Loading...
HomeMy WebLinkAbout040-1125-30-400 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Ric'-fvi Le ADDRESS 1 v S ~.4r 5 Cpowx Acw-.s _ 2. F. SUBDIVISION / CSM# (1 L ! LOT # SECTION_33~_T_.-&" N-R W~ Town of. ST. CROIX COUNTY, WISCONSIN -bk PLAN VIEW ` U- SHOW EVERYTHING WIT IN 100 FEET OF SYSTEM ~p 100 33 u V 92 3 \4E DIA J9 ARROW a co Provide setback and elevation information on rev of fgporm ZONING~FFIG~ Provide 2 dimensions to center of septic tank m cov 9 BENCHMARK: kwf l ~ i ~ w a r Pole ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING.TANK INFORMATION Manufacturer:Llies-ell Liquid Capacity: 1000 Setback from: Well S(D House 310; + Other Pump: Manufacturer Z0eIXer Model #-9 5>1 Size Float seperation~ ' Gallons/cycle: P-(~j- Alarm Location :SOIL ABSORPTION SYSTEM F /c/et' is Width: ) Length _ Number of t-r~~ Distance & Direction to nearest prop. line: 1( ti r- Setback from: well: Housel- Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade i DATE OF INSTALLATION:. - / - '3 PLUMBER ON JOB: l~'~IS c~r~ r LICENSE NUMBER: 'AI? S7 F INSPECTOR: iirartrtTettrOtlncf~sry28.19.522 L~ ~0 RD. M County: -.Labor and, Human Relations PRffA'ff5EJATG 5Y5TIE'M Safety and Buildings Division INSPECTION REPORT ST_ CROIX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 193407 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: B qE ev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: 040-1125-30-400 TANK INFORMATION ELEVATION DATA A9300065 TYPE MANUFACTURER CAPACITY STATION BS HI ELEV. Septic Benchmark Dosing a%', 03.9P. Aerati Bldg. Sewer F74" Z 2Zi [Holding St/.Vf inlet TANK SETBACK INFORMATION St /,K Outlet ,f 7 to 2 TANKTO P/L WELL BLDG. Aierlnt ake ROAD Dt Inlet d~ 7 Septic f NA Dt Bottom 32 Dosing NA der / Man. D . 76 Aerat' a NA Dist. Pipe 7 ' Holding Bot. System PUMP/ INFORMATION Final Grade 10 Manufacturer Demand 45' Model Number GPM TDH Lift Loss Syetem TDH Ft H Forcemain Length 27 ~ Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length/ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type 0 CHAMBER OR UNIT Model Number: System: Mcoti 1C~ DISTRIBUTION SYSTEM ` Aiaadvr/ Manifold , I Distribution Pipe(s) x Hole Siz I x Hole''Spacing I Vent To Air Intake Length Dia. Length Dia. Spacing Y8 ,SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only j Depth Oyes Depth Over „ xx Depth Of f rr xx Seeded/ Sodded xx Mulched /I Eenter Bed/ f'dges ~Z - /d Topsoil LY- ❑ No S ❑ No . - 'COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 33.28. 19.522E, SW, SW, LOT 3, CO. RD. M C~ ~~6 f~~ "Tye. 7,, ~"Z'4 Plan revision required? ❑ Yes U40 Use other side for additional information. U 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: L SANITARY PERMIT APPLICATION COUNTY ZOO L HR In accord with ILHR 83.05, Wis. Adm. Code S~" C M, X TOIL STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than -V~ 8% x 11 inches in size. ❑ C~ ~ it rwfsionntto previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. IS 23-1/6161? PROPERTY OWNER PROPERTY LOCATION R l Lt t- L4e SU) Y45 Lj 1/4, S33 T , N, R ~ W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3o SS /-W-f W,504 L K 0d 3 CITY, STATE ZIP CODE PHONE NUMBER OR CSM NUMBER (nom W; q o g, (BSc-z1 q L. Ii. TYPE OF UILDING: (Check one) El State Owned VILLLLAGE ' NEAREST ROAD =N OF: ro Ca. tQd ~1 ❑Public 1or2Fam.Dwelling4ofbedrooms3- A EL TAX NUMBER(5)- 111111. BUILDING USE: (If building type is public, check all that apply) © D _ / /A 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. ® New 2.E] Replacement 3. ❑ Replacement