Loading...
HomeMy WebLinkAbout030-1088-70-130 N y 4 O C ti O N n O i i .o I i s ti m I z° c li c ~ I M 3 Z II! 3 E Z ~ I o°> H Z a m O z a c 7 z a ° v1 H r i ~ N N !n C C (D N O O 00 a L m m c\ c O u w c, O O ¢ N Z H Z 0 Z o N 0 N_ fV co l0 E m O C Q w 00 v O G G a a 0 C~ co U) Z d' > O F- H H 7I U a cn I ~N v =aaa CL LU 0 U) 0 0) a) (0 0 N \ 04 0 ° ° 0 CO N j V O O .p E ° ° C m 2 a fh N N N C ¢ U) 0 G O H co cn O ¢ O O V 0) C7 O ~ V a 0 0 U N N C C 00 CL : - co 4) a, W O y N~ H C' s Y N 0 to - Lo t~ ~ d M Z' C N O N O a0+ 7 - O M U) F- O Z N fn w I v v~ d ~o I', a a 4 c E ` 'c c r A o a 0 N 00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / TOWNSHIP U~ %f SEC. _ T N-R ~W ADDRESS] ST. CROIX COUNTY, WISCONSIN ffi~ ei Tip r At I~ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 41 /x rr, f Gi 7-l EN C Y INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used J Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: j,/'yta4 T'S Liquid Capacity: Number of rings used: Tank manhole cover elevation: ` - - z63 , _ Tank Inlet Elevation: Tank Outlet Elevation: 3 . Number of feet from nearest Road: Front' Side Rear, ~ 0 , 0 feet From nearest property line Front,0Side,/9~Rear,0 /3,19 feet c Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEi? ~tl?VI?.RSI? S I i)I? t ; PUMP CHAMBER Manufacturer: Liquid Capacity: pump Model: pump/Siphon Manufacturer: _ Pump Size Elevation of inlet: Bottom of tank ePump off switch elevation: G ons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Nu er of feet from well: umber of feet from building: clude distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Jt Width: Length: Number of Lines: 3 Area Built: d Fill depth to top of pipe: r Number of feet from nearest property line: Front, O Side, Rear, Ft.,9 Number of feet from well: f Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on a of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: apacity: Number of rings used: vation of bottom of tank: Elevation of inlet: Number of feet from arest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 177- ` Plumber on job: License Number: S 3/84:mj Wisconsin Department of Industry, Labor PRIVATE SEWAGE SYSTEM County: .ynd ifiuman Relations ' Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION L (ATTACH TO PERMIT)) Sanitary Permit No.: NW4,SE4,sec.30,T30-R19, Co. Rd. E 149155 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: Al Theisen St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: Co-14- 1 030-1088-70 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ivite- 5 ~OUV Benchmark I U`, ly Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet c o3.7~ TANK SETBACK INFORMATION St/ Ht Outlet I ~3d TANK TO P/ L WELL BLDG. AirI to ROAD Dt Inlet Vent take Septic ~ 3v r NA Dt Bottom Dosing NA Header / Man. 92.61 9'70 Aeration NA Dist. Pipe a~, lz a, 3y Holding Bot. System 4~.~~ rc.,51 cr3 . ~ i PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift F Loss riction System TDH Ft Forcemain Length Dia. Fi Dist.Towell SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pith Inside Dia. Liquid Depth DIMEN 1 N-0 DIMENSIONS r SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: ? Y~'~l OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over TBe epth Over xx Depth Of 7 xx Seeded/ Sodded xx Mulched Bed /Trench Center d/ Trenc Edges , Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code cli lpanciel, persons present, etc.) _tV 42 -7 - Plan revision required? ❑ Yes ❑ No Use other side for additional information. I