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HomeMy WebLinkAbout020-1281-60-000 5 C~ 10 STC - 104 AS BUILT SANITARY SYSTEM REPORT % b ~5 OWNER er I SC~ir~,,~ i t ADDRESS k92d C9 f n u ex G-VoU 4~~~5 r~'w Sao $ F' SUBDIVISION / CSM# G~ c y r~' LOT # E SECTION 34 T N-R_LE W, Town of 4LJoko i ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V1 OT T 6; Vh aus'Q 7 t - d 3ti ,S,i 50,,. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: t_e_ n~a c a / d 2. 3 7 ALTERNATE BM: rt, 100,06 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W te,~S a he Liquid Capacity: /D 0 0 WD T Setback from: Well House / Other Pump: Manufacturer rvo- Model# Size Float seperation Gallons/cycle: Alarm Location ,SOIL ABSORPTION SYSTEM Width: S Length S2 Number of trenches Z-- i Distance & Direction to nearest prop. line: 76 Setback from: well: woT ~w House as , Other ELEVATIONS Building Sewer q7. 47 ST Inlet; q4. Z 9 ST outlet PC inlet w 9- PC bottom ~v p Pump Off ig4~z Header/Manifold NN Bottom of system"''24314 Existing Grade 0 Final grade 16.7 0 DATE OF INSTALLATION: tC a 0 y PLUMBER ON JOB: Car ( -lie, i e LICENSE NUMBER: M P17 J INSPECTOR: 3/93:jt ,Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hruman Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PeGERTrmit Holder's Name: BARRY ❑ City village fl. Town o : State PlanID No.: CST BM Elev.: , Insp. BM Elev.: / -7:-.r, ption: X Parcel Tax No_: Hudsnn 16;0, Gv Ild , Cc~ ?.s TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic PC Cl"7Benchmark Dosi g Aeration Bldg. Sewer 97 jr, Holding St/ Inlet 2. 7 ~7-' TANK SETBACK INFORMATION St9P Outlet b, G2' Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic >'S NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe •s(~ , Holdic-° Bot. System g 36'T9 975 3 PUMP/ SIPHON INFORMATION Final Grade 9~f Manufact, Demand t' 0` Model Numbers TDH Lift Loss System TDH Ft mead Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ~ DI EN 1 N DIMENSION Manufacturer: IMS, SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACH SETBACK INFORMATION TypeO etAr CHAMBER e Nu System: tiLJS OR UNIT DISTRIBUTION SYSTEM - Header- Distribution Pipe(s) x Hole Size x Hole S en Intake Length 4~2 Dia. Y Length / Dia. Y Spacing Zo~ SOIL COVER x Pressure Systems Only xx Mound Or At-Gr Systems Depth Over Depth Over v xx Depth Of xx Seeded /Sodded xx Mulched d /Trench Center e Trench Edges Topsoil ❑ Yes No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) -Y li~ - c / /P-s LOCATION: Hudson.34. 9.19W NW SW L Qt 18, Edie Lane C~ct~~ 1,~✓C ~E.~.-;1,C. 'ell /Y1 17a Plan revision required? ❑ Yes B_IT0__ / Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION TDILHR In accord with ILHR 83.05, Wis. Adm. Code COLIM a.w,,,vnv ~ re~.wu.~vawnwn,vw,v~ STATE SANITA Y PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than 01 Wq 2?) 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP Kyy,/ OWNER PROPERTY LOCATION G er C N W Y4 5W S 34 Taq, N, R I `I 1$(or) W PROPERTY OWN R'S MAILI G ADDRESS LOT # BLOCK # q o 4 S,~'C L -n oZ 6 3 WA CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER f-nvw ramie FITS 5569 12 V;21- 9F5- 4tyVr t ; II. TYPE OF BUILDING: (Check one) 0 CITY R STR AD F-1 State Owned Ej. VILLAGE ~~5 W NEA w ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms.. PA EL AX UMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 0,26 0 1 ❑ Apt/Condo 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 in line A. Check line B if applicable) A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12.