of 4.E] 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 X Mound 30 El Specify Type 41 El Holding Tank 12 El 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 J D REQUIRED (sq. ft.) PROPOS/ED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7 Y -7 1.. d Feet IC)(030 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed e tic Tank r Holdin Tank 660 ift Pum Tan i hon Chamber Z a 1_~+_. X I Ll F1 F1 I El I Fj VIII. RESPONSIBILITY STATEMENT I, a undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu ber's Name (Print): Plu ber's Signatur =(Ntamps) MP/MPRSW No.: Business Phone Number: 7/5 ` S&6-t&c~' PI tuber's Address (Street, Ci , State, Zip Code): -7 W r L-L-t3 1) IX. COUNTYIDEPARTME USE ONLY ❑ Disapproved Sa itary Permit Fee (includes Groundwater Date Issued Issuing A t Signs pproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1..- A sanitary permit is valid for two (2) years. 2. Ycur sanitary, 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.~.ewage system, contact your local code administrator or the State of Wisconsin, Sgfety & Buildings Divisiop,.608-266-3815. . To be c"ete 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_in6telled: , II. Type of btiilding 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;.;!`) sail te$t-data on a 11.5.form; and F) all sizing information. GROUNDINATEA 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. SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING & DESIGN Owner. RICHARD LEE BOX 74 23055 LITTLE WOOD LAKE RD RIVER FALLS WI 54022 GRANTSBURG WI 54840 RE: Plan Number: S93-40169 Date Approved: April 19, 1993 Gallons Per Day: 450 Date Received: April 15, 1993 Project Name: LEE, RICHARD Location: SW,SW,33,28,19W Town of TROY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND a 9 1 Inquiries concerning this approval may be made by calling (6 ,$5-93*S. Sincerely, N) m ozX rn r M co GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/25 cc: RICHARD LEE X Private Sewage Consultant sun-6423 iu.OMI) ~ r Page of b MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE Sy3 1/4 OF THE SW 1/4 OF SECTION 33,T ZBN, R )9 W, TOWN OF TR-4`Q ST, C\2A1X COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN -PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~ZZCh ~ tz~~ LES Z1055 1_1 T'1`l.E ~ ooD CNkE p-h. GczA,~TSC3U`t.G, w! s_y9~{o PREPARED- BY ®®~~~20e~~oe6 WEGEf:RER SQ I L TEST I NG 4e® ° AND. ARPiIJR L. It DES I CM SEF~`! I CE WE tRER G,iSR Q ELLSl+1'pRTH, F.O. BOX 74 421 K. KAIK ST. • RIYEP FALLS. W1 54022 715-4~,-0]65 ®°o® ~~S I G'S ~4 v~ -_i- ~A JOB NO. 9 3 - 3 $ PLOT PLAN Page Z of 6 Scale 1"=40.' 3 $z> Rm tt, PR'' ATE SEWAGE SYSTEM Conditionally 30, S .41 'k. 94 ~ ~ k Y ~ k DEPL OF lt,, %S4RY, LABOR HU4~ AN RELA ONS D1VIS10 OF SAFETY Ah0 ILDINGS SEE GOR E O DENCt L4.S'01= 14xPU r C' 4, v• \ z 1 el- y°- v a~, ~ 3S ~ OF Z" 1~ V C 49. S o 6p 47 a•Z Z'Xi• srn~ ~~,to\y ~ RT BFI cov~~RS DO tiJp~- C-O~-tPfCY-T~ opC~2 O1SlvRt3 ~tS \ / 2t way lb fl\LLU t'k+rt~{ fK . COr r %*MU cX701J / , . J AA / QN\ ~o B- 3 ti 8?1 - ~7-_46.3 0.~ s4t~ \a" rs6ti ~~s L.ocPcT~. 51~-1'cH i GRrwuo ~owt~ x sttF Po ~t 21 \1 dI~ ~Cld ~ a U 0 -A -T c_vl-oE~shC \ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( 14 required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be \000 gallon capacity manufactured by w ~ L SeR- Lply c.