q HE L I r s d r,n 5 SBD-6710 (R 05/91) Date Ins ctor's Signature Cert. No. LL HR SANITARY PERMIT APPLICATION ZEE In accord with ILHR 83.05, Wis. Adm. Code CouN STATE SANITARY PER T # -Attach complete plans (to the county copy only) for the system, on paper not less than / 7 / 5 S- 8'z % x 11 inches in size. 1:1 heck f L 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. PROPERTY OWNER PROPERTY LOCATION %a -L%%4,S T.310, N, R E(or PROPERTY OWNER'S M ILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 001- TO A/--- 1/,/j I 511t2OR:2 Ilf II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE NEAREST ROAD =N QF: -76,5 25011 Ic- ❑ Public 1 or 2 Fam. Dwellin g g-# of bedrooms ~ AR LTA NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 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. TYPPgE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 9 New 2.0 Replacement 3.E1 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 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 97- ELEVATION i ,0 0 C~ Feet 7 76. Feet VII. TANK CAPACITY Site in alions Total # Of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank - r !LI Lift Pump Tank/Si hon Chamber, F1 0 1 Li VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on th attached plans. Plumber's Name (Print): Plum s Signature: (No Stamps) /MPRSW No.: Business Phone Number: e 17 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTM T USE ONLY rte( ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued Issuing Agent Signature (No Stamps) LEI Approved ❑ Owner Given Initial Surcharge Fee) T' Adv rse De rmin on X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: fill SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber ' APPLICATION FOR SANITARY PERMIT 9TC-100 This application form Is to be conplatad In full and signed by the owner(s) of the property being developed. Any Inadequacies Will only result In delays of the prrmIt Issuance. -Should this development be Intended for resale by owner/contractot,(spec house), then a second form should be retained and completed when the property Is sold and submitted to this office vlth the appropriate deed recording. Own:r of property _ .0Yeen a,--O AI A (s n Location of property _ -W i/4 S~ /4, Sectlon T 30 N-R q -V Township _ ,10Sep~'l Mailing address 3 0. koaj 4a r, I.t) r0 8 2 Address of site 3T9 CO• Pnla wbdlvlslon noes - , Lot number -4- Previous owner of property ~bSPO~, IVOide Total size of parcel Date Patcel was created gjzo/gp Are all corners and lot lines Identifiable? Yes xo Is this property being developed for resale (spec house)t______Yas x Ito Volume ~____and page Number Q2(0 as recorded with the Register of "ads. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUDS WITH THIS APPLICATION Tilt FOLLOWINCI A WARRANTY DRED which Includes a DOCUHSHT HUNBtR, VOLLM AND PAOt NVmlzR, and the SIM OF Tilt R80ISTtR OF D9RD9. In addition, a certlfled survey, it available, would be helpful so as to avoid delays of the reviewing process. it the deed description references to a Cettlfled Survey Hap, the Csttlfled survey Map shall also be required. PROPERTY OWNER CERTIFICATION i(We) cattily that all statements on this form are true to the best of my (our) Rnowiedgel that I (we) am (ate) the owner(s) of the property described In t h I a Intotmatlon form, by vlrtue of a warranty deed recorded In the Offlce of the county Register of Deeds as Document No. ptesently own the proposed site for tho sewagee dlepossalsyste~~J(+atI ( we)i hav` obtained an easement, to tun with the above described propr constcuctlon-ot said Inystam, and the s mo has been duly recordedeInt, r the of the Coynt Register or Deeds, ocumant No. ythefoorrice 9natute o[ owner 8lgnatu of Co-own It Appllcabie) D to of signature Data o Ignaturs WARRANTY DEED i . 