Loading...
HomeMy WebLinkAbout020-1024-80-110 v o a ~ d o c a) ° N ~ y a vi b s ti crow' ~ I I v O V N 4a1 ~ I ~ 3 c t I o, oo~~ I A Z 75 n o r ~ CL N t a C O N m N o y ~ o a L E Fr CD Q) p « U U o z y y c O 'D C C. 'X LL o'E~cc-o~ I 3 " ~ ~ C_ N N u)i a) E - t I 3 M 3: c Z~ r o z 'a 04 ' w IL ° z I O zv' c a~i Z ° v _ N O) C ~ N f0 d v c L_ C -0 -19 Z ) a O ~ d N m E Y a. C _ a R b co H a C O a o Z~>I~3U) co E a ~3 hw 000 `''+J ~ ~aaa I IL ~ I ~ I ) J U w rn rn Q C M N O 0 0 ~ ~ m Q Q, 0 QZ in I (D CD U) cc CD m IV FN CD C OP o F w o. N r m jo E o of N c Ht H N O N Lo j o YO E ~ I e~ r/~ 'm E a ~#6 a ~a r`1V ° v 't c r A 0 a~ 0 viCi 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERSp-/I" l~I /Z _F!1 ADDRESS,RQx'IlZg 7 SUBDIVISION CSM 7 Z / i LOT SECTION To1~ N-R Town of ffyOSO JV ST. CROIX COUNTY, WISCONSIN PLAN VIEW I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q,rn1 1"Z.P, EI:fDooz WEST col L/tiE I SALE l 55 ' S/0PE ) aL F/Z ►4~1 f A yo -Z - NOTE', I 'C,T '("o a E ,m AD E ALTER AJOE ' d To (PA I N r" "k'r / R S A W loT H R1 Q~~r~ars ►zs~ ~ o y ~ v V 13 I Z 1-{0~ sf $)OTf. AS of 7-z 3 9s W E LL L,rU, A/oT y6T yNS7f1LCE4 ~f} f a~><s2 3S INDICATE NORTH A ROW Provide setback and elevation information on reverse of this orm. Provide 2 dimensions to center of septic tank manhole cov r. i BENCHMARK: 7o 70 n,-- / P1 PE 7- GcJ <oeni~ E/_ S , 3~L ~ /eo, one ALTERNATE BM: Io fl cF JS' /6C k ~OvN~AT/oN F/ - 3 yo - /02_,0 'L SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W E / 5 E2 Liquid capacity: 1000 A ~ L, Setback from: Well -_House 7 Other ~o ' To 5 ' Co/'it/m,. l1F Pump: Manufacturer Model Size Float seperation _ Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width : Length Number of trenches Distance & Direction to nearest prop, liners' y-o W Setback from: well: ly?- House /ZS Other 30 •ro ELEVATIONS Building Sewer ST Inlet. ST outlet 22' 9~,Zo PC inlet PC bottom Pump Off ~ Header/Manifold 9'9r_ 9S.y7' Bottom of system Existing Grade 9 2 g ~ TcD'- ' Final grade Co.~ 9~, 9 Z DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LaborahdHuman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268531 Permit Holder's Name: ❑ City ❑ Village 20 Town o : State Plan ID No.: MILLER, SAM E. HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /Gv, co icd-cC.,~lti. Z -~d-/l t7 TANK INFORMATION ELEVATION DATA ~~a3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q ; ~,vte Benchmark eD Do rig ~14 4 . r3,4ti`I. Ko 1a~,42~ Aeration Bldg. Sewer ~ Holding St Inlet p 1/ g6.51 TA 4K SETBACK INFORMATION St/fit Outlet g Zz, 96,-ZTANK TO P/ L WELL BLDG. Air Ito ROAD Dt Inlet rntake Septic ~7' NA Dt Bottom Dosing NA Header/i. Aeration NA Dist. Pipe 9, pS 4~ H o I g Bot. System 16, S7 9 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Friction Ft Loss ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Tr riches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ DIMENSIONS ACHI) urer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE%~~~( INFORMATION Type 0 /leu v r CH BER Mode Num er: System: 5`- /(c, /a~5 /542( A- OR UNIT DISTRIBUTION SYSTEM Header 1$.. Distribution Pipe(s) x Hole Size x Ho pacing Vent To Air take Length ~ Dia. Length Z7 Dia. Spacing Co SOIL COVER x Pressure Systems Only xx Mound Or At-Gr Sys Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded c ed Bed /Trench Center Bed/ Trench Edges J~~~ JT • Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.15.29.19W, NE, NE, MCCUTCHEO '1~ ~11e4 aqz( i Plan revision required? ❑ Yes [I~ Use other side for additional information. / J < / SBD-6710 (R 05/91) Date Inspector's Signature WCertl.