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)► ( qq.~v LEVATION J V& 450 56:3 6-11 0 e wW Z 13.19 Feet 9& 1 4 Feet VII. TANK CAPACITY Site in alIons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App ✓ Tanks Tanks Septic Tank ok 1000 000 z C Su'_ K L-1 I El- F1 Ll Lift Pump Tank/Si hon Chamber Fj F1 I F-1 -LL+ 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: o Stamps) MP/ Business Phone Number: Car us.a 33 ~/f 4 2S- )~S Plumber's Address (Street, City, State, Zip Code): W9_ -t h ~„LLf W 4,u a~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanita ermit Fee (includes Groundwater Rate Issued Issu' g Agent Signature (No Stamps) XApproved ❑ Owner Given initial Adverse Determination Surcharge Fee) X. CONDITIONS OF APPROVAI~~REAS NS FOR DISAPPROVAL: MkA) SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS a , 1. A sprvitarypermit is valid for two (2) years. 2. Your san fary permit may be renewed before the expiration date, and at the time of rene.<rai 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 Farm (SPIN 6399) to be submitted to the county prior to installation. 5. Onsife sewage systems must be properly maintained. The s<>ptic tank(s) rmist be P. licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code adi 'dnistrator or the State of Wisconsin, Safety & 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, , econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity r)f every new and/or existing ',ank, I st the total yzai::~r : liurnber of tanks and manufacturer's name. indicate prefab or site constructed and' tank material. C:or,, etr~ for all septic, primp/siphon and holding tanks for this system. Check experimental a;)prova, only i' tanks received experirnontai product approval from i:)IL.I-F VIII. Responsibility statement. Installing plumber is to fill in name, license n _,mbe- with a,:)pro,ri: prsfix (e.g. MP, etc.), address and phone number. Plumber, must sign application farm. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications no-'smaller than 3'/z x 11 inches must be zubmitter'! to thi: county. The plans must include the fallowing: A) plot 'plan, drawn to scale or with coinl:icdim€: is ions, socation of holding `.ankls), septic tank(s) or other Treatment tanks; building st overs vr~'fwa`er viler service, streams and lakes: pump or siphon tanks; ri±siribution boxes, soil ~ibse: system areas, and the ~ocafion of the b~aildin) e-, iAJ, 3) horizontal anc , ertic& Iev: 'ion refert-v: C) compiete specifications for purx,ps and controls; close volume; elevat! d,i erences fi;ct;.,n loss; pump performance curve; pump model and pump manufacturer; D) cross section =1f the soil absor.-,ion 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 b~ffect groundwater. The monies col!'ected t'~rcugh t cse surcharges are usec f^r mon torh,, ; q c tc?r, r r i water corltani'+nation invesi~gaiior}s anti estabiisfhi -rn, SBD-6398 (R.11/88) Fresh Air Inlels And Observation Pipe - " Approved Vent Cap for Minimum 12" Above Final Grade TSC ■ 4" Cast Iron ~~~.