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HomeMy WebLinkAbout022-1023-20-000 'a 0 N O~ Oq O M 0. O a C i CIO N a N N N ~ rn I I h O ~ O CL C_ N ~ O O I C z O 7 f0 U LL a ~ O WU L Q U ' M N Z N W LLl E Z w 02 z d a°i H N w a m rn z I I o z :!t c m 2 c fA H O c E 0 0) Q) C ffn (n O C l0 C • N t L O U m U N C C O 4= O O d Q O Z 1- Z 15 Z O N N ~ I m E p c-, R cu L N o d C CL A Lo N d _oea o emu. •r~v o a a a a ry, c) 7 O N > rn rn o Z 0) LO ~!~i c o o 0 rn o Y o o m5 E m o CL O 00 Q fw o O 7 « C] ~ O c ~ a a I 3 ao w c E 04 CN CO °o m H ° (D N O > N N U U C C U- N N N C.~ U) E E M _ O N 00 C C N O 7 00 N 00 U p W N 'O 'O C N r W 1]rV/, ~ N N C p o CS N O O O U • o o Y cn o z N z z Cn Q Ca ~ ~ a L a w in v A 0 m 2 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~Z ADDRESS m 2 mom. TYr~~ SUBDIVISION / CSM#LOT # SECTION TN-RW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ s 01 /7~ ZO Y p4 9 i9rr Trer•~~i,rs SjCbd INDICATE NORTH ARROW Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: OvL / S ALTERNATE BM:(!? S ~SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: "k Liquid Capacity: M1!511 Setback from: Well House Other Pump: Manufacturer Model# 5-~ Size Float seperation k D/7' Gallons/cycle: Z SK Alarm Location y e :SOIL ABSORPTION SYSTEM Width: Length 9 Number of trenches 3 Distance & Direction to nearest prop'.' line: Setback from: weal -House _1"~"_ Other ELEVATIONS Building Sewer 915, ST Inlet'` qg-. Z ST outlet S PC inlet PC bottom Pump Of f DHeader/Manifold I Bottom of system Existing Grade U Final grade .D # 8S, 7 97 7 • Q~d 17o DATE OF INSTALLATION: 97 S- I fL• S' PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L0C%AZ10kertX; IXPt;;4NIC 9.28 PkfVA_??yE, iP JfSJfA• 65 County: Labor aAd Human Relations INSPECTION REPORT .Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 193444 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: NNIC e o_: 'T1111f Insp. BM Elev.: BM Description: Parcel Tax No.: 022-1023-20-000 -1 1 TANK INFORMATION ELEVATION DATA A9300105 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. A ir Ito ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction FFiiSyestem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 9.28.18.129B, NE,NE, HWY. 65 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r SANITARY PERMIT APPLICATION COUNTY// In accord with ILHR 83.05, Wis. Adm. Code tom......,.., STATE SANITARY Pn t pr viou aERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Cn if evi 8% x 11 inches in size. pplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Se A;_- ~/4 t/4,S T N,R E(or PRO E TY OWNER'S MAILING ADDR LOT # BLOCK # o "Cl- S- CI STATE IF I IP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER c, a 0 IQ II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ ILLAGE ~ 1 7 El Public 1 or 2 Fam. Dwelling- # of bedrooms %9- PA EL AX NUM ER ) 111. BUILDING USE: (If building type is public, check all that apply) 'f5 -;k. - / 0 3 a 0 1 ❑ Apt/Condo 2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 El 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. 