Loading...
HomeMy WebLinkAbout038-1091-70-001 C 0 CO) Si 3 o d `r1 M rAn 1 p U) 3 Vi z O O (D C (n N W • CD -a S W. N (n ~ N i 0) CN 0) O CL a Hy F-r 7" 4 CD DOj CD 7 01, 00 1 N O- 7 7C y F D v v ; ~4 CD O 3 S m'I D° I o d ~ W ~ ~ CD D a N m cs~ CO N a (7 T W CD c 3 ° - Ib C CD 0 a l v O _ CD Fp V O 0 O O rt H vi 000 000 0 A r CO) rn rn N fT C (D C 3 0 Cn (D '-I d C p [p y S p rt fD o OOOo', Fl- rl ~ L ! a N D ~-d p v v CO) 0 CO) m (D co :rL4 H = tai S't (T z s Ct ~ V (D 41 CD Cn cn N d .Oe co H r 1 In z D O z CDD o r D' O a ? J CD y • N ~ 6~ N N M. OIQ N CD N V W CD G 00 W tt a O I Z CD cb -I N fS 00 l O A Z 1 H v a a± z o W ~ I Z Z N ~ W M C7 O rd W CD N Z 00 cn O rt C) oD W rr y Z !D n w CD m I'd w ~ I p~ N N• N d n (D a: C oz a CD I b I I ~ I t Cb N O I ~ O q CD ~Q A C, e C ` 00'0 00'0 00'0 18301 soBJe43 3uenbunea soBJe43 lelaadS quewssessV lelaadS 3unowv tioBeje0 opoO leloedS Jasn :sleloadS EL-90 433es 9002/94/60 :93ea uoneollum 0 :3uno3 wleI3 :lIpaa3 /(.Ia};off 0 0 000,0 ue o0 OOZ'6ZZ 006'066 00£'8£ 0£t~'S A:pedoJd leJauaO :9002 JOB sle3ol 0 0 000'0 ~a do dJaua OOZ'6ZZ 006'066 00£'8£ OEtl'S J :9002 Jo; sle3ol ON OOZ'6ZZ 006'066 00£'8£ 0£t7'9 6E) IVUNMISEI2l uoseem a3e3S le3ol anoadwl pue-i SeJoV sselO uoildlJosea VOOZ/b 6/06 :peBue40 3sel :SUOljenle/fr 00£'69Z 8Zt,9L 6 :431en pessessv :onleA 3a)IJeW sled Ilia AwwWns 9002 9,VZ/£ 6L L66 6/£Z/LO (IM V9 b/£66 L66 6/£Z/L0 edA1 aBed/10A # ooa e4ea :IGols!H IaoJed :s830N M8 6-N 6£-ZZ (v/6 096 t/6 Ob Bub-umi-o8s) :(s)33eJl £9S/9ZZ6-lfl-Z3 b9t,/£66 OSM AMH Ol id OX3 69t,6/S INSO AO Z lOl O`d099'9 :Bp18 opuoOploo1e WI, MN Z/6 N iUd MM MCI ZZ 03S 31OVIl` AV ION-`d/N field 0£b'S :saJoV :uol3dposea leBal O11M OOL6 dS aNOINHO1b MEIN Z96£ OS O Qa .110 Z£ 6 6 . uol3dlJosea # 3sla edA1 tiewud . :(sa)ssaJppV A:pedoad leloodS = dS 10043S = OS mo!J3s!a L60b9 IM dNOM0111 MEIN 0M:lA1OZ£66 1HO3in `d 3NMd3r v f 13`dHOIW `d 3NMd3f"8 f 13`dH0IW '1HO3in - O jeumo-oo Iuenno = o `,sumo luaiino = p :(s)Jaunnp :ssaJppV xel 0 00 odA13!wJad # 3!wJed # uo13eollddV eejV sales # deW ezea IeolJo3sm ezea uol3eaJO NISNOOSIM '.11Nf10O XI02iO '1S X_j 3uemnO 312 IVIdd 2]ViS EIO NMOl - 8£0 `dLL£'86' 6£'ZZ IaoJed 11V LAO 6 3SVd Wd WV0 90OZ/80/Z6 L00-OL-M4-8£0 laDaed Ix T) ti tu- o ,n tn~.~~. 2Z ti~1103S 10 I MN 31J; -40 3N1-1 . ;n 3 4- 0 cur~,~ v! •ar N1140'J 3H1 Ol 43~N3b333J SON1?~ V! 'ff3a lY~ LU•oirw vn'' Q quo ~i :310N -Ito to tea M _ b 1 U C) N f y) , 11, ~Zt' ? l b . 10'59 £~ELb h%, 1 ~7!1twwV •NI O• Y~. Z OI,Z IS col J~ ~p ^ stOn I S^~ W Al. i r. 0 -16 cc N3AV to Eu 117 13 io t" Z v~ LO NO ON ~S! 3 y Z 1,1) ion ~j tiJ] > Ud 1- / N rc)• t en q U_ i O t► ' to b a FF ;~N z / 4 J C1 ~-.z"► zlb M.01•ZOats 1 © S. y tWYt . J y tY M sr - k r~ ? w to 2 y Q e_9 ry 4 3 t N 4 a m co *'t(~ U N X a - X CL vr. To Mel` o V, o C W - J O tN 1 It m Too wo+ C r y Q Q \ \ ty y N°n , } W f y 't t 2 H j y , v tl to X O ~r y ~N A W x y 1 V N N \ O tm c0~ p tG "'_III ? y 'on co to -4 iN' !n H SW- 3 - N ` 1 U f r Z f{~ . to 1L tr L .l mot: / 0- ~lo to 3 uj cc u co ` St O tn0 _j to t- OK tD 1 W. 1n' ~ t-: h C4 0 _j (Z O t o •1\ %t- N r ° to ,L to W N rt p- 1 < N N ri `r ' III: n~ t Ul t3 ( O 1 j Q O O ti t • ` N Nn tilt: ~t .r to to .Z:. NyO } tun vi ~t1 W U N N i' W 't M n ♦ vyti .A NO O li' UZZ t t. S 1 i;' R CC J ~i ! on .0 on > 12 ~O p ,SZS9 -0 '1 '~fya$ co~ ~~c N'r - - ~ ~ r+ ! l vii I '~'s° t 9~~09C~ PI V1 L,C i 3 3 i bz d:~ 1v.