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HomeMy WebLinkAbout020-1062-70-000 o 03 o a. O c 000 co 0 O L ti M rv w~(Do b ~U N X~ o c oEn= y O L v 3 ui3EmE O 0 0 y O 'Q U (n w Q _-D x T N N 'n 10 0)O OF- v b h c > o 0 0 O Q 0 C 0 H M •LM N 0 0 I I .0 O N 0 N C M.0 ~I C Z J O O y-O 7 (0 M N LL O r O N 0 0) U) M O N U) c M n.0 c Q U co 0).- 7 3 N > N > ~ Z N O) = O Z N N d a m N F- W O Z a c ~ r 0 N d Z ~ o ~ fA F- ~ N c E (D M (D N N (D U) r- co (o N O O O O • ~V''' t L w O O U M M N N I a C O V~ 0 0 O O Q w N N Z F- Z 0 Z o 0 N N v O ' a °0 ca i 06 v ai O D IL` E E 0 Fes- FN- al 5 °030 " > 0 N rn rn N J U W m Q) a) (D O T O N N 0 O) O O m M O O E N N N r to 00 m N (D 00 N N D O O d Q r (n Q ~l ° to c E O 9 Q c U O N O V N O _M a) C> 0 1 V E M 0 N c U a 0 0 0) C 0 it N ~ F- w E (OA m N N N C~ (O C4 c (4 O ` O N C N N (n CD C)i a (V III a 0 20 (D F- E C L ° ° O ` O O y E R ~O lo N= III Y O Z y F- N a U °3 Q (D u a 06 d c c 0 (`a m I': 3 o ~1 A Ua~ jov)U *DILHR SANITARY PERMIT APPLICATION O dO~ ✓ % In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than nn 8% x 11 inches in size. ❑ ~ V C Eck 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. 44 PROPERTY OWNER PROPERTY LOCATION TE~ ? /l 161311 k - AW'/a 5jE- S T , N, R E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 13f 3 E- li f` CITY, ATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER MV L ISS'10& 1(772. & s6 y A/ . 4- . II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned ❑ VILLAGE : ~V.44p ❑ Public 41 or 2 Fam. Dwelling-# of bedrooms - A LTAX NUMBERO Z 3 - 17 - 2-3 n d _ _ p 111. BUILDING USE: (If building type is public, check all that apply) 76000 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. ~0 New 2.0 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 X1 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure , , 43 ❑ Vault Privy 14 ❑ System-In-Fill 2r 2- -/k£„ve"_: Cf e& S X SS r VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELE FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/da /sq. ft.) (Min./inch) q-q, !Q DELEVATION 3D ® 330 KG~ 3 ' Feet d - y Feet I P, VII. TANK CAPACITY Site in allons Total of Prefab. er- Exper. New jExistIng Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App INFORMATION Tanks Tanks structed Septic Tank or Holding Tank / ~X Lift Pump Tank/Si hon Chamber e5Ow VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ;COB 9,2 T 2/16,ki6/1 H r, I X 3 6 7 7! 5 3 FG Plumber's Address (Street, City, State, Zip Code): / IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (includes Surcharge Fee) Groundwater a e Issued Issuing Ag m Signatu o Stam Approved ❑ Owner Given Initial 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 8 Buildings Division, Owner, Plumber FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER boa y TOWNSHIP 1+U'9-570A-)- SECTION a3 T 2 f N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN I/ V SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i INDICATE NORTH ARROW Tar a~ / BENCHMARK:Elevation and description: /0010 Alternate benchmark Co. SEPTIC TANK:Manufacturer: 4t)e 6e? Liquid Cap. too O N~- Rings used : Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: .>200 No. of feet from nearest road:Front , Side , Rear Ft. >io0 From nearest prop. line:Front , Side Rear Ft. No. of feet from: Well Building: 12- (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid pacity: Pump Model: Pump/Siphon Man ct.: Pump Size Elevation of inlet: Bo om of tank elevation Pump on elev.: Pump f elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from arest prop. line: Front, Side-, Rear_Ft.