HomeMy WebLinkAbout038-1027-30-000
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Parcel 038-1027-30-000 01/24/2006 09:36 AM
PAGE 1 OF 1
Alt. Parcel 6.31.18.120C 038 - TOWN OF STAR PRAIRIE
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
STEVEN W & REBECCA J GEHR O - GEHR, STEVEN W & REBECCA J
2327 80TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 2327 80TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 2.810 Plat: N/A-NOT AVAILABLE
SEC 6 T31 N R1 8W WEST 375 FT OF S 330 FT Block/Condo Bldg:
OF NW SW
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/30/2004 772948 2645/551 EZ-U
07/23/1997 1129/104 WD
07/23/1997 1062/406 TI
2005 SUMMARY Bill Fair Market Value: Assessed with:
118745 167,200
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.810 36,100 128,200 164,300 NO
Totals for 2005:
General Property 2.810 36,100 128,200 164,300
Woodland 0.000 0 0
Totals for 2004:
General Property 2.810 36,100 128,200 164,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 212
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STAR PRAIRIE T31N7-R.18W,
r, _JLPOLK- 57 CRO/X
POLE COUNTY
CEDAR L.
~n
c.
711
7-2
H Q ' yY n ~~STA
N /
H N
y e
n ;I RAIRIE
z2o 7h/ m 1 - lv yi ~ ,
O eo SQUAW )L.~
~ ~ ~W"~ f f t < AVE
i iC a P
V>i
- +
ti
h s p e I ''i •AV
• ~H SB R(.
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v ^.i' .,ti tea;- • ¢
r
T a < .F
s,z - ~ T
u 2007H AVE
f f,c ~Y I~.~i N/G t ly L1 , f`ifi,
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HThAWK DR 1 -
95TH _ I. j•
AVE -
ti
I
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C ? L. 64
,
/B2ND L/~ I5 ~j ~I?.. ~ 57N ~T
It! t T
AVE •
- o ENE EW RIC M'ON
i
v 64
va_ tF 64 ? 65~ ,
°t'.~~. p~
SEE PAGE 53 180r,v SEE PAGE 43 AVE
BERNARD'S
NORTHTOWN UTGAARD S HATCHERY
HIGHWAYS 64 & 65 NORTH POULTRY BUSINESS SINCE 1901
NEW RICHMOND, WISCONSIN 54017 Year Round Poultry Service
PHONE: 246-2236 POULTRY FEED - EQUIPMENT - REMEDIES
Phone: 248-3200 or 248-3209
TWIN CITY STAR PRA RE WISCONSIN JV 40,26
PHONE: 439-2905
a
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER -~~z~X TOWNSHIP f~ r ~jys rH/ t SEC. _ TN-R,~W
ADDRESS ST. CROIX COUNTY, WISCONSIN
e) X, G~ ;
SUBDIVISION - LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IZIIR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
c~
6h
sr
v
V
I I
1
Rx
M INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
o5-
Elevation of vertical reference f
point: fDL? Proposed slope at site:
SEPTIC TANK: Manufacturer: _;l Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side, Rear, O 3az> feet
`,From neare8t property line Front,0 Side,0 Rear, 9 1 6 n feet
Number of feet from: well - r
S , building: / ~
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer : We e ~s 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: ~~r~4_gleecK`s.
Number of feet from nearest property line: Front, 0 Side, Rear, 0 Ft.
Number of feet from well: /D
Number of feet from building: ;7
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: rTrench
i
Width: o2 :K f Length: Number of Lines: a Area Built:
Fill depth to top of pipe: 1-
Number of feet from nearest property line: Front, O Side, 0 Rear, 0irt.~~ '
r
Number of feet from well: L/
Number of feet from building: o~
(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, 0 Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
t-
Inspector:
Plumber on job:
J-t,~~,Ja
Dated: -7
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONAL ~17ALTERNATIVE S'- PIenID N umber
If as sign edI
❑ Holding Tank E:1 In-Ground Pressure Mound 8506678
NAME OF PERMIT HO LDER ADDRESS OF PERMIT HOLDER. INS EC ION DATE
Ardell Fox R. R. 2, New Richmond, WI 54017
EN IPenn3nenc reference poinU DESCRIBE IF DIFFERENT FROM PLAN REF. PL ELEV. . `F CST RFF PT ELEV
SW SE, $ection 6, T31N-R18W, Town of Star Prairie
N- 11 Plumbe MP,MPRSW Nr, C"""'
53iil.~ry Permit Nu ether.
