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HomeMy WebLinkAbout008-937-19-4206-SAN-1989-006 ��ILHR SANITARY PERMIT APPLICATION �o�NTY - -� � In accord with ILHR 83.05,Wis.Adm.Code "����� �Q� __ ._�w ������6������_��� STATESANITARVPERMIT# � Ci5 -21� � -Attach complete plans(to the county copy only)fo he system,on paper not less than srnre a�q 1 0.niubsea � 8%x 11 inches in size. � S89-20023 -See reverse side for instructions for completing this application. PETITION n I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. p O�- 37-I 9-`�a o� FOR VARIANCE ❑ves tJ No PROPERTYOWNER PROPERTVLOCATION .�7'.9�/b��9C���'�/�.�G�+ L9kG �So.eif/l/G(�Ye SE'/<,S /9 T.'3�f�,N,R 9� E(or)� PR�OPE/RsT.�YOWNER'SMAILINGADDRESS LOTNUMBER BLOCKNUMBER SUBDIVISIONNAME - /rf-Y- � CITV.STATE/ ZIP CODE PHONE NUMBER CITY � NEAREST ROAD,LAKE OR LANDMARK i.e-C-y LG�CG'� �I /S �S"%3g ❑ VILLAGE:�I � - � I D N s O II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family �l OR Public(Specify): �So,�s� III. PURPOSE OF APPLICATION:(Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑New b.�Aeplacement c. ❑Replacement of d.❑Reconnection of e.❑Repair of ar System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM:(Check only one in#1 and only one in#2) 1. a. ,Conventional b.�Alternative c.❑Experimental 2. a. �System- b.❑ Holding c.❑ Pit Privy d.0 Vault Privy e.❑ Mound f,�IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b.❑See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSOFPTION AAEA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6.WATER SUPPLY: (Minutes per inch): REQU RED(Square Feet): PROPOSED(Square Feet): p / �{' � ���� ���� /C�i �C� Fee� ❑Private ❑Joint k:]IPublic VI. TANK CAPAGTY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic APP Tanks Tanks structed Se ticTankorHoldin Tank �� � �J! A � � � � Lif�Pum Tank/Si hon Chamber 2,�J� / �„5/��L(,I � � � � � VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Prin[�: Plumb r' ignature:(N Stamps) �p PRSW No.: Business Phone Number r�J��li G Co�t� �/� � �'/s �3 - S Plumber's Address(Sireet,City,State.Zip C e): ' ' Name of Designer ��'�.�a /O�r C:.��o 7c./C�is,.S"t���-�--� ���.LGJ�cs l.�,..c� VIII. SOIL TEST INFORMATION Ce�rti ied Soil Tester(CST)Name CST jj G--ye-c,. �r_�'�'��'�e°�.r� /iZ� CST's ADDRESS(Sireel,City,State,Zip Code) G Phone Number: �����' ��-C ��.�', /�G P�.fz.E!G �i 5 J�Y�O G � IX. COUNTY/DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee Groundwater Date Iss - Agent SignaNre(No Stamps) �Approved ❑Owner Given Initial Surcharge Fee AdverseDetermination $145.00 $25.00 3-16-89 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(brmerly Plb-67)(R.03/86) DISTRIBUTION:Original to Gounty,One Copy To:Bureau of Plumbing,Owner,Plumber 3�,5�a }' r?arUi;�11ATiC,� ;w : - '�}.;; rt�;,lv r 'r �;;JnrtFLETPN.�'.y A � : , !, ,� �'tri�r' �; ,� APPLICATION � , �.�_ � TO THE APPLICANT: L This sanitary permit is valid for two (2) years: `s.2. Your sanitary permit may be.�enewed before tne expiration date, and at the time of renewal any new � criteria in the Wisconsin Administrative Code will be applicable; � 3. l�IY revisions to.this peimR must�be approvQTby the�p�rrr�it issuing authorify:�A:new permitmay be needed , ��� _ if there is a change in your building plans, system location. estimatAd wastewater flow (number of bed- � rooms, etc.), depth of system, or type of system; � - _ � 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Aenewal Form (SBD 6399) to be . _submitfeci to the county prior to installation; ,�,�^ _ - - � � ��-- - - - � � 5:�- Private sewage systems must be p�operly�maintainea'1he septis tank(s) should be pumped by a licensed pumper whenever necessay, usually every 2 to 3 years; � - �� � � � � � - 6. If you have qyestions c�nceming your private sewage system, contact�your local code administrator or the - State of Wisconsin,�Bureau of Plumbing, 608-26638t5; - _ -, � _ �- . . a To be complete and accurate this sanitary permit application must inctude: . `,� L �Prcpeiiy owner's name and mailing address. Provide the legal description where the syste�ih is to be .