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HomeMy WebLinkAbout020-1009-40-600 ti Q) o c O 0 r,. Sc ~ o C c • t U 0 c0 CO b N vdi ~ yL-' c n ~ N I' L_ O N y C L C 3 p •N N C O 0 O o O p a x U `o C 3 y 0 0 O a~ C V.a pOj C C O _O •0 C ti -0 v > S N 'o ° z (ai CO n. c n C c m o LL C m 0) 7 .C N o mc~ a C) •0 °o0u~ 3 Q o=p o 0 3 r) v o rn w z E z It E z a m o FN- Z I 0 z c 'V ~ r 00 N d' m Z c fn F- ~ ' o N C 0 70 0) o a N c 0 c O - O O o O Z F- Z Z Z O 0 C cc a~ 10 N m N (0 d -C 0 IL i~ LO U) U) J ° ~r~t m rn 3 3 rL in 0 a a a 'a =3 N O N = N N N m J U c 0) 0) } v ~i J N O O N O O co E = d y N n ~ N ~i ~ Q Q 'y^ O O O i. > N C (O CO C C Lo r > Q o - a°i c a rn °o l \ O M F- cn N E a) w Z L t.•_. w O O O c a) r` F- '0 co (n 0 E a) 7 U E U F- tf3 V C~ d t0 Gam. • C~ O. 0> V ' ' d Y C rr'1~~i E L C c ~ `~1 A vam O~v AS BUILT SANITARY SYSTEM REPORT OWNER -S 7-eU-== Bcha~e~UD/~/= TOWNSHIP cl ra~c~ SECTION Z:1 _T a ? N-R !f W ADDRESS _Ey'c G✓ w ST. CROIX COUNTY, WISCONSIN SUBDIVISION Gtr!{naval r :5-rg 7'e'd-111 LOT-1-1LOT SIZE csr ~S PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM. mss- 0o5e~ Z6 0 f~ S` IND CATE NORTH ARROW BENCHMARK: Elevation and description: Sa t -e 4 .c' 1 l S Alternate benchmark d/o~v -c-'- SEPTIC TANK:Manufacturer: &zj' d wfs7`' Liquid cap.-/AQ Rings used: L Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line : Front k , Side , Rear Ft . l 21,;?- No. of feet from: Well DU2s~ 7d , Building: 13 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length S- Number of Lines : _ Area Built 4~7`z"s Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft.kV No. feet from well: o f' No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: 7 l//®1ryJS.r~!/ DATE : PLUMBER ON JOB : i LICENSE NUMBER: 172 6/90:cj IQiiso sin artmennto I~nduslry, HUDSON' PR(VAfE SEWAC`iE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171474 Permit Holder's Name: ❑ City ❑ Village EiTown of: State Plan ID No.: STEVE SCHOENOFF HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A, 1. PAS C TANK INFORMATION ELEVATION DATA A9200238 ~8 9,Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - r6n sP Cc r acQ Benchmark Dosi .33!r/ Aeration Bldg. Sewer Holding St/ 1 ji Inlet TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet ~j Ar I Septic NA Dt Bottom Dosing NA Header / Man. 7- 1 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa Demand odel Number GPM TDH Lift Friction Syst TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width r Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIM Egg I N LEACHIN Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER Number: INFORMATION Typeof CM-F.- System: OR UNIT DISTRIBUTION SYSTEM Header Mlla~*-_ ,i Distribution Pipe(s) ~i x Hole Size x Hole Spacing Vent To Air Intake Length zo Dia. 4Z Length - -~5_7 Dia. Spacing E-., 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 Svp/Trench Center _ZaafTrenchEdges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) yp ~ ..~1r1 '9 :3 n / Qi✓iC_1 ~~'1t ~ i CSC oA 4n vision required ❑ Yes [o q Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ • IZI QILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ' STATE SANIT Y RMIT -Attach complete plans (to the county copy only) for the system, on paper not less than / ~ 8% x 11 inches in size. ❑ Check if revision to pr sous application -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 5 dUe- ScA 2 w%4,101/a,Sla To29,N,R If E(or _va PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 6-0-7 T 6ea / 47 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER e 97"0%L - 0 CITY II. TYPE OF BUILDING: (Check one) El State Owned