-R. re tZC~L>ye.rS 5. Bench Mark S Z~ "(SQ ' 6. Divert surface water around mound to prevent ponding at the uphill side. w L t L ~D 4'E R T L ~ SO' F~2 o ff M ~v1u\~ N), t j PtT I.IASY 2 S' ~i cv~ S ~P `t) C 'T , l t, Page Of Approved Synth,,tic Covering Distribution Pipe Medium Sand G Topsoil F Elev_ ipy, E D 3 / I' pfiIV TF SC~+lAGE S % Slope 'io$IY Bed Of 2"- 2 % Force Main Plowed Conddi ¢ Z Aggregate From Pump Layer 9d W o Ft. LABOR & HUMAX RELAttOMB D D'EFi. OF 1t~4OU5'EitY, BUILOIHOS E \ . y Ft . DIVIS + Cross Section Of A Mound System Using Bed For The Absorption Area F O. a Ft. UNI~NGE G i • o Ft. A 8 Ft. H \-S Ft. Linear Loading Rate=°1-L GPD/LN FT B y1 Ft. Design Loading Rate= o,y GPD/SQ FT I l b Ft. J_ Ft. K Ft. A1 teate Peq#; L q Ft.. -ems Force Main W 37- Ft'. L Observation Pipe---,,, g K 09 A - W I Distribution Bed Of 2~- 2 2 Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of j(o_ Perforated Pipe Detail 0 End View Perforated / End Cap) PVC Pipe 1 . ``OVA c° °os`O° Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S i P PVC Manifold Pipe PVC Force Main Oistri ution Pipe Lost Hole Should Be Next To End Cop End Cop P Z Z Ft. Distribution Pipe Layout S 4 Ft. S EVI AG E SYSTEM . gx X Y$ Inches lion -ally Inches k, Hole Diameter )!y Inch E D Lateral I Inch(es) DEPT. OF !''t z 10" n cam, LABOR St HUMAN RELATIONS llMSb N OF SAFETY O Lift ~S Manifold to Z- Inches ~ Force Main Z. Inches SE CQRR N NCE # of holes/pipe b Invert Elevation of Laterals 10y9 Ft. Place lst hole 2.4" from center of manifold with succeeding holes at y$'t•intervals. Last hole to be next to the end cap. • PUMP CHAMBER CROSS SECTION ACID SPECIFICATIONS ' PAGE 5 OF C~ VEWT CAP ti"C.I. VENT PIPC WEATHER P4T"' APPROVED LOCKING MANHOLE JUUCTIOW BCOVER WITH WARNING LABEL 25~ FROM DOOR, 12"MILI. R FRESH YJIND OW O AIR INTAKE GRAD fit, 10S~ 'i" MIIJ. COW- PROVIDE IMLET P41VATE SEWAGE % Tb} I SEAL I ' ~ I I V APPROVED JOIAIT A v APPROVED JOINTS III ALARM a "CA IONS nEr. OF INIUSTRY, LASS I i c s : °«S DIVISIT aF SIFE+ R$.~ S I CLEV. FT. --J OFF SEE GO PG t7ENCE D tTL X7.50 COM6RETE BLOCK ` 3" APP>RoVep RISER EXIT PERMITTED OA1Ly IF TAWK MANUFACTURER HAS SUCH APPROVAL gEOO1µG SPECIFICATIOUS DOSE TAWK MANUFACTURER: LEI E ER cuuC.R~ AWMBER OF DOSES: 3' PER DAU . TAWK SIZE: SO GALLOWS DOSE VOLUME S• S- ~ZEC Z SYSTEMS INCLUDING DACKFLOW: 3 GALLONS ALARM MAb4UFACTURLR: MODCL WUMBER: lS' \ 1622 CAPACITIES: A= b If 7"INCHE5 OR 330' GALLOWS SWITCH TYPE: 1--yy1Lcj ►-yf 5= 2 INCHES OR G~LLOA15 PUMP MANUFACTURER: Z'O k E'`'IiM C~b"'E'ft ca 6 INCHES OR ~ Zo. 3 GALLONS MODEL IJUMBEM 011 D= i's INCHES OR 3uo. a GALLOWS SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO DE MIWIMUM D15CHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEM PUMP OFF AUD..DISTRIBUTIO►J PIPE.. FEET + MIAIIMLIM IJETWORK SUPPLY PRESSURE • . . . . . . . . . . 2.5o FLET + 3S FEET OF FORCE MAIN X 1-31 FYofr.FRICTIOU FALTOR.. a•v$ FEET TOTAL DtIWAMIC. HEAD = q-\3 FEET DIAMETER $01 Toi> 1 39 •r IAITERWAL. DIMLWSIOKIi OF TAWK: LENGTH ;WIDTH 0 ;-LIQUID DEPTH ~Z BOTTOM AREA - 231 GAL/INCH AS PER MANUFACTURER = -LC) 0 25 GAL/INCH - W n>~Gr 6 0l` 6 W W F HEAD/CAPACITY CURVE 4i6 6'~ - MODEL 97 4 , 30' 0 8 41A 25'- ° 7 -I- 1' - 11 NPT I W 6 20'~ 43/,6 v z 15 O 4 J H O 10' ~ 9- 13 2 5'- 0- 8. o US 10 20 30 401 50 60 70 GALLONS LITERS 0 80 160 240 10 s FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY HEAD UNITS/MIN 35/16 FEET METERS GAL LTRS 5 1.52 56 212 _ 10 3.05 46 174 15 4.57 35 133 20 6.10 15 57 Lock Valve 23.75" CONSULT FACTORY FOR SPECIAL APPLICATIONS a Electrical alternators, for duplex systems, are available Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. e Mechanical alternators, for duplex systems, are avail- Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIUE 1 Integral float operated 2 pole mechanical switch, no external control required. Standard All Models - Weight 33 lbs. -'/2 HP 2 Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. 