOLATION TESTS
TEST
NUMBER DElA16HeS FTERSWELOLING INTERVAL-MIN. MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES
PERIOD 1 PERIO 2 P R PER INCH
P- I
P- ~s.
13.4 4150
P- >J
f
P
P_
LP-
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 9S 9
i
a
TT
E
r-
`.s
T__
/Ge ( I
i _
- E
f y 4
0
i
'
01
I
J
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in a d Ah4e'ke)dd91!9,d 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 int
TESTS WERE COMPLETED ON:
ADD ~ DLL (O
CERTIFICATION NUMBER: PHONE NUMBER (optional):
C T GN TURE
(DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
'0I1-HR-SBD-6395 (R. 02/82) - OVER -
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 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 - Loamy Sand - Greater Than
sl - Sandy Loam < - Less Than
*i - Loam 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 wl - with
sic - Silty Clay fff - few, fine, faint
*c Clay cc - common, coarse
pt Peat rnm - Many, medium
m - Muck d - distinct
p - prominent
HWL - Nigh 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 request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a perrnit. The sanitary permit must be obtained and posted prior to the start of any construction.
- Model 3870 Submersible Effluent Pumps
140
1
120
7LA
S i
3100
0
0 80
v
I 1yp
u 7S
E
O ~Yp A `
0 60 70 7 hl
IYp
J
-40 wp 05 ' '
S~ NL---
WP 03, Y3 H P.
20
Zz:~
0 20 40 60
Capadty - Gallons PerMlnutr 100 120
r
l H.P. Order No. Volt Phi"
<1PM ioNda (Ipo
WP0311 E ~n
WPM0311E 115 9.4
WP0312E 1750 56
WPM03/2E 230 10 4.7
:•w WPHO$11E 115
WPF10512E 230 6.0
WPM0532E 206/230 3.4 60 30 WPH0534E 160 1.7
WPH0712E 230 10 911
ii WPH0732E 2081230 5.4 30 WPH0734E 460
2.7
WPM012E 230 10 11.6 70•
3450
1 WPH1032E 208/230 6.4 30 WPH1034E 460 32
- WPH1512E LOU 10 13.3
Y- WPH1532E 206/230 92
30 WPH1534E 160 4.6
1K 60
WPHH1512E 230 10 13.3
A j WPHH1532E 208/230 30 92
l
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SPECIFICATIONS ARE SUBJECT TO CHAN<;E WITHOUT NOTICE
3
~,~C~J~1 u✓);o PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"C.I. VENT PIPE
-frT 7 WEATHER PROOF APPROVED LOCKING
25' FROM DOOR, JUNCTION BOX MANHOLE COVER
WINDOW OR FRESH 12"MIU.
AIR INTAKE I
GRADE I
--T I y"MIN.
1®" MI IJ.
COAJDUIT
IeMMw. ~
V:T
I&JI-E T PROVIDE I
% AIRTIGHT SEAL I I ( ----f
I I
APPROVED JOINT A
W/C.2. PIPf. APPROVED JOINTS
EXTENOINt. 3' I III EXTEUOlNG 3'
ONTO 501.10 SGt;, ALARM
B I I ONTO SOLID SOIL
I I
C I oN
I I
I
oil PUMP '
OFF
D
H CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC AND SPECIFICATIONS
QDSE rAWKS MAWUFACTURER: ~J"rs~)F NUMBER OF DOSES'
PER pAy
TANK SIZE : GALLOWS DOSE VOLUME
ALARM MANUFACTURER: INCLUV!~:C, ZAC4RLOW: GALLONS
MODEL NUMBER: CAPACITIES: A_
INCNES OR GALLONS
SWITCH TUPC:
PUMP MANUFACT LIKE R: B= INCHES OR GALLONS
C=__~[__-I'll HES OR 13 7 GALLONS
MODEL NUMBER: d
D -,L--INCHES OR __Ll-_ GALLONS
SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHAR(.E RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BEEN PUMP OFF AND DISTRIBUTION PIPE.. -L-- FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET
♦ FEET OF FORCE MAIN X --FY0 fT.FRICTION FACTOR-
FEET
' lit _ TOTAL DYNAMIC. HEAD = FEET
INTERNAL. WMEWSIoMrs OF TANK: LENGTH ~6•
,WIDTH --ALO// ;LIQUID DEPTH
SIGNED:,.--, LICEMSE WUMBER: A~I.3
-117- DAT E:x-~..~
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kx f~9 r
86'
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33 ~ ~
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PAGE OF
CroSS Seejlun o~ A Zco SYst•er"
~
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/ Fresh Air Inlels And Observation Pipe
A4u 4Vo~,o Approved Wnt Cap
7 Minimum 12' Above Final Grads
E
20 - 42' Above Pips _ 4' Cwt Iron I
To Final Grode font Pips
Marsh Hay Of vering
regate
OlstP0 0 - Teo ls Perforated Pips Below
ps
Covpliag Termi nating At
Bottom Of System
i
i
PropoStD Tlnkl 9rad4.
lip-
~I~v•.~ ton ~~~CA~. t-
SOIL FILL
DISTRIBUTIOA] PIPE
APPROVED $ijM E-TIC COVER
'MATERIM- OR 9" OF STRAW
2"oFAGGREGAIB--~ oR1hARSN NAy
tLEV. OFF, FEET, OF %2 -2i/2 AGGREGATE °
-4-
DISTRIBiUTIOW PIPE TO BE AT LEAST 20 INCHES BELOW ORIGIUAL GRADE
AMU AT LEASTZ0 INCHES BUT MO MORE THAM H2 FICHES BELOW FINAL GRADE
MAXMM DEPTH OF EXCAVAT160 FROM OPWMAI WK. WILL BE INCHES
MINIMUM MM11 OF EACAvATI®N FRoM OkI(AW4L 694PE WILL BE INCHES
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SI&MED : d 'O +
LIGEUSE DUMBER:
DATE:
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