46 7912 VoL• '897 Pot 314 REGISTER'S OFFICE - I ~ This Deed, made between ST. CROIX CO, WI Recd for Record .:.and...S hi_r.]_e y... J....: Ua l-de.,... hu s kzaad-.. ,and..w.i fa APR 0 31991 t ..Grantor, .and kl-lea..U.-.............. sr+ ' k-R :50 P M a.s..}oir1t..t enazita , l i>Iterof Ceeaa Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... one...dollar . and .ot.her va.luab.le cons. . .ide. co.n.si.de.rat.io.n .rat.ion • conveys to Grantee the following described real estate in RETURN TO County, State of Wisconsin: i Tax Parcel No: Lot 4 Four) of CSM•.filed as 'Document Number 457750 on April • 20, 1990 in the St. Croix County Courthouse as Volumn 8, page 2196, St. Croix County, Wisconsin. I 5 rRA N w~~~ 1 ' Y This .?S._.not...... I. homestead property. (is) (is not) Together with all and singular Lite hereditaments and appurtenances thereunto belonging; ` And... Gra.pt ors warrants that the title is good, indefeasible in fee simple and free and clear of encumbraucea except • ~ i and will warrant and defend the same. Dated this ............2 8th day of .......i1a rh................................................. 19....91. (SEAL)....`-C.............. (SEAL) I • * .ose- ....1Yolap Jz.................. ; Q (SEAL) UQU ................(SEAL) i ' Sha.x.l Y .~...No1de AUTHENTICATION ACKNOWLEDGMENT I Signature(s) STATE OF lwJ ~ a as. • Washir~gfor~ County. authenticated this ........day of ..........................119 Personally cwne before me this ...28fh....day of. .....March 19.9.x... the above named Joseph ,A. Nof..jX.,-...an-1..Shdx1>w~t... • ..A. Nolde.....husba?ia...s~Ad..g7.fe............_.. TITLE: MEMBER, STATE BAR OF WISCONSIN (If not . ...DONNA.F_NOI~.._........................ authorized by § 700.00. Wis. Seats.) to Itto k b Q!N!El~TA ho executed the ' foregoin t+ll~iM same. THIS INSTRUMENT WAS DRAFTED BY tl • T.L.... Nolde.._... V,,el"`.' ......1.... P.O. 119 M it1------55U-82 Notary Cuhlic ................................County, wig. St-iliw•at~-r---•-............ (81 l;natures cony be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: 19.........) r ,Names of persons alanin¢ in say capacity should be iypwl or printed below their alanaturen, i r...•il+ 1:1i If BTATi R1lt /'.P n'CiC/~~{SIN IVF,:onnfn L. -.l Bleak C-2 Ioe. 1t'•1I:?.AFI Dr3cll 4 +it i.7 No. a lbV2 ~liJa, blu: VF. STC 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 6vnfn and Al ne l S en ROUTE/BOX NUMBER '3 1 W . Ro" U FIRE NO. CITY/STATEIL ~ ~_r zip Jam- n$ 2 PROPERTY LOCATION: N_1/4 _1/4, section 30 T 30 N R_iq _W , Town of~ O S h , St. Croix County, Subdivision , Lot No. 4 Improper use and maintenance of your septic system could result in its premature failbre 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 $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.Croix County Zoning Office within 30 days of the three year expiration date. SIGN ` DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address ADLA ,vu-4l To TiE-Y //plEPOPt or- A00I1P/L 19t0 13Y CST- 1- •Aleoey 70M,-)so^.l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION HUMAN AN RELATIONS LM PERCOLATION TESTS (115) MADISON W1 53707 (ILHR 83.09(1) & Chapter 145) Pr49T' -F 12. 