97 Series Control Selection 3. Mechanical alternator 10-0072 or 10-0075. Model Volts-Ph Mode Amps Simplex Duplex 4. See FM0712 for correct model of Electrical Alternator, "E-Pak". M97 115 1 Auto 12.0 1 or l &7 - 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) N97 115 1 Non 12.0 2 or 2 & 6 3 or 4 & 5 or (4) float system. D97 230 1 Auto 6.0 1or1&7 - 6. Four (4) hole "J-Pak'. junction box, for watertight connectionorwired-in simplex or E97 230 1 Non 6.0 2 or 2 & 6 3 or 4 & 5 2 pump operation, 10-0002. 7. Two (2) hole "J-Pak" for watertight connection or splice, 10-0003. CAUTION For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices and wiring should be done by a Starter. FM0514; Piggyback Mercury Float Switches, FM0477: Electrical Alternator, qualified licensed electrician. All electrical and safety codes should be followed FM-0486: Mechanical Alternator, FM0495, Alarm Package, FM0513: and Sump/- including the most recent National Electric Code (NEC) and the Occupational Sewage Basins, FM0487. Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old Millers Lane Manufacturers of. . . ZAIZZLff 7. P. 0. Box 16347 • Louisville, Kentucky 40216 (502) 778-2731 • FAX (502) 774-3624 QUat/TY PUMPS ,./7NCE /S39 Qsconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Z Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S``'. Cho iX Attach complete site plan on paper not less than 81/2 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. o\413_ \\IS -3 400 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION F_I C!A Ntb Lam, 9. =Q; Sw 1/4 SW 1/4,S 33 T Z$ N,R 19 E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ZIOSS I.1TTLZ woo`D t_s~ ROAD 3 - aS y UOL. -7 , 1) zo i-► CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD GZ u\'t 611 Sq O (-)tS7 68?-7-)141 0- T. New Construction Use Residential / Number of bedrooms 3 [ j Additis~n to existing building (j Replacement [ j Public or commercial describe Code derived daily flow U 50 gpd Recommended design loading rate 0, t4 bed, gpd/ft2 - trench, gpd1ft2 Absorption area required 21 S bed, ft2 3-1 S trench, ft2 Maximum design loading rate - bed, gpd/ft2 - trench, gpd/ft2 Recommended infiltration surface elevation(s) 1 OS • 4 It (as referred to site plan benchmark) Additional design / site considerations Parent material L oNass - Flood plain elevation, if applicable N - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S O U [a, ❑ U ❑ S ER U ❑ S Iz U ❑ S ®'U ❑ S iuU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure consistence Bancffiry Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Mach 1 v-lo ti0`1Q. 313 5t is Z fib- tp`-1Q 31(. - 5 - ~~`H - - Ground 3 26-30 10 yR t!/ C S --iZ y/L St - Yn - - elev. vwj oft. LU 0 11 J GL Depth to t p E 5 1'7 8- t l- 8 limiting L C r_'Y'~j cW ' I.JoT "8E USL . arc 5`t SZU Remarks: Boring # Iu 3 ) QE . Ili L c1~t"t M Ekv Ground lG \..p L G 1=. p . GhO FT" Z ~ w elev. ft. ell 1 15t1 coF K 1l9v E~SlS Lug! -t" Depth to V L1? L 'RS1-' u t_ H U u' limiting `I factor 1 S L14 L R O1L I Remarks: CST Name:-Please Print Phone. Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: 013 _ 3 ~3 Date: f~ Z 1411 3 T Number: 0 0 5 7 6 PROPERTY OWNER SOIL DESCRIPTION REPORT Page - 0f PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnch Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) • PLOT-PLAN Page Z of SCALE 1"= 3Q ' l~u~sE A w~u, 'Tb %Ie >Loo' c 04 e 11%d 9% 0 ~ 8y ~ y 64, sJ~o ~ e•z y z \O A Z' S L~1 _ q~- g~ eow ~S jiG.,,, _ Cif x.