� installed; II:� Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill irt number of bedrooms if building is a one or two family dwelling: IIL Purpose ot application� Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or - repair; � - - V Type of system: check all appropriate boxes depending on sysEemtype. Check experimental only if project is in conjunction with University of Wisconsin; v . . V Absorption system information: Provide all information requested in #1-6; �� `11 Tank inform�tip n: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tafiRs and mawfacturer's name. Indicate prefab or site constructed and tank maTerial. Complete . for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval onty if tanks received experimental product approval from DILHR�, - � � � �ill Responsibility statemenY. Installing plumber is to fill in name, license number with appropriate prefix (e.g: , MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if � applicable; � VIII. Soil test information: Certified soil tester's name, cerificatipn number, address, and`�one number. __ IX. County/Department Use Only;-� � X. Comment area for use by county or resaon given whan application is.disapproved. . Complete plans and specitications not smaller than SYz x 11 inches must be submitted tothe county. The plans must include the Tollowing: A) plot plan, drawn to scale or with complete dimensions, location ot holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water m�ins/water service; � streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horimntal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation ditterences; friction loss;�pump performance curve; pump model and p�mp manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as�the groundwater protection-law. This change in statutes was the ' . �.'��.?�\' � result of over 2 years of steady negotiation and pubtic debate. The grounCwater bill Ground ater — �-� inciuded the creation of surcharges (fees) for a number of regulated practices which Wisco tn's can effect groundwater. The_surcharge took effect on July 1, 1984. All of the water that buried reasure i�`` .� , �is used jn your>tiuildi���s.re�tumed to the groundwater through your soil absorption , ,,. %' s�stem or the'disposafsite used by your holding tank pumper. � ��� � C� �- The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- j water, groundwater contamination investigations and establishment of standards. Groundwater. ��!� iYs worth protecting. SBD-6398(R.03/86) 1� _ , 6�t�.�'/fs'�.�v�'s ,�',.��: >/L�,�� ��so�� � : - ��/ , ��, �;r.c��.�oa�l� .5..5 � .�/GeJ�Y SF'%y Se�/9 r.37 N.�y ac� . �avn/,SS�_ Ed j`�'-�/a f�,�'� -- S.s'u j'e� Go. �tLc�i �.v/G'Fi '� � i G �'n WJ NA �� �A�' � � �� A y C � �� � � r I� z �ai AZ ' / N � Q ?� i ,! � z � � / �s� � � `� ' =o � n F _DU � c o � � ; � � � �- - �__ __ _ __ ___ o -�_____ � // N � � V / r''i J� � � � �.�- ' � a ' � ��� �. �;������ / � I �. � �/ �� j � Y ��-�` � -�_ �/l�� -.�__ � j� a �'-��u' `��I� _-_ �.���,� � _�. ! SPECIFICATIONS BARIBEAU'S BIRCH LAKE RESORT IN-GROUND PRESSURE SYSTEM TOWNSHIP OF EDGEWATER SAWYER COUNTY, WISCONSIN \'°��4V�',5�,��;S�j���'` r `� . �.. . ,�• �' : : • . ?{� ROB T A. % SE ON ��/ '56 . �j . RI E AKE, •�{C',�� � '. WIS..��,y .1-\ i � �� ��`` `� � i����OH/AG,,,`� a PREPARED BY: RICE LAKE ENGINEERING COMPANY FIFTEEN EAST EAU CLAIRE STREET RICE LAKE. WISCONSIN �s�5-�El� ��yPG S o��`� �� �� .���Q� �,P�a P�`�j\4N A��J�,1GS �����,eu�og���.o oF\Np Jo��EEr pN D�QpP�ENO\V\S�pN oNo�N�E � � OQ��gP 5 SEPTIC TANKS AND DRAIN FIELD ---------------------------- PART I - GENERAL ---------------- 1 . 