VILL GE: NEAREST ROAD l~~- Gds ❑ Public Ell or 2 Fam. Dwelling- # of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) Q J4DQ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. k4 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ Specity Type 41 ❑ Holding Tank 12 Seepage Trench 220 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. tt.) (Gals/day/sq. ft.) (Min./inch) 9a ,p ELEVATWN '4 ~400 C L~6 Feet -Lo Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Manufacturer's Name Con- Steel Plastic INFORMATION New istin Gallons Tanks Concrete App Tanks Tanks structed glass Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Fj r_1 1:1 F-00- __1171 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) P/ PRSW No.: Business Phone Number: 40 ; of nW u Ma Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signatur tamp Surcharge Fee) pproved ❑ Owner Given Initial _ q / G . 25_ 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 s Buildings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your 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 5y 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. 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 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 infcrmation. 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, purnp/siphon and holding tanks for this system. Check experimental approval on,! if I.anks 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; (Jose 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) STC-100 This application farm is to be completed In full and signed b the owner(s) of the property being developed. Any inadequacies will only result in delays of the issuance. this development be intended for resale bytowner/contr chtor,d(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 U O ~Or(` Location of ro ert Al"' P P y 1/4 *C- 1/4, Section _Z~2, T,2~ N-R_ZLW Township S1 Mailing address .507 Cry 111A /74tiso/0 Address of site go Subdivision name Lot no. Other homes on property? yes % No Previous owner of property r Total size of parcel / . C TES Date parcel was crnated f / 8 Are all corners and lot lines identifiable? Yes No ,!s this property Lcing developed for (spec house)?,____Yes ✓No volume l ~3 and Page Number L of Deeds as recorded. with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER a NUMBER & THE SEAI, OF THE REGISTER OF DEEDS.r VOLUME AND , PAGE certified serve In addition, a y, 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 the owner) the property described in this information form, by virtue(sof oa warranty deed recorded irk, he office of the County Register of Deeds as Document No, and own the proposed site for the sewage disposal t sI (we ystem) orr I e(we) obtained an easement, to run the above described rt, for the construction of said system, and the same hasp been duly recorded in the office of County Register of deeds as Document No. Signature of applicant Co-applicant Date of signature k) ` (ia Date or Signature % nOcuMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 =-_~8~~3s V;11 REGISTER'S OFFICE Dale G. Wucher and Sandra S. Wucher, husband ST. CR©IX Co., W1 if............ and we as point tenants, L Recd for Record JUN O 21992 and warrants to --Steven K. Schoenoff and Joan M. Qf 8:40 A. M Schoal~o.€f,-- husband_.an~l_ we~ _.a._uxvvorshig----•--•------.... marital-property, C? RETURN TO the fr.JJ...vIr,K I.