4 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 - 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 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) 7 ELEVATION Lind p2-,T- T o Feet . a Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION- New r-xistin Gallons Tanks Manufacturer's Name oncrete strutted Con- Steel -glass Plastic App Tanks Tanks Se tic Tank or Holdin Tank FT F-1 Q Lift Pum Tank/Si hon Ch mber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume respo sibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps *H:YMPRSW No.: Business Phone Number: FWnber's Address (Str et, ity, State, Zip de). i o , d1 IX. COUNTY/ EPA MENT USE NLY ❑ Disapproved Sa dary Permit Fee (includes Groundwater a e ssue Issuing ent Sign re (No S ps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination -1 - , X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1 sanitary permit is valid for two (2) years. 2. `~'Y©u~sarHtary permit may be renewed before the expiration date, and at the 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 & 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. 11. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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.' j ` 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, ground- water contamination investigations and-establishment of standards. - i 'A 1 SBD-6398 (R.11/88) i V\ X 6 w -i - r T w o ~ e X O b £ 1 v _ _ _ _ _ ~ ~ ~ i i I ~ I i I ~ j I ~ ~ i _ ! i ~ I i-_ ~ i i _ ~ _ ~ - -f - - 1 _I. i_ r_. - - _ I t_. i - I i - - ! ~ I _ - i ' _ , I _ _ r i ~I ~ _ i I J 4r f r ti ~ ~ . ti ~ I~ ~ ~ N Y f '~1 ~ ti N ~ 4 ~ ~ ~ ~ ~ ~ 1 ~ C ~ ~ ~ 0 N `1 e ti ~ ~ e G, ~ ~ f ` N - A P u t PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP I i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 2g' FROM DOOR, wl000W OR FRESH 12"MID. I AIR INTAKE GRADE I 40 MIN. I ~ 19"MI1J. CONDUIT 16"MIN. IAJI..I:I PROVIDE I I AIRTIGHT SEAL I I.II J/ I I APPROVED JOINT A i III APPROVED JOINTS nl/C.Z. PIPF. I III W/C.I. PIPE EXTENDIMC• 3' I II ALARM EXTEUDING 3' ,.)NTO SOLID SCI:. B I I ONTO SOLID SOIL I I I ON c PUMP _-j lt~l ~ OFF D CONCRETE BLOCK RISER EXIT PEWMIITED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC FICATIOUS rIC AND TAAIKS MANUFACTURER: 5 NUMBER OF DOSES: -PER DA!d TANK : IZE : GALLONS DOSE VOLUME ALARM MANUFACTURER: _ INCLUDING BACKFLOW: /-f-,ZZ52Zz zP GALLONS MODEL NUMBER. ~P •u- CAPACITIES: A= 2 6 INCHES OR 96f GALLONS SWITCH TYPE: 15 = Z INCHES OR ~3~ GALLONS PUMP MANUFACTURER: C=INCHES OR _ GALLONS MODEL NUMBER: - q 7 D- _q INCHES OR 72- GALLONS SWITCH TYPE: efl ~ MOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARCwE RATE w GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKENCIE Big WECN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + FEET OF FORCE MAIN X7~F/// ooFtFRICTIOU FACTOR.. 2 FEET TOTAL DYNAMIC HEAD = 7 . FEET INTERNAL. DIMENSIOMS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: LICEIJSE DUMBER: 3-122' _ DATE:_4z,~? -11~- ion _t , TDH ra A IT V 3D - TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE i EFFLUENT AND DEWATERING SERIES 53-55-57-S9 97 137-139 163 165 i o ; M L1 RS LTRS '...,j LTRS '.L. LTRS I LTRS 28 1 52 163 248 394 231 231 EFFLUENT AND DEdVATERi~lG ? s os lzs 216 300 231 :231 1- 4.57 1 72 163 242 _ 1227 + 227 K 26 v SEWAGE AND DEWATERING 104 ~ 136 ~ 223 1227 \ i ! 7,62 6~ 30 216 1223 ! a 1 ♦ I 9.14 206 1220 172 1'206 24 f 12.19 \ 1524<. 125 _$191 p i ♦ 18.29 :5; 57 - 11 161 - 1 114 22 - ♦ 21,34 ♦ yy \ 24 38 _ i 1 3 53 MODEL \ MODEL Lock Valve: 19 24.5 26' 66 87' f{t 20 1 63 1165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE k \ \ SEWAGE AND DEWATERING II 1 \ SERIES 267 268 282 .284 293 18 \ \ M aL LTRS LTRS C,R•L LTRS LTRS r 11 LTRS \ 1.52 . 