Byron Bird, Jr. 3318 St. Croix 74990
SEPTIC TANK/HOLDING TANK:
MANUFACTURER J~ LIQUID CAPACITY WE EjIJ ELEV a TANK OUTLET ELEV (WARNING LABEL LOCKING COVER
J,6/aPROVIDED PROVDEj /{JYEL)NO ❑ES LINO
BEDDINGVENT DIA.VENT hnAT ATER ROAPR pPER iV WELL BUILDINGVENT TO FRESH
ALARM LINE LAIR INLET❑YES LINO -]YES LJN EADOSING CHAMBER:
MANUFACTURER BEDDING 1-10010 CAPACI TV PUMP M(IDEI PI'Mp LI PI'()N MANl1I Al TURF H WARNING LABEL LOCKING COVER
Q S o o P,ROED PROVIDED
-C.JV; ❑YES NO ~JYES LINO LTYES LINO
GALLONS PER CYCLE: PUMPaNDcONrROL_soPERATIDNAL N UErCIR M OF I'""F IVTV WELL BUILDING JVENTTOIRESH
(DIFFERENCE BETWEEN FEET FROM LI"F'-7 AIR INLET
PUMP ON AND OFF) YES LINO NEAREST-_ 0 7
SOILABSORPTION SYSTEM. Check thesoil moisture atthedepth ofplowing FORCE uIA1,,ITFR MATFHIAIANDMAHV
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.) ^ `
MAIN '
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LING n1 ND of DISTH '1T sP"' ,)VEII T =PITLIQUID
rHE NPIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTH PIPE DISTR. PIPE MATERIAL R OF P ROPERTY WELL BUILDIN G VENT TO FRESH
BF LOW PIPES ABOVE COVER EI FV INT ELEV LINE AIR INLETEET FROM
STs
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-
ES NO meets the criteria for medium sand. TIONS MEASURED.
O
ky LI
SOIL COVER TEXTURE =Y Ti 1s OBSFRVATII)N WE L IS
_ LINO L_SIYES LINO
DEPTH OVER TRENCH BED 11EIT11 11111 TIIEN(:H BEU 111 PTU III T1)PSIIIL Sf)UUf I) SFFDFD h1 ULCHED
CENTER EDGES
/ ' LJYES L~iNO _YES LJNO YES NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LA rEHAL SPACING GRAVEL DEPTH BF LIIVV PIPf~ FILL DEPTH ABOVE COVER
DIMENSIONS rRENCHS, T /
MANIFOLD PUMP / MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IPI(PES DISTH ISTH PIPE DISTH IBUTION PIPE MATERIAL & MARKELEVplA
ELEVATION AND DIA/. L L
DISTRIBUTION / +
INFORMATION HOLE SIZE OLE SPACIN(, DRILL E D COHRE C T I V COVEH MATERIAL - VERTICAL L ITT CORRESPONDS TO APPROVED
PLANS
r ~J YES NO L YES LINO
COMMENTS: PE MANE NT MARK ERS OBSERVATi ON WELLS NUMBER OF PROPERTY WELL BUILDING
FEET FROM LI"
DYES LINO _ 1: XES NO NEAREST) 7
Sketch System on 'Retain in county file for audit.
Reverse Side.
