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• AS BUILT SANITARY SYSTEM REPORT
"BIER (r~~c t f,: , TOWNSHIP T 2l N, R_12 W
,0. ADDRESS ST. CROIX COUNTY, WISCONSIN.
'_'BDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r n -
,
:.?TIC TANK(S) MFGR. CONCRETE'--- STEEL
NO. of rings on cover Depth DRY WELL
'.INCHES NO. of width length . area
no. of lines width
-REGATE length ~area yf-
dept to top of pipe
:K RATE ~ c AREA REQUIRED-Y6 L' AREA AS BUILT q ~ C~
,-claimer: The inspection of this system by St. Croix County does not imply complete
,pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
:_.tem operation. However, if failure is noted the County will make every effort to
-ermine cause of failure. _
-'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECT0
DATED ' ( f
PLUMBER ON"J OB ,'~;;~t
LICENSE NUMBER
RFPOP,T OF IJ7SP_,CTI0?l--I:dDIVIllilAL .,L,•]AGE UIaPMu, S1STF11
F
S"nitary Permit
State Septic / s7 7/:
t T61411SHIP - C t
P
Grob; County
SIRPTIC Tl.'.J; -
Size gallons. `umber of Compartments
Distance 'From: `Jell.'., ; ft, 12% or greater slope £i.
Building ,Z, £t. Wetlands fy
ILigliwater ft.
DISPOSAL SYSTL:1 Tile Field or Seepage Pit(s)
Distance From: hell _
ft. 12% or greater slope - - £i.
Building ft. Wetlands f:.
FIELD 1"Jighwater ft.
Total length of lines ft. Number of lines Length of
each line ft. Distance between lines ft. Width of the
trench -ft. Total absorption area sq. ft. Depth
.of rock below tile in. np-pt-h of rock over the in. Cover
vvex.xock,, Depth of the below grade i.n. Sloe of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
Number of pits Outside diAmeter ft. Depth below inlet
ft. Gravel around pit: yes no. .Total absorption area
sq. ft.
.Square feet of seepage trench bottom area required
Square feet of seepage oit area required r.
Inspected by: Title:
Approved JD ate _ 197 ,
Rejected Date 197.
• 1
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
nd
LOCATION: NE '/4, NS '/4, Section ? , T ~N, R1? E (orrQ, Township or Municipality Hammo
Lot No. , Block No. County St. Croix
Thomas Power. Subdivision Name
Owner's Name:
Mailing Address: RR Hammond, Wis
TYPE OF OCCUPANCY: Residence x No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS Sept 12, 1978 PERCOLATION TESTS Sept. 13* 1978
SOIL MAP SHEET 2FF70 SOIL TYPE Sandiago Silt Loam
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- 1 48 6* T.S. 42" Sandy Loam 24 None 10 is is is 20
P 1 48 6" T.S. 42" Sandy Loam 24 None 10 1" 1" 10
P_ 3 48 6" T.S. 42" Sandy Loam 24 None 10 1" 10
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B_ 1 72 No 6" T.S. 66" sandy Loam
2 72 No 6" T.S. 8g" Sandy Loam
B-3 72 No 6" T.S. 66 sandy Loam
4 72 No 6" T.S. 66" sandy Loam
B-5 72" No 6" T.s. 66" sandy Loa-
6 72" No 6" T.S. 66" Sandy Loam
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. 945 sq. ft, Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) Stephen L. AABY Certification No. 1406
Address Woodville. Wise
Name of installer if known Aaby Plbg. Htg. & 9160t
CST Signature /'f"
COPY A -LOCAL AUTHOF?s i"v'
State and County State Permit #
`8 6 7 ~ Permit Application County Per i #
for Private Domestic Sewage Systems County ` .
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Thomas Powers RR 1 Hammond, Wise
B. LOCATION: NS '/4 N$ '/4, Section _ , T~2 N, R 17E (or) (W ) Lot# City _
Subdivision Name, nearest road, lake or landmark Blk# _ Village
Township Hammond
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family x Duplex No. of Bedrooms 3 No. of Persons
ID. TYPE OF APPLIANCES: Dishwasher YES Z NO Food Waste Grinder YES A NO # of Bathrooms-2
Automatic Washer Z YES NO Other (specify)
L. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks
`Holding tank capacity Total gallons No. of tanks
,Iew Installation X Addition Replacement _Prefab Concrete X
'Poured in Place Steel Other (specify) -
FLUENT DISPOSAL SYSTEM: Percolation Rate 1) 20 2) 10 3) 10 Total Absorb Area- 960 sq. ft.
'Jew Z Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
S-epage Bed: Length -40 Width 24 Depth _ Tile Depth 30 No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size 4"
Percent slope of land 4 Distance from critical slope None
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
'.visconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
W the Certified Soil Tester,
;dAME Stephen L• Aaby C.S.T. # 1406 and other information
obtained from Owner (owner/builder).
:'lumber's Signature *ftld~lze. MP/MPRSW# 5184 Phone #69~ X407
Plumber's Address ood Visa
j PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY La
Date of Application C' Fees Paid: State 'I UC County Date
A -1-4j,41
Permit Issued/Ra}ested (date) _ ~I _Issuing Agent Name
Inspection Yes No Valid# Date Recd _
1. county (whit copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink cop-) r,i_rr P~ea~ara _nn,.,~