HomeMy WebLinkAbout038-1127-10-000
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Parcel 038-1127-10-000 10/10/2005 12:01 PM
PAGE 1 OF 1
Alt. Parcel 31.31.18.516T 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
O - BERNING, DAVID P
DAVID P BERNING
1886 CTY RD C
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1886 CTY RD C
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE
SEC 31 T31 N R1 8W PT NW NE 1.200 AC LOT 1 Block/Condo Bldg:
OF CSM 5/1275
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 719/207
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.200 26,400 111,900 138,300 NO
Totals for 2005:
General Property 1.200 26,400 111,900 138,3000
Woodland 0.000 0
Totals for 2004:
General Property 1.200 26,400 111,900 138,300
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
00
Total 0.00 0.00
Parcel 038-1127-20-000 10/10/2005 12:02 PM
PAGE 1 OF 1
Alt. Parcel 31.31.18.516U 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
GARY T HARTY O - HARTY, GARY T
1874 CTY RD C
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 1874 CTY RD C
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.070 Plat: 1275-CSM 05/1275
SEC 31 T31 N R18W PT NW NE 1.12 AC LOT 2 Block/Condo Bldg:
OF CSM 5/1275 EXC PART TO CO HWY AS IN
774/490.05AC Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-18W NW NE
Notes:
Parcel History:
Date Doc # Vol/Page Type
11/10/2000 633417 1558/327 WD
08/18/1999 608771 1449/615 WD
07/23/1997 1038/208 LC
07/23/1997 858/368
more...
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.070 25,500 176,200 201,700 NO
Totals for 2005:
General Property 1.070 25,500 176,200 201,700
Woodland 0.000 0 0
Totals for 2004:
General Property 1.070 25,500 176,200 201,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 501
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANI'T'ARY SYSTEM REPORT
OWNER TOWNSHIP
ADDRESS Q~ r, ST. CROIX COUNTY, WISCONSIN.
E1/S r r .
SUBDIVISION L0T LOT SIZE
PLAN VIEW
Distances and dime.nsiona to meet requirements of 1163
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 h~
y
t
I di at N r h rr w
BENCHMARK: (Permanent reference Point) De- scribe: N• ~ x
Elevation of vertical reference point: -Slope at site:
SEPTIC TANK: Manufacturer:_J) Liquid Capacity: Number of rings on cover Tank manhole cover elevation: _
ACT
--Tank Inlet Elevation: 75 Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer Number of gallons
Number of gal. pui}~V-Vset for a cycle --gallons; Total capacity of
distribution I• e I s gallon: size of pump-- head;
gallon per ,•nute- horsepower ;brand name of pump
and model number
Type ofwarning device
HOLDING TANK: M ufacturer Number of gallons
Elevation manhole cover ;
Type of arising device
SEEPAGE PIT Sl' Number of pits feet diameter
feet liq •d depth--- _ seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines Z width /a I length_<z/ tile depth
SEEPAGE TRENCH: width length
PERCOLATION RATE Z AREA REQUlitED AREA AS BUILT&20-g'
INSPECTOR
PLUMBER ON JOB
LICENSE NUMBER
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
12~ CONVENTIONAL ❑ALTERNATIVE IS,,,, Plan I _D_ Number.
(If assigned)
D Holding Tank ❑ In-Ground Pressure ❑ Mound
r
NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE.
Bruce Jezior RR, Somerset, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN'. REF. PT. ELEV.: CST REF. PT. ELEV.
NW NE, Section 31, T31N-R18W, Town of Star Prairie
Name of Plumber. IMPIMPRSW No. Cou n,y'. Sanitary Permit Number'.
Gary Steel 3254 St. Croix 38544
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACIT V'. TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCK( G V R
PR r YES PROV E
V Lt 7 ~Y7 YES ❑ NO NO
BEDDING'. VENT DI A.. VENT MAT L.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING ENT TO FRESH
ALARM. FFROM J LINE. ' AIR INLET.
OYES ONO YES NO NJ % t ( 2 / /v
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACF11111 PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED.
EYES ONO EYES ONO OYES ONO
GALLONS PER CYCLE: AND CONTROLS OPERATIONAL. NUMBER OF PR OPERTV JWELL BUILDING. IVIENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) OYES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNGTH DIAMETER 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:
WIDTH JLENGTH NDISTR. PIPE SPA ING COVEq INSIDE UTA. #PITS LIQUID
BED/TRENCH TRENCHES MA7kPinL PIT DEPTH
DIMENSIONS a /
GRAVEL DEPTH " FILL DEPTH UISTR PIPF DISTR PIPE DISTR. PIPE MATERIAL: NO p15 H. NUMBER OF PROPERTY WELL. BUILDING'. AVENT TO FRESH
BF LOW PIPES ABOVE COVER E EV. INLET ELEV. END PIPEW LIN C I NLET
C FEET FROM JS
1 • l ~ NEAREST---►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill mat for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to ma - rtain t t_jT" ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for m diu San/ 7"'IONS MEASURED.
DYES ONO
SOIL COVER TEXTURE F7E E NT MARKES JOBSERVATION WELLS
YES ONO DYES ONO
DEPTH OVER TRENCH: BED DEPTH OVER TR ENCH;BEU DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES.
7 ❑Y S ONO OYES ONO EYES ONO
PRESSURIZED DISTRIBUTION SYSTEM: Al
WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELO1N PqA FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. 'D PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV. DIA.. ELEV.' j [S. DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY TER IAL J PVELARNTIS CAL LIFT CORREPNOOAPOVED
INFORMATION
EYES NO COYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION W ELLS: NUMBER OF PROPERTY WELL. BUILDING.
FEET FROM LINE.
OYEF, ONO DYES ONO NEAREST
r
1 H I 1° 4- ~~r.►~ - 13 s
Sketch System on Retain in county file for audit.
Reverse Side. TITLE.
SIGNATURE - -
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF3 APPLICATION f3 SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z 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:
2VI w 0- tV_ (A S ;7 j Ir .12- r~1 4 r'
Property Location: Qitq-Viliege.or Township: County:
N 0% V C %S 3 I i T 31 N / R 6 (or) W )42 P9- P_ 0 14
Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
- 4'' (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 (Specif )
SEPTIC'TANK CAPACITY o L/
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: 10,C_ 9- Z ,-f
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): 54-New ❑ Replacement ❑ Experimental 19,Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
K Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name oJ-Plumber: Signature: MP PRSW No.: Phone Number: 4 5 /9 9 j
% 3-;, s (his ~~r/~~a
Plumber's Ad ress: Name of Designer:
L. Mn ,
COUNTY/DEPARTMENT USE ONLY
Signa ure of Issuing A ntFed: ~y Dale: / APPROVED Sanitary Permit Number:
s ~L~(J(Gy t(/~f ❑ DISAPPROVED
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
DILHR-SBD-6398 (R.07/81)
Form - S `1' C 100
Owner of Property
Location of Property ~4 ~4, Section_ T N R. ( W
Township `711 t~l~1~11
Mailing Address ~L X (Ll
-
I
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel lt` XC
Date Parcel Was Created_
Are all corners identifiable? X Yes No
Include with this application one of the following:
.Certified Survey Map
.Deed
.Land Contract, or
.Other I:egal Document 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. ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
~-Am co 7"'
SIGN RE F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNS
A F F I D A V I T
STATE OF WISCONSIN )
SS.
ST. CROIX COUNTY )
Bruce C. Jezior, being first duly sworn on oath, deposes
says that he is the owner of a parcel of land located in
the Northwest Quarter of the Northeast Quarter (NW; of NE34) of
Section Thirty-one (31), Township Thirty-one (31) North, of Range
Eighteen (18) West, St. Croix County, Wisconsin.
That affiant hereby states that he is unable, at this time,
to complete the driveway on said premises until such time as
affiant has his cement work done.
That affiant hereby states that he will, on or before
June 1, 1983, complete the driveway located on said premises,
in accordance with zoi;ing regulations required of him.
That this affidavit is made for the purpose of advising
the St. Croix County Zoning Administrator that affiant will comply
with all necessary zoning regulations on or before June 1, 1983.
Br ce zior
Subscribed and sworn to before me
this 22nd day of April, 1983.
1 \tr-T/ / /„L t L(Lf~ l
R- uut 1 A. John n , Notary Public
St. Croix County, Wisconsin
Comm. Exp. 12/28/86
~I
TiVIENT'OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, 1 C DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 539069
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: f TOWNSHIP/- ERRtFFY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
~/4' 1/ 1 /T3 1 N/I\ S(oo IN ~7~l~t r r ✓-f
COUNTY: OWNER'SfB~ NAME: MAILINGG ADDRESS:
51 &01;k Y U_C 6- E2 rCh.r, (2, n It, So ►re-r-56 6)i, J~'`7~Ov75
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence -3 New ❑Replace L O _ 9-5
RATING: S= Site suitable for system U= Site unsuitable for system y
CONVENTIONAL: IMOUND::-----IN-GROtilqD-PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDEDSYSTEM: (optional)
®S ❑U CkS ❑U INS ❑U 0 S &U ❑ S ~U U #,1 V C6~ -4- o-,,„a
If Percolation Tests are NOT required DESIGN RATE:
I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: lq
Floodplain, indicate Floodplain elevation:
(),S~m41' PROFILE DESCRIPTIONS w° C,
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH hhr ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
o 0,7._ . Z5- Qn.s; c,
B-~ too ONA- > ,,2 .zs13 ,,.s -~p4. S, 4,, ?sDn.s,4,~~~ h.~-~o':Z ~Q,,. ,dam,
ti rU 13 / d~~, S; / fir. s,.c, • ' ~ t rJ, s', o? C,n, .c,s,
B 'Z l3 1'7 o l13
B- 3 ~3sB /01.33 /VU N e X13 ?Z 97.S; J-
i7 zf 17 / 67,6,1. C. S" .33 6,1,S."4' .67 Qn.S aim
B- 0 /J 6- ~7 Z~7 on B ~a~? )00 1 g Q jti1 7 /a kip .~8l~/~•~.,S, ,Gq.$„ 7(~/!.e$, VL
B- I
PERCOLATION TESTS
D'Cs~rr„al
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER ipde'+ES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P- Z. 7 A) r) -5- V Z_ -5,114 l
P- D CA Ci < 3
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
A m. P ~~u7, J~o`"} L°orntr~S~AKER+ Ino~
~ '.:510G_C aL°uf ~ _ n
av'Ad6 +0 b6' au-+
ko `~y b~on~ y b.'
33
p-3
0 '
700 A4 "14
P
its-0, ~COr»fw 5}ra'r~tE '
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):
CST SIGNATUR
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil T; ete!
v.. € { .'i `r„
i"
a r
tz,
the ai-)w
{
r. ~ e
r
5 °1
v 'a
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fZ CrC ~~#Z17
i
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
IND1.ISTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% 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
i'-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.
Proper Owner: Mailing Address:
' r So rn (b
Property Location: asip.bil}age-or ToP~K ip: County:
JU k) t_%S 3~ /T 31 N/ R (or) ~7F9r P4 V- I ,
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If assigned)
e
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (speci y)* Bedrooms:
fA1 or 2 Family *State Approval Required.
TOTAL N MBER PREFAB POURE IN ST E Fl ERGLAS NEW REPLACE- OTHER
GALLONS OF ANKS CONCRETE PLA STALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHA BE
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSO TION ARE
(Minutes per inch): PRO OSED ($cl.. feet): New ID R place ent ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Alter tive (s ecify) Seepage Trench
O
Water Supply: OName as Listed n Soil Test Report (If other than present owner):
Private 1:1 Joint ❑ P Ii
I, the undersigned, hereby assume responsibilit for installati n of the private sewage system shown on the attached plans.
Name Plumber: S nature: ~AR/MPIIW No.: Phone Number:
PlumUr's,Addr s: ame of Designer:
COUNTY/DEPARTMENT USE ONLY
Si na re of issuing Agen F Date: APPROVED Sanitary Permit Number:
i~ r G'.Lfcl _ ❑ DISAPPROVED ~J
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
DILHR-SBD-6398 (R.07/81)
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABQR & HeJIMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707 X CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
III assigned)
El Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: DDRESS OF PERMIT HOLDER: INSPECTION DATE:
Bruce Jezior A RR, Somerset, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEYk T REF, PT. ELEV..
NW NE, SECTION 31 T31N-R18W, Star Prairie Township
Name of Plumber: IMPRSW No.: County: Sa i18fy Perm ber:
Gary Steel 3254 St. Croix `34Q9
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARN N EL LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO DYES ❑NO
BEDDING: VENT DIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: JPROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE. AIR INLET.
DYES ONO DYES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING' ILIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ❑NO DYES ONO.
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PR OPERTV WELL BUILDING. V NT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST 01
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LF NGTH IDIAME 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:
WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING- COVTfF- INSIDE DIA SPITS LIQUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR. PIPE IST . PIP MA RIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH
BELOW PIPES. ABOVE COVER ELEV. INLE I ELEV. ENU PIPES FEET FROM LINE. AIR INLET.
NEAREST
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-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS
DYES ONO DYES NO
DEPTH OVER TRENCH/BED IDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
DYES ❑NO DYES ❑NO DYES ❑NO
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. DISTH DISTR. 1 DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV. ELEV.. DIA ELEV. PIPES CIA
DISTRIBUTION
INFORMAT I ON HOLE SIZE ROLE SPACING DRILLED COHRECR-Y COVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYE ONO DYES ONO
COMMENTS: PE RMANENTMARKER : OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FR
DYES I -INO DYES ❑NO NEARES TM LINE
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE
DILHR SBD 6710 (R. 01/82)
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19 v A464 40 6j, 9'4
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