+d r : ,l 8 ;7 PJ,^✓1 f~3 ! 3 ; f n S ! Pr1 ` .l ! ~t C i 0 o x 10 `q o '_L S ` .?0 i'PA (`l ?N1 A0 /f :-l m 13}i_~. N 'i r'r1111 f s!. ~Q y/f r'v11`! ~f1! f ~~_I~y0 0 1 Form - ST C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP - SEC. TN-R_W ADDRESS 2e~_ 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 12, 4 INDICATE NORTH ARROW R BENCHMARK: Describe the vertical reference point used Qa7 ,~O n w Elevation of vertical reference point: V Proposed slope at site: 6 SEPTIC TANK: Manufacturer: /!'in7 W~ k Liquid Capacity: Number of rings used: Tank manhole cover elevation: 7 Tank Inlet Elevation:-9319-,Q Tank Outlet Elevation: Number of feet from nearest Road: Front,& Side, Rear et O.~~Q feet From nearest property line Front,~Side,O Rear, OrL feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ~ 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, 0 Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: x Trench: r Width: Length: Number of Lines:Area Built: Fill depth to top of pipe: ~r Number of feet from nearest property line: Front O Side, O Rear, ~lrt. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbt16n 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: Inspector. Dated: f~ Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING NXCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound IIf assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: Michael Utecht Rt. 1, Somerset, WI 54025 1yof7- , .,Jo BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV NW NW, Section 22, T31N-R18W, Town of Star Prairie Name of Plumber. MP/MPRSW No. C-o" Sanitary Permit Number: Cal Powers 1563 St. Croix 79169 SEPTIC TAN HOLDING TANK: MANUF ACTU _IOU D CAPACITY. TANK INLET ELEV.. TAN LET ELEV.. WARNING LABEL LOCKING COVER PROM ED PROVIDED YES LINO ❑YES eo ❑NO BEDDING: VENT DIA.. y, VEN ATI HIGH MAT A NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH AFARM LINE / FEET FROM ' ~AIR;~LEr_ YES ❑NO 1. ❑YES ❑NO E_T _ J •~C G% 07 ;Ior DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP; SIPHON MANUF AC TIIREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL NUMBER OF I'HOPEHTV WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST N. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 11, I IAMF TER 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: BED/TRENCH WIDTH LENGTH CH (/,J~ DISTH PIPE SPACINI, COVER INSIDE DIA spi75 LIQUID EHIAL' PIT DEPTHDIMENSIONS / GHAVEL DEPTH FILL DEPTH UISTH PIPE JNO DISTH.P MATERIAL DISTH NUMBER OF PROPERTY WELL . BUILDING: VENT TO FRESH BELOW PIPES ABO_V~Ef COVER E VLF I ELE P ES_`~ LINE AIR III NL FEET FR J~ 4✓ 11C~ NEARESTO--X r MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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. ❑ SOIL COVER TEXTURE PFHMANI NT MAHKFI'S OBSERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BED OF PTH OF TOPSOIL SOOOEO SEE DFD MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NIDTH LENGTH NO OF LATERAL SPACING GHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH pISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST- Sketch System on Retain county file for