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HomeMy WebLinkAbout040-1001-60-200 o v, o LI 3 -o n o d o R -3 1 (D ICI A~ Q (n _ Z O N (n I --I O O e~y, • 0 ff8 N 0 . o 0 N O Imo. 0 n C 1 Q Q y cri CD .~3 CO : O 1 Q III j ~Do ~ O CD Ut 3 ' (n a ° 0 cn (n Co CD (0 cn m (n a o m s7 (on 0 a o W f 3 oA~ N owo 0 ov (D (n co n r (n (n co o c! N o c N N Q 3 Q h• N ~yZ_ N. O o O oC OC - ~t o N -p C G C G O Z op (n ai (n C'n D ° 3 v o v v p (D (9 y V y 7 ("D CD to N A 3 E. I cn N N Z) CD V Q z p C ~ Z o (D o w O o > > _ n o CD c, (D c C N _ N W (D O_ 7 Z (D p p Z (D cn c - ;u A Z o v n o. Z co co a M ~ z 3 a ; G 0 U) C m w z I p D a oc o' (n T ~ 47 C o Z O. A o CD (D N o ° o m o C) ~ 0 o a s C7 p cn I ~ o < 0 N I A A ~ A 0 cN ' ° I a (n (D oro o0 da 69 0 r N O b • O (D y O ! V O -4 ~i v • ~ !/RV 0 0 N r 00 4-J N U I N rn t~ 1 _ cn ~ W ~\'Jll O J }a N 0 00 I J I N > rl O 0 rl o a, P ~4 1,0 0) H ~ Q) cp H P z 0 ~ ~1 0 4-J ~ H 4 Q) 4 ~ x x ~ AS BUILT SANITARY SYS1'L:M REPORT UWNER ~.r 1'OWNSHII'_ Q - SLC / '1~ZA - o 9w ADDRESS ST. CROIX COUNTY, WISCONSIN. LI d~ C6 A) SUBDIVISIQN LOT LOT SILL: PLAN VIEW Distances and d:.mansions to Meet requireraent5 of H63 jQ V,~;$,YTNING WITHIN 100 FEET. OF SYS`1 E 71F 1, 11 1 - G, D .Q - i eI di a o th Arrow SC ~altrR l~a~. gENCHMAAK: (Per"nont radfarence Point)' `Describe : 100 4f Elevation of vsrGic4,fre trance point Slope at site . _ SEPTIC TANK: Manufacturer:/SSA-.T Liquid Capacity; Number of rings on cover e Tank .ularthole cover elevatlon Tank Inlet Elevation Tank Outlet Elevacion. PUMP CHAMBER Manufacturer: _ Number of gallons Number of gal. pump set--for for a cycle ealloFiS ; total- capiAc i t y of distribution lines gallon. Size 61 pump-___ _ head, gallon per minute horsepower brand nawe of l)un►p and model number TYp# of warning ev ce HOLDING TANK: Manufacturer Nuuibe of balloi►5 Elevation of manhole cover _ Type of warning device SEEPAGE PIT SIZE: Number of-pits Feet diaweter feet liquid dept Seepage pit inlet. pipe-elevation bottoan of seapaKe p~t~elevatTon test SLEPAGE BED SIZE: nunibc~r of lineat_witich4 r i 1u dupLh SEIrPACE `TRENCH: width leri~,tl 22 VL9GULATIUN, BATE ARLA_t.EQu b_~._. _ kEA At di INS1)hC 'UR 142 4ezn PLUMBER ok 1(040 LICLNS ~ ca.imbEK DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LA30R & FjjJMAN R? CATIONS PRIVATE SEWAGE SYSTEMS $fa + DIVISION P.O. BOX 7969 V BUREAU OF PLUMBING MADISON, WI 53707 1(D XCONVENTIONAL ❑ALTERNATIVE IS,,,, Plan ID Number: Ilf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound N E O PERMIT HOLDER. ADDRESS OF PE$p41T HOLD INSPECTION DATE. 8 H MARK (Per ent h~ren ce r mt) DESCRI IF DIF ERENT FRO PLAN. REF. PT. ELEV.: CST REF PT. ELEV. Name crf P rnber. MSW No_ County Sanitary Permit Number. #it SEPTIC TANK/HOl fNG- ANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. YES ENO DYES ENO BEDDING: VENT DIA.. VENT MAT L. HIGH WATER NUMBER OF ROAD' I PR OPERT WE BUILDING VENT TO FRESH ~ ALARM FEET FROM LIN/E AIR IN ET. E YES ONO DYES E NO NEAREST DOSING CHAMBER: _ MANUFACTURER BEDDING. LIQUID CAPACJTY PUMP MODEL 1PUMP'SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED DYES ENO DYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PRUPEHTV JWELL JBUILDING (VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM I INE AIR INLET PUMP ON AND OFF) DYES ENO NEAREST-30. SOIL ABSORPTION SYSTEM. Check thesoil moistureat thedepth ofplowing un,.IIIER 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: EPTH WIDTH JLINGT~ STR PIPE SPACING COVEN INSIOE IA tt PITS DLIQUID BED/TRENCH TRENC ~ TRENCHES ~ MAtEyIAL PIT DEPTH. DIMENSIONS CiRAVFI I)FI'Tl, F I L EPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO.p R NUMBER OF PHOPERTV WELL. BUILDING. VENT TO FRESH BF Lt"'1 PIPES ABOVE COVER ELEV.INLEF ELEV END. PIPS LINE AIR INLET _ FEET FROM P? NEAREST L MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systgms to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. EVES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS I DYES ENO DYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES EYES ENO DYES ENO OYES ENO PRESSURIZEDDISTRIBUTION 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. F LFV. ELEV. DIA. ELEV. PIPES. DIA.'