1 General Reguirements_ Work under this section shall include sanitar�. and forcemain piping , sep[ ic tanks , dis[ribu[ ion boxes , and seepage beds . Comply with Chapter ILHR 83 of the k'isconsin Administrative Code . The location of the septic and other treatment tanks shall not be located wi [hin 5 feet of any building or its appendage , water service , 2 feet of any lot line , 10 feet of any cistern , 15 feet of any pool , 25 fee[ of any well , reservoir or high water mark of any lake , s [ream , pond or flowage , wi[hin the in[erior foundation walls of a building nor shall a neM� building or addition to an exis [ ing building be constructed or located over or wi [h- in 5 fee[ of a [ank . . PART II - PRODUCT SEPTIC 2500 Gallon Tank SKAW PRECAST , NEW AUBURN , WISCONSIN � PUMPING : z500 Gallon Tank 2_1__Septic_Tanks ,_and O[her Trea[ment Tanks . Septic tanks shall be fabri- ----------------------- cated or constructed of welded s[eel , monolithic concrete , fiberglass or o[her materials approved by the department . All [anks shall be watertigh[ and fabricated so as to cons[ itute an individual structure . The design of prefabricated sep[ ic tanks shall be approved by the depar[men[ . Plans for site-constructed concrete tanks shall be approved by the depar[ment prior to construc [ ion . 2 . 2 Desi n of Se tic Tanks . ---------�-------P--------- See ILHR 83 . 15 Para 2 ( a-i ) . 2 . 3 Bed & Trench Construction . The excavation and construction require- men[s for pressure dis[ribution system trenches and beds shall meet the requirements specified in s . ILHk 83 . 13 ( 1 ) , ( 2 ) , ( 4 ) , ( 5 ) , & ( 8 ) . 2 . 4 _A��re�ate_and Backfill . A minimum of 6 inches of aggregate ranging in size from � inch to 2z inches shall be laid into the [rench or bed below the dis [ ribution pipe elevation . The aggregate shall be evenly dis[ribu[ed a minimum of 2 inches over [he top of the distribution pipe . The aggregate shall be covered wi[h synthetic materials approved by the depar[men[ or wi[h 9 inches of uncompac[ed marsh hay or straw . Building paper shall no[ be used [o cover [he aggrega[e . A minimum of 18 inches of soil backfill shall be provided above [he covering . 2 . 5 Pipe_=_General_ The pipe furnished for this work shall conform [o size shown . All pipe shall be laid to line and grades indica[ed on drawing . Pipe shall be new . free from flaws and defects and shall conform to appro- priate ASTM or Commercial Standard Specifica[ ions . Forcemains shall be PVC forcemain of cast iron pipe . Sanitary sewer , distribu[ ion pipe and per- forated pipe shall be PVC sewer pipe , ABS soilid wall pipe , cast iron soil pipe , or non-reinforced concrete pipe . 2 . 6 PVC Sewer Pipe . Pipe material shali conform to requirements oE ASTM D3034 , Type PSM SDR-42 , or approved equal . A solvent cemen[ed bell and spigo[ type joint shall be utilized such [ha [ when join[ed in acordance wi[h the manufacturer ' s recommendations , a water-[ ight joint will be ob[ained . Pipe shall be ins[alled in accordance wit:i ASTM D2321 , underground installa[ ion of flexible thermplastic sewer pipe or the manufac[urer ' s recommenda[ ions , whichever is more res [ric[ ive . � 2 . 7 A8S Solid Wall_ Pi�e shall meet the requirements of ASTM D1788 and D1527 , Type 1 Grade 2 , Schedule 40 or ASTM D2751 , SDR 35 . Pipe shall be installed in accordance with ASTM D2321 , underground installation of flexible thermpolastic sewer pipe or the manufacturer ' s recommendations whichever is more res [ rictive . 