`No.1~1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ; SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County - 5-L than 8 112 x 11 inches in size. • ~f'w( 0 See reverse side for instructions for completing this application State Sanitary Permit Number a&P:531 The information you provide may be used by other government agency programs ❑ Check if revision to previous application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ~ 5/f m / LLB N61 IWf 1/4, S / S- T Z 9 , N, R /9 E (or~".%' Property Owner's Mailing Address Lot Number Block Number 8c) 2 8 Z __j I C% State Zip Code Phone Number Subdivision Name or CSM Number E] City Villa TNearest Road II. TYPE OF BUILDING: (check one) E] State Owned Public Eff 1 or 2 Family Dwelling - No. of bedrooms Town OF Ulf J Q~ rC U7~0 iY III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 0Z.0 - /0 Z4-/- SJO -//o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 1al New 2_ ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-ln-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ysb to qJ 7 Z O • '7 C gS,7S Feet 97. 40 Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank x W E I C E4_ 19 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 6 /r Plumber's Address (Street, City, State, Zip Code): o 14 0,V TFoe- 1o6E J-/uAsoN W I IX. COUNTY / DEPARTMENT USE ONLY /C.,~ 7 4f_ ❑ Disapproved W/ tary Permit Fee (includes Gr undwater ate ssue Issuing Ag t Signa re (No S pproved ❑ Surcharge Fee) Owner Given Initial ,~1 -7q/~~i Adverse Determination lJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. 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. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems;. replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. /~/I C U TC N,EO.V ,eo.9,b 5oJ7N 4,57liiv6 aSJc7 Y I V 3 ~ 3 oo_ f ~ N p Z th p A D~ m A '1 01 D ~ ~ \ b W O U , a ~ z m W Q4 A 0 b tz*~ nl ~ I~ C N Z G ~u 0 I ~ ~ r o 0 (IV 0 0 i i 4-3 z ~ r o ~ m j z I I I to E; j l I 6'' I ,f I U I b I t I m I fi~ m l I I I ~ CA I c, I rn I W O I I I ~ ~ n I I ~ I I ~ 0 l I I ~'1 ~ 01 t I j n j --gyp 1 I I 6\ j I I rn I W w -n 1 I I ~ I j z W u I O W I~ Z ce I C'1 I m U z 'Ai Q n O R° x p "p+e C~ 0 OS x Fri n 7C -4 V = z 0 O -i z -u b T m p '0 - O C !*1 A. z m o W q- J9 DEPARTMENT 'rI4'y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS If;IDUSUSTRY DIVISION LABOR AND PERCOLATION TESTS (115) P.O, BOX 7769 HUMAN RELATIONS 1 1 MADISON, WI 5:1707 (ILHR 83.09(1) & Ghapter 145) LOCATION: SECTION:<~ p TOWN;iHIP%NFk3AttetPACtTY: OT NO.:BLK- NO.: SUBDIVISION NAME: :NL '/4 NF_ '/4 /I L9 NCR/9 E (o w IL ~~C)rj C IS COUNTY: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COM919RCIAL DESCRIPTION: I Z`RIP COLATION EST7 lg,Residence N WNew y `L 9J 7 . RATING: S= Site suitable for system U= Site unsuitable for system t~.~ N, l i CONVE~c`NTION'AIIL: MOU ~`D: [IN-GROUND-PRESSURE: ISYSTEM-IN-Fl !LL HOLDING TANK: RECOMMENDED SYSTEM:(o tional) ~J ~VS OU cc ~J ❑U OJ ❑U ❑J~ C.,r,llr,i r=t r P.v If Percolation Tests are NOT required DESIGN RATE: 1 under s. ILHR $3.09(5)(b), indicate: If any portion of the tested area is in the - L L = Floodplain, indicate Floodplain-elevation: N Q I PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPT NUMBER DEPTHtW ELEVATION OBSERVED E HEST__';TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 1 1-7 ~O,.