S I CNA TUBE TITLE
DiLHR SBD 6710 (R. 01/82) r
wlsconsln APPLICATION FOR SANITARY PERMIT -
~ DILHR ~ro~k COUNTY
1111111 OERRRTMEnTOr (PLB 67) UNIFORM SANITARY PERMIT #
InOUSTRti, LROOR 6 HUMRn RELRTIOnS 2// O
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/~x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY O NER - MAILING ADDRESS
WkQPER LOCATION ITY:
1 /0 I /4, S , T , N, E (o o A r i
LOT NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
~ -tea Ql~~
TYPE OF BUILDING OR USE SERVED
1~'t 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A: /
❑ New System G ❑ Tank Replacement ❑ Repair
Replacement 77 ❑ 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
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):
Private ❑ Joint ❑ Public
_3 Z, I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signatur MP/MPRSW No.: Phone Number:
Plum s Address: Name o esigner: /
gz~z
COUNTY/DEPARTMENT USE ONLY
Signature,of Issuing Agent: Fee: Date:
Disapproved
❑ Owner Given Initial 'Cj Approved Adverse Determination
Reason for Disapproval:
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.
PLAN APPROVAL Safety and Buildings Division
DILHR
Bureau of Plumbing
P.O Box 7969
r ' ❑ General Plumbing Plans Madison, WI 53707
F Private Sewage Plans Telephone: (608)266-3815
Plan Identification No.
_ Gallons Per Day, ~J f s}~ r PRIORITY PLAN REVIEW ONLY
7 Plan Review Fee Received
Petition For Variance Fee Rec.
Project Name Project Location - Street No. or Legal Description
County
❑ City El Village Town of:
The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is
based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval
is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the
city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of
plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can he
made.
❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g
This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan
approval must be obtained.
FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3 0(4a) (4b) (6) (7) ..c~a-
This approval will expire two years from the date approved below or if a sanitary pomIt is obtained, it will expire the day the initial sanitary
permit expires.
The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be
submitted to the Bureau of Buildings and Structures.
Comments:
By:
James Sargent
Bureau Director
If Questions Plans Approved By: Date Approved:
Contact ♦ ~Q
nvate Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health
County ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
Du f 1K-',W)-6099 ;R o 1 8-,? Owner ❑ Other
PROJECT ter,%~~ck ADDRESS
<<L , 1 /4Si~ 1 /S ITS/N/fit - W TOWN ~ ` OUNTY
PLUMBER -1-t ISCENSE NO. MPRS3318 DATE F- - j
BEDROOM. CLASS PERC_/___i_ CONVENTIONAL- IN-GROUND PRESSURE
CONVENTIONAL LIFT_ MOUND.., HOLDING TANK._
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREAS /PERC RATE - s~ RED SIZE
I, F>I'v+I A~Rllm;., Pic-17r,t. on i mi•
V RP H.R.P
Loocation of Peen vhmark 7,oe,->
Boreflole Won
Rev, Hide
3[f~
SreI]1 Elevation e
7, 2 T itPAR COVERING 1 n ~ t~~ 12 f G.~
2.,
~ I
t t. 4 ft.
1
PLUM
DEPARTM,F IT
OF ffv'DUSTRY
DWISi "J OF SA ETY'ORND 1I~1rT~,tJ Rt~p ~
du~
to L,g~ SEE COf~RE^At~`No~~~.
&J ~tl e ats(4~Ce
0
f ,
V fl
Straw, Marsh Hay, Or
` Synthetic Coverinq~
Distribution Pipe
Medium Sand
G
Topsoil
3 E
b
0% Slope
PLUMgtAtG Bed Of 2~- 2 %Z Force Main Plowed
Aggregate From Pump Layer AP V LW
D
AN RF ATIONS E
DEPARTM~ENT OF INI)USTRY, tAE0R~A8~1~ . ection Of A Mound System Using
D1VIS104 OF SAFETY
- • A Bed For The'Absorption Area F
SEE RRES?ONDENCE. G --+C -
A Ft. H
Signed: B- Ft.
License N er: I _ Ft.
Dater J Ft.
K 1 Ft.
Alternate Position L r-y Ft.
Force Main W ,c Ft.
