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Home My WebLink About020-1169-60-000 St. Croix County Planning and Zoning wednesday, March 01, 2006 at 5.01:27PM Detail Sanitary Information Page I of 1 Computer 020-116960-000 Sub/Plat: Ranchwood Section: 7 Parcel 07.29.19.1053 Lot: 29&30 TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: 114114: SE 114 NW 114 Owner: Sukowatey, Don 345 Highview Rd. Hudson, WI 54016 State Permit: 79148 Issued: 0511911986 POWTS Dispersal: Non-plumbing Sanitation Permit: New County Permit: 0 installed: 12/03/1986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Reouirements Additional Notes Money Owed Mary Jenkins Yes Powers, Calvin $0.00 Tom Nelson Signed Off: No Maintenance Scheduled Puma Date Pumped 1st Notification 2nd Notification 3rd Notification 12/312005 Parcel 020-1169-60-000 03/01/2006 04:53 PM PAGE 1 OF 1 Alt. Parcel M 07.29.19.1053 020 - TOWN OF HUDSON Current [X] 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 O - SWINNEY, STEPHEN A II & TERRI A STEPHEN A II & TERRI A SWINNEY 345 HIGHVIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 345 HIGHVIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.190 Plat: 2362-RANCHWOOD SEC 7 T29N R19W SE NW LOTS 29 & 30 PLAT Block/Condo Bldg: LOT 29 RANCHWOOD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1236/237 WD 07/23/1997 770/560 07/23/1997 739/72 2005 SUMMARY Bill M Fair Market Value: Assessed with: 92875 314,700 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.190 69,800 251,200 321,000 NO 05 Totals for 2005: General Property 2.190 69,800 251,200 321,0000 Woodland 0.000 0 Totals for 2004: General Property 2.190 48,500 184,000 232,5000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 128 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Cha 0 00 Delinquent Charg00 Total 27.00 0 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP r SEC TCN-R-W ADDRESS i,~'Up ST. CROIX COUNTY, WISCONSIN X20- SUBDIVISION LOT LOT SIZE 0:~3 IF L" PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i 6cj B7 ,62 i vow INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4z- Elevation of vertical reference point: Proposed,slope at site: 1, SEPTIC TANK: Manufacturer :,2,0,cvj a4, Liquid Capacity: Number of rings used: Tank manhole cover elevation: z; Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side Q Rear, O feet From nearest property line Front 10 Side,O Rear ,(D 'z-dz1 feet Number of feet from: well -~4--' building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) 8 VERSE.. SIDE 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: x Trench: Width: Lendth: Number of Lines: Area Built:-2'1- Fill depth to top of pipe: Number of feet from nearest property line: Front O Side, 0 Rear,O Pt~ Number of feet from well: r 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, OFt. 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: 3 3/84:mj SAFETY & BUILDINGS DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR DIVISION LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. s6X 7969 MADISON,aW 153707 State Plan I.D. Number: ZXCONVENTIONAL ❑ALTERNATI VE I"as"gned1 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound INSPECTION DATE: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: /11 aL Sukowatey Home Builders 126 Second St. , Hudson, WI 54016 OJT CBSTvREF PT.ELEV REF. T. ELEV.: BENCH MARK (Permanent r.f.re-ep.intl DESCRIBE IF DIFFERENT FROM PLAN. Lots 29-30,RanchWOod SW NW, Section 7, T29N-R19W, Town of Hudson, unry Sanitary Permit Number: MP/MPRSW No Cn 79148 Name of Plumber. 1563 St. Croix SEPTIC TANK/HOLDING TANK: LIQUID CAPACITY. TANK INLET ELEV.. TAN^K OUTLET ELE V._ PROVIDE LABEL pROVI ED OVER MANUFACTURER: ~ / S DYES ❑NO ❑YES O I O O ROAD. PROPERTY WELL. BUILDING. VENT FRESH RI E N ET. HIGH WATER NUMBER OF LINE 14 At BEDDING: VENT DIA.: VENTMATI ALARM FEET FROM. to t^1 ►V o~,~~ ❑ YES NO NEAREST e~ ❑YES O DOSING CHAMBER: PUMP;SIPHON MANUFACTOHEH WARNING LABEL LOCKING COVER LIQUID L:APACI TV PUMP MODEL PROVIDED'. MANUFACTURER BEDDING: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PROPERTY WELL BUILDING AIR TOF E H GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL BE ET: F TF (DIFFERENCE BETWEEN ❑YES ❑NO N A ST PUMP ON AND OFF) lE t UTAMF TER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORC or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) a pl DEPTH CONVENTIONAL SYSTEM: INSIUL DIA TS LIQUID WIDTH. LENGTH NO. OF UISTH PIPE SPACIN(-. COVE HIAL: PIT -79 BED/TRENCH TRENCHES / r DIMENSIONS (O PROPERTY WELL. BUILDING. V NT TO FJR~ESH GRAVEL DEPTH FILL DEPTH UISTH. PIPF UISTH PIPE DISTR. PIPE MATERIAL pN OE SI I NUMBER OF LINE ' 1 /I r AIR "T BELOW PIPES ABOVE COVER ELEV INLE I EL V `EIyU FEET FROM Gt So c2S:so J•~ NEAREST--- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- TIONS MEASURED. meets the criteria for medium sand. ❑YES F71 NO PE HMANI NT MAHKE HIS GHSEH VATIONWELLS SOIL COVER TEXTURE ❑YES ❑NO ❑YES ❑NO SEEDED S(IOUF O CENTER MULCHED DEPTH OV ER TRENCH BED ED DEPTH GES OVER TRENCH HEU DEPTH OF TOPSOIL S 0 ❑YES NN ❑YES -❑NO CO PRESSURIZED DISTRIBUTION SYSTEM: - FILL DEPTH ABOVE COVER WIDTH. LENGTH NO. OF LATEHALSPACING GRAVEL EPT BELO PIPE BED/TRENCH TRENCHES: DIMENSIONS PUMP MANIFOLD DISTR. PIPE MANIFOL MATER POEDI TH DIA ? PIPE UISTHIBUTION PIPE MATERIAL & MARKING MANIFOLD . ELEV. ELEV.. DIA. ELEV. ELEVATION AND VERTICAL LIFT CORRESPONDS TO APPROVED DISTRIBUTION. COVER MATERIAL PLANS HOLE SIZE HOLE SPACING DRILLED COHHECI LV ❑NO INFORMATION ❑YES DYES ❑NO PROPERTY WELL: BUILDING: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF LINE: COMMENTS: ET FROM ❑YES ❑NO ❑YES ❑NO t ' in county file for audit. Sketch System on Reverse Side. nTLE. S NATURE. DILHR SBD 6710 (R. 01/82) imm~ wlsconsln APPLICATION FOR SANITARY PERMIT 011 DILHR COUNTY (PLB 67) 4199P UNIFORM SANITARY PERMIT # - OEpgRTTEnT OF n A/ Al InOLISTRV,LRBOR6NUTRn RELRTl01-IS 7 FT o -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 PROPERTY OWNER MAILING ADDRESS &AA PROPERTY LOCATION -LILY: A~s>' VILLAGE: D~f 1/4 1/4,S, N, E (ora TOWN OF: LOT NU ER BLOCK UMBER IS UBD I ION NAME NEAREST P _.0 gA AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): j, / 74t THIS PERMIT IS FOR A: Qd New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Al Lift Pump Tank/Siphon Chamber Holding Tank capacity 4 9 Manufacturer: ~ IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na f P mber IP t): Sign e: MP/MPRSW No,: Phone Number: aKs Y/ Plumbe Address: Name of Design ILL c COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved S J p ?-,f ~ ~ El Owner Given Initial Approved Adverse Determination Reason for Do p val 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/contractq~k,("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 S11~ ` Av- Location of Property - kJ y~ Section -Z T,:; N - R ~ W Township W r r, ~ A ~o w o t 0 (D rt 0 H. k1eo- IN 00 v C H ~ i. r s identifiable? Yes oped for resale ~ I (spec house) ? Yes No Z 30 ° M Number _ as.xecorded with the Register of Deeds co :b 1 THIS APPLICATION ONE OF THE FOLLOWING: F-3 (D CL 1 N 0 ed with the Register of Deeds Office Bey, if available, would be helpful so as to avoid delays the deed description references to a Certified Survey e e ert ed Survey Map shall also be re quired, PROPERTY OWNER CERTIFICATION - I (We) c"6y that a t atatement6 on thi6 ~oAm aAe t ue to the but of my (out) knowledge; chat I (we) am (cute). .the.owner4.6) o{ the ptopehty de,6eAibed in .thin in6onmation,6oAm, by viAtue.o6 a wa4Aa.nty deed %ecoAded in the 066ice of the County Regi4 teA o6 Deed6 " Document No. ; and that I (we) ' pne•a entZy own the pro po4 ed .6iie 6oA the Awag"K poa b ya tem Ion I (we) have obtained an easement, to •►ua.n with the above ductibed pnopeA.ty, 6oA the conztnucti,or, 06 aai:d 6y6tem, and the ,name hab been duty Aeconded in the 066ice of the Coun4V Regi4teA of Deeda, as Document No. J, SIGNATURE C+F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED z y a STC - 105 r" r a SEPTIC TANK MAINTENANCE AGREEMENT ry-+ St. Croix County z z d ` a OWNER/BUYER S~~~OWO~¢~ C.e~,~~ ~ap,~.~~o.r►;~O►iV ROUTE/BOX NUMBER ,...A Z~, Fire Number .CITY/STATE kkv~-.a.SaN ZIP S~te1S. PROPERTY LOCATION: Z _'k,_34, Section-TE::2~ N, R_W, W t Town of ~r 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, 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 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ►~d 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. SIGN D}~ 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. UMCCrl, ILH PERMIT SANITARY _ R Coun ti GROUNDWATER SURCHARGE Sanitary Permit No. 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 years of steady negotiation and public debate. The groundwater bill ' surcharges (fees) for a number of regulated practices which ca atutes was the result of over surcharge took effect on July 1, 1984, All of the water that is used included the creation of the groundwater through your soil absorption system the di can effect groundwater. The tank pumper, in Your building is returned to disposal site used by your holding The monies collected through these surcharges are credited tered tered by the Department of Natural Resources. These funds are u water, water, groundwater contamination investigations and to the groundwater fund adminis- worth protecting. used for monitoring ground- of standards. Groundwater, Signature of Issuin Ag t: DroundwaterFee: Ground. 1" Date: WISCO'S DILHR SBD- g 84) PG burled Sut$ , '6 PAGE OF r. CroSS Sec~lon o~ ~i ~en S sten" Fresh AM InIsts And Observation Pips t C Approved Vent Cap j 12" Ahow rads 20ve Plpe _ 4" Casf Iron Trade Vent Pipe overing regate Pipe 0 0 -Tee 6ate Bipe ° Perforated Pipe Below CeMIM Terminating At Bottom Of system I 5.00,11 P~~POSCD Tina' 9rAd< £~eJ•.~ ton / t SOIL FILL DISTRIBUTIou PIPE c APPROVED SWPETIC COVER OF AGGREGATE MATERIAL OR 9" OF STRAW OR MARSH HA`.i ELEV. o . ' (e~OF/A-P-lp AGGREGATE F, '2- FEET, i DISTRIgUTIOM PIPE TO BE AT LEAST s•.~_ FICHES BELOW ORIGIMAL GRADE AUEJ AT LEAST20 IAICHES BUT 110 MORE THAI) 42 FICHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXC-/WAriao nom OwmAL 6RAoE WILL BE S~2-INCHES MINIMUM AEPTH OF EXCAVATION FROM 0iR1f.1W-%L 694PE WILL BE s. INCHES I ff SIGHED LICEIISE HUMBER: DATE DEPARTMENTfOF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND LABOR AND DIVISION HUMAN RELATIONS PERCOLATION TESTS 115) P.O. BOX 7969 • (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCA ION: SECTION: N/R (or O tN~ I NICIPALITY: LOT NO.: BLK. O.: SUB VISION NAME: OUNTY: 0 NER'S ER'S N E: USE NO. BEDRMS.: COMMER IAL DESCRIPTION: DATES OBSERVATION ADE Residence PR F LE D S R P IONS: AT ON TESTS: New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system COENTIoAL: 11V1UU11JU:❑~ IN_GROUNDPRESSURE:S STEM- - ILLH DNG :R EC MENDEDS STEM:(optio "I) (~~QQJJJJSS UU S ~S ❑U ❑S ®U CIS 1U If Percolation Tests are NOT requir DESIG2RAT E : under. s.H63.09(5)(b), indicate: rFloodplain, ny portion of the tested area is in the 77 indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARAC T ER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER pEPTHT~d, ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ►B2 , > - 7 } - _ B-.s- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME NUMBER +H@":&S AFTERS ELL ING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES P PER10 1 PER10 2 p ~ PER INCH P- 7 ~ P_ LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hork )ntal 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 f land slope. 'YSTEM ELEVATION / I P ' E I m _ , ~ E N 3 ie undersigned, hereby certify that the soil tests reported on this form were made ninistrative Code, and that the data recorded and the location of the tests are correct to y me in accord the proce an he bet of my'kn wledge andrbelief methods specified in the Wisconsin VIE ( int TESTS W RE COMPLETED ON: S CE IFICATION NU PHONE NUM R(optional) : C TURE- •RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L 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 commerci'ab project; 3. MAXIMUM number of bedrooms or cornmercial 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; lace N.A. in the appropriate box, 10. If the information (such as flood plain, elevation) does not apply, p 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 Other Symbols Soil Separates and Textures BR - Bedrock st -Stone (over 10") SS -Sandstone cob - Cobble (3 - 10") 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 *sI - Sandy Loarn < - Less Than *1 - 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 se - Sandy Clay w! - with sic - Silty Clay fff few, fine, faint *c - Clay cc - common, coarse pt Peat mm - Many, medium m Muck d - distinct p - prominent HWL - High water level, surface water * Six general soil textures for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point e 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 permit. The sanitary permit must be obtained and posted prior to the start of any construction. r~< £G6 7_~' p' r~ ,ct~ oot ~ 0%1 avy ray s