`7~{.1~Y rd C~✓1a2ra(~frs~ 20- 42 Above Pipe. - To Final Grade Vent Pipe Synthetic Covering. Min. 2" Aggregate Over Pipe Distribution Pips 0 0 0 0 0 -Tee 6" Aggregate 0 ~ ~q•r7 'Z-- Beneath Plpe 2 Q 3 0 C la . EtitE L.N- . N` L\ W t\l J N oust fl) Z -J _ 6 r 0 3 Sp~h~ 1~~ f Q Y 51 10 .~z. d' FQ9 I - - - - a ~5 t -6 L) F, LT- (3 m ALT ARFA 3FC,~4q.1a5 ~s p ~1 OS B~ lab r S~C~ _ Din<.✓ 0 0 0 SONb''1 o311d~dNn 1 ~ ~ (3, CB,6 r9E'69E WOE n. i ~Iml w }Imp 3 wl-ml m ¢ 1 m D ICL oo q ~ I m o° o Wiril LL w ~i ( z z A I JO I m o i WI>~ w ° 9 u to 0 u7 Q fn p n Q fn 2 n Q °o to m o LO ~q 39N) cm tmo Z co ij 39 N W ' to w ^j tD . a m o O~ O O .p to in 0 co to Z~ 6gL a m ~y z M ~~p,BE V~ S v Ln 11 N to 6rr .20 4 S.- 0 i O cm 2. Z4 ~cm N Afo 0 A ~4 . 99 m i o~ U Q to It •c°v 0-1 B S m m Sa1~~•~°.~ o m C, n I m ~ 14 mh L41 m N Z •m N 0 CD I . d • 2b 2gS l p O` I ti~ o`O •869 S ~ / C o / / 3 / L; LL ~to N / / gN to rv o i / I lD IN o`O / S c Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Laborand Human Relations D,fvision gf5afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 020-1281-70 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCAT , Barry Gertschen GOVT. LOT I~]1/4 SW 1/4,$34 T 29 N,R19 xfc(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 4920 Ashley Ln. #203 18 na Cherr Hills CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Inver Grove Hts., 55077 (612)221-7795 Hudson Edie Ln. [x] New Construction Use [ x] Residential I Number of bedrooms 3 ( ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpolft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpolft2 Recommended infiltration surface elevation(s) 94.72-93.19 ft (as referred to site plan benchmark) Additional design / site considerations -_step down trench system Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem 13 S ❑ U ❑ S In u ® S ❑ U ®S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trer& 'k 'X 1 0-8 10yr3/2 none sl 2mgr mvfr 9w 2m .5 .6 2 8-21 10yr4/4 none is Osg mvfr gw lm .7 .8 ,....t Ground 3 21-84 10yr4/6 non { S Osg ml na na .7 .8 elev. 98.22 ft. Depth to h` tY` limiting factor +84„ r )N~ vL may, r Remarks:" Boring # 1 0-6 10yr3/2 none - sl 2mgr mvfr gw 2m .5 .6 2 2 6-24 7.5yr4/4 none §1 2msbk mfr gw if =5 , u 3 24-33 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 Ground 92eig ft 4 33-78 10yr4/6 none is Osg mvfr na na .7 .8 Depth to limiting factor +78" Remarks: CST Name:-Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 th. Ave.,, New Richmond, WI. 54017 Signature: Date: cstm 229T Number: 6-17-94 PROPERTY OWNER Barry Gertscbpn SOIL DESCRIPTION REPORT Page, of 3 r , PARCELI.D.# 020-1281-70 Depth Dominant Color Boring # Horizon Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed ITtercf 1 0-10 10yr3/2 none S1 2msbk mvfr gw 2m .5 .6 2 10-1 10yr4/4 none sl 2msbk mfr 9w if .5 .6 Ground 3 18-33 7.5yr4/4 none scl lfsbk mfr gw if .2 .3 96. 19 ff 4 33-8 10yr4/6 none S Osg mvfr na na .7 .8 Depth to limiting factor +80" Remarks: during # 1 0-8 10yr4/6 none sl 2mgr mvfr gw 2m .5 .6 4 2 8-30 10yr4/4 none sl lfsbk mfr gw if .4 .5 3 30-82 7.5yr4/6 none is Osg mvfr na na .7 .8 Ground elev. 98.20 ft. Depth to limiting factor +82" Remarks: Boring # 1 0-12 10yr3/2 none sl 2msbk mvfr gw 2m .5 .6 :::•:a•;•<:•:::: 2 12-2 10yr4/4 none scl lfsbk mfr gw 1f .2 .3 Cvki~4:J:•: iiiii 3 24-80 7.5yr4/6 none lS Osg mvfr na na .7 .8 Ground elev. 92.40 ft. Depth to limiting factor +8211 Remarks: Boring # Ground elev. I ft. l Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Barry Gertschen 1554 200th Ave. CSTM2298 Sw4 S34-T29N-x19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 f lot 1&-Cherry Hills N 1"=40' BM=nail in tree at el. 100' Alt BM= top of 3/4" pipe at el.94.65 301 Zp 7' ~ 9' I 2 z ~,h hod t ~ - `L V 1 ~c Gary L. Steel 6-17-94 1 • . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 'B0<?_9_Y ►4N~ C 2oLYN ~°j~i C14 MAILING ADDRESS YA N SS7~ PROPERTY ADDRESS (location of septic system) Please obtain fiom the Planning Dept. CITY/STATE 4C Ul-,t6o Q PROPERTY LOCATION ~ 1/4, Sw1 1/4, Section T_2a_N-R_Aq__W TOWN OF A U-b ~56 N ST. CROIX COUNTY, WI SUBDIVISION CA y Ak lr( LOT NUMBER ' CERTIFIED SURVEY MAP VOLUME7, PAGE I g 3 , LOT NUMBER 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 i is 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. I/We, 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. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 I 6TC-100 • This application form is to be completed in full and signed by the t 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 'BAmq "b e-ka-0 L.yp (zi'5Ct~ f Location of property _N W 1/4 C.~ \41,1_1/4, Section 34 , T aq N-R 9 W Township Mailingaddress- 4gao 2u~ / , ao3 Address of site 4 r Subdivision name # r.94Z_y Ak u-5 Lot no. Ig Other homes on property? Yes No Previews owner of property CL \r( l Total size of property ~l Total size of parcel '3. Cr-e Date parcel was created _ 19sq ( - Lk, "O! i~ Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes V No Volume 109~o and Page Number (21% as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWIN . A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PA -GE 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 office of the County Register of Deeds as Document No. srI1(') S0_)_ , and that I (we) presently own the proposed site for the 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. stg ~s~ Signate o Applicant Co-Applic t ~G 3 /6 42t! Date of Sig ature Date of re % ~ I TNIe [►ACL R[S[RYLD fOe R[COROI DocuMENT No. WARRANTY DEED NO DATA jI STATE BAR OF WISCONSIN FORM 2-1588 518'752 ; .r E~. CF.L~i C•O;.1 M I~ Richard A. Me qrn QWd1W"@*ad JUL T 1994 A Gertschen.-rind.-Carolyn-_M...... 11:4 :#d at,. I - 1 G~ertschen ~usba>s1d ~t15~..~fs, . conv ya and wawa is to . >I~Yr5flo~ed5 . i 60 the following described real state in ..............County. State of Wisconsin: Tax Parcel No-........... Lot 18, Plat of Q*X)ry Hill in the Town of Hudson, St. Croix County, Wisconsin. rr 1 1 I .hia is--not---------- homestead property. Imv not) Exception to warranties: Easementi ytrictiOnB and right-of-way of t July-- 19.-.94.. Dated this 6- day of . .............................(SEAL) (SEAL) A (SEAL) (SEAL) ACENOWLEDOHBN? f€,~ AII?SSN?ICA?IOIi STATE OF WISCONSIN Signatmv(s) as. St. .Croix..._. ..County. - - - - - - is th day of be - 1 authenticated this day of--------------------------119 Personally came fore as .h - 19.9--- the above named a• l l-- - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, • who executed the authorized by 706.06. Wis. Stets) to me known the same. ?o i g instru - THIS INSTRUMENT WAS DRAFTED BY Kristina_Ogland Alice-- - ° Notary Public County. Wis i . P1,tCS)XAB,Y.At.J.ei.. MY Commission is permanent. (If t, mate ezp s on (Signatures may be authenticated or acknowledged. Both . 1 ~1•) are not necessary.) date:.' / ~IOamee of D~pm In W uDsell, should be typed or printed below their siffnoture& Wisconsin L"M Blank Co., Inc. STATB O! WiscONSIN Milwaukes.Wisconsin r WASSA,ITT DBxD I. SNe. a- 19[2 FAMPPRAWWWW DEUELvPT- 6-PouP_ _ 4. a DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS )NbUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.0911) & Chapter 145) a,4,3"~ LOCATION: SECTION: TOWNSHIP/ M4HNi8tPikiiil': OT NO.:BLK. NO.: SUBDIVISION NAME: N ~/4 501/ 34 /TzF H/R If E ( ) W l~voso ~ (g ~N~~Ry I+~ i~ ~nol COUNTY: ~0YeI,; MAILING ADDRESS: ,64.6 ?dfX AJI kE SCEOA) 4 ot'SOZ C,~rs S40e(, USE 74 9- 3 2 2- / DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PERCOLATION PROFILE TESTS: Residence ? ❑New ❑Replace q S - I O fAa . 17, 1 ~0 v wi.,u7C , T--sr co-t~~i'7~p JS : su,~.toV, 33 ° F y" +0 0 RATING: S= Site suitable for system U= Site unsuitable for system Z q " FR Q ST QAA-)6t CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) BS ElU EIS aU CIS 0U 0S Egu 0S ~U c19,%RA) IDJAY.>I TK'E Q1'1Q. - 01 hG~ SIO aE-5 10i EX S S OF 12 ~p Sl p E` • SEE NOTE 904./ SilPE If Percolation Tests are NOT required DESIGN RATE: R If any portion of the tested area is in the under s. I LHR 83.09(5)(b), indicate: C L'4 S S Floodplain, indicate Floodplain elevation: ~`tT $C$ (p(o 130PeA4R,07- PROFILE DESCRIPTIONS T J 'bfECi -IA-L f-I BORING AL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED T. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ,S' oe(L. S/) Li 2-j 5;t, .2.0' vA.'Df,nE Sr , V1% G r ,75 or. 3 o. S/ 12-S L- 1214 u Si l z O o B-Z d `77 LCC 149 ~ 9 D Zl'e -r 511, S v~' M✓',K 0f 6R . sl j oR . ^-)%D . S. /,6 'Dk. to S t 1,0 ' .7`/ r3a t' Dt Gy N B_ 3 ~•l' ~~.~~e ~ se~so..~~~0fe~ET y0''S naDfD 'Nw f~ 5, w f,l .5.~rv~s - ca.uTxfNs 3 M~1N y" Cam" wl. E De.uSe 2>40PS tH&fl,E,0 Of 5 N B- ' S.O~ ~O •33' AC[i,~•5~2 G'.J0AJ.2 Pop 5'1, S. T~{a B-S 1•x'61 S'; .G7'-iS-e ©R - 5, lS, G . 01z S B- 6e 9 O 2Ce ' K 6• o F,3~ M-tf S, s N S 1 3.0 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES' AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH p- -5. 0' < 2- P- 2 S. O` /7 /O 2 L t 2. JC^ P- (7 (n P P= b 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 Z of land slope. N t 'in- 1,.e$ 1 T te enac.~ /r Z . 2.(~e ' M i 0ot,-- T,Pf'-If'= ~ m. Q - SYSTEM ELEVATION. 1-o LJ E s -t- T Q a = . I I 3 { i d %1~~ © ,P# 3 - s~rsd-fi -5,f 7 W VZ 57w, SPiL S x I'S 7- ,Zpe'. I to 5i;et fi Z c*u I_ - s Ef= P L- T ~F-V 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: CMESITE SEPTIC PLU41BING CO. at.. G 1 c' !f'O n 655 O'NEIL RD., HUDSON, WIS. 5401_6_ / 11 ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): VIS. MASTS 3 PLUMBER LIC. NO. 3307 M.P.R.S. 2. L4,? Z J p6 ' p 0 l .5 'INN. INSTALLER & DESIGNER I . NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - L LOT PLAtJ Lo T- +1 eeR INSTRUCTIONS FOR COMPLE ' ' )IOFrIESITE P IC PL ' BIB CO accurate oil test, your report must include: 655 O'NEIL R A N IC g r 1 y Z 1 ROBS =ai a un ion; . VIS. MAS? PL p or c fm cal proj @~tqR.S.rly indicate whether this is a residence ',INN. INST~LLE% number ' bedrooms or commercial use planned; 4. Is this a new or replacement system; / 5. Complete the suitability rating boxes. A SITE IS SUITABL OF1 A~&dM TA&TSNI Y IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; ~a ~.T~ 6. PLEASE use the abbreviations shown here for writing prof ilecl& b i s nd co~mp ting the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test loca(ioi4s. *AN" scOWWrrbfered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood 3flood pla t, ebcslatisrbtpgt ex tor,~j~ appropriate; N 0 f c AI nro J QC Op 10. If the information (such as flood plain, elevation) do not4fppFy,~lace N.)A. irf &Aa`prja-te't9x# I 11. Sign the form and place your current address and yur ertification number; 12. Make legible copies and distribute as required. ALL OIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. 3 3O t 34 f ABBREVIATIONS FOR CERTIFIEDbIL TESTERS BZ 'r P Sall Separates and Textures Other Sy ols st - Stone (over 10") i 3 9O BR - edrock v cob - Cobble (3 - 10") S 100c_ SS - SS?ndstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW recolation gh Groundwater cs - Coarse Sand Perc - Rate med s - Medium Sand W - ell N fs - Fine Sand Bldg - Building N and Is- Loamy ;1) S > - Greater Than 'sl - Loamy Sand - Less Than V '1 - Loam Bn - Brown (►1 V 'sit - Silt Loam BI Y t Black aY • si - Slit GY Ft_. Ray cl - Clay Loam Y - Yjllow scl - Sandy Clay Loam R Red sicl - Silty Clay Loam mot -1 Mottles sc - Sandy Clay w/ with sic - Silty Clay = fff few, fine, faint 'c - Clay V k cc i common, coarse . pt - Peat J lomm Many, Medium m - Muck C Q d , distinct tU p S prominent HWL - High water level, 18 surface water Six general soil textures - Bench Mark for liquid waste disposal S1o~39P - Vertical Reference Point 1 i 2 . M . V E 2T. 2'r F. ~t • S TOP o f TO THE OWNER: Polar' Si.$D • SP/k£ Se r- ~A-K - fi?PPOX . t b~ i4 e00 E~ .F° ~i~wl 9 This soil test report is thegirik ft&~V-lj sec&i;t (JAa"Wb RrnV0&ye&ounty or the D partme t a st p N C~ vetiflcation of this soil test in the field prior to permit issuance. A complete set of p fort private 4*1~e sys em and a permit application must be sub fnitt Eo the appropriate local authority in order to tai per it. The sani ary permit must be obtained and posted$pririorto the start of any construction. MOe(4- culure'r exex4l /-,v PLOT PLAtJ HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS.C1AS07 # 2 y8 Z \ ROBERT ULBRIGHT 7' .NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ;INN. INSTALLER 6 DESIGNER LIC. N0.00663 • /3Ac/l/~DE ~~'Tf = pE,Q c S~7Es NOTE Io~~~~o J OF SL)BD»fSica So 1L ~OI'i•J(r \ # 4 S - S ' f1?6Al 3oeC,# 3 BZ if P i3go v S/p SS N ~v ~v P2Y . 3y < lu a- 2 Cy 18 °)a S/opE UERT FCCF. p-r. 5 Top vF 3~e1 , Pole Sl.ev • spike- St r ik3 i~ p N C i Cul Vrer