~vT c0~-thh'c.~!-~ 0% ~J1~~tJR plc l tS , - LL N,3 'rn fl~2~v ~+cy P(( C 1~~.+ SOU c'nghl ti p. q-) s - fit, a 6 -3' oN A ~ow U Ue I X SITE ~ J ffp jyuac'~j O ~ ~iaz CuL- ~I:-S k~. c.T.H 'M u 1443 (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # riJMENT OF REPORT ON SOIL BORINGS Hrvu L , a ~ DIVISION LEA *SAND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LO A; ION: 1 SECTION: r (o OWNSHI UNICIPALITY: LOT BLK. NO.: SUBDIVISION NAME: Sw / sw / 33 T Z/ 19 C COUNTY: NER' UYER'S NAME: MAILING ADDRESS: 711. Ll)\JTi;-: C..gl)l?<- 01~ ~VZ1~0 U~Z L W S~O'ZZ USE DATES OBSERVATIONS MADE NO.BEDR COMM R AL7DCRI TION: TFRFOFILE R N A I N STS: ~esidence New R'` cyv -S t.~ BY ~ l.. )~L.so~ Uav US -Z~-SB RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: Y LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) O S no ®S D U EIS ®U D S ou S ®11 «N zovw D~r~7~7t DESIGN RATE: If an It Percolation Tests are NOT required \ I y portion of the tested area is in the (under s, ILHR 83.0915)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-It"*° CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Pt ELEVATION OBSERVED ES IGH T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) s o.q U`rcGysi) rs~ B y.2' 11~3,Lf 2 6, 2.1 pfy►S 1 n S Z.' X01 y~ SYt1"QhTL~~ Z o,I' b1-cay si ITS ~>7 Sj 1.3'C3r B Z ~"f 2.9 ' S C sl.tG L-y O SE woT co•--)' tSk 6.,y s i I ?-s ; 1 S' 9h si I ; Z, L/ tans 1 B- 6' B• B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP 1 WATER L VEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN, PERIOD PERIOD PER INCH P. 1 Z No 30 1 3 1 5116 l t1 Z P. 'z 2 fJ~ IQ N 3/ I` 1 1 ~8 1 1/ 8 Z'J P- 3 -Z o 30 SIL6 1 ~y 11. Z P P P- - 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 of land slope. ~'O 3Ei b -f"I //U ~'^D ~U Q JK~ G 7~6E O)~ C T ~-d^ '1 M OU►Jp DES 1 GfV SYSTEM ELEVATION - % I I ! TIf" P•J ~3S O -r-H C iJL C-0Z C3~2 OF '77~FQ _ . . ~ , ....~'7 ar-_ ~ ►`7 t] lid -•---t_-_.--,--__ ~ ~ ~ i Loch Toay SII E B.3 r ~ FvN,- I'~1 o v lvq e W SC-1kUL 1'I= 60 f 6ec. 33. 1, 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 tothe best of my knowledge and belief. NAME (prmtl: TESTS WERE COMPLETED ON: ADDRESS: ZQ,U Y Zo x, •L2 CERTIFICATION NUMBER: PHONE NUMBER (optional): LAj o S7 6 1S-U2S- o~ G CST SIGNATUR : DISTRIBUTION: Original and one copy to Local Authority,M•'lProperty OwTer and Soil Tester, VER.- DILHR•SBD-6395 (R. 10/83) r 0 NI do ~ d FILED AUG 301988 I jAxts of CONNFII 4$0978 m R co •Bhlr of Deeds I 14 Goo Comly, ' 1Hh5oei 4t) CERTIFIED SURVEY MAP a LOCATED IN THE SWI/4 OF THE SWI/4 OF SECTION 33, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. OWNED BY: w-j)YZW I/4 CORNER SECTION 33. TOM 8 SUE BURMOOD (COUNTY MONUMENT FOUND) RT. 3 UNPLATTED LA N D S RIVER FALLS, 1V1 N. N 1, ORTH LINE OF THE S 54022 W-SW ° S09037* 30"W 1 3 1 8.05' U7 6• `q' 358.05' 740.00' Y20. 00"' _e,~• z• n Q. m J' n b 6 0 LOT 2 (D 0. 7.14 ACRES LOT 3 01 (310,914 SO. FT.) O Q, v Z v 0 z 7.16 ACRES J• N 4 (312,077 SO.FT.) N 9 3 9 W E Q+ n N37. 2S' 33"W S83-35.3 I90.00' O eE "6"E 310.66' O I p Fence y z w O 1 3, 9 A 0- • o. W LOT Doi ati tie W. 14.40 ACRES a LOT 4 o N,-. = N 1627,458 SO.FTA 7 4.56 ACRES ^ 3 3 (198,722SO.FT.! N i o0 0 13.19 AC. EXCLUDING ROAD ^ mQ. 1574, 603 SO.FT.) .I = .1. m TO a BE LLa. I o* 8 N89039'05"E 661.24' Wj. W•F' m . ADDED SEE NOTE: Z F •w nl ON ON SHEET: 2 OF 3 3 3 -ERTIFIED SURVEY MAP J: m- m~ 10 . 