~ Distance om: Well Building z S SOIL ABSORPTION SYSTEM s''X S S Bed: LTren)c Seepage Pit: Width: Length Number of Lines: 2 Area Built Q6 ^ ^ 9 ~ q8` Exist. Grade Elev. /0 3 Proposed Final Grade Elev.,-/0 2, 3Q' %2 Fill depth to top of pipe: > Soo ' No. feet from nearest prop. line:Front , Side , Rear Ft. ~0 , No. feet from well:/3 No. feet from buildin /0 3 g HOLDING TANK Manufacturer: Capaci No. of rings used: Elevation of tom tank: Elevation of inlet: No. feetrfrom nearest p line: Front , Side , Rear Ft. No. feet from: We 7-01 building , nearest road Alarm Manuf urer: INSPECTOR: TQ ti~`L S o.~~ DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90 : cj vEPTIC PLUMBING CO. 't, HUDSON, WIS. 54016 ''LBRIGHT NIS. A'''' . !_IC. N0.3307 M.P.RA n!ni err: ; : , ,^-NER LIC. N0. 00683 ~I 1 0 13°~ C7M 2AJ 13t D~P~ ~ ~'+3 ~ J r d~ ~N ~ RoD~~s O r wF>~s Lp,v(it.Q7~Q 71 ' f7 0 D cS°'P TANK a 13 M O i h 99,?y- y ~r pip ~t ToP of -TOP v T .01i _ 9 S -To /a a ox y yo _ 9y Yu' f~ of ToP of P%~ , p; p,e 95 -bo ss z4 T~ t uc.G. S pt"c S cv is v 'MY p(~ ~ Z72y sy (~~n f D(7 AJ ups. Tie A.114- PLOT t' W4 l~Ro~ fox I C `%S IT[ SEPTIC PLUMBING CO. I)., HUDSON, WIS. 54016 C L - T ! lLBRIGHT - I F t u _:i. LIC. NO. 3307 M.P.R.S. NIS. W. F- -NER LIC. 0.0001 DEWTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NW 4 j SE4 ,Sec . 2 3 , T 2 9 - R1n CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson El Holding Tank E] In-Ground Pressure ❑ Mound 'R e NAM F PERMIT OLD ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Permanent re rence point) DESCRIBE IF DIF E 83 NT O L REF. PT. ELEV.: CST REF. PT. ELEV.: F' eFl Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 148990 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK IN TV.: T NK OUTLET ELEV.: WARNING LABEL LOCKING COVER / A Z U P IDED: PROVIDED: E/` YES ❑ NO ❑ YES L~1~N0 BEDDING. VENT DIA.: VENT MATL : HIGH WATER NUMBER OF 0 : TPERTY WELL BUILDING: VENT TO FRESH ALARM: FEET FROM AIR INLE YE 0 C E:1 YES NO NEAREST 10 DOSING CHAMBER: PT 17M AN FACTURER: WARNING LABEL LOCKING COVER MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PROVIDED: PROV I DIED: ❑ YES [:1 NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERA O A UMBER OF PROPERTY WELL: BUILDING: VENT TO fB6$~F+ INLET: _ (DIFFERENCE BETWEEN FEET FROM LINE: AIR - PUMP ON AND OFF El YES ❑ O NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: I _e WIDTH' LENGTH NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH `7 TREN~C}S ! MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. P E DISTR. PIPE DISTR. PIP AT RIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIP ABOVE O R: ELEV. INLET: ELEV. END: t} w PIPF~,ss FEET LIN ` L AIR INLET: 1 .7" 3 71 C~ NEAREST007 Is( 0 ~OJ ~7 MOUND SYSTEM: i Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: L_ I ~ ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ S ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: ( OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: COMMENTS' 14 Y NO ❑ YES ❑ NO NEAREST 1 61 \ p~' q~ i !19 0 R8. gs.33 Sketch System on R in in county file for audit. Reverse Side. SIGNATUR TITLE: SBD-6710 (R. 06/88) • APPLICATION FOR SANITARY PERMIT 8TC-100 This application form Is to be conplatod In full and signed by the owner(s) of the property being developed. Any lnadoquacles will only result In delays of the pztmlt Issuance. -Should this development be intended for resale by owner/contractotr(spec house), then a second form should be tetatned and coppleted vhen tha property Is sold and submitted to this offlee wlth the appropriate deed recording. I L Ovntt of property l~°l~ JcQ~J/~L~ Location of property N~ 1/4 f~ 1/4, section T21 N-R /7 Y Tovnshlp Melling address ST • A04, tili;r~.v 5,5_1 6 60- Address of s Its y Subdivision name /V A- Lot number N• L - Previous owner of ptoperty _N09MA,-► C. PEALS ' ) G~ pLi9,JT~• Total size of parcel 2-6 ~CiLf Oats parcel vas created st/D % rwd L,).