Observation Pipe--
B K
~1
I _
A I.---------------------- =-----I
VV I•-----j--------------- -----------------------j Force Main
From PurKp
Distribution Bed Of 2~- 2 %r
2
Pipe Aggregate
Observation Pipe Permanent Markers
RECEIVED
Plan View Of Mound Using A Bed For The Absorption Area n ry 1
sfi,r,7rr,'P*PUP AU
Page _ Of
Perforated Pipe Detail
.0
End View
)Perforated
End Cap)) ev\- PVC Pipe Holes Located On Bottom,
S Are Equally Spaced
R
PVC Force Mai
x
P PVC
Manifold Pipe
L. ;AA0btiu n Alternate Position Of
////~~~~~~CC ! Force Main
1111 Last Hole ShouldQ6l~111
Next To Endjrn 3
Cwl s V" nd i+~op~ r i ATfONS
0 ~jr44tlfidt~~ fi'p~ Layout
pc.PARTMEN7 OF fNDUSTRY. LAf3uR P Ft.
D1VISfON OF SAFETY AP~Q R~
SEE CORRESPONCENC
X -.L-~ Inches
Y Inches
Signed: Hole Diameter ---f- Inch
License Number: Lateral Inch(es)
Manifold Inches
Date: Force Main_ Inches
# of holes/pi pe_
Invert Elevation of Laterals Ft.
/"r/ er" S
; CEIVE1)
OCT t,
t iF~,7-.t~r F'tj '
PAGE OF
PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOKIS ~ '
VEKIT CAP
y" C. I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUNCTIOKI BOX MANHOLE COVER
25' FROM DOOR,
WINDOW OR FRESH I2 MIU I 1~)-n c~ww~
INTAKE
GRADE
k, I 4' MIN.`
IB"MIN.
COQDUIT
IB"MIN. =L
INLET PROVIDE I -
AIRTIGHT SEAL
I I /
APPROVED JOINT A ~;',ti~+a I III APPROVED .10WTS
W/C.I. PIPE r~- ~1e I I I W/C.=. PIPE
EXTENDING 3',~. I I I EXTENDING 3'
ONTO SOLID SOIL B~ I ALARM
ONTO SOLID SOIL
C ~S1R~ Pip
N i
ELEV. FT. pEP ~R~ MECy S\ON SAS J
~
OFF
D z) G
CONCRETE BLOCK _ _
7~
8 '36 75 f
RISER EXIT PERMITTED GULy IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPEC.IFICATIOUS cLj
DOSE
TANKS MANUFACTURER: HUMBER OF DOSES: PER DAy
TANK SIZE: GALLOKIS DOSE VOLUME
ALARM MANUFACTURER: ~c~tc ~Z-71ef /-1*7 INCLUDING BACKFI.OOW: .46 GALLONS
MODEL IJUMBER: f~ CAPACITIES: A= 2 INCHES OR 24; GALLOIJS
SWITCH TYPE:i' 41c;u g=INCHESOR GALLOKIS
PUMP MANUFACTURER: r-= 71 INCHES OR GALLONS
MODEL HUMBER: D=ZJ;2-INCHES OR - 262 GALLONS
SWITCH TYPE: t1-
~E N07E: PUMP AND ALARM ARE TO BE
MIKIIMUP'1 DISCHARGE RATE cX . GPM INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. X FEET REceiveD
+ MINIMUM KIETWORK SUPPLY PRESSURE , . . . . . . 2.5 FEET
+ FEET OF FORCE MAIN X ~FYo FT.FRICTION FACTOR.. FEET n T 0 v
TOTAL DYNAMIC. HEAD = FEET
7~"' ~.1 #
I INTERNAL DIMENSIOKIS OF TANK: LEKIGTH ;WIDTH ;LIQUID DEPTH
SIGNED: ' I LICENSE UUMBER: f3~` f DATE: ! S
i
I=1 i
I ,
( C I
J
J
f, 1
q \ t
~F1A
1 ,
H EAb CAPACITY CURVE
TDH
N
w_
W ~j
-90 TOTAL DYNAMIC HEAD CAPACITY PER MINUTE
- _ I EFFLUENT AND DEWATERING
-r SERIES 53-57-59 97 137.139 163 165
26EFFLUENT AND DEWATERING FT ;lwi GAL 1 GAL ZT GAL -LGAL 1--jM GAL tt
% 5 43 20 65 104 iFiW, 61 2ak-z 61 -AU \ \ SEWAGE AND DEWATERING 10 3.0 34 12Q 57 Z - 79 61 33 1 61 $3r"
24 , 15 19 42 43 64 *760 2W-: 60 -
_ 36 8 3 364 59 60
20 r_.T: 27
25 57 59 Tr
22 , j 30 55 3469. 58 X24;
~j 46 55 JIVIi-i
40 fatp
70 \ 50 e. R 33 6125= 51lY.-
60 ;Zak - z yae' 15 n 5 43 11
20 70 ;a{ 30
80 14 I
_ 163'
241, 26 66 87
MODEL Lock Valve 19,
18--60 I i j TOTAL DYNAMIC NEADICAPACITY PER MINUTE
SEWAGE AND DEWATERING
SERIES 267 266 262 264 243
55 jM^
\ FT GAL GAL GAL UIS6` GAL LTFB GAL ,J.16 l~ 5 _ L5Q t OB t 02 386 130 {g2 180 861
. 50 - \ - 1 1 10 ` 60 !27 , 72 Itn 95 80 167 -
v 15 -4.57 20 43 40 57 216 - 143 v
% %
14 11 20 - 6. - 8 .30 33 32~i 123 A66 c
4 45 ln
\v 25 7.42 - ➢ ; 78 236
30 6:"t1 50 '1 b " 77 ','Q
4 J_ 35 10-67 w;- F , i • 60 21tT
12 MODEL 40 .41 46 ±,pra
1 1 i 45 13.72 El 406
7- - - 7- _
- - 3 5r---±---{-- -T-- ~v 50 1 s.24 s, -
1
10 Lock VaNe 21 26 34 53
1 ~
r~ 1 1 -
A30
MODELS ; fp ?cr
8:25 - 137 139
1 ! i
1`t1~ :MODEL!
6-20 ~T
L I 284
MODE
S
I I 1
~j 12
82
MODEL
4
2 MODELS
5 1
57 ! MODE 1 MODEL i
0 59 I ; 97 207
.
u S -GALS ° 10 2 30.4 50 60 70 ' 80 - 90 -100 110 X20 30 140-~_150 - 160 170, _ 180'
LITERS 8,0 160 240 320 400 480 560 6 0
FLOW PER MINUTE
3280 Oki Mlllem Lane Manufacturers of .
P.O. Box 147
uisville, Kentucky 40216
` ZA9Z-ZZAF.R CZ7. Lo
(502) 778-2731 QV.411rr PuMas S z- /9227
OPTIONAL WORKSHEET
1. MOUND SYSTEM ~`j~ II. IN-GROUND PRESSURE SYSTEM-Continued-
1. Wastewater Load, Total Daily Flow= ~ gal. 10. Force Main: G
Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate "~1~ gpm
Adm. Code and PROVIDE A DETAILED Diameter = 7 in.
LIST OF SIZING ON PLANS. 11. Total Dynamic Head:
2. Depth to Limiting Factor = ft. System Head = 2.5 ft.
3. Landslope = % Vertical Lift = _Z.r_ ft.
4. Distance from Dose Chamber to Friction Loss ft.
Distribution System = ft. TDH = /3ft.
5. Elevation Difference Between 12. Pump Selection:
Pump and Distribution System = ~L ft. Pump will discharge at least t'Z.0 gpm
6. Absorption Area Sizing: ~ ~ at ft. total dynamic head.
Area Required = _ 3_22~sq. ft. Pump model and manufacturer: e/el'
Bed or Trench Length (B) = ft.
Bed or Trench Width (A) = ft. 13. Dose Volume:
Trench Spacing (C) = ft. 10 Times Void Volume of
7. Mound Height: / Distribution Lines= gal.
Fill Depth (D) ft. Daily Wastewater Volume
Fill Depth Downslope (E) _ 2q- ft. 4 Doses in 24 hrs. gal.
Bed or Trench Depth (F) ft. Backflow = gal.
Cap and Topsoil Depth (G) _ ft. Minimum Dose = gal.
Cap and Topsoil Depth (H) _ ft. 14. Dose Chamber: d
8. Mound Length: Volume gal.
End Slope (K) = I(~ ft.
Total Mound Length (L) _ ft. III. CONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal.
Upslope Correction Factor = Use section H 63.15 (3) (c), Wis.
Upslope Width (J) = ft. Adm. Code and PROVIDE DETAILED
Downslope Correction Factor = LIST OF SIZING ON PLANS.
Downslope Width (1) = :LL ft. 2. Required Septic Tank Capacity = gal.
Total Mound Width (W) ft. 3. Percolation Rate = min./in.
10. Basal Area: 4. Absorption Area Sizing:
Infiltrative Capacity of Refer to Table 2 in chapter H 63 .
Natural Soil = _~~e~ gal./sq.ft./day and PROVIDE A DETAILED LIST OF
Basal Area Required = v7 - e~ms- sq. ft. SIZING ON PLANS.
Basal Area Available = F~4 77Z sq. ft. Required Area = sq. ft.
11. If Standard Tables from Chapter Length = ft.
H 63 are Used, Indicate Table No. _L Width = ft.
12. For the Distribution Network, Use Numbers 5-14 in Section II. Number of Trenches =
Trench Spacing = ft.
II. IN-GROUND PRESSURE SYSTEM 5. Distribution System:
1. Depth to Limiting Factor = ft. Lateral Length = ft.
2. Landslope = % Number of Laterals =
3. Percolation Rate 4 min./in. Lateral Spacing = in.
4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in.
5. Wastewater Load, Total Daily Flow: !!igal. System Elevation = ft.
Use section H 63.15 (3) (c), Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL
LIST OF SIZING ON PLANS. Fill in All Items from Secti9A,!,Il r Q
Required Septic Tank Capacity = gal, 4}, !e'1~
v
066 7
6. Absorption Area Sizing: V. SEPTIC TANK
Percolation Rate =
_.1~_ min./in. 1. Capacity = _gal
Area Required = ~ 7G sq. ft. 2. Manufacturer: Z*1'`5/_ .1,
System Length = - ft. 3. Show Site Constructed Tank Details on Plan
System Width = ft
7. Distribution Pipe Sizing: VI. DOSING TANK
Hole Size = in. 1. Capacity = gal.
Hole Spacing = ft. 2. Manufacturer:
L:derd Length - It. RECEIVED. Pump Manufacturer:
L.tleral Size in. 4. Punlp Model:
I..ucr,il Spacing &J it. C) 1 15I 'r Operating Head= ft.
Dist,mce Isom Sidew,dl to Pipe in. OCT Q cf 1 low Rate= gpm.
8. Distribution Pipe Discharge Rite: 7. Show Site Constructed Tank Details on Plans
Number of-I toles Pet Pipe _L L1~ r a
I low I'ei Pill g1) VII. HOLDING TANK
9. Manifold Siting: I. Capacity = gal.
1 ype (center or end) r
2. Manufacturer.
Length = It. 3. Show Site Constructed Tank Details on Plans
Diameter = .e in
/A ,
-SHOW ALL INFORMATION ON PLANS-
DILHR SBD-6761 (R.03/82)
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ST C- 105 r'
r
a
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
a
OWNER/BUYER Ye. Fox
r~
ROUTE/BOX NUMBER a pX /S Fire Number _5- C
CITY/STATE_,.,A)e W Ricil me)Iad ( JJ 1 ZIP 5q(
PROPERTY LOCATION:_k k, k, Section T~3/ N, RJ_W,
Town of Star P~( 6iY i St. Croix County,
Subdivision' Lot 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 ~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. ~~~~/~J
S I G N E D Ziv~.ct' 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.
APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property A r~ g,__1 ( {-fix
Location of Property ~k 5"/_ 14, Section , T N-R W
Towner St a r Fr r i e-
Mailing Address ~t aj ) S 2
A) Q-Lj 5 4f
Address of Site R a. o px IS-2
Subdivision Name
Lot Numb e r
Previous Owner of Property V Q V Y'1 2 so n
Total Size of Parcel J ~GYre,
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 q-79 and Page Number ~169 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) cehti6y that aU statementz on this 6oAm cvice tltue to the best o6 my (oulc.)
know.tedge; that I (we) am (ahe) the owner(s) ob the pnopv ty denscA bed in this
in6oAmation Sonm, by viAtue o6 a wvtAanty deed neconded in the 044ice o6 the
County Register o4 Deeds as Document No. 3C)2 2 j 5- , and that I (We) pnLuentty
own the puposed site 6oh the sewage duspos system (oh I (we) have obtained an
easement, to nun with the above deg nibed pnopenty, 6m the constAuction o6 said
system, and the same has been duty neconded in the 046ice o6 the County Reg-usteA ob
Deeds, ass Document No. ) .
SIGNATURE OF OWNER p. SIGNATURE OF C0-0 ER (IF APPLICABLE)
Z/_ 6 O f' l l 6
DATE SIGNED DATE SIGNED
~ DILL-IR PLAN APPROVAL Safety and Buildings Division
Bureau of Plumbing
P.O Box 7969
❑ General Plumbing Plans Madison, WI 53707
❑ Private Sewage Plans Telephone: (608)266-3815
9~ Plan Identification No.
4C ~ ''`cD
% ° Gallons Per Day
ci V,
JL9 r..
PRIORITY PLAN REVIEW ONLY
Plan Review Fee Received
Petition For Variance Fee Rec.
Project Name Project Location - Street No. or Legal Description
County
❑ City ❑ Village ❑ Town of:
The plumbing plans and specifications for this project have been reviewed for compliance with'applicable code requirements. This approval is
based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval
is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the
city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set ( )I
plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can 1w
made.
❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g
This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan
approval must be obtained.
❑ FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7)
This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be
i
submitted to the Bureau of Buildings and Structures.
Comments:
By:
James Sargent
Bureau Director
If Questions Plans Approved By: Date Approved:
Contact
(C Private Sewage Consultant L i Plumbing Consultant ❑ Environmental Health
County ❑ Local PI ❑ Facilities Need Analysis "(,("or,
UW-SSWMP ❑ Plumber ❑ Department of Agricuiturc
«n ~H siii~ ~0<3<3 ~rU~s) 1_I Owner ❑ Oth _-r
1
SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02)
STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Forl'1'1 With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 141
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE: PROJECT:
Star Praii
4, Bo'
PLAN ID.
DETACH HERE
- - - - - - - - - - - - - - - - - - - - - - - - -
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ Fee Received is $
❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance.
❑ Plans being returned. ❑ Overpayment-Refund forthcoming.
❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.
1. Plan Submission ❑ Soil boring and percolation test data on 115 completed
❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy)
specifically noted. ❑ Petition For Modification signed by county, owner and
❑ Plans not clear, legible or permanent. notarized. (1 copy)
❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building.
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy)
Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy)
❑ Plot plan showing location of land parcel (distance from
nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks
private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm,
course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete
vice road, etc. Show benchmark with permanent elevation. construction details if site constructed.
❑ Holding tank agreement signed by owner and local
II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed).
❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from
and notarized. (1 copy) county or soil boring and percolation test data on
❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system
❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel.
Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed).
❑ Cross section of system. ❑ Pipe lateral layout.
❑ Plan view of system. V. Dosing Information
❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons
pumped per cycle.
III. Private Sewage Systems ❑ Size, length and depth of force main.
❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including
system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM).
❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s).
data.
❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.)
constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge
❑ Construction details and cross section of soil absorption of trench before side slopes begin.)
system. ❑ Depth and type of fill.
❑ Copy of signed onsite report by county or district staff.
ST. CROIX COUNTY
WISCONSIN
77
ZONING OFFICE
)bra r ! ' t SxYi~ I ""Y~.h~, 'C~i
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
September 4, 1985
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An onsite investigation for the Ardell Fox property located in the
NW-4 of the SW-4 of Section 6, T31N-R18W, Town of Star Prairie,
St. Croix County, revealed suitable soils at a depth of 24 inches,
below which seasonable high ground water was noted.
This site should be suitable for a mound system.
Should you have any questions, please feel free to contact this
office.