3 4«E5 LOCATION: SECTION: ~TOVWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME: ,V&) 1/4-610 4 3c IT.3oWRI`l E(o JoS& PO COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: $lGC°D~.C 4 ThE/SEMI f D6-J-0 To Sr'. s'1-- PAU(, 5-5- /0.? USE (,/2 ^ 77Co - I 2 DATES OBSERVATIONS MADE 7_[).B:MS.: COMMERCIAL DESCRIPATION TESTS: Residence ®New ❑Replace v,Ug Z ELK S ~ Y~ ~ 2G f/ 3 -,---,v CAI S RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND PRESYSTEM-IN-FILLHOLDING TANK: RECOMMENDEDSYSTEM: (optional) osau ZS EA ©sESSURE:as[A osau Teti s ~~'~r wiDPd P A9 6y IfnderPercolation Tests are NOT required [DESIGN RATES:--~-~}-~ FFFloodplain, an Y Portion of the tested area is in the u s. ILHR 83.0,(5)(b)indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUN!ES TER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED T. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Y 3 S% o 73 l 2f5dir r..G, 1.2 2.e /ojR4/z S./zfSb.f B- 10S 17.3JO ~p to~ 5 fl, 5,-zp~oy YI-0 51 zf56;k,2d"-/o p° 71sYR l P_ I Z 72 5C nKfi •9"/o ,Q 3/3 5-, zfsbk,r.f; 9"-1y„/AYR 4/? .,s ,t; B- J_G /00. Yt,CS' (O 2csb;,Y-56 1/0yR513 s': 3m.sbt 1.",f'~ 5G"'-~O" to yR4 , /g s~ oiooy,'j/3S,y2fsh/~~ ICs' 10 =z2Y"i0 yr~/z i B- 2 3 ~~v > /fSbk) („-Fk; x2''- jo '/QyR Y/JL 5/, 2fsbk,n»)C/; ~o= z~. sh.~, nK U 7,S G 5,B- ' o-14& ioyx'3 S: z)45,0 ; 22--/0 /1¢/z B 1 l S /0%/2 ~v > !lS 51/ 2-P 5,6/w.~ ; z2 IrS „ioYeY/.g 5, Z q,e B- 644PE 4F/,"U~tT/D,vS 0,~c PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P- P- 2 ya /oo . S 30 30 P- P- , 0.1 _4 U P- PL SAN: Sho *s of ep tion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zo to nd ver~iggI ele "G fere ints and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent o I~ slope. U~ I(U H/ ~-f)~ T/PE,uG = 7_ Co 0 p (i • sa 7AI T l~V10 _ . /P 3 3 SEA V ,~4 17 A4-4V-1 iruS f T/'o AJ DoT 4_1"l;C*R 72~~v ~frL vE'.c 1 T /"T S i 7` Tip,.vSC sus .►4C "o,s ~ o 2 + ~r S' /Dc ~►-Tivu ~v. .sei 7 4P I _ 4( . i 40ti _ 0,7171 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 : PIOMESITE SEPTIC PLUMBING TESTS WERE COMPLETED ON: G+ 655 O'NEIL RD., HUDSON, WIS. 54016 Z & ADDRESS: ROBERT tItBRO61 IT JIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. CEtFFI TION NUMBER: PHONE NUMBER( optional): ye'2 3p( a-y/ s CST SIGNATURE: e ~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - INSTRJR#f 5 FOR COMPLETING . . 1 15 - 51313 - O0 a co, rates i1 test., your report MUSt - Cc a ptioa ; 2,. Tf e clew ly irid cat.e whether this is a reside„ or co€ meacial project; .tMA3f IMUi: r4 b iroo s or commercial use planned; :4 .,'Is this a no,. meat syst_; 15- oariplete rating boxes IFOSWABLE R 4OLUINC TANK ONLY IF ALL OTHER , *k LFDi(3t~T k' f*,qIV SOIL CONS IT" . lam, 6.,fPLEASE c a abr viations sh6vvr€ &rre for Wrid 7y profile d ,scrap,,=.~ns Ind completing the plot plan; J. MAKE A L .B E diagram acc~sra}~~~~9~pour test to ations. Drawing to scale is,preferred. A ",separate shoe, e [Aso( a Ces reel; 8 y llrake s, r:rk and verti'aa ,ataon re erence point ar c : ; `,_)vvn, and pare permanent; E: 9. -Corr , appropi iate boxes as t , names, addresses, flood l;h,,ai 6uta, per€:olat on test exeanp- ir appr 9 , f rr , god pla n, f At:icn) does a Rice N,A. in the appropriate box; jn `he iorn your curren address and your a =artier; 12. (Nuke legible copies and distribute as niquired, ALL SOIL TES'i S MUST BE FILED WITH THE .i,_OCAL AUTHORITY WI_111. SQL YS OF Ct~iVIPLETI~ SEi ~~~A E Q S FOR CERTIF SOIL. TESTERS ~nK 0 p;lPA . il~io,17 Soil Separates and Texttk(o 3s' Q)h Other5yPbols T~ R Bedrock