✓ Are all corners and lot lines Idsntlflable? -_,__-_Ysn xo Is this property being developed fat resale ('spec house)?_an i_1t0 VoluAw C 5 and Page Number as recorded wlth the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING1 A VAARANTT DEED which Includes a DOCUMRNT HUMSitR, VOLUNS AHD PAGE NUNS[R, and the SLAL 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 taferenees to a Cattlfied Survey Nap, the Catt/fled Survey Map shall also be riequlred. PROPERTY OWNER CERTIFICATION t(ve) certify that all statements on this forte are true to the best of my (our) knovledgtl that I (we) am (ate) the owner(s) of the property described In this lntormatIon form, by vlttue of a warranty dead recorded In the of[Ice of the county Register of Deeds as Document No. __},S3'0 1 and that f (we) Presently own the pro seed site for the sewage disposal system (or I (we) have obtained an sae nt to tun with the above described property, lot the consttuctlon t ) V IN stem, and the same has been duly recorded in the o[[ice of thel coynty eg a t Deeds, as Document No. - ! ) '4 . signs o[ owns signature at co-owner (11 Applicable) Date o[ 811 nature Data of -signature i • r. ifr 3 n ~33 K ~p STC - 105 4 PTIC TANK MAINTENANCE AGREEMENT pr St. Croix County _ /7~It { T NUMB$ `"y FIRE . NO o ZIPS' CITY/R f P OPER LOCATION:' X1/4. `sue 1/4, Section TN, RW, Town of v~sdw St. Croix County, ' r f Subdivision Lot No„ Impropd use and maintenance of your septic system could result in its premature I to II rar a handle wastes.` Proper maintenance consists of pumping out.the septic tank ey thr~a years or sooner, if needed, by a LICRNS$D S$PTIC TANK PUMPER. r What ! pot Into the system can affect the function of the septic tank, as a lea Otago in the tram.te disposal system. f ,t ? $t. x County Residents MAY be eligible to receive a grant for a NU MN of $,3000 the coat of replacement of a failing system, which was in operation' prior, July 1, 1979. St. Croix County accepted this program'ln August of f 1980, ' th the requirement that owners of ALL NEW SYSTEMS agree to keep their SXY$te operly maintained. The pz rty owaer agrees to submit to St. Croix County Zoning a certification gned by` the owner and by a master plumber, journeyman Plumber, restr pluamr or a licensed pumper verifying that (1) :the Qvsite I s e r 41apoaal system is in proper operating condition and (2)~,`after and pomping`(if necessary), the septic tank is less than 1/3.full of sludge scum. Certification form will be sent approximately 30 days prior to f t, Kee a i # ig~►. w, T I/wE, r' undersigned, have read the above requirements and agree to maintain the p ` to seva9e disposal system in accordance with the standards set forth, f herein, as set by the Wisconsin Department of Natural Resources. ''CertifIcation r s forts t be completed and returned to the St.Cro x Count ng Office within. 