audit. Reverse Side. S T E TITLE. DILHR SBD 6710 (R. 01/82) , iulsconsln APPLICATION FOR SANITARY PERMIT ~ DILHR PLB 67 COUNTY - OEPRRTR1Er1TOF ( ) InOUSTg4,LgBOq UNIFORM SANITARY PERMIT # 6 MURIgn gELgT10n5 -EMJ '7 9I~ 9 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP RTY OW ER MP I G ADDRESS PROPERTY LOCATION C-17Y: 114 1/4, N. R VILLAGE: F_ (or)a TOWN OF: LOT NUM ER BLOCk-P UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 2 1 or 2 Family Number of Bedrooms: Public (Specify): cJ G THIS PERMIT IS FOR A: 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. X Seepaye 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 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 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): -12 / Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for installation of rivate sewage system shown on the attached plans. Name of P umber (P int): Sture: MP/MPRSW No.: Phone Number: - Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El `Disapproved :3 ❑ Owner Given Initial ti./ Approved Adverse Determination Reason for Dis pr al: 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 fea".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 14, Section ,~~r•--- T~-N-R1 W Township ~27.4.'o /A ~ Mailing Address •,S, Cj Address of Site Subdivision Name Lot Number L C,- Z Previous Owner of Property Total Size of Parcel L4 (0G YG 'A (Ll 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 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 Re&i.ster 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) cekti6y that att .statements on this 6onm ane true to the best ob my (ouA) knowZedg e; that 1 (we) am (ahe) the owneA (,s) o6 the pno pW y de s cA i,b ed in this .in6onmation 6ohm, by v-iAtue o6 a waAAanty eed teco&ded in the 066ice ob the County RegisteA o6 Deedia~s Document No. and that I (We) phez entby own the ptopozed site 6o& the sewage dispoz ~yztem (oar. I (we) have obtained an easement, to nun with the above danibed pnopen ty, bon the construction o6 said system, and the same has been duty tecmded in the 046.ice o4 the County Reg.usten o6 Deeds, as Document No. SIGNATURE OF OWN R S NATURE OF CO-OWNER (IF APPLICABLE) t Z lc- f~ DATE SIGNED DATE SIGNED ° H z W H a ST C- 105 r r H SEPTIC TANK MAINTENANCE AGREEMENT ,-a St. Croix County z t7 I/JJ' a OWNER/BUYER • H ROUTE/BOX NUMBER Fire Number .CITY/STATE ~`dmE,QS~T ZIP i PROPERTY LOCATION: ~14, Section , T S1 N, R1 W, Town of St. Croix County, Subdivision , Lot numbers:~2_. 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. Ho • E I/WE, the undersigned, have read the above requirements and agree Cn 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 ~ Y DATE 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. r o ~ a m o W Nw~~ CD 77 ID =3 N o a3 vc° ate, w w ~ ~ Ool 3 c co co o CD CD =0 :t- ~ ~ c cp N m~ O N~~ wo~ a 0 o" w w 0.000 0 -0 WD m co co q m o CD m CO 0 3 a o --~cCC, w c0a~o-. 