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HomeMy WebLinkAbout022-1085-70-100 0 y O 3' - -0 0 o d col cD CD ID 3 3 n m o N Con o O co- ~ m not °C C 3 C C2 CD 7 N N 1-1 j Q Z E N A d Co O C: (D co r,j O W N• rt C o p ry 'v CD N Jo 0 C N m rn p a o (D ~d Ft N 3 7 y p o p r to -G D m C,) o N. I~- o d y v CL a r p rY N x O (D CD N v - N ti 3 °O con CD FP "WAWA ~ i O O ''.(D C co Co d CA 00 00 C) 0 C W O C ro lf, H z 1 -0 -0 -0 -n En (D , 111) ° D Q r t t n cn N cn O N tmj oo a CL m ~ w 4 a, t~ U) p, O _ j N 3 y O I~ M N ON H Z z 00 N E g z o ON b r -h 00 Ci D z v O m C] Fl- CD 1 cn tv a ' 00 I ~ m m ~ ~ t1 I-~• t m 'O N C rF+ rt W Q • (D F a 3 0 CD z n ~N a ALz o' I z n~i ~ W co a zz ° A o a' cn 3 m 'a ~ w m m 6 v CD nD 3 o=CCDD o ao : c CD CL : Z a ° m m N CD a E ° y 0 7 o o i m' w ? I ° ~ a S n 0 =r 'Do (n CD y N ° CD O 3 o. CD ° w Q o r CD j CD DQ W O O N O tl ~ Parcel 022-1085-70-100 02/08/2006 11:39 AM PAGE 1OF1 Alt. Parcel 29.28.18.462C 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ELVERD, DONALD R DONALD R ELVERD 102 S LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 102 S LIBERTY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.500 Plat: N/A-NOT AVAILABLE SEC 29 T28N R1 8W THAT PART OF LOT 1 OF Block/Condo Bldg: CSM 6/1614 IN NW SE ASSM'T INC 022-1085-80-100 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 02/03/2003 708005 2128/295 QC 1070/70 AF 737/207 2005 SUMMARY Bill M Fair Market Value: Assessed with: 143908 302,700 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.500 70,000 236,100 306,100 NO Totals for 2005: General Property 4.500 70,000 236,100 306,100 Woodland 0.000 0 0 Totals for 2004: General Property 4.500 35,000 171,900 206,900 Woodland 0.000 0 0 i Lottery Credit: Claim Count: 1 Certification Date: Batch 141 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 r AS BUILT SANITARY SYSTEM REPORT OWNER I)ow Ei.VERta TOWNSHIP _Y=t4yAsxw-xmWTx_ SEC. T 2$ N-R I16 W ADDRESS RT. Z I&VA 3Z_ ST. CROIX COUNTY, WISCONSIN S49 L2_T-- SUBDIVISION tjA LOT LOT SIZE 4.5 PLAN VIEW Distances and dimensions to meet requirements of I=LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ri 1 9 a~C 1 \,O d t CtifiMF~- w 3 c • 4_`~ ; W S~ 500 fb. DRtv~wa~ Q r T ti INDICAT4 NORTH ARROW 6 BENCHMARK: Describe the vertical reference point used Wootea &QaMm _ Rwr O~ ~nKac 13y i3A" Elevation of vertical reference point: IM-00 Proposed slope at site: 60/1p SEPTIC TANK: Manufacturer: ?~E51ES2. Liquid Capacity: Joao GraLt.a~l Number of rings used: to Tank manhole cover elevation: gS.IS Tank Inlet Elevation: $$.©5 Tank Outlet Elevation: el.57 Number of feet from nearest- Road.: Front 10 Side0 Rear, O 0\ftVt- 16, feet From "nearest- property line' Ftont,OSide,ORear,O feet Number of feet from: well 60' , building: 2$1 (Include this information of the above plot plan)( 2 reference dimensions to septic SEE REVERSE SIDE PUMP CHAMBER + t Manufacturer: 'k- Liquid Capacity: -750 G "A-09-j Pump Model: SS-,4 Pump/Siphon Manufacturer: 1V1euca;S Pump Size Elevation of inlet: $'1.11 Bottom of tank elevation: I5_4Z Pump off switch elevation: p SS_75 Gallons per cycle: 130 Alarm Manufacturer: 5.J. [LEt:yQQ Alarm Switch Type: Memw!i Number of feet from nearest property line: Front, O Side, O Rear, Ft.05-(0 Number of feet from well: 95'-o" Number of feet from building: 15!-400 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: X-3 Width: Len the lobs^4`t Number of Lines: ( Ru~tN&rea Built:3151gb1z Fill depth to top of pipe: b~~ l.IP:E*1CA1 r Number of feet from nearest property line: Front,O Side, O Rear, 0Ft Number of feet from well: g!5&-01% 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, ONumber of feet from well: F Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: C~ Inspector:. Dated: 6--A1 J~~O Plumber on job: License Number: 1 / 3/84:mj y, DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ERCONVENTIONAL ❑ALTERNATIVE State Plan 1.0, Number: (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION ATE: Donald Elverd Rt. 2, Box 32, River Falls, WI 54022 -6-1 --96 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NW SE, Section 29, T28N-R18W, Town of Kinninkinnic Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number: Paul R. Cudd 2739 St. Croix 79134 SEPTIC TANK/HOLDING TANK: MANUFACTURER'. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER 1 PROVIDED'. PROVIDED: 0 _IS? 0 YES LINO ❑YES NO BEDDING: VENT DIA.: VENT MATt JHIGH WATER NUMBER OF ROAD- 'PR OPERTV WELL. BUILDING VENT TO FRESH ALARM FEET FROM (JU f' ILIl AIR INLET: ❑YES O C. ❑YES O NEAREST_ _ O ZS DOSING CH MBER: MANUFACTURER BEDDING: LIQUID CAPACITY 1111101, MOTEL JPUMP; SIPHON MANUf ACiIIHEH WARNING LABEL LOCKING COVER 1 PROVIDED: PROVIDED: &I S p a 54 YES LINO YES LINO GALLONS PER CYCL PUMP AND CONTROLS OPERATIONAL MBER OF PH OPEHTV WELL 26GIL15ING VENTTOFRESH (DIFFERENCE BET E 7NEIAREST ET FROM LI A w ETJ~ PUMP ON AND OFF) ~0 YES LINO (D / IV/ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1+ TMFTEH MATF IAL 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: WIDTH JLENGTH NO. OF IDIST11 PIPE SPACING COVER INSIDE DIA -PITS LIQUID BED/TRENCH TR Es MnrrulAL. PIT DEPTH DIMENSIONS ® 4 R', 'v EL DEPTH FILL DEPTH IDIS-rii PIPE UISTH PIPE DISTR. PIPE MATERIAL NO I_TH NUMBER OF PROPERTY WELL. BUILDING'. IV ENT TO FRES BELOW PIPES ABOVE COVER ELEV INLf ELEV END EET FROM XS 9.1 el L PIPES LINE AIR INLET. F 1 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- ❑ YES NO meets the criteria for medium sand. TIONS MEASURED. LI SOIL COVER TEXTURE PERMANF NT MAHKE RS 111111EH VATION WELLS ❑YES LINO ❑YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL St1DDED SEEDED MULCHED CENTER EDGES ❑YES. LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING IGHAVIL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO DISTH I'D ISTR. PIPE DISTHIBD TION PIPE MATERIAL & MARKING ELEV. ELEV.. DIA. ELEV. PIPES I A ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRE CT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS: JPERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES NO ❑YES LINO NEAREST 7- C' 0 4- Sketch System on R tai n co my fle for audit. Reverse Side. SIGNATURE. TIT LE. DILHR SBD 6710 (R. 01/82) a wlsconsln APPLICATION FOR SANITARY PERMIT D' L H R St. Croix COUNTY ~jjjj (PLB 67) - OEPRIdTT EnT OF UNIFORM SANITARY PERMIT # In..T. V, LRBOR & HUTRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inche's in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Donald Elverd Rt. 2 Box 32, River Falls, WI 54022 PROPERTY LOCATION XnX X. NW 1/4 SE 1/4, s 29 , T28, N, R 18 EXU) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK T TATE PLAN I.D. NUMBER Liberty Road TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 Public (Specify): QQ /v THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair EXI Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑x 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 - D 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 1000 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Wieser Concrete Products 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): Class 3 900 900 [2 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: Paul R. Cudd IMPRSW2739 (715 425-204 Plumber's Address: Name of Designer: Rt . 5 Box 364, River Falls, WI 54022 Art Wegerer COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ^ W ❑ Owner Given Initial 1~ O{~j OC Q (O Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-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 / / ,r✓;c L-A Location of Property Section , Tag N-R/S, W Township Mailing Address- s >C ! y /A/ls Gc Sao a z Address of Site. &-'e 3~2_ Rt i v ~y /l 5 r Sao y Subdivision Name Lot :Number Previous Owner of Property Total Size of parcel 'y Date Parcel was Created /Y /7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? _ Yes No Volume _ and Page Number 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) ceAti,j y that att statements on th.vs 6otm ate true to the best o6 my (out) knowledge; that I (we) am (cute) the owneA(,s) o6 the ptopehty dact bed in this in6onmation Jotm, by viAtue o6--d wattanty deed tecotded in the 04jice of the County Register o4 Deeds ass Document No. s- ; and that I (We) ptesentey own the ptoposed site Got the sewage di6 o_s Z y6 em (ot I (we) have obtained an easement, to nun with the above desot bed ptopetty, 4ot the constAuction of said system, and the .same has been duty tecotded in the 04ji..ce o6 the County Registeh o6 Deeds, as Document No. a -5 a4_,V SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE S GNED DATE SIGNED H ' -1 CA H a STC - 105 r a y SEPTIC TANK MAINTENANCE` AGREEMENT o St. Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER a PL 3~ Fire Number o CITY/STATE [,o`•~~,~4 GC~~~SG~rvS..iU ZIP .7 ~oz.Z PROPERTY LOCATION:, 3L, Section T:2,N, R /ff W, Town of 4i J^ 1-'#9 1 $t . Croix County, Subdivision Loi number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree CA to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Iv 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 yea 9~i~~ 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. v f" fA 2 R W (CD CD co ? ~r w Q 3 0 w w o c co ~`<w u°, v c m a m a ti° C0° w0 to 0 00 w v m m 0 CD =t2,,< 19 CD Co 0 0 3 aft (D r 1 0 c o w ofQ 0 10 o C-° a, co N c c n 3 w Er cZ vm a? m W_ O O p 0. 7 m w 'ca A" p N m c N. F)- CD Cl- w m0) :aco m O ° w m AN vN m05 Z m o~,m ~►o~-~m °-w0 3~NmNa D --i ?w ac ° f f Z! v 3m° w'~ww~ C It1 o 0.° m N =r 3! oar w3'~Qw~ n 0 C w o - !~fQ 'i 01 7 m A tOA y a0f ai3cc0 w m a p Ri no m a_aaCL(a ° y o ao 3 occ a ° C4 a caw m-+mcm aC a ~C ~w :.nom f°3 O~moo w m ° a3 a ° 0 3 0 m v; 3'a p < C 3 to 0 Z 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DOX ISION 7969 BoR ANO PERCOLATION TESTS (115) HUMAN RELATIONS M4DIS 153707 ' (H63.090) & Chapter 145.045) PAL DIVISI LOCATION SECTION: TOWNSHIP/AtF LOT NO.: BLK. NO. NAr ~/S/4 z_1 /Tz6N R►'~s Eco W t~l~►.~L01 VV,IQ11.~A IC COUNTY: OWNER'S BUYER'S AME: MAILING ADDRESS: ST • cR~ tK -nom ELV o ~,T z_ ~.\v(~5R F-I u,s Sir u 2 USE DATES OBSERVA ADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIP TESTS: Residence N ❑New Replace _ p -2s ? RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U NS ❑U S ❑U ❑ S MU ❑ S RIU 371aekr~ - emiiI S ' x 6D' Lau G 1- Ocs E- ~Vjp vt R ~D - St-uPE SuPf'l IQQT R GRAu ITY F..ow , ETLO" oQSe If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the h under s.H63.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IfS• CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r VrpZ-(a 0 B~Jk Gy an SO TSB .8n Sl );3•_Z'B'1 1s 1\l c -DOSE AT 5.3 'T)ee~ ' O. S ' Gree h C o. 61 _bVC-GyBh SI~ TS; o S'G~t 9hs ) ; )-S 'EN Sf j9-S •8n _ B- Z- 1 93< 1 ~o~~ moT@ 4 (Z'1- S) ; 0.9' Bn 14' •0•-) ' u1t h WEAYtL CE~?t TGO ! ; o• y B- 3 S. z' 9Z.~' ~o~e w,oz @ 3•z' o•61?„ sills 1.yG,;P, 8" GrSI • ~.9' ~vQa~ C B- t} ~,.o' 9S•2 NoNC ~+oT~ 5•Z' V0'-Z)1rr_ GY18nS' I IS•o_8'Ensi 1 i`.3'Bn Gr'S ' 6'gn)s- 1.3 ' ~K. e r. \ S B- S 6.0 ' 94.0' ►JotifE > 6.0 ' 0.6'-z\-Gy Rh s'I TS • 1<S' -Sri SI (Z, •'7'Sh )S .i o-3' DFC B- 6 5.z' 93.6' r~or) wwT S.1 ' CC-)'bttG1 NS-i CIS -tti.8't IS •o )'&Ga \S -S.o';~3.\S Ii/cob PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PER D PER INCH P_ 1 z4 3a 7/g -7 / 3 I/ P- Z ZY t~ 3 0 1 r/ t Z- P_ 3 Z 30 5/$ 5/~ s/ l8 P-_ P_ OJ~T~ LvtJ l l 1. ebczl~~ C) -M _V z z " lne;m_-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. 3) 91'•O © 9~• G~ 1 ~~N0~1A ~AR1AuT SYSTEM ELEVATION sz,4' lc~c C3F1 Z'~ ~~11. 96, TDIP ,OF cork ~ ' i - w~ o A~1ON WAII AT_ o IL I S1 O C 'R~ 100 : iJ. -)O W 'or- 7~1 1 y € I w w ~ ~ t qq : 1 t I I # _ _ ~ ~ 5 ; i € ! 1 SST', r his k 3 i { I p7 J a e , SCA LE l 11 % 60 ' Ek cfmPT AS StlQwm SEC i9 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): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): C I$ V, ~-Z LLSw0iZi 1,U) SVr-,)1 Sib 11S-~{ZS_W6S/ CST SIGNAT E: r ~Z~.rt.S~ 8-z..9-$S C'Y'ol~I`i7utih~ $ulu:uG `.I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~~~11lUw~l'c( ~~~CN _ ~ZC~/►ru1uS - DILHR-SBD-6395 (R. 02/82) OVER we IN T UC- I{ 9 III COMPLETING FOF To be a )rnolere . , accurat_ soil test, your report must inrhic.ie ~ 2, y indicate wh tl 3. MAXIMU tc ,s or corn 4. ^I" G TANK ONLY IF ALL completing the t plan; 7. scale is A . - ! L as r t; to e: flo [ I 10 sx; ,:'TH THE 3,IATIf.- ~I Asil i C wn T TE i I Owner's name San, rErmlt tJo. H63.05 PLOT PLAN S hG+W Location of building served Dosing chamber Septic tank Vertical/horizontal eference point 1 93.0' qz.y' Building sewer ►Q System elevation is 3 cy) Effluent system Well NP Replacement system area Property lines w/in 50' of System Scale or t~A Distribution boxes Pump and controls: F E• F V1Ls ZS CO. - Z S r y ~i - Mfr. & Model No. Vertical Lift Size Force Main \\O SG Fr_ction Loss T. D. H. Vol, Dist. Pipe Gal, per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan,below: ~ ~3~" i - l00 •O C~ ZU~ O~ --ISO sn 1J t sseR Pulp C f-)\ Z oZ \DOO GALLOOj Lk - 4 3 i' aVC Y' 0C / ti r I d 5 1~ VEST V / Q to 0 J N 0 J Ho~SE 7o Ex1STlg6 SE~?T7C 7+wtt ADD b"..,EX-L A~a► ~oo~~~t~) C 'TO By the,grantinc or _cproving of the above plan, or upon the event of a subsequent -1 permit being and the - ~_~oi.rCo my Zoning Administrator, does not assume or hold itself 1,.abie for any de rc` in plans or specifications, plan omission, examination ov rslight, construe _c::, lr.y damage that may result in or f a installation. Ae$r ;7,-5c7 -If S r, -ire Y _ C~~C~ S S SEc: i`1 O~ So1L A4i~[Znv~ s`~F~~1Tt: v"cr vE~~T ~~re wi~;r~,to~ CAP cCU\)tz ) G 01-~ g"OF \Z" ABJUE F:tJiSlzea `-i D~ V F-~ CbF'1 l~-1~ C`~ S`1ZA w ELEM iP~ 1PE O.0 5 rz ~ ~ ~u2 E ~w w 1-U UPtitLl'~LE'-NCHtS• GRR~E - -o EEL. (~'`oF i~Z~~,Z~A2i AGGRE6AT~ PERFORP,7~ P1P~ i'o BE~o~ P►PC ~u0 Z" cF BIZ-TD►~1 ~F 7RE1-~.1~1 AS6REGi~1E H-OOQE PIPE ~1S~R1Bvno~ pipe- TD BEI AT Ll fms-r ~Z IlJCttES BELpw OF21611.►H~ G( D Pi1.~D AT LEST Z~ iv-N"ES ~"Z 1J0~ hORE J-rt~U t4Z 4.3C.tiEs BELOW F1NA%L ~7AXIF1l~~1 Q~T?i ~F= >;XCAI~h~OlJ FR(3M OT21G1NA%L GP`R~, w1t-L @E Z6' INCHES S 1 G E\J B~f LtcE1J5~ ~O 5 l C rQ ED ; - LV ~~Z1~ ^✓v 'L'~,NG ✓ X17✓~' C.r (QIJ tIJv r-L rl,` r~ tlt r D WEATHER PROOF _A FF,:j D LC'~YVFJG JUIJC T IOtii BOX-- COVER = D F.I_: UG P„ ~I_I_~tn' On FR=5H E GRADE A I _ --T CO►.iDU1T - - r f - - - 7 - - PROVIDE I~JL-E r--- C"V'-gam-1 AIRTIGHT SEAL I III I III V I I ( AFPROVED JOILJTS APFROVED ,JOINT A I II W/C.I. PIPE W/C.T. PIPE I I) I EXTEAIDILIG 3' EXTENDIm(. 3' ALARM ONTO SOLID SOIL O*1TO SOLID SOIL I II B i 1 I I OA1 C --J ELEV.g_S,SFT - PUMP OFF D CONCRETE BLOCK - i L I `L ~y•S~ RISER EXIT PERMITTED GUL`J IF TA1JK MAUUFACTURER HAS SUCH APPROVAL SPECIFICATIONS DOS T,& iEKS ' M A U U F A C T U R. E R 'V-X C.OkiC" buC-'TS IJUMBER OF- DOSES:- PER DAy - - TANK SIZE: SO GALLOMS DOSE VOLUME &Lc-c'mri Sy s S IEICLUDiUG BACKFLOW: GALLONS ALARM N.AUUFACTURER: MODEL MUN,BER: ~Q~ I"J CAPACITIES: A= ~S INCHES OR 30) GALL OIJ5 SWITCH 1 SP E: B-? INCHES OR GALLONS PUMP M,A.FJUFACTURER: F. G= . 'F'1~'CE~t S C 1►JLHES OR A3 (3 GALL 0LL'S MODEL MUMBER: S S W D=__---L--INCHES OR GALLOUG SWITCH TSPE: i-,\ T-`t DOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE GIRCUIT~ ,AjI.)tMU1"i D SCF1RGE RATE- S'?__GPM VEFCTICAL U!FFF_KEfJCE BETWEEU PUMP OFF AUD DISTRIBUTION PIPE. ,'ZS FEET M►,!iMUM LlF_Tti'ORK SUPPLY PRESSURE . . . . . . . . . FEET FE ET OF FORCE MAIN X 't 9 FYo FLFKICTIOU FACTOF.__ o .At/ FEET TOTAL Ct~,F.!AMIC, -HEAD = ~ .Z9 FEET 7.1 ItJTEhrJA! DIMEIJSLOQG OF TAQK: LEUGTH ;WIDTH ;LI~U►D DEPTH z zo.aS 1 1 t i c. i e Li 1 i li i i7. r 1 cn r\-) O ~ c. o o > C C3 ~ ~ n CD CD f o co - c c U' Li ~ CD Sri :g (n ° Z cn v cn 00 ~ ail fib O N °O Ul N N m O O I N -P► cn m ~1 w CD TOTAL MEAD IN IVIETEHS