408 386 492 681 \ \ f 1 3,05 227 273 360 598 3- 16 ` 4 57 a? 76 163 3 238 3 511 \ 6.10 8: 30 125 401 ` 7.62 288 14 914 4 163 11 292 10.67 •0 227 \ ; is 1219 '6' 174 13.72 3 106 12 524 - - t2 45 \ 1 MODEL Lock Valve: 18' 21' 26' 35' 53' 10 \ 1 293 MODELS ' t 8 137 139 ! 6 MODEL F 284 f 4 MODEL 1 MODEL i 1,) 268 ` - 282 f. 2 MODELS\\• I\ E 53, 55, MODEL MODEL `F 57, 59 97 267 10 2#:+ 30 4031. E tl 70 § ! 90 100 g0 120 30 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . 1 -Z ( rV TZ7. Louluisvllle, Box 1 Keentu ntu ~,J cky 40276 (502) 778-2731 QUI[/r,- PUMPS ,Smrr /939 1 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS`%:.. FIRE NUMBER CITY/STATE ZIP_ PROPERTY LOCATION: ~G 1 ~ 4 , SE TION N-R W TOWN OF ki 4.9 J C ie61,1) t•'' St. Croix County, SUBDIVISION_ , 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 a 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. 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 Co. Zoning officer within 30 days of the three year expiration d e. SIGNED: " DATE: S~ 21A3 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by the owmer(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 Location of propertydCl/4 dgff~j /4 debtion ~ T~ -N-R_ _W Township ;ht) %C,C'ih flailing address V/ Address of site , ap e, 4) y, Subdivision name_ Lot no. _ /i,/ 'I'd' Other homes on property? yes No Previous owner of property A/ 1)14 Total size of parcel _r Date parcel was created Are all corners and lot lines identifiable? Yes No Is this roperty being developed for (spec house)? _Yes LNo 1 volum and Page Number ° of Deeds,~3~ as recorded. with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A IIARR.ANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE ItEGISTI R OF DEEDS. certified survey, if available; ;would be helpful I o asd 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. 1~ ~ -ql own the proposed site for the sewage disp salt system) orr I e(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 county Register of deeds as Document No. *Satur of ap licant ¢ co- pplicant Date f Date o Signature VOl 929. 592 _ ' - - TI„a srAcc ncscnvzo IOR RCCO••u,NO DA.w DOCUMENT NO. WARRANTY PEED 4 (r~.y33 STATE BAR OF WISCOli$! ) FORM 2-1982 rII { ALMA VAN BEEK 5T, CRol)( Co., wt& rd ftris 9~- 'd. for Recn 9 ec pD. llr. day - _.a ar i N+ conveys and warrants to ...l.l$A--AIDNETTS.SOLlO.--•_•--•--_----• ~ - gylt . • R[TUR TO - ti -r "d C J.C. + HA1 1 r ~r r.0. Box W1 54022 e follotei a g des•a St. Croix ........Col/ncy, River Fain, .b'ed real estate ;h in . Mate of Wisconsin: Tax Parcel No -.r Wes 22 1/2 acres 1 E 1/4 and t, T28Nt R18W- ALSO: oThehWest The SW 1/4 of the S 4, 1/4 of the SE 1/4, all in Section t 22 1/2 acres of the NE 1/4 of the NE 1/4 of Section 9, T28N, R18W, Township of Kinnickinnic, St. Croix County, Wisconsi!n• all lands lying to the East of the through the real EXCEPTING: Therefrom _ recent extension of State Trunk Highway '165" t all road right- of estate described hereinbefore; further, EXCEPTING -ways, easements and conveyances of ~recorrd'described C PTING42 the right-of -way for, State Trunk Highway 6 Pgs. 99-101. ' Contains 72 acres, more or less. This ...is.1. t........--•-•- homestead property. fift (is not) Exception to warranties: , 19..9.1... 