2 . S Cast Iron Soil_ Pipe shall be service weight conforming [o C5188 --------------------- and of lengths by ASTM A-74 . Join[s shall be neoprene gaske[ [ype or caulked lead , as designated . Lead joints shall be caulked with Oakum and Type 1 lead conform�ng to Fed . Spec . QQ-L-156 . If neoprene gaskets are used as the jointing ma[erial a sui [able jointing device to [ool shall be used to push , draw and drive [he spigot through the gaske[ until seated firmly in the bell . PART III - EXECUTION -------------------- 3 . 1 Installation of Tanks and Drain Field . In accordance with the ------------------------------------------- Depar[men[ of -H-ea�tth and �tc2s recommenda[ ion N 83 . 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AMERICA'S BEST CHOICE Wet Pit Dry Pif - Applicafions Installaiion " "Dual Rail" If your specification calls for a dry "Pultruded Rail (PR) $ Sf@Ri pit application, Hydromatic pumps are System y an excellent choice. Because our oil- Hydromatic single rail lift stations The Hydromatic Duat Rail System filled motors have Class F insulation are ready for installation in concrete utilizies two guide rails placed on on the windings and overload heat sumps. These systems use a single, centeriine with the pump unit itself so sensors, many of our submersibles are non-corrosive FRP pultruded guide rail. that when the pump is raised or capable of running dry without damage Here's how it works:The I-beam lowered, the guide rails (2" galvanized for installation in a dry pit pumping shaped rail attaches to the aluminum or stainless steel pipe), serve only as a station. frame in the cover and to the discharge guide without any binding. The guide- In many cases, water jackets or elbow located in the sump bottom. No rails are held by the baseplate/ other special cooling systems are not base plate or carrier is required. A wire- discharge elbow assembly which sets required. And, because the pumps a�e form stainless steel guide connector squarely on the bottom assuring submersible, flooding is never a attached to the pump discharge flange perfect alignment and a smooth flat concern.The Hydromatic top pullout guides the pump along the rail as it is surface on which the pump rests. design allows for easy inspection of lowered or raised in the tank. When the Because the pump discharge flange the rotating assembly-motor, shaft, pump reaches the bottom of the rail, and the baseplateldischarge elbow bearings, seals and impeiler. There is rods cast into the hydraulic sealing flange don't actually make contact, no need to disturb the volute, suction , flange contact stainiess steel arms preventing the possibility of unwanted or discharge piping. flanking the discharge elbow.The connection through corrosion, the downward sliding action of the rods sealing of the two flange faces is System helps clean the arms of sewage debris accomplished by the proven � �nd aligns the proven and patented Hydromatic hydraulic sealing Components ,�ydromatic sealing flange with the diaphragm. The same hydraulic sealing discharge elbow flange. A small, diaphragm system that's used on the Hydromatic is your singie source crescent-shaped peg on the bottom of. pultruded rail system. choice for complete lift stations, the elbow flange matches a Refer to typical installation drawing including the pumps, components, and corresponding groove on the bottom of 8510. controls. All components are avaifable the hydraulic sealing pump flange to Available with pump models: S4F, for installation in a concrete basin, insure a flat, vertical connection and S4NX, S4MX, S4LX, S4NVX, S4MVX, including our newly-designed door and spaces the two sealing faces apa�t to S4LVX, S6L, S6LX, S8L, S8LX, S12L and frame assemblies. prevent rustlocking. S12LX. Aluminum frame and door with When the pump is running, flow aluminum tread plate and stainless pressure seals the diaphragm tightly � steel hinges and hardware is offered in against the face of the discharge elbow load ratings of 150 psf and 300 psf. A flange. When the pump shuts off, the -�` standard size of 24"x 33" may be pressure drop eases the connection, �` installed on concrete basins for ermittin the pump to be lifted with ,�.:� simplex,duplex,or triplex pump p g stations.Simply install side by side, no need to enter the wet well to part metal-to-metal seals. one per pump. Refer to typical installation drawing 13004-000-1. Available with pump models: S4MN, ; ; S4M, S4L,S4NX, S4MX, S4LX, S4HRC, _ 't S4NRC, S4MRC, S4LRC, S4HVX, S4NVX,S4MVX and S4LVX. ~��S , � r" � '��:�"� i i + �� C � � r � • • ' FEATURES THAT HAVE MADE � HYDROMATIC A LEADER . � IN THE PUMP INDUSTRY FOR YEARS Hydromatic non-clog Their oil-filled ball bearing and sensor cords sealed provide positive impeller - submersible sewage pumps motors dissipate heat seven into the cap with epoxy to drive and permit easy include both enclosed and times faster than air-filled prevent water entry. Motor removal for field service, if recessed impeller designs for motors, so they run cooler leads are staggered in a required. Shafts are of flexibility in sewage handling with better lubrication and are second epoxy-potted area large diameter and application. Their cast iron easily serviced. Several to halt wicking. Additional minimum overhang to impellers are designed to models are capable of running chamber between seals reduce shaft deflection and handle 3-inch spherical solids dry without damage or the provides extra sealing prolong bearing and seal or larger with minimum need of water jackets for security. life. • vibration and noise and may installation in dry pit lift 2. Two rows of heavy duty 5. Dual mechanicai, oil- be easily trimmed to meet stations. Consult ball bearings rigidly lubricated shaft seals. exact operating conditions. manufacturer for proper support shaft and motor Carbon and ceramic f�ced Their oil-filled ball bearing selection. rotor for reduced vibration seals mount in tandem to motors dissipate heat seven A complete range of and wear and to absorb double-protect the motor. explosion-proof models, tested thrust and radial loads. Seal sensor electrode and third-party approved in 3. Oil-filled motors provide provides early, positive V � � the U.S. for hazardous sump long life and quiet detection of water in seal locations, are available. These operation through full chamber. Dual probes- � �- designs incorporate increased pumping range. Pure supplied on explosion- �� ` �,. uniform wall thickness and dielectric insulating oil proofed designs. �� \ � �t" flame paths, flame-proof joints lubricates motor and 6. Efficient two-vane enclosed ��_ and extra heavy duty power bearings, effectively impeller with pumpout � '-^�?/„ and control cords, in addition dissipating heat. Heat vanes prevents buildup of r�� �" �. � to the features listed below: sensors detect abnormal stringy materials and grit in ��`�� ��,�'�; ♦l�� 1. Double insulated and heat buildup in the stator seal and wear ring areas. compression fitted power to prevent pump from Bronze wear rings are � � �+ ��-��e continuous operation at easily field-replaced. - ,s!�\�'``�,� �� high temperatures. 7. O-ring sealing of joints on � ;-^� 4. Tapered and keyed 303 a beveled edge adds to �r'' �l rr� ;�� `y�,�' stainless steel shafts serviceability. 1'L7�� £� �e� ;�� .�I � �. � � I '� `.� �� �� , � " Q ! :�: ,� ,'�`,` �� ; .ti.� G , �r � � ��� �. � ; ; , - �� _ . � { -- , T - � � ��� - � �-� ,� � . � ��3 � O ,`�.�i� i _ '�? �...�i _ - :� .z- �a�::K'.n:::. "w::.:k;.�'a.+` J I �_ , � ��r. _ . . . � f • � � � Recessed Impellers �,.�''""'�.