30 day f the three year expiration elate. SIGNED I a DATE ` St. Croix County Zoning Office P.O. Bog 99 Hammond,' WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address IN 4N IF Nrrvrll LABOR AND PEFRCOLATION TESTS (115) P.O. BOX 7969 HUMAN f#EWIOM (1 3 o f 3 MADISON, WI 53707 (ILHR 83.090) & Chapter 145) ' s LOCATION: SOCTIQN: TOWNSHIP/IRtVMCrPAl:TT11: OT N0. N0,1SUDDIVISIUR A : uwI/ sE Z3 %Tj N/R I E la )W Rupso,v Pyre o .26 ' r9c.t S COUNTY:. MAILING ADDRESS: 5f • Gta'll Zqf t= kot3 r ~K-t-- U E DATES OBSERVATIONS MADE COMM R AL DESCRIPTION : ROFILE /I p 9{ ( iesislenctt 3' QR 4- A ®New ❑Replaca ~ J•V Ly l3 ~ l l S0, Jo Ly 14 ! fo 3 T r RATING: S- Site suitable for system U- Site unsuitable for system MIS IQ~ . MO S, Q~ IN ® a~ E. ISYST QI Q~ L D~ G©NK: RECOMMENDED SYSTE aopptional) U T0e,)C44 S- Rop Qox. / i 13 v o.4 If Percolation Tests are NAT required DESIGN RATE: I If any portion of the tested at" is in the under s. I LHR 83.09(5)(b), indicate: CL"- S 'r Il Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS HORING TOTAL D~PTH T R U DWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSIRVEQ EST. H TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) '7O , 75 ' ~k Q~, • -r IS, ~ 13'j . -F vrti~ ~ ~.f~ S/ w/' I a o f fff 0 k-G . '0-e of 5, 6,0' 5' /,O' /3a•/S 3.o vE.~rE- 7 g- 9.D~ /Q .GZ~ 9 3ti s Na ".fvts B. s- D. PERCOLATION TESTS rN CS STRAT3iS TEST OEPTH WATER IN HOLE TEST TIME DR INWATER LEVEL-INCHES RA INU ES NUMBER INCHES FTERSWELLIN INTERVAL-MIN. -Fil~14100 I- lop PER INCH P. 2 P P. P. ,LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale pr 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 bodript and the direction and /percent ,f land slope. /Q SYSTEM ELEVATION ~ l'S T • 20,E ~ G- ~(1~.~-r . ` NOTE--' "ro K6 F 5C4 .2.71-j DrS . P i i,a (r t-E'SS 'r i4. - 'f~ rr GIO40 FiA /.ff/Ep .Y----- TIC Bo- 13 s, ~ ~ f Spry,-~ .~f "f,~Fs'!~ ~,E- ^ O/2 sr~G- • ,y-LT~~e it r1r o,~ ?o p s o L o fr<1. 1, the undersigned, hereby certify that the soil tests reported on this lorm were made by me in accord with the procedures and methods specified in the Wisconsin administrative Coda, a", Jhat the data recorded and the location of the tests are correct to the best of my knowledge and belief. .4AME lprint): E SEPTIGG FL ING TESTS WERE COMPLETED ION, ~O 655 O'NEIL RD., HUDSON, WIS. 54016 0(/ 2. A08Eff I LBFWANT O~N NNUM13ER: PHONUMBE~ (gpticy..11: ATI WIS.MASTER PLUMBER LIC. NO. 3307 M.P.R.S. CERTIFICATION (f 1376 MINN. INSTALLER & DESIGNER LIC. NO, QU663 CST SIGNATURE: a15TRIBUTION: Original and one copy to Local Authority, Propel ty Owner and Soil Tester. )ILHH.580$395 1R. 101$3) - OVER - , 1 a `3 y ~ C ~7 70 m ~ c Z 0 f `off 2 90 sio~oE- K W h .N 1i n n ~M~77 N ~ ~ CX 14 ~:Aj 70 N r z J ' N o C:L 70 0 l 0 ^ ~ l z ~ ~ s ~~-c 2 % , I s~d~oE- W r~ i c, 1► n n a ~ I 1 QI I 1 d3 0~ I I 7D ~ I 1 _3c I I d I I I ~ I I O V1 ~ `I I y I ~ n 1`~ , ~I I OA ~I I b N I I xo ~I I I I l r ~ ~x I I I I I -I I ~ 25 ~ I I I r I I h'`SO ~ ~ I I I I " --j I I I I y N I I I I I , r ~ I~ 1 O J ' DEPA, N R I T"T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION LABOR AND PERCOLATION TESTS (115) ins'- I ° f P.O. BOX MADISON WI 3969 HUMAN RELATIONS 0 LH R 83.0911) & Chapter 145) 3 LOCATION: SECTION: TOWNSHIP/I*IJN+eWA,"~: OT NO.:BLK. NO.: SUBDIVISION NAME: #w 1/ s_x~- 1/ 23 /Lz N/R if E (o W ti ups o,u IP7i e of~ 24 ~4 ct.e s COUNTY: MAILING ADDRESS: 1 U(, IL,~N ~G J4- CPO (A- 13,P 3 ti,", l„h- 55 4, S-(USE DATES OBSERVATIONS MADE NO. B DRMS.: COMMER IAL DESCRIPTION: - Residence DQ Z New ❑ Replace ~TUAu1L SO - 9 TO Ly 1(0 ' RATING: S= Site suitable for system U= Site unsuitable for system i RNVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) IS ®U ES Su DS Qu I OS [3U C]S ©u Mov,-jo If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: CGS S r Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERV D EST.-HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / r , 47 ' PI do 33 ' .3-Sy S/~ 1. S' Ole- 49A..' . S 1. p ' . 757 B- l 7,0 /~/j 0 S.() 3-5 3-$ / ''rF 3i1✓OEIJ Lim-SI w/M. LS .DiST ~IPGy.noTS. vl9r~G Dr. R-N B-2 Z 0 S CS rLto_ Gf. 3.$'%/1~M^i~~ S w~ ^vCS Ru p~vo D A7- S , ~K fs , . S 2,0' '8"'. S La. R...)- 6.O o ` 3- 5- I)--a- 19'15r B-3 Y B- 4 0 y ho > - 0 s. 6 P u pDCED o s ' /c S/~ 3, S B- S G, ~2 . c/ A T 3. S 3 • S B.v -G L.%„? 19k pe- S/ w f nr ~P, ~i'sT . o /t p 7`S . B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME R I WATER LEVEL-INCHES RAT MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t P I PER INCH P_ Z 3:a • S P-L L 3~ Z L IS- P- y 3 s Z ! S 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. , SYSTEM ELEVATION. /0/0 « s Q TH Eo TjO.✓ T p Se',AJ +S S T 2- e o /,J (J- 71Q Af 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 to the best of my knowledge and belief. NAME (print): TESTS W,ERq,COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. g - ( I S 0 , - V ° !ADDRESS: 5-ONS Aft, HUDSON, WS 540 x6 CERTIFICATION NUMBER: PHONE NUMBER (optional): ROBERT ULBRIGHT 2 VP Z 3 P 6- P/'? S WIS MASTER PLUMBER LIC. NO. 7 M.P.R.S. k-INN. INSTALLER & DESIGNER LIC. NO. 00663 CST aGNATURE; DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. OILHR-SBD$395 (R. 10/83) - OVER - C ---/o~S GL ce 'LL = K it -LA 7-Z v u ,i A vpp . 't- ~o t U O 06 O °6 v 0 w r c INB 1S T Y OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INUU:TRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS \ MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) P~' • 3 of 3 LOCATION: SECTION: TOWNSHIPlfvltTfCtt'tP7tCTTV: OT NO.:BLK. NO.: SUBDIVISION NAME: 11W11 se-1/ 13 /T-qN/R I7E(o)W Nupso.y P ?W]7- O -2(2 r9e S COUNTY: MAILING ADDRESS: 5f- 6a'R Z eF F- k-,a 13 13 f3 57 - ~m----e I'i,j . Ss~o G USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMM R IAL DESCRIPTION: ROFILEDESCRIPTIONS: PERCOLATION TESTS: _ / c ktesidence 3 6R ¢ A t Z New ❑ Replace UU Lr c 3 - ( TTO J U Ly RATING: S= Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND.PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) r0S0Uj1flSE1U1 ©S EA Z]U OS ©U TPEjckeS- w/ zeL Qox P1 5 7 12113 v t/ o.t.) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.0915)(b), indicate: G~,f S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ? 75`AleQ,J• s l /.1S' 13 A9. S 3.p' oEv~ 0 OF af~_6-. moots o B- 7 I.0 / /D,3. G Z • 9 , sv ' . /s ' 3,~ . /s 3, a ~E~ rE- 3,v S Na /Lt Uts N cS B- U( ~a 77 a ~.s rya, si v T cs B- B- B- ~ r~ " ~ c~rro.~ foe •~rarr .Q~ /3d,~~ ~ ~ PERCOLATION TESTS L'(P CS S TRJt'T7t,$ ) TEST DEPTH WATER IN HOLE TEST TIME DR I WATER L V L-IN H S RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2__ PE PERINCH P- ItT_ -1 2 (e r3 - p- S. 5 ' 11- _ Z 40 Ce Y3 P. S, o 221 < Z 1~0 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. ~f(, _ / ~f/p ~•~U ~ `,+o ~ `ti ~ T~~'V 'mow / ~ D r SYSTEM ELEVATION. VS/7~L / / 14rS c (6,-r 2.0,0 e' A,3 Cr- /4l>~-/ . N C~ T 7-0 Ks~ SC -2-71-1 'D IS LeSS 96i0w Fi -(511/1-p OF O S~i~t~ I~ j /f? fi ^ /c fi'TE 0- S s a F tilO.C~ ~~.t,~ f f 7b s oil 0 f>t1 ,q-4,71EW 4-751c ~ se'tz-p ,ox . ~ p 3 y L_ /~'~Ol~~l~ S y S 7 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 to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 ~Gl AOBERT.ULBRQiT (gpti9pal): ADDRESS: WIS. MASTER PLUMBER Llc. NO. 3307 M.P.R.S. Y8 CERTIFI ATIO~N NUMBER: 3 uY! PH011~ -Fir uf/ 5 MINN, TALLER & DESIGNER LIQ NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER -