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Z /JUC ~C SUBDIVISION LO'1' LOT SIZE PLAN VIEW llistaaces and dimi.:nsiotas to west requirements of H63 SHOW EVERYTHING WI'1'LLIN 100 1'E•f:'1 OF SYSTEM LJ Ii dic at N r h rra w BENCLLMARK: (Permanent referuut,:u Point) Duscrlbc. 419 Elevation of v#srtical ruts reuL.u point: -Slope at site: GU F5t P SI:111'L'1C TANK: Mauulacturc:r: Liquid Capacity: t Number oI riuhs on covUs _4,10Aj i' lank manhole cover elevation:/o_ 'l'ank Lulea 1 Levatloii: ~ Tank Outlet Elevation: ~ ~ PUMP CHAMBER Manufacturer; - - --Number of gallons Number of gal. pump set for a cycle gallons; Total capacity o distribution .Lines gallon: size of pump-_ head; gallon per mliaute huruepowor ;brand name of pump and model number - ' Type of warning device _ HOLDING TANK: ~a uutacturer__- - _ Number of gallons Elevation of manhole cover ; Type of warning device- - SEEPAGE PIT SIZE" --Number of pits----- feet diameter feed liquid depth- seepage pit inlet pipe-elevation- botCum of seepage pit elevation--- feet. SEEPAGE BED SIZE: number of width length tile deptl ~ ,,y~ffi~1✓M SEEPAGE '1'REN( It widtt: iengt1 PL:RCOLATION VATE AREA REQUIREDCv~joAREA AS BUILT' (r~c,L~ }~rfiINSPECTOR DA'Z'ED PLUMBEIL ON )OB- - LICENSE NUMBER ? i ' i o I I HOMESTTE VTpnC ENGTNEERINO CO & EXCAVAT'I'G A'-f-D-" ' TES tv i l pol 4 WISCONS IT IN AIASTER ITUTA B t w , 3307 MPR$ L. ~ 7 W INNESOTA INSTALLERS & DESIG. , itS LiCENSE NO. 0003 -RT. 3, O NEIL RD, HUDSON, WI 54016 C 3~ WAY N I bq 607' L~. 7 16 A.) V V ~I Al 0,6 I n Nkv iFc DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION F.O. BOX 7969 BUREAU OF PLUMBING MADISON,INI 53707 EXCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number Ilf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Doug De Rosier 415 6th St., Hudson, WI 54016 BENCH MARK (Permanent reference P-t) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. SE SW, Sec. 36, T29N-R20W,Lot#2,Pine Tree Meadows, Town of St.Joseph Name of Plumber. MP/MPRSW Nt. County. Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 49424 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIDUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER } 1 , J t "-j tt , PROVIDED. PROVIDED. L G ! Jr i' f ? t4' OYES ONO DYES ONO BEDDING: VENT DIA.. IVEN T.(,NATL HIGH WATER NUMB R OF ROAD. PR OPERTV WELL. BUILDING: JVENTTOFRESH ALARM LINE. AIR INLET. i / FEET FROM S DYES ONO ! OYES ONO NEAREST x l 0 DOSING CHAMBER: MANUFACTURER BEDUING: [1111111 CAPACPPUMPAND UMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER I PROVIDED. PROVIDED. OYES ONO / -11 OYES ONO OYES ONO GALLONS PER CYCLE: ONY7R O ATIONAL NUMBER OF PROPERTY JwELL BUILDING IVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLETPUMP ON AND OFF) Y'ES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER IMATEHIAL 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. LENGTH IN O. OF DISTR. PIPE SPACING COVER JINSIDE DIA. -PITS LIQUID BED/TRENCH t ; TRENCHES MAT-10 AL °v' PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDIST11. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO DISj NUMBER OF PR OPERTV WELL BUILDING: VENT TO FRESH BELOW P/FES ABV E ~oVER EL~v. IN F }EV. END 7 PIP FEET FROM ,LINE AIR INLET. U • l (i, C. NEAREST--► i 1 5' 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- O meets the criteria for medium sand. TIONS MEASURED. YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCHBED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL .D ED SEEDED MULCHED CENTER EDGES OYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA. ELEV.' PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. OYES NO OYES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: jf n D YES O NO OYES ONO NEAREST Sketch System on 1 Retain in county file for audit. Reverse Side. t SIGNATUR,Ec TITLE. DILHR SBD 6710 (R. 01/82) f' PPP_ DEPARTMENT OF APPLICATION £ SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUP~AN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: -'DO v 6- - ' 7 li40R,+ De~- P65 51 yvVSa-t) 6 ay Property Location: q City, Village or Township: ` County: '/45w'/,s3 iTLI N/R 2~6) E (or W t_1JE,;47 174__ 57' eb/,~ Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: L 10144E (if assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ;1 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: rd-j Ce IA.) EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSE (Square feet): N New ❑ Replacement ❑ Experimental Z. Seepage Bed ❑ Seepage Pit V3 1Qr~ ❑ Alternative (specify) ❑ Seepage Trench Water Supply: 00 Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/MPRSW No.: Phone Number: &0O13AE4-T -7l11JR/cy-7_ 7'eZ I 3307 (7i3-3,?,l Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing jAgent: Fee: ` Date: APPROVED Sanitary LPermit Number: J~ C~J►.P d~~ ~7 ❑ DISAPPROVED /Q `77 /V T Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DI LHR-SBD-6398 (R.07/81) Dorm - S T C 100 4 1 Owner of Property~y~(~°'~ Location of Property S~ z5 Section 'P z/ N RW Township J I ToSel /,A-- Mailing Address .~f ~.'~s~-tip . y~ ~ _ Subdivision Name /nF.4-de)w Lot Number 2- Previous Owner of Property Total Size of Parcel 2- f}lAX-k- Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or Other Edgal DOCUUIent which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No-190- ` 2~ ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have Obtained an casement, to run with the above described property, for the c truction of said system, and the same has been duly recorded in the Office Of *fto County Regist of Deed , as Document No. S~UfVA7UHE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED 1 DATE SIGNED i n JI: ti ~l ~ I. ARTMIE TRY NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION i,S S LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX QN WI 53707 .r 4UMAN RELATIONS - (H63.09(1) & Chapter 145.045) t.OCAr ION / ~~l1UN p- TOWNSHIP/MUNICIPALITY: `L r2- OT NO.: BL~K. NO.: SUBDIVISION AM ?C '/4 .36 /Tz! N/R1VC for aaS~"pTT //illt • £if-& _ _~qPll~ 'f OUNTY: 6Qt;F 7Rb_yW§NAME: A IN-6 ADDRESS: • ~iPo /X 77ou l-~4v,PA l~r /PGis~E o~ S/l/~So J . S S s'a/ fo USE DATES OBSERVATIONS MADE NO BEbl2MS : COMMEfaCTAL DESCRIPTION: rR FI IPTIIINa: '1°eSTS: ERCOLATION R[V~f XNew Replace I z/'~~ n ,ynW/267AIS RATING: S= She suitable for system U= Site unsuitable for system 4014"f/,+ 10.