Sincerely,
Thomas C. Nelson
Assistant Zoning Administrator
mj
STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township /bV9fZf#RW:
NW 14 SW S 6 T 31 N/R 18 E(or)W Star Prairie St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Ardell Fox RR#2, Box 157, New Richmond, WI 54017
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
Signature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19
Notary Public, State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
Location NW 1/4, Sw 1/4, Sec. 6 T 31 N, R 18 x#(( W
Town ~IYjS Star Prairie Street Address
Lot No. Block Subdivision
Landowner's Name: Ardell Fox
The application for this site is for:
❑ new construction use.
Mreplacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
to have one of the first five approvals guaranteed for this year. This is
number - - of those applications. (Use one of the first five
quota numbers ssueTto you.)
[ ]one of the applications needing a quota number. The quota number assigned to
this application is - -
for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
[ Ifor an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
[.for an application on file prior to February 1, 1980.
[_]for a lot that meets the criteria for a conventional private sewage system.
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
replacing:
Q a failing conventional soil absorption system.
El a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a
conventional private sewage system, check here
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson $1 ure
County Official -
Title Assistant Zoning Administrator Date September 4, 1985
DILHR-SBO-6158 (R 12/82)
DEPARTIVENIT OF REPORT CAN SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
t ' ;SOY' AND PERCOLATION TESTC (115) F.'7. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
3707
iH63.09i1! t.. i:iiap:ei i45.,.
1 0.-141 ION SECTION: TOWNSOIPr_' AUT.; LOT NO. BLK. NO.: SUBDIVISION NAME:
i
114-b'14 C
;COUNTY: OWNER'S/~t+Ef~'S NAME: MAILIN ADDRESS:
DATES OBSERVATIONS MADE
iEURMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER LATION TESTS:
`*1
AResidencr ? ) ❑New eplace q
RATING: S= Site suitable for system U= Site unsuitable for system
~NVEfu JNAL.?MOUND: IN-GROUNDPRESSUR E: SYSTEM-IN-f=ll_L OLDING TANK: RECOMMENDED SYSTEM:(optional)
S~ l U S U❑ S U C~ S qU ❑ S U d
Perrni ion - tests are NOT required DESIGN RATE:
-I If any portion of the tested area
elevatonis in the
idBr,,ii63.D9,5)(b), indicate:
Floodplain, indicate Floodplai
} l!?1/~l% PROFILE DESCRIPTIONS
RIN ITAL ~Uc°TH TO GROUNDWATER IN( HES HARACI-ER OF ';OIL' WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
I o 1 r:.: i E i r~ ! 85ERVED atr A i; V. ~?N
eeP
B -r I -S V 70 17 r~ 75
5
Z )7
. w mr7-
B
f ; ,~A7 ~ PERCOLATION TESTS
-F-ST DEPTH VeATER IN HOLE TEST TIME DRO? IN WATER LEVEL-INCHES RATE MINUTES
n 1f Q3 R LtaOkF" A. , ER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 Pl Rf PER INCH
-f P[ Ai\Sh a . ,et ions of per_c,tation tests, soil boring:: and the drrrmr,nsiens '3t suitao!e sju ai-as, indu.ace soaf s.~ ,r - .
tal : jrd cal a< n reference points and show their location on the plot plan. Show the surface elevati at fl bbri tg$ #~kl t £ Action and percent
and sloc~e. J
'SYSTEM ELEVATION ~ - -
8 ,
2 -_0 ~
I, L~ t
( @4L c~
I
j RECEIVED
i
1 1
,f OCT 0 3 198}
I
P I 1 I f1'l'31 n
e undersigned, hereby certify to -t the soil tests reported on this form were made by me in accord with the procedures and methods specified in the. Wisconsin
nir, stfativ't Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
AE (prim) TESTS WERE COMPLETED ON:
DRESS l CERTIFICATION NUMBER: PHONE NUMBER (optional):
IA!,~
CST SIF N E:
DISTRIBUTION: Original and one copy t.^ Local Authority, Property Owner and Soil Tester.
ifs-SBD-6395 (R. 02/82) - OVER -
L