0 ~ ~ =3 w:3 m c moo c- c J 3 -"c o c 3 o aC 130 oC = o ~o a~ w w 00 o ~ < c Q ' (Q Q O CD N, NO y c_ C 1 rU) C) U O n = 5) C7 n. o fD d w CD :03 0 a Q• :3 W C CL ^•NCO N ~ o m CD A) N Z 0 (D CD =r --4 CD CD 2r a o aim 3-•N 0 D CD =r " 0 o a Er ~0 0 =r v;wa 2cC CD C m CD 20' CD 5 3 a :3 CD =r o m m M, CD CD o °•o N o d =cam D w Q o0 c c~ oN Vi m 0 A w 00 vm ,cccnm Nwo ITi W - D) a n a nom QM Q§G) cn m ?m 3 c o N O G7 co 7 N m o C O n - O CL 0 :3 O(a CL c CD c -1 0) a =3 0 a =r C = O 0 M fw n~3 0= 0-^3 m mat °m 00 w m 1 N a o< ~R co 0 c INDU5 TMEN')rOF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION N P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOW SHIP/M ITY: LOT NO.: BLK. O.: SUBDIVISION NAME: N/R it (o UNTY: OWN R'S/BU R'S NAME: MA ING ADDRESS: USE DATES OBSERVATIONS MADE 2I Residence COMMERCIA DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: JdJResidence ~ New ❑Replace - RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE - N-FILLHOLDING TANK: RECOMMENDED SYSTEM:(op ional) ~ s ❑u 1Zs ou _ ®s ou a s Zu EIS 2u - If Percolation Tests are NOT requir DESIGN RATE: I If any portion of the tested area is in the f under s.H63.09(5)(b), indicate: LFloodplain, indicate Floodplain elevation:/ PROFILE DESCRIPTIONS BORING 'TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IV, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- - y .j 10 B- 3 > - i B- 96 > - a B- g > B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMB/ER INQ4E-S AFTERSWELLING INTERVAL-MIN. PERIOD PERI 2 P D3 PERINCH P- / s A4 "A Ak A11Z P_ .3 . 3 jI P_ "3 J-0 lilf)Alzr 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 -4/ I i lI I € ~ .4 X ./AVG.✓Fl/~ lJ"I//' -l- v, - -r-._ ....m......_.. ` I f t 'ar's E _ /7`r - I p 3 a j N E € i _A L E g € i ( t 4 _ 3 i € 1 3 3 Orrrlrc( 1 I, the undersigned, hereby certify that the soil tests reported on tT-form w made by me in accord with the procedures and^i5iethods 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 rin TESTS WERE COMPLETED ON: AD S: CERTIFICATION NU E. PHONE NUMBER (optional)-: CST SI AT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SR - 6595 , a c )mplete and accurate sail test, your report must ;,,r'10de: ^ 1. le rl descriptio 2. _Jon mutt clear' whether this is a project; 3. 0 1M numi - commercial use pia 4. Is this a new c r r t 5. A SIT" - "";G TANK r)€VLY 4E ' L ri -r Ac 6 _ comply. PI preferr A 7, S nit-n- t; T 1C. r, )x; 1 1 . Si I t r; 12, Mdk t N.JST BE .:__D ITH THE I - COI. der 3") rn sI an * I l psi, s C _ r :ry pt - Peat m Muck l-WL Paint Tr) THE 01 V Arst step in securi tment may request for the private -ity in order to la ( utructiOn. 1 ~,co PL FZ S9 a7' 4q yy r s~ 3` i PAGE OF Cross S ec ~ l o n p 4 A r- SY T S ed ~ Fresh Air 11111016 And Observation Pipe ---Approved Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe -4" Cost Iron To Final Grade Vent Plpe Marsh Hay Or Synthetic Covering Min. 2' Aggregate Over Pipe pipe ion Tee pipe 0 0 0 0 0 i ' 6" Aggregate Beneath Pipe Perforated Pipe Below o CoOlne Terminating At Bottom Of system i PropoSel~ ~Inal 119radt tJwT 1 on SOIL FILL DISTRIBUTIOA] PIPE APPROVED S4UPETIC COVER oFA6GREGATE ''`~MATERIA O , 91' OF STRAW OR MARSH HA`.i 1a' OF 12 -zAGGREGATE ELEV. OF FEET, DIS-rRIF3UTION PIPE TO BE AT LEAST Q29' INCHES BELOW ORIGINAL GRADE ANU AT LEASTZO INCHES BUT AIO MORE THAI) 42 INCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVATIOP F014 ORI&VVA.L 6KAIPR WILL BE Lzk _ INCHES MINIMUM 9f rh OF EXCAVATION FROM. 01Kt(AW-W GRAPE WILL BE IKICHES ' r SIGNED: 1 i LICENSE AJUMBER: t A DATE: