Loading...
HomeMy WebLinkAbout030-1043-30-000 o to 0 o d c > > o 3 U) 0 z U) fD ~ ~ m v ~ n 0 N O Z y 3 m O L w 0 cD 7 ~p (D OD (D O p W~ c CDo o ~(D~ o O W N y N CD ? W O N N Q C 0 ? W C) C) N o m o o N W O Q vi < D m a m m n y O ~ a I CD CD c w C m i;5 3 - PO lot -c O O (D U W O 0- (D CD (D 0 0 r- Cn CO CO cn N N ~l % O O O ~i nn F o N 1 I3 c o m rV r O o N N fn 1C 'U 0 0 N O cf) (D c) C) C) ui _aJ eQ w w v c m o to 0 N A _ Q ~r iv o z OD z nr O a o o m CD w N O C (D N Sl(J- N l d W (D C - -•I fn 1 G O O A? n C z • t o O Cl) w o j W C m o (D CD C Z 0 ~ Cl) W / 3 y D a W D7 ( O CD o ~x cc~3 a 3 p_ O W N O N l0 yam 7 o C'7 _ 7 O , T pNj CD (p , (O d O O I4i o m v o 3 z a m - o 3 -0 D W O N C C V: N O -o 3 3 -0 0- O S -o 0- n C N 7 0 q Q - O (n O - (D ~0 ~,6~ N p a o s,'A98 CL n v N N O 0 A N O E N CD 0 0 v A CD m m m N n e 7 O CD O. ~ O_ 7 O 0 CD N 'm I ~v O_ I Oo A 0 31 O O W o n V o n(4 O m~~ C ~1 o c m O cD d T m c CD m m A o to z o~ W to 0 w CD cr, o C lr . v ° 77 0 (D ? m CD w o o r. Q N o w E) = o ~ - m w - CD o w F ? ~ ` 1\ i- > ? m 0 o w o rn w 3 N N o m o r 7 N ? 7 O Q .N. C w O "J O d Z v co F m m ,D D v a O co cc a) N) rQ w J ~ ~ w n o O O N 0 0 0 o o 0 0 - hi w o z N) N) 2 O C) CD 0 0 C U) 0 r- (n 0 c 0 0 - 6 v z ~ CD O O O C D * * * cn M `iy 0 0 fA N t~A o m C) =3 a T v v co (D N N 00 00 O N ° (D (D N 7 CD y 'O go w w CD _ M, Q N o w N m n N N z M 0 D D D n~ O v O 0 CL o E C h n CD o (D N fl CD S c v w (D a ~3 E3 z =r m 1 N o O _ p Z 0 A z O y O OD 0 O Cn ~ N c W m w o 3 A o ~ A p ; cn ~J o 0 co N z O C) D a n o - T 97 C z a o CD i ii a w ti 0 0 a o CD A CD 0'p N 69 O O w °CD O i I A Y AS BUILT SANITARY SYSTEM REPORT OWNER A,Q~ S JBm( K- TOWNSHIP 5f . -50S:EP4 SEC.Zb T3ON-R/?W ADDRESS +e- / y Lir ,wi ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 1-163 W- LVERYTHING WITHIN 100 Fl,"E'T OF SYSTEM - - - TF j_. roc 1W A - - - - - is ea . Y ry r ~ r A I di a r orthl A rnW SCAC. Z, C/jf[ i_ V A'r-ZfF -r 6~ tiL 1-7 f'J' BENCHMARK: (Permanent reference Point) Describe: XV7b S`1°£fL_ f~-"e£ 1©e~T Elevation of vertical reference point: j00, on Slope at site: SEPTIC TANK: Manufacturer:.9>c is-r/#V & Liquid Capacity: ,r-,AL_ _ Number of rings on cover : Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation. PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; totes capacity of-- distribution lines gallon: size of pump head; gallon per minute horsepower bran name of pump and model number Type of warning device HOLDING TANK: -Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: -Hum e~ pits e~ er iameter _ feet liquid dept seepage pit in et pipe-elevation _ bottom of seepage pit e evation feet. , SEEPAGE BED SIZE: number of lines _width j ' lefigth ;tile dep0i_ S1?EPAGE TRENCH: width length PERCOLATION RATE i -AREA REQUIRE 4~ /S 'AREA AS BUILT_ %S - - INSPECTOR - DATED PLUMBER ON JOB LICENSE NUMBER, 6EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR L SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969' BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL DALTERNATIVE State Plan LD Numbers n+assignedl ❑ Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT. ELEV St- sui 0 - Joseph Nam, of Plum IF- I-P/-PRS- No. County Sanitary Permit Number_ i SEPTIC TAN HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED- DYES ONO DYES LINO BEDDING VENT DIA.. V6N TMATL 111131 WATER NUMBER OF ROAD: IPR OPERTV WELL BUILDING. IVENTTOFRESH AkA M LINE AIR INLET Y. - = % FEET FROM DYES LINO YES ❑C NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID (:APACITY P1P MOUFI PUMP;SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED- ❑YES DNO DYES LINO DYES LINO GALLONS PER CYCLE: PUM AND o OLS OPERATIONAL NUMBER OF f'1r)PEHTV wELL EHILDINa VENT TO FRESH (DIFFERENCE BETWEEN ) 1 FEET FROM I INt AIR INLET PUMP ON AND OFF) I DYES L_ NO NEAREST SOIL ABSORPTION SYSTEM. Check the son I tureat th depth of plowi ng ~ i .-11 ul Ar,:r 1E 11 JMANDMARKIN(, or excavation. (If soil can be rolled intg a wire, constructi shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: _ J WIDTH I ENGTH NO. OF 1111ST11 PIPE SPA, I' (:OVER t. INSIDE DI 3 SPITS 11-11 UID BED/TRENCH TRENCHES j tit tHI aI PIT DEPTH: DIMENSIONS P ~ I~r 1'I I L~OFPTH UISTH PIP( DISTR PIPE DISTR. PIPE MATERIAL N DIS H NUMBER OF PROPERT, WELL BUILDING. VENT TO FRESH OVE COVER EI f V INLI T 11 '11I ENO - PIPES ~Lif AIR INLET: 7 < '7 7 L. FEET FROM / .V~ ~ ,t`l. r ( NEAREST--~.~~1 ~21~ ~ 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- D meets the criteria for medium sand. TIONS MEASURED. YES El SOIL COVER rExrIRF PERMANENT MARKERS OBSERVATON wELLs DYES LINO DYES LINO I)(PTH f)VFH 1H[N(:II BFU UEPTR OVCR ENCH EI) DFPT11 (1F TOPSOIL ISO11111D SEFDED - MULCHED C'F NTF EDC;ES { j DYES LINO DYES _LINO DYES LINO PRESSURIZED DISTRIBUTION SYSTEM( _ I D I H LENGTH NO'F LATERAL SPACING IGHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH F8o ED/TRENCH TR C s I MENSIONS t ' '~',INIFOI 1) PUP ANIF LD DISTR_PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL& MARKING ELEVATION AND I-LTV. ELEMV r IA ELEV.' PIPES DIA.. DISTRIBUTION INFORMATION 101LE SIZE HOLE SP CIN~', DFiI FD C HFCi I V 7ATIHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS _ V. ❑ ES LINO DYES LINO COMMENTS PERMANENT MARK HIS OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING EET FROM LINE DYES NO DYES LINO y ` i I'a l Sketch System on Retain in county file for audit. Reverse Side. JS/ TITLE L 7 _ DILHR SBD 6710 (R. 01/82) , ~ ~ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS .DEPARTMENT 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% 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: \ Property Location: City, Village or Township: County: 3C)NiR /`7 E (or 577; U/)( %-5ti," %S ~JC /T Gt Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: Ix - (If assigned) A; 14-- TYPE OF BUILDING fi~I (d 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 0-Erv, i5T/ HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: S S. EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPO ED (Square feet): ❑ New Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Tow- 1, ner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint El Public 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: °f - (7/5 300&-2,e3 Plumber's Address: i ` c Name of Designer: COUNTY/DEPARTMENT USE ONLY Si nature of Issuing Age Fee: Date: [Sanitary Permit Number: APPROVED n antDISAPPROVED • ilk I-, 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) i _ II ~1 . DNPAISTME`NT OF REPORT ON SOIL BORINGS AND SAFETY & B DI LDINGS .IND~JSTR Y, IVISION H HUMAN RANEDLA' P.O. BOX 76 TIONS PERCOLATION TESTS (115) MADISON W153707 HUMA (H63.09(1) & Chapter 145.045) LOCATION: SECTION: ITOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE I/ 1/ 0 /T 3D N/R E(or)W 3y ,ToS-E h` ~fiaT A':volt>4-) COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: _ -T 1 57- USE DATES OBSERVATIO S MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence A//1 ❑ New Replace { ? 2 j J 9 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) [XI), s ❑u ❑ 5.1- ®s ❑u ❑ s au ❑ s ou eoMCOT)4,04- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: w PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) ` © F y,'/~-6/ ~,,,G,{Q~, 7 f. . OAP L, •~3N ESL B Z 4 / 20 ~~•y~ ",4iX Cs Ls "E1-QN-"OAP C5 B 77 ? / dy >/f 3~ L Qv CS •Q0 C'$ Z-1, AV B- 1 3- \A B- % &-,& fr PERCOLATION TESTS A TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P- 'a • (u Z P 1+1~ P- / 41,~T /C' t v dES$ M/A.) C P- _ 5JQ fAtE F e ovo o S of- LEO- = 9t~. 7y FT 3 = v FT - o 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. /whom df AeP Z--oAv#nev n L;E- 9r crlevAbe-v ®F 75 ✓ to. l~ SYSTEM ELEVATION laxA`71-y 13-1Y F` 13cl-Ow d'E~r poi, r , V s //VIM el- c 0 f-4 -A~ TIC 01 (~A E pP ~~yt~ 0,0 ri _ti►~`~ - - yC~ ZI-T ;iD . leERi Aff, y R s TEFZ f A)eE- dos 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: \ T r~6~''~~~~~e 9-- ~ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): SIGNATU E: y /,l , . . l ';e hl it , lmidruCl" 0i Uli ..le: MAX is hs , m r _nsiw t %IYP P! EATF we M iatw,..n A.n„ ,i.:;?_ „tiff inn q ,.,r ,t dfS s.,,,1f.u n and c"onlPIi':"- Gi M'_Y7€CSi ylan M1 .:1 cam. e,,. r=. ° ,.,bLl"_.trg>`j. F= r.v-. °1 .v W.., 5017 ,U[.i" e.rc i£, c: C.t,.., L~ srx 7{; 'LCT St',a, is p); ytt "'tZe . we yaw ,3€ I . : E? d = d y , &; 'l.r?f€'T7 Wo! we ch w, shown d rme p 7=?m .t, UnVIVY . f. yI.Er%s imam as [o Ei2t _ t._e~7,. d;-- o~w sQe w i ,tT r£';°# k mq}- 1 Wr, i' , ni W& o Kod Pain fl . ,c on &A, in 3pl ; .omit We box; .C ,;afgAP ayii <l=dt3lwa l tg6m,_ AL%.._ as?..4=I._ BF_ FILED `2i1VITH 3FEl Sol supaaws am! Tax symbufi rays, S Kmwlnn'l VOW 13 i NCO` Hit"h C Y Ninon , Awomn &W,-, ' E Swlci [ ~ air 35 l SwAy Los 5 hill Ski s, w£ i <i (AV tnv ca! d - i G~. 4 Pl .t vue i f ,lEft t i t SO .`:E rat all hu! wY TO THE 010010 j o. x t a 1h; E.., t of nt., Sol s. v13+. Lad ~ _ PLB (o7 nor and CROC55 yak SEcnoN p1ANS z s r IAW& 01 t , PQf Pt , , .ti_ .,t~ G F,L~ Pj /0 Of u) AIV E u b a Poke 3 ~ rr 3 Q~~ or r O ~ r how ER'S s P~Po Y6-6 7- Nor 50►~ TEsi Polk) ns ~ . • ~ ~~s ~ E fit ~ L /00 11C' Fresh Air Inlets And Observation Pipe ' C~ V► Approved Vent Cap ~LV rj C~jG ~~Nt Minimum 12" Above 7~~ Final Grade vu I 4" Cast Iron 30" Above Pipe Vent Pipe -to Final Grade Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe . Distribution Tea Pipe 0 0 0 ~~h~l1a~/ O f /.iL Age}regate o Perforated Pipe Below Bengath Pipe o Coupling Terminating At Bottom Of S y s t e m