}rl 5019 _ NVENTIONAI . MOUND: IN-GROUNCifiRESSURE SYSTEM-IN-FILL OLD G TANK~: RECOMMENDED SYSTEM: (optional) S ❑u ~s ❑u_©s ❑u l as ©uos Z u(~a,~~E~T„~~ ~ j If Percolation Tests are NOT squired DESIGN RATE If an y portion of the tested area is in the under s,H63.09(5)(bl, indicate: I Floodplam, indicate Floodplain elevation: - PROFILE DESCRIPTIONS BORING TOTAL T R UNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED .q I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9 0 / O • IO Z / / O ' L~ CyV . Si L • f+~ L7~ wJ . Si L r . P3' Ll QN . . 9/0 r s,c. 6, oiP. Cs . 97.24e' L~a~,- sue, 43'0* sue, 6.s /S-' A~N B 9P/ ~ .1 y ~3 ) G,V. Pd-4 ?,Y L 04 -44 P.3 o - L C S C? S ,O9 B0.6Y. /,0 141-Q4J.5,J4, -XI 0e. S4~ TJ'A 1 B- 1 PERCOLATION TESTS TEST DEP H WATER IN HOLE TEST TIME DROP IN WATER L VEL-IN HES RATE MINU ES ? NUMBER IN AFTER SWELLING INTERVAL-MIN. p - per- _Tp_Eljl D PER INCH PERIOD } Z i I P _ ~ P 3. Z < P, 7 P- 2-~ 'V S-11 7 ~0 7-1- 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 rind vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent oflsnt►slope. 13O_TT0 M .0 13,e-,L) SYSTEM ELEVATION , • 1 ~ a ~ - „ 41 ~-x I i 1 r i_ { i 1 I I. ~ i I - ' I t" tt I , I i, ttte undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speeifieq In the, Wieconiln AdMirilatriltive Code, and t rat the d'#6WV ah'&'A of the tests are correct to the best of my knowledge and belief, NAME print : TESTS WERE COMP ETED ON: 1MESITE TESTING CO, Na y .z ~3 ADPRESS: aFa• Sr~~~~L. ~DAd CERT_LFICATIONNUMBER: PHON~NUMBERIoptional: ~~a Ott-vv~s.r- o~► s -02- y,f.z_ ,3 CST SIGNATURE: }t .1 d1FTRIBUTION: Original pnd one copy to Local Authority, Property Owner and Soil Taster, fl R•SdD8386 (R. 02182) -OVER 4 S '.,REPORT ON OIL BORN&S ' PERCOLATOR/ TESTS ` PLOT PRAM PROZ-Ec T S• D. DA1"E &)O,2143 :Doocl :bzc-/Vos~Zx HOMESITE TESTING CO. SL S~ y SGC. / -2YA/ /f'lo 40 kr-3, O'HOL ROAD BOB Ul.1;1►1L',,. riiuusotil WIS. 54016 C5 SS 02 yez I PROPOSED HOUSE MUST Li 2~ Fr oR MORF F~P4M .qL~ TEST ij~PE`gS. PRo POSE 0 WEII M VST LIE 5o Fr a,~ /yp~QF FiPO~ ~qc L TEST ~,PE/)S, = 4A~yoE P%rs Q = -GriSAIW 6 - !-CELL X Pf,P~ /oGgT"iovf = f1~4,vp fga9EREv Oe 5-40aft of iU4~ /-o 110'e;z . 3 M VER1'ic,►t &,rrRCA1C • ~oiar" -r10 st*,P- a,,r 0,v1p 41-6 v IT~w w LEGEND /EV~rio v ©R 11"l 4M.. PT / D 0 . Q Fr- ti w Lo T 0 f P' 46 yS' -,13 P3 3 i r y s LD~t ` 13 133, w 'Ilk o lS`-as~ S/~~~5 it,Sr i pv PL B PLOT cLn8 CRO-55 CjEcrjoN FIANS scgl~ za' o b^ ® ' q CAD a nl 0 ac - • W /-O ;r z- tt ~y 5'zo SS 6 7-2- y N X z 0 c 91rGNFD ?_t 33 a 7 T"q Ike Fresh Air Inlets And Observation Pipe SOIL TESTIA15 By HOMESITE TES-,'.JNG Co. L \^~s Approved Vent Cap RT.3, V'ilc; RCS:, ` _ HUDSON, WIS. '-y4416 Minimum 12° Above Final Grade /d1kXt ~t UM 4" Cast Iron Above Pipe Vent Pipe -1"o Final Grade Marsh Hay Or Synthetic Covering .1 C1L-V147-/dli Min. 2" Aggregate Over Pipe ` ~j Distribution Tee 0 0 0 0 0 rt Pipe 3,0 °M " Aggregate o Perforated Pipe Below i Beneath pipe 0 Coupling Terminating At T~s / i5 Bottom Of System