. ELEVATiON AND DISTRIBUTION _ HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS DYES DNO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF 1PR OPERTV I J WELL. BUILDING. FFFT FROM LINE Sketch System on R tain in county file for audit. Reverse Side. - IGN T RE - / TITLE DILHRSBD6710(R.01/82) DEPARTMENT OF APPLICATION SAF & BUILDINGS INDUST43Y, FOR SANITARY IvlsloN LABOR AND PERMIT r^, jYyn_` P.9j- B 7969 HUMAN RELATIONS (PLB 67) SON, V6 707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensi Sa or drad,xp sd/Horizo tal and vertical elevation reference points must be shown. All appropriate separating distances and physical cha eristiel ' ~ clfiegin cj ter H 63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the inner. If signed by<a ster Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction o 4~iil test r 't ust be included. Property Owner: Mailing Address: yv~~d~ cc~l.S scti 47-3 acX /69f /Uc~~IicEi 0173: Property L ation: G rlrr--V~ or Townshi : County: Al IV t/a '/aS j /T 2y N /R~ W 7A_110 Lot Number: ~Bllk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: /5 f{ t G f~})NV`~s f (If assigned) wl TYPE OF BUILDING ~P c~L 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_00 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA f (Minutes per inch): PROPOSED (Square feet): LL New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): ii Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signa e: MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: -22-2- COUNTY/DEPARTMENT 0. J/l~f~f®~✓/ USE ONLY e: Sanitary Permit Numb Signat re of Issuin Agent: ! Fee: Dat APPROVED 21/K 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 (N.03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND ~N IND-USTQY, LABOR AND PERCOLATION TESTS (115) I0"1, ON W1 jog HUMAN RELATIONS LOCATI ~ :5117 SECTION: r-- TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBD I NAME: Xxk) / / , /T2-' N/R z E (or) W 7x- OWNER'S BUYER'S NAME: MAILINGADDRESS: COUNTY: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R DESCRIPTIONS : ER LA ION TESTS: 1,4Residence New ❑Replace I RATING: S= Site suitable for system U= Site unsuitable for system IONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)~~~p ❑u $ ❑u $ ❑ $ ZU ❑ $ ©U !%~,fi~~'iit'.y,9Ggf~ aY'XS3 L If Percolation Tests are NOT required SIGN RATE:SYSTEM E I If any portion of the lot is in the under s.H63.09(5)(b), indicate: DE Floodplain, indicate Floodplain elevation: 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.) B- ~ e74~ l f ter' ~ c~.~~ ` ~ j~~ B lam' > y~ B- > f3 OZ' 07 ~':/ZVA /'nA) r PERCOLATION TESTS TEST DEPTH « TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES e~ INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- 2 c P- P- f PLAN VIEW: 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 slop. SYSTEM ELEVATION Re/,~; Ga~,or ~V C•~tli G,4 7-1~ e'rl ov 7 m _ 0 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, NAME (print):~j TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): r .y DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) V, e-" - 745%,-41f S 114e7. 641 ~ (>E~j ~PtF Pr. S-e l-- E XAC71 V o sJ 7 fdye Gt ooDS S ~~sTcct¢~Q '01"'Va PL B A" 4s 4,61,00X. Soo fT Sooy, $ twee pi. ()r and CRO 55 UE,FT. XY. pT ~D~ soic TEST) S EC71 Q N PIA N 5 fir.." s. d, 5- f7- l3e /0 W r r 1rE•,vT- r n O r r ' 1 d vJ y '1a .n v I I g LT£RNfITE" yd' X ~o r ,c'°et dYV s - ~ ~QiUf OA y rnlp S'%GNFD Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum' 12" Above Final Grade 3 ` - - 4" Cost Iron ' 30 Above Pipe Vent Pipe -ro Final Grade w. Marsh Hay Or Synthetic Covering Min. 2r' Aggregate Over Pipe k O;stribution Pipe LO ® o JZ Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At q Bottom Of System 46 VAfio ~ t A~ 130#,m