21st November day of I?ated this (SEAL) (SEAL) ....AIna-.Van..Beek (SEAL) (SEAL) } . .I AUTHENTICATION ACKNOWLEDGMENT 'I':~TE OF WISCONSIN ss. Siennturc(s P ierCe ...............County. ' Personally ca:nc Sc:orc .-..c this ........:?....nay of 19 November authenticated this ........day of . 19-91. the above named _ . Alma -_Vdfl. Bee . TITLE: MEMBER STATE BAR Or WISCONSIN S I'. •::N~M X14 (If not authorized by $ 706.06 Wis. Stats.) m• known to be the person Lfi •rcl;oing instrument and ackn t,dge tke s$f1- _ (11 • {7 i Ttil n~SA~ - ~ HAK1 Tn~'~ W8 Y S.C. Sharor►•zl,•-StrFC :C P.O._Box-a67---------------------------------- 4b - = fi Falls,'.otarv Public ..P1.erLP Rive Wl 54022 . n (Signatures may Commission is permanent. (IC not, stale exp . be sutbenticated or acknowledged. Both 1 c . 09. _ 25 1?...9.4.,) are not necessary.) ifdt~tt f eT,aona [{=nine in any capacity should be typed or vr:m-4 be,- u, * :~~~^awree. _ - is v sj. awes of p ,X z r, ~~~r~~ r -n~'~~._`i s ~ ~{~At~ ~~..5i .A~k.... rte. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 'HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNS HIP/I rbll`*E+P~Rt+TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: g 1/ 1/a /TZ N/R ~E (o T ; nn 'no COUNTY/: ' OWNER'S ova=E P::,iviE: MAILING ADDRESS: S ~t~dSsYC l rJl Sf~G~ I/ • C/Lm r / /YC /,/1/ 2 '-/f USE P774 DATES OBSERVATIONS MADE NPROFIL DESCRIPTIONS: PERCOLATION TESTS: Residence New 11 Replace y/~0/y,3 !'/~//f3 RATING: S= Site suitable for system U= Site unsuitable for system r2S[:1U:1E1S[ZU1_ ONVENTIONALMOUND: IN-GROUND-PRESSUJYSTEM-IN-FILLJHOLDING TANK: RECOMMENDED SYSTEM:(optional) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: 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.) /Sw av» t , B- z ~P Nd 'd/ X, B-~ d /f,,9 es CZ w 7" Io, B- y F~ 97.7 NB > / S141 / w .1 B- S- 77 o e s S s l - /SYlsf r,* Jed, IB- ( o /o/• P er Yo 11u, t /7 [ Z - R 8.7 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN TER L RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PE RI D PER INCH P_ -3 P- P- 2 1 c? M ~1 i/l %P .79 42M C_ ;2 P sd 9. P- -7 3Q P k P s' PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Des a what are the hori- zontal an vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and a direction and percent of land sl pe. SYS M ELEVATION wz Pr < w e rr ~ i E E 3 E l a N E 13 #3 71 - ' =g", 'Pss.raboa 10 X =6er~ilq_~ g's - 3 F 3 f I © irk ~ ,~/C~' 3 0.=Yl!//OW rF~~ ~.Gss~-sGG000~ tT'-~iT~ ~hG~ e i'haC. 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pr edures and methods specified in the Wisconsin dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge an elief. NAME (print): TESTS WERE COMPLET ON: DAVE FOGERTY PLUMBING V a 3 ADDRESS: LiCensed Polk 3233 Tester & CERTIF CA ION NUMBER: PHONE NUMBER (optional): Fogedy Heights Road ROBE S, WISCONSIN CST S~qNATUR Phone 749-3656 J/jJ ION: Original and one copy to Local Authority, Property Owner and Soil Tester. 5 (R. 10/83) - OVER - i I i TO THE' 0 O " r NI S J3 W N 03 Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS. WISCONSIN 54023 (715) 749-3656 S~3~f3 s X.0 X let, 44- © ih iB ~ tiic s~r fr.-fc/' Sr z c i ~ Q er f1 ~ t24'S'wT' a'I ~~r'-`.✓~' YU.ck s*-~t dri'~-y i rr ~y c~~7 3~- S ~ ~ f ~i~ Gr~~~~-~~ ~s ~•~rr Hafi %Y/s J ~Ptr~CYrcv ~r ~ °r jor / 6th C/Z, ~+s Sri anti I t y k_