�„�. Recessed impeller pumps under high head/low flow �'�� 1�=`._. _ are the answer to high headl circumstances. ��` ��,� � '� � � low flow waste handling The recessed impeller I situations, which require large creates a liquid vortex in the � �-��� -- ��' � ��, solids-handling capability. volute which directs sewage • ;� They are capable of and stringy materials through � ;� continuous operation without the pump. Since the 8 impeller �-- - - ------=� damage, have a low noise vanes are out of the main flow( ; level at any point on the of sewage, stringy, fibrous � ';..-_.--"` — - operating curve, and are not material that sometimes binds subject to radial load the vanes or works up into the f � problems commonly seal area is eliminated �— ----- -- —'_..__ ?oc�,^;c.,c.� �, I.E _.� itlr)r . IV�,- � .r. �cl-�.� rl0^°. Controls and Options � Mercury Tube Switches (3900 floats) Alarms � t�� `" ( - -� Hvoa o mc�r�c H'.'OR p 1}�TK 'l i� '9 *��, f. ��..' .l.e�&,r " !kenr;�.. � Polycarbonate Polycarbonate Mercury tube switches (3900 floats) activate the Alarm Light & Bell Alarm Light pumps and alarms. Float switches are sealed in waterproof, shockproof, solid polyurethane shelis HYDROMATIC offers NEMA 3R panel mounted integral which protect them from the corrosive effects of alarm lights as well as a targe variety of separa!e sewage and most chemicals. alarm panels in weatherproof enclosures. Select from 3900 controls can be supplied with normaliy open or flashing light, bell, horn or a combination of warning normally closed contacts for pump up applications signal devices. These alarms can be used to monitor such as filling surface or elevated tanks. such conditions as high water, seal failure and overrid� Power cord is 2-conductor#16 flexible cord type on duplex systems. Typical features provided are alarm SJO oilproof, 300-Volt. Weighted cords prevent the test push buttons on light alarms and bell or horn floats from hanging up on rails, ladders and other silencing push buttons on audible alarms. � obstructions under turbulent wet well conditions, thus decreasing the possibility of nuisance tripping or con- tactor failure due to chattering. See bulletin 710.1 for more details. VLC SwitCh VLS-II � Mechanical Alternator and Stand NEMA 1 electromechanical �-� � I switching device permits servicing without having to open up a control panel. Includes mounting flange and pipe support, 7-inch float, built-in alternator. Five-foot stainless steel rod resists corrosion. � VLC (Variable Level Control) Switch'. NEMA 6 rated enclosure with circuitry fully encapsulated in hard epoxy. System includes (2) 8300 floats, one piggyback plug on 8 feet of cord and encapsulated circuit. This control will service all manual single phase, 115-Volt pumps with a maximum of 12 full load amps. See bulletin 710.2 for more details. VLS•Il/lll" NEMA 4 electromechanical controls operate in a minimum of space with a high degree of durability. NOTE: HYDROMATIC standard control panels are Two 8300 floats set at appropriate levels in sump start designed to cover the requirements of most and stop the pump. For use primarily with simplex waste water pumping systems.The addition of pump systems in the HYDROMATIC SP and SK series some of the available HYDROMATIC options such up to a maximum of 12 AMPS on the VLS-II and 18 as integrally mounted high water alarm lights, AMPS on the VLS-III. Available for 115V and 230V. � elapsed time meters, dead front cover, etc. may require a specially engineered panel. 'Apply downstream from fuse or circuit breaker protection. 6 �EPARTMENT OF . . � . REPOR� ON �OIL BORINGS AND SAF,ETY & BUILDIN(�t: NDUSTRY, c , ' DIVI:'fON _ABOR AND PERCOLATION TESTS (11J) MADISON WI 53707 -IUMAN RtLATtONS (ILHR 83.0911) & Chapter 145) � LOCATION: SECTION: TOWNSH /MUNICIPALITY �� LOT NO.:BLK NO.: SUBDIVISION NAME: N ul �/ 5 � �/ /T37 N/R `f E co �d uJ �- S��r N COUNTY: � MAIL NG ADDRESS: � �D �i�� v���.(,4 w � �� hc �-Ke sa � ' us ir� r SD� . 1SE DATES OBSERVATIONS MADE NO.BEDRMS.: COP,AMER IAL DESCRIPTION: � � R ER A I ESTS: ❑Residence // �Res o ►�TCA.��I n/ �NeW eplace �6'_��_ �- �(j_ �9 - �`2�' —� 3ATING: S=Site suitable for system U=Site unsuitable for system �ONVENTIONAL: MOUND: tN-GROUNaPRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:loptional) s au �s ❑u �s ou ❑s u as �u � ��-- a If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the - � Floodplain, indicate Floodplain elevation: �� I under s. ILHR 83.0915)Ib),indicate: � � PRurILE DESCRIFT��hS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPrH IN, ELEVATION OBSERVED E . HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 1yl oTi , 1�A�4 N f l° ' �� � 7-S ' r'� 1�1 , ' B- f� 7�� j �� � O f1t �r r,.1°7; � 0��4N e m m �' l�'' To �� ,� B- � � c � - r ;�•' � � 7� � '' � g- .� p -l - ��- �e �' '' � 7� '` c , c B- �-1 �� � .. ;- 2�--•�-- B- 95! �i ,-. -�-�.�. > 7 � '' 8 c � �B- PERCOLATION TESTS TEST DEPTH . WATER IN HOLE TEST TIME DRO IN WATER L V L•INCHES RApER I'NCH ES NUMBER INCHES AFTERSWELLING INTERVA�-MIN. P RioD i P R� 2 P R p ,1. •.1,� n p. ''.� �,.+T• �C' P_ � -,.. � .,.�1 � _ — � O_ P- P- ?LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are [he ho: zontal and vertical elevatio� reference points and show their location on the piot plan. Show the surface elevation at all borings and the direction and perce� of land slope. - — '- — — SYSTEM ELEVATION .�� �— � '� __. - -----� �--� � T ; - �- � � , , �---� �-- , �-__�� ��--�� � �---�- ; ---- --� I [�I T-1 I � � � :_. _ � _ . _ , � --- � ; . r__ _ ; ___�-_�- , _; , ,-_�- ,__�_�_� �---�--- - - --�----fi--;-- � -- . , -- ' _. ' .__� '! _ � � � , i � � � � f � � - r- _ ,____ . �_ i ._-, __�-__�� --f--- i---1----}_.__._ ��'— _� f- � • ---i---- - -f-, . ..__.i_. ...�._. ' ..... ' . � � � ( � __I ' ; � ��" C?; �� � J�r��- ,-�---�(��--�- -� -�--I �- �-t � � . � -- c i I � � �-_ ; t � _ 'I i � t ' t I t__�__L_ � , , � i � � , � ' � - - - - --- -- - - ; ! � - -- ----1 --�— --, - ---�-- -- -?_ ,. _ T. , _. -�- ' ' ' r i i i � � � , � � ` � i � ' � � � ' � - -- - �--- - ' � - -- ; --�---- � � -- --r �__ _ I , 1� , � r- � � ; .__ _.. _ _--<-- --�__,---� t ; � � ; ' �� ' , -�-__ � � _._�_ ' �' ' ' � ' @ ' . --�--� , � ; " i � � � ` � _ --� , _-_ - r-- -}--- --- --- _--j --�--,- � � � �- � { �i _ f_ �-�- -t-- t � __. _� � .�_- ; � � � � 1 � � -- � � �._ � � ��-- � � - - — �1 --�- ' , _..._._, - �---- r_. - - �_._ i 1—..r_1 -�----r--1- i T--�-- � r__I I --} � �, -- � ; -4-- ---.'; ' --�- � � i � �____:.__�; ` !__-1---4---_� _r---;._� � � - �---�-,--- � � ; -- , -- —�---� ---�__ � � . � --T--- i i � � � i � i i � ---i- , � , _ - , = � .- ---- —� -- . � _. . _ _ r � • - _ ,_..._ �-- 1 �, � � ; , , � , - i � � ; i , � , , , , � -_�-- � - - -- __ . �� ��. , , . _ _ , � . _ - , . __..___ --- - _ . � � �. � 1 _�__._,-__ : �-- � ;— -- . -__._ _ __ , , , , , —; , _ . , � � L _ r- ` .1 � ; � ; ` ' ' _ . � ' ..�___ ._. . ; , ( ; ' _. � :_ ._._ . _ . ;_. -;---- -- —r---1- � _ , __.. . _ ._ ;- —. .._..�. _ _ ... .,._. ..l i i-- , � ' i . '� , , t � � ._—.�—_�- i I � , , , � � � ! � �_ �! � � — -i--- --� --�— � ' � —;--� � __--- ! , _ _., _ _ , _ _._}_---t-- — -r----�----' - ---f- ,�—t" � I T i � , -T--; � , , T� � � i � ; � i �� � I � i � � j , C � � _ _ __� I i � � ' '' ... __ ( j � �_- � i �_ _ _�__-.•--- +-- +--- r-_._. � � r___ — -'--- � t I � I ' �' ,f-- _ 1_ l_' _�l � '� _ . _._�_ -1-- � i ..i � � __., _�__ �.._ �._ 1_. _1. _ �_ _�_ _.��__ � �.__�__1__ 1__ 1 _ ,__-- , 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 Wiscon,: Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowtedge and belief. TESTS WERE COMPLETED ON: NAME (printl: � I / O _ � q � P � / J r t � 4 Gco h � "�{" � �r � '• � C +� -- - CERTIFICATION NUMBER PHONE NUMBER(option� ADORESS: C ..,.-. �" ! �� / i � � ��l C S ! 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