0L, A 1801 . . a „,0 66' WIDE ROADWAY QO1 W a' - 0 EASEMENT. - ___S- I, co Z Hm (SEE NOTE SfIEET 2 hM ~ D 0 OF 3). =I 66' ZM I El 14 200.06 213.68• 66.0 1-_ c N88000 40 E N89026'40"E 279.68';w `N 69" 26.40E 156.14• SEE DRIVEWAY AGREEMENT ON SHEET 2 OF 3 Z Z `yrsur~~ssn~~yy \ 'w o SET 1"r 24" IRON PIPE WEIGHING u2 /A ll''IGW.e~ • (IN"S V W 1.13 LBS. PER LINEAL FOOT. N S. WO • e 1" IRON PIPE FOUND. JAMES M. WEBER S z > ' ~4L Cd3,? 4 GOUNfY S-1804 = o ~ 0 1a7I4TI;tS~ar'kvlmmr;llPf s SPRING VALLEY . z Q ; n RFd.511'x2:GfXXJ1YJIr1IT Wis. J 3V0 NOTE: BEARINGS ARE REFERENCED TO "'...4 THE WEST LINE OF THE SWI14 / 1 (BASED ON RECORDED BEARINGS). .,~~,rQ fS , Hµ V~♦ BER SCALE 1": 200 JA~M-ES M._ B'E 5-1804 "r'z~,~y1~~ WEGERER, WEBER 8 ASSOC. S H E E T 1 OF 3 DATED T-'-' 19+ 1800 0 100' 200, 400' REVISED NAY 26, 19BS. 8B - 22 T141S INSTRUMENT DRAFTED By ,IJN,tc.rt.>•L.mbrv ti~LUOf 7 PAGE 201( STC-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), thensa 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 Richard H Lois J. Lee Location of*property SW 1/4 SW 1/4, Section 33 , T28 N-R 19 W Township --Troy Mailing address 516 County Rd M Address of site 516 County Rd M Subdivision nameC S M- 1~6't 7,Og _~2017 Lot no. 3. Other homes on property? yesxNo Previous owner of property _ Dwayne Thomas & Mar sue Burmood Total size of parcel 7.16 ac. Date parcel-was created May 19 1988 'Are all corners and lot lines identifiable? X Yes No Is this pr~perty being developed for (spec house)? Yes X No 7 Volumend,Page Number 26' as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER VO NUMBER & THE SEAL OF THE REGISTER OF DEEDS. VOLUME AND PAGE 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 'A o f c~ of the county Register of Deeds as Document No. , 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 County Register of deeds as Document No. signature of applicant Co-i licant Date of Signature Date of Signature S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Richard H. Lee ADDRESS 516 County Rd. M FIRE NUMBER 516 CITY/STATE R i vPr Fall c inii _ ZIP- 54022 PROPERTY LOCATION: SW 1/4, SW 1/4, SECTION 33 T 28 TOWN OF Troy p , St. Croix'County, SUBDIVISION-- C S M ~Dt `71F ~D17 , LOT NUMBER 3 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 dat . SIGNED: DATE:- 3 rzy' St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 i II . ;I TNIa SPA,C RESCHVED FOR RC%OROINa Data li DOCUMENT NO. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-11182,! 977 3-" 1L 490639 r~c~ 10 { - - REEGiSTER'S OFFICE II R _ Dwayne.... Thomas. Burmood and_ Marysue Burmood,-. _ 1 s-OOacoo Hn _ Husband- and.-Wife,and each ia.his and-►er.own.Light - Wd 1W Record . . . . . . III OCT 281992 II conveys and warrants to . . R.i.Chard. H. Lee- an.d..Lois_-J... Lee.,... 8:45 A. Husband .and.Wife, holding. as aurvivnrshiy..marital property...... _ . _ . Rptsta of 1>.eds RETURN TO . . . the following described real estate in Sty. Qxoi4 .....................County, State of Wisconsin: Tax Parcel No: II Lot Number Three (3) of that Certified Survey Map as recorded in the Office of the St. Croix County Register of Deeds, in Volume 7, rage 2017, as Document No. 440978, as located in the Southwest Quarter of the Southwest Quarter (SW}SW}) of Section Thirty-Three (33), Township Twenty-Eight (28) North, i Range Nineteen (19) West, Town of Troy, St. Croix County, WI. Along with a perpetual vehicular easement for ingress and egress over that 66 foot wide roadway which serv.icesi** This deed is given in full and final satisfaction of that certain Land Contract between the .