+IL >9-7 /6 6C1_7S ,8 34 1? ti`,,~.r%:krJC !`~S 0 N >s r' CS f C,Vz 4 P 6 q •9z I,~Z I~1C .9 y6?Q':~ B- PERCOLATION TESTS t' TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 1 D r1 t~:' 99.0 3 >-Z > P- "-6's r 0 r'l x 9 3 > Z > 2 < P- P. P- LOT PLAN: Show locations of percol tion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe whit are the hcri tontal and vertical elevation reference ints and Show their location on the plot plan. Show the surface elevation at all borings and the direction and percent :)f iand slope. SYSTEM ELEVATION. t z ; DL T6 14 o~ \ 1 n ~NCS1MAti.c 1 t~'OIJ 215 f1r ~Yi C~.SS Ti~AN ~ /0 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER 5,11 MAILING ADDRESS Se~- z 7L PROPERTY ADDRESS ~9D M CL) T C H t N (location of septic system) Please obtain from the Planning Dept. CITY/STATE ffL.) o t-( Lo L S yv% PROPERTY LOCATIONS 1/4, /E 1/4, Section S T' 9 N-R) 1 V TOWN OF J9 0 D d N ST. CROIX COUNTY, WI SUBDIVISION L r LOT N M13ER I CERTIFIED SURVEY MAP 7?, VOLUME 8 , PAGI°~, LOT NUMBER I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. U«le, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. i f SIGNLD:~ DA fG 7 St. Croix County Zoning Office Government Ccntcr 1101 Cannichael Goad Hudson. A1'I 5),1016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property _ S11 op/ 17,1 ,le ~ Location of property A/C 1/4 NE 1/4, Section /S'- , T_?I_N-R Township 14 u 0 Sa A/ Mailing address s'o y T, 2- H D S C Al ~4J / S ~/4 l& Address of site_6?o U 7`c/7`Ec~ ,c/ Subdivision name C Lot no. Other homes on property? Yes )e' No Previous owner of property Total size of property t-.'7 Z~ /4c Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 113 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 o fice of the County Register of Deeds as Document No. S , and that I (we) presently own the proposed site for he sewage disposal system or I (we) obtained an easement, to run 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. 3 3 r ature f Applicant Co-Applicant 7" /,V✓ 9;:~ Date of Signature Date of Signature vF ^ 4629'7'7 4 CERTIFIED SURVEY MAP Located in the NE 1 /4 of the NE 1 /4 of Section 15, T29N, R 19W, Town of Hudson, St. Croix County, Wisconsin. Owned by: Greg Corcoran East line of the NEl/4 of Section; 15. 690 McCutcheon Rd. Hudson, Wi. 54016 NE Corner S 1°02'29"W E1/4 Corner Section 15 3 Sect 1311.69' ~p 1311.69' T29N, R 19W UNPLAL EI LANDS 0 a) N s S 00'57'21"W 56.18' z M I I w of F1~-F,`~ ' >r. '6 z 628.27' I F-1 QI . 2 I JI JI C~ p 5150' lL ® _T 1 I ( a 0 ONNELL til a 1 ZI JAMES 0 G Deeds R%pf K; 171,D67 Square feet (3.921 acres) ti a~l_ _ $ ~~"WO N Including right-of-way N~ I0 -0 BAKKE ti 163,18471 Square feet (3.7$1 acres) I 1 10 _ROAD_ Excluding right-of-way 128.20 North line of h S 1 2 of the NE 1 4 South line of. the NE 1 /4 E- u,l c°DU of the'NE1/4 of Section 15. N00022'5d,E I of the NE1/4 656.39 °I r u- ® 7f' 2 I I 0. 1 71, JI 171 , 136 S. F. (3.929 m Ac) ~Im v I ~~~I Q o ~ ~ Inc. ROW Shed r`IN to w C41 W °n z N° 163,835 S. F. CD a N ~lal I (3.761 Ac) la rn I Q _ H 5' Exc. ROW House :9 I of l JI to J JI 628.17' CL N 00'11'30"W 656.67' v 'q- DI '01 Cn tolo 0:1> cv Z64,343 Square feet (6.069 Acres) co IZ CD of UI Including right-of-way I zZ 00 228,981 Square feet (5.257 Acres): I - y 0 cv 12' Excluding right-of-wa o k 31 7-1 ~ 352.92 5 717 01 W _ =I L) Up t UJj Z°l W iv =1I QI $ a ~ to I a _j~ J~ M N- West line of the NE I /4 of I ul _j M I 0- °o~~N the NE1/4 4 w :3I CD N I 01 z S 00' 11_30"E 474.28' LU z ~T co - SUTT ROAD W LO =J I • Statt: Bar of Wis,_onsin Forr,h ' - 34fL2 5133155 WARRANTY DEED ^i DOCUMENT NO. 1137W l Gregory J. Corcoran and Virginia K. - ran %G z s t~s~ Corcoran, as tenants in A common, - - 11:30 A. conveys and warrants to Sam E. Willer, THIS SOACE RESER-.ED :OR RECORDING DATA 4 NAME AND RETURN AODr=-SS f l~a~/ice the following d,scribed real estate in St Croix s- County, State of Wisconsin: (Parcel Identification %umber) Part of NE 1/4 cf CIE 1/4 of Section 15-723N-R19W described aF follows: Lot 1 of Certifi- Survey Map recorded - Volume 8 of Certified Survey Maps, Page 2279, as Document Number 4c=3,7, and Part of NE 1/4 of hE 1/4 of Section 15-2-31h7-1119W described as follows: A. Lot 3 of Certified Survey Map recorded in Volume 8 of Certified Survey r Maps, Page 2279, as Document Number 4629T7. St. Croix County, Wisconsin. a. is not This homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this . 28 (SEAL) (SEAL) G EG Y CORCORAN (SEAL) (SEAL) RGINIA K. CORCORAN AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day of , 19 Personally came before me this 28 day of August -.1995 the above named - Gregory J. Corcoran and Virginia K. Corcoran, TITLE: MEMBER STATE BAR OF WISCONSIN - (If not, - authorized by §706.06, Wis. Stats.) to k wn to be the perso s who executed the foreg g instrument and nydedge the same. THIS INSTRUMENT WAS DRAFTED BY DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION HUMAN NDLATIONS PERCOLATION TESTS (115) P.O. BOX 7969 MADISON, WI 53707 (ILHR 83.0911) & Chapter 145) aZo LOCATION: SECTION: TOWNSHIP/Mi:N 'RCY t : OT NO.: LK NO.: SUBDIVISIO19 A NL'/ NE'/ /T~9 N/R/9 E (o W /4U 4~~r~ (1L / 1/ COUNTY: MAILING ADDRESS: C-06 ~ C kv, C~~ N: _1 P ~4 rJ ~~`'r~ lt'lcCuTc , USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PRSFIL DESCRIPTIONS: A I N TESTS Residence gvNew ❑Replace UL,/ L j ~J . a? ) rcSr f C~ S` y 'Jt(y~'ut V7E-~ ? r / I!L RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: . M S . []U IN GND URE: SYSTEM-INFILLHOLDING®NK: RECOMMENDED SYSTEM:( al r S U (l TS ~U ~S U '.~t. a' r. © 1 )AliY11. r If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: NQ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IM ELEVATION OBSERVED EST. 1 HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- i - , 19 17 99,x) Oj LC 9.1`7 i'6 gccrs ,ir] r`' B- ` /Uo,I$ IVoNLC 1 P•`._c~ IZJ LCTa ~~_bK..,~. r;S~j, B- 0 N tnLL Zro yf3Rr~`a~( 27 Vii: ,~~•.r' 1',~%r. B ,6? S~ t~` ~c > g.~~ S LL(~ ,.ter' rJ I~GCS~C~' 4i P""' IIN0 1€ > 91 14!/L~QN B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCITES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- f oS 11"46 N ~ 4J-16 > Z > > ? P- .`oS fro x 9 G 3 > _Z > ~ > 2 < P- J.~S FJC>F f 7.C'o P- P- PLOT PLAN: Show locations of percol tion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference ints and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 4 ` i P ` g- SYSTEM ELEVATION. - " te _ l - t 14 S ~ t/~.N~~1'N~l. ~..~If'ca~l ZIS' j~•N ,~1ri ,..A L~SS ,T/.IAN