n° t -Stone (aver 10") N (Ey SS sandstone roo, Cobble 101 gr katiel7un d er 3")- LS 1OLimesione :a s Sand HGVI HigtCV(5A?d Eater o PPrc rcolation Fate oarse Tiaa(cro -VV V1I~ axed q- Mekiaam Sand - - and - fs Fine Sand o • Bldg BuildinN Loc3r~y~~ - - - - - - - - - - - - > -greater Than i sl _LQan4- - - - - - - - - - - - - ~f Less Than arm 5~4 Coo Bn Brovvn t rs=l o.. SiIrt- LJatrt -----------------,BI - Black I <<~~ - - - - - - tsy Cray Sil a cl Clay Loam 71/ Yellow l scl Sandy Clay Loam U _..ORB 3 / l Silty Clay Loam ~ rnot - It sc a Clay vv' . _ F 5 u 669I -a9ty Clay ff1 fev!,4ine, fa "44" -r p v I t Peat rmn Mail nedium $ ~G i Muck d - (distinct z p proininent t HWL - High water level, ==al soil textt.aa-es surface water SM - Bench Mark ;raid waste disposal 1t RP Vertical Reference oi i t I I t { C j b' *d-T1-I OWNER: 30 Thi soil test report is the first step in securing a sanitary permit. The county or the Dep r' merit may request We s rification ~T~ ~X~~t1P Pto permit issuance. A complete set of'ifEq'+S`fffF'V PAC r3! sewege sys r :tir's1Tt'[ ly_LW~ted to the appropriate loffel gty ~ r G,us mils~ hkt:ained and posted prior to the start of any construction. ;obtain age rm' s 5#4 MINN. l!►6TA4R 8 DESIGNER L{C. N0.00663 I'S T'lz C__ 1P 11 D e a DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IIJDUS:tRY,- DIVISION LABOR AND PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RELATIONS ` / MADISON, WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MHhfTCTPRi1Ty: OT NO.:BLK_ NO.: SU DIVISION NAME: Nw 4 S~ 4 30 /T3o N/Rig E (o ► S-r. 611 P14 - ,~~~Pc p CSI~'~ r 4 COUNTY: \ MAILING ADDRESS: ~T 04'. IX J or Pvik~~cl-r QI .C 7,LLL1 SSG Z USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMM R IAL DE RIPTION: A STSPROFILYES71 ION : d.O Residence New ❑Replace 3u 9o A 7 't S ;:J RATING: S= Site suitable for system U= Site unsuitable for system l ~1 - ^ ~y1t~lP CONV NTIONAL: M U O: - IN-GND PRESSURE: SYSTEM•IN•FILLHOLDING A K: REOMMENDED SYSTEM: (optional) S ❑U A Ilu ~S EA OS ❑U OS U Coy uAL a If Percolation Tests are NOT required DESIGN RATE: If an M__~] I Y portion of the tested area is in the A14 under s. ILHR 83.09(5)(b), indicate: CL ass Floodplain, indicate Floodplain elevation: ~C PROFILE DESCRIPTIONS BORIfT OTAL PTH T R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBEPTH'! 9ELEVATION TO BEDROCK IF BSERVEO (SEE ABBRV. ON BACK.) B- ZX q 9 ,9 Z v 6 . o S 3'~LsTS ►6 B~. Gv sI l i4'.eo~s~'~e 4o'fPoGv Bo,ec k B- DT5 g4. 6Z . ~~C~[.Stf,TS 23ryGv~en,StL 1D ~?0.$Qn ~1~~iG~2 B p,S6 0N f fS , S ~'&SI CTS 19 "Gy$at~ fL 62 "~dBQti ~1 ~4Q qp~,y r',~_ B- 9.0% S,BC SL-r317~"$(.BQNSL 70'48eN r►tS~Git 17'T4&14 O*f B- 5 bg 92-79 I . > ~.o$ 9"$LLTS91GV$aN L ~4 YGY Sr - R K `i ~S ~a$Par r-MS~G [B- PERCOLATION TESTS EPTH AFT ER I HOLING INTEST T MIN. DR 1 WATER LEVEL-INCHES RATE MINUTES NUMBER 2DI fELRVAL PIP 117,7- P. J V~ No we )~-'90 P R t RI PER INCH 30 P. z ~0 a 94•c6 30 Z 74 Z P. 3 SO is '.?O 2 Y Z Z / F- P LQV Wr A-r >i it 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. ?9. o 3 . 1 _ r... i , r p` f3wcta~r cio ALTom Wle- 7.%9 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pro edures 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 COMPLET D N: ADDRESS: CERTIFICATIO NUMBER: PHONE N MBE (optional): 67 S Ova i Cj L~r.~G h~ r 1 C 3A ~ 4' 3 1~ " O G CST SIGN RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. lil 1-+B-cRn ~1~F rp ~nlo~t ,.e 1i DANAI N 134 a~ Sk, ~t 9 . o i ~ 5i i - - - ----P 014A - I ILI V,2 765 Va-l k i e-j -Itt I *ZZ