•arties, dated December 20, 1990, recorded December 26, 1990, at 8:30 A.M., in Vol. 889, Page 244, as Document No.465125, Office of Register of Deeds i for St. Croix County. the property and is more specifically described on the above stated survey map. State of Wisconsin County of St. Croix ; hereby certify that this Instrument is a full; true and correct copy of the document on 61FRANSFEh and of record in my office and has bee$ compared by me. FEE ar h ~a _11993- . ~ homestead pro Register of Dee This is----nat property. James O'Connell (is) (is not) James O'Connell Register of Deeds Exception to warranties: Easements, restrictions, and rights-of-way of record, if at i I ~I 26th Dated this day of October, . 19 92 ....-..(SEAL) X f~.tlayM. NUtp (SEAL) Dwayne Thomas Burmood (SEAL) i7"4" l5EAi.i Marysue /Burmood AUTHgNTICATION ACKNOWLEDGMENT ' Signature(s) of Dwayne Thomas Burmood STATE OF WISCONSIN ss. and Mar3!sue Burmood County. aut sated this 26t~Nay f. ogtob-A----------- 19.42. Personally came before me this -......-..day of , 19 the above named 0 . _ Leo A. Beskar - - TITLE: MEMBER dTATE BAR OF WISCONSIN . (If not. anthorized by § ?06.06, Wi Wia. Stata.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED HV . Leo.-A.••Beskar~..AttorneX Rodli, Beskar & Boles, S.C. . . Notary Public . County, Wis. (Signatu gnatu River res i~amay y be be'auutheth ~nticated cated or r acknowledged. Both My Commission is permanent. (If not, state expiration ( are not necessary.) date: - 19._.. •Nanis or persons signin5 in any Capacity should be typed or printed below their sigi-tcrr,. Wlsccnsln Legal Blank Co . Inc WARRANT! DEED STATE BAR OF Wi5('JNSIN Milwaukee. Wisconsin FORM No. 2 - 1,92 r ST. CROIX COUNTY .rk WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 i MAP Ell (715) 386.4680 April 1, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Richard Lee property, located in the SW 1/4 of the SW 1/4, Sec. 33, T28N-R19W, Town of Troy, St. Croix County, has been conducted with the assistance of Art Wegerer, CST #576. This onsite revealed 2.1 feet of suitable soils. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj f .a ST. CROIX COUNTY `t WISCONSIN ous ZONING OFFICE Y ~l"! r R ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON WI 54016 (715) 386-4680 March 23, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: ~ G Acc An onsite investigation of the Tom Burmood prop ty, located in the SW 1/4 of the SW 1/4, Sec. 33, T28N-R19W, Town of Troy, St. Croix County, has been conducted with the assistance of Art Wegerer, CST #576. Onsite evaluation revealed established high water table at 2.1 feet and zones of saturation at 2.6 feet. This site should be suitable for a conventional mound system using 1 additional foot of state approved sand. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator cj DEPARTMENT ~f'13Yy, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND DIVISION AU MA AND PERCOLATION TESTS (115) P.O. BOX 7969 3707 HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: &2~HI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Sw~/4 Sw'/4 3 TzbN/R 19 E (o `TRu 3 - C s''~ COUNTY: NER' UYER'S NAME: MAILING ADDRESS: C-'T- CAwl) L a>~ ;vZu~o v Z w SVO'?-Z USE DATES OBSERVATIONS MADE I nce NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Weside Q<New ❑ Replace S _ j ~1 ^ 5? $ _ I _ ¢ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ $ ®U:®S ❑ ❑ S ®U ❑ S ®U ❑ S ~U ~ov>~~ - tt lGH Gt~.~Dwfii~72 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the l~ ' under s. ILHR 83.09(5)(b), indicate: IV - Floodplain, indicate Floodplain elevation: "1 PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IBS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Rsl, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) s u 0.9 DtzGy S' Its ; 1•z'8R S o.~~-h B 4-2, ' 11 3- ~T 2, 6 0' 2.1 O&rQ S Z 1 n S SyCIUV_Aq sib , 0.1 " O h_ G y S i) Ts ; Z. 0' 13v1 S 1 ; 1.3 ' l3 r B D GY Sit TS ;s1•S'9,tis1I ; Z.y't31, s B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ 1 Z ND ~O 1 3 1 S!!6 1 Z P Z Z 1~0 30 3/Ifs t/8 1~$ Z~ P- 3 z o 3o SIH. ll~y ll' Z P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimen~ions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on t plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~E ~"1lN ClU R-1N G1~6E O)Q ri CIQK~p DES 16 SYSTEM ELEVATION ~>N ti' of s~ a E CD: ,lus ►A o S ' WI/4-ft . TN .J~ rp~~3s~ `1=1-1CL :0-4 lk ?J Git~ O T7FE. a•) ti v S " C _I ~Its ' ftT s S ' S e 1f' OvJ.,b'; 1-J MIA- 1b i@F k1' L.LT*S t SO /70 i $ ~ f ~C- N a •L 1 4~~w1 liz-d M1 u vvp , t V>e E , Sf"tl° E i I f E E 3 41 E fi 60 ec, 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: ADDRESS: VU~~ Y x Z7- 60 CERTIFICATION NUMBER: PHONE NUMBER (optional): S, V u) S-)6 1S-U2'S-0/G LL w w CST SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Ow~er and Soil Tester. DILHR-SBD-6395 (R. 10183) - OVER - 1 HE T V Mj Ues't e ` ivate DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDLT+R'Y, P.O. BOX 7969 PO AND LA PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) -:z, I I. IIO~N NAME: LOCATION: SECTION: OWNSHI UNICIPALITY: LOT NO..BLK. Sw~/a sa NO.75- w1 3 T-N/R 19 E MAILING ADDRESS: COUNTY: WNER' UYER'S NAME: LAJI StlOcz-Z- DATES OBSERVATIONS MADE USE (PROFILE E RIP IONS: OLATI N TESTS: NO.BEDRMS.: COMMERCIAL DESCRIPTION: L__9ee LKNew❑ Replace sidence 'V ~P\_ _ l1 v V ~ -S t~ BY t 0}-f ►`1~tsIJN or„ S - Z~-~8 RATING: S= Site suitable for system U= Site unsuitable for s~F] stem CONVENTIONVL:M ffOU D : IN-GROUNDPRESSUEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S®S❑UDS®U SZU ❑Sa Mo ~~~-~tGN Gzuv~D ~7t DESIGN RATE: I If any portion of the tested area is in the If colation Tests are NOT required u:Pedei-r s. ILHR 83.09(5)(bl, indicate: fem. Floodplain, indicate Floodplain elevation: • 3\ PROFILE DESCRIPTIONS DEPTH TO GROUNDWATER-INCIH-=5 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) s 0191 ~~Z Gy ST ) TS ; N.z'Bn S o.--)/~h .6 r S Smy S TS Z. O bS P` 2.9 S C S~'LGttTL-Y O~SF W-L o Ott GY s i I ~ns1 S' 9,ti st L/ Ian S 1 B- B- B_ PERCOLATION TESTS TE T DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD( P RI D2 I PER INCH ..1t p_ 1 Z No -.11 Q:1, 3 1% IS 116 -z-,./ p- Z Z 1J0 'so ) 3/)( 1 1r$ Z-7 P 3 -2o 31ZI, S t Lb 1 1 Z P- P P_ 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 ~v 3t D~TLf'~ttN~-o ov R.l~ G ~Pc6E ~O ~T i-~tv~-T of land slope. 'h OU►J~ DES 16(v SYSTEM ELEVATION ~tti ' ~F S>~t~'o1 _ us M'_ ff" IVia•0 O/J 1~~I~_~11o!oQ STl~t~.~ W ~ L R?ld O F 'T~•i E ~J L C~1 Z ~ +~SZ. OF T-}Q _ _1~vgE ?v IIC .!'tT LtMST__ZS',F*-0f__ - - P•3 _ r-~ov~p. W lay FIG- R-1' L13*3 T So o ' s o - Few "o T N S U I `i`{`m LE ''tom ksF\ A ~~I° ~ FOOL i'tpvfv~ _ 1 C , •h • 5C/kL_C- 60 ec' :3 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord pith 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: ADDRESS: uV`S~ 4( CA x 7iZ CERTIFICATION NUMBER: PHONE NUMBER(optional): w u~ S76 !S-UZS-o✓6 CST SIGNATU aR DISTRIBUTION: Original and one copy to Local Authority. Property Ovger and Soil Tester. DILHRSBD-6395 (R. 10/83) OVER - ` '