-Abed renl estate in Stt_ Croix County. State of Wisconsin: Tax Parcel No:~.2~. Lot 9, Plat of Burkhardt Station, in the Town of Hudson, St. Croix County, Wisconsin. ~t 3- r- i I ~I iI II This ._..is..not............ homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this 30th day of May-•------- 19.92 II q~ / (SEAL) Q L -r-.Waea. --------(SEAL) * DALE G. WUCHER - (SEAL)- tit/ (SEAL) * * SANDRA S. WUCHER AUTHENTICATION ACKNOWLEDGMENT Signature(s) cad__I2dle__5,..__I~IS1~hQx__s3ri53 --------_...,._ST E..OF_*'J44 MINNESO A Sandra S. Wucher ss µy --••----------------------------------County. authen icated thi .3.0___day of May .................1 19.92- Personally came before me this day of .G - r 19.92 the above named *._...5TERH N..J.,__DUNLAP-----•----------------•--------------- TITLE: MEMBER STATE BAR OF WISCONSIN fly/436t'✓.--------•------------• to me known to be the erson who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP Hudson, Wisconsin Notary Public County,/Wis. MN (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: , 19_____---.) 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. 1 3TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~Aoklo_ 3cna1 11monIV ROUTE/BOX NUMBER Z EP H YR 1-4, 690 FIRE NO. (O v O CITY/STATE ~I ZIP ~~©I Lp PROPERTY LOCATION; VI/9 10F 1/9, Section T-L-N, R W, Town of St. Croix County, L Subdivisions Lot No.. Improper use and maintenance of your septic system could resLIt in its premature fail6re 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 y treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 systems properly maintained. ,The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.C-raix County Zoning OI,- 30 days of the three year expiration date. J_ \c. DATE e In e, SIGNED G- Z St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 59016 (715) 386-9680 Sign, Date, and Return to above address nervn i vii %-)viL ovnmua F " DIVISION AB LABOR AN b BOX 7969 LABOR AND PERCOLATION VESTS (115) N6MAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) 60P14 kAI?7- S't'1TI000 L f 16,14: SECTION: TOWNSHIP/ OT N NO.: SU DI NAME: VISION Nw ~4,4E 1/ /0 fj2y M/R/9Elor)W Nvuso •J (,-,,o S-+ Zos~ pH r~ t Cu~tE" LvT CJ COUNTY: . MAILING ADDRESS: Sf . e P0/ x 17J41E r,C,1 tJGLiE,p~ T EN,.t t G- 171S 'PA V t 1 I,- 141,'e V• 1 5+,4 P I E S, M f-.v..7 5_6'17f USE DATES OBSERVATIONS MADE 1 NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION '1 9 ®Resldence 3 eR f- . New ❑RePlace IAIPRi L j~r')Cf f 0 APPI 1 / -1~ RATING: S- Site suitable for system U- Site unsuitable for system S C.5 CS O I I O T- S I 'l W/ C -S `s V S ST4I1 TJ}S . 0NVE WT-IJOYN AL: MOUND: IN-GROUND4'R : S STEM•IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑U ©S ❑U ES ❑U ❑S OU ❑S ©U C0NUE.3T- d,3A L- T~REackt$ If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ~l~-- under s. ILHR 83.09(5)(b), Indicate: C (.i°4 S S r- Floodplain, indicate Floodpiain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HHIG-a-ESf- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /,U' /3//- S/r z,0 ' 3,,. S./ 1.0' 74•~ Sr'l~ 11 B- q / ~•J` 17• 0 ~ > ~~S oP -Gr.Hofs y S' T'ha VE C I. S ' 13I St'/ , S ' D'e. &J, S;/~ 0 ' T,} ti S11 ) 0' U13- Z $ 96.So r 1~,- > FS 51- is M►x y. s ' TA4 Ua 2 9 t .~c c , 2, 0 ' SrY 2 • o r?.,. B- 1 5 r~ Fe..r ~a~ D, sr~ a2-GY Kof S M` y 0' 7-,f j C 5 B- ~~'3~r rGp 9 / Io~P. ~s k S,Lf~/.S l.0' Sw S/.G T,f .u U Ede t C B- -j o 97. 1 key- 9, VET CS S. ' Rte- T o v tog V CS B_ l 0 rtc i ~G 0 I E- A PP I i to PERCOLATION TESTS I DEPTH. WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P lalq_o t a R 02 PERIOD 3 PER INCH P_ / 1 < Z / P-Z S•S <2 ` Z - P-' 3 C, 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, 5y/ T-E,4 ICJ SJ--A 111-rtc-, MA Pt 001QF- S 1TtF qL-tC=P jT/Onj : SYSTEM ELEVATION. C044fAjt- orF 17" L) SL/" 1-9 ~ OP, 'm 9 'A)~ 11'' oo 1101Pe of sEwEQ R o c/< . G owE~ T~°E~u 0 9 2, 0 Zrpp T~'~~ 9 z , s v his test site APPROVED em• . for a conventional septic sst tN 5~1= ~~or Pc..na P E U EY2 S► I~ E i 1, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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 : HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WS. 54016 APR 1'L I-) _ 11.70 ADDRESS: ROBEK W39%,14T- CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. NPIr OMA t ER A DESIGNER LIC-NO-0066 IG y F 3 P6 d~j/ J0S CST SIGNATUR DISTRIBUTION: Oriqinal and one copy to Local Authority, Property Owner ind Soil Trster. ,vW DoT co~'~~r~~ Fbv,~r~, ; u v I;; yd s YZ o~ E(LL) 7~T'~ --"/0c 0 0 LU TL g5 33 -'1 } yes ys I i xr -7 ~ r Z 83 ~ ss I ~ t ~ J I c~, HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 'CSr $ ZyPZ WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. INSTALLER 6 DESIGNER LIC. NO. 00663 I Scrg /E : / O f3,Q 1,16 L7 13 o~ -'4-)~5- S P~RC ~oc~Ti'oA-) row . Ta~✓.~/ µ * ,s- - ~ y sio ~9 rt'~l GJ ~ 7' ~ ~ ~ S?u•t` uds~v z 7D ` ms's 9a .rte • jr ell y ~ ~ zd v 6 U• FeV DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION CIgS, LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) ~~oPn P.O. BOX 7969 g q MADISON, WI 53707 (ILHR 83.0911) & Chapter 145) 130R14 kA12T- Tl0^J LOCATION: TOWNSHIP/ T /N NO.: SUBDIVISION NAME: Nw ~4 NE 1/ i0 /T21 N/R /9 E (or) W "%j VS v j (,*-o S4 S 0 se PR rv t ~u-t E /_0 l' COUNTY: MAILING ADDRESS: Sf•CRoIX t7A(E ~tJGtieQpTEN~~ 17#,? ^v,-IIA- Ave 'V' St4p(ES, Mi,u,v SGy7 USE DATES OBSERVATIONS MADE DESCRIPTION: dd G C: (,Residence 3 04 . New ❑Replace A Pf~i I- ,f(y'I ~y0 i1PRl I?-j7/ RATING: S- Site suitable for system U- Site unsuitable for system S c5CS i 0 r SO &J/ C -S S U S S7_09)f 7A S ONVEN NAL: MOUND: IN-GROUN : r0S S EM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:Ioptional) ©S OU ©S DU ~S DU E]U CJS ©U Coti,uE~r~ea~4t_- TIRENCk.ts 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: C LI~ S S r- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ' /10 , 811. z,0 , 3,,1- S1/~ I.0' V4AJ SiI~ w~ i'aw n►~ B- / IS ' S 17• 0 _k-16 S o 12 -64. M of S Y U C S1 o' ZU . 1. S ' 13l e S'11 • S ' D ,f' /g.2 Si/1 71 f A.) B- Z P'S 9(.So >e•S 5.1- Is k;x 4.s' rj Ueloy C5 t q/ C 2,0' 4Ir P/ 2.p' /_0' r-f-- s./~ w/ 1l0• -,I, > Q -Fa..'r iw.adP, arsr) aft-&Y Hof 5 E` 5! o' 7-,f ..1 C S B- 0 J 7,0 r ~6.3 0' /L, 4• D r I.$' 31k S'd S'f 1.0 r4- S,'/~ /.G B• S X1, 0" ~ 7• f ~ r J0 ' , s ' A w si , • S ' a'i S/, s1-1 A 0 R-9d UCA CS S . R•icQ - 74'.) C's ? 6-2 B- I ~1' OtTGi UlE APP( 1ty PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER V H RA MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I p 1 p R PER INCH P- / < Z P-2- S.5 ~Z P.` Z t P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. - 5yTre-,-j 1/JSfA114Tt0.a MAY I2f=Qu1,QE` Srre-~LTEI?'rTT~d^1 SYSTEM ELEVATION. c0•4~Ajlr OFf_ Il."f lY" rs nP_ q4Sf'. C_ (1 o2 MoIPE OF 6,S Roc, . LOGvE,e T~oE,,u G ~ 9 2,0 z , 570 SL- TN E PLOT- pL•rA I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 AAt j L I-) I I F O ADDRESS: ROB ULBRIGHT - CERTIFICATION NUMBER: PHONE NUMBER (optional): VOS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 1 y Z 3 ~t; S CST SIGNATUR • p4fA-t __j DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nn uo con c1ec to ,nm"t - - Ally Lo T" GOkA. &R. U (2 J e YD R' 6(& U T a = /Gd• ~N H avd-c- Ro g5 33 70 L ' {S ' , Y$ 50 / sy a Pl 19< > s - Ile I >n~ i i - . ~ y 0 1J ~j HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT SST ~f 2-YpL WiS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ~z'fJN. INSTALLER 6 DESIGNER UC. NO. 0060 f3,4 _4- 13 OA01-06-5 PERK 1 ocAT10A-)