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HomeMy WebLinkAbout030-2043-80-000 -0 C) o 3 o I O M y a O O 0 N c O O N . y p O O N O CO N f0 N M =O R Q w Oyi 0> > m C 3 N OL p y O a 0 3 6 Z =0 2 y N 7 N L LL c rn, Y o j,s 0 N O a a ti y or' Q Q t~ y (n N ! M ~ N I Z y ° Z E Z ~ ~ d d (D m a m c C7 O Z a c c U) H ~ CD E O O N N O N ~ O O 0 a c •N L L IL M W N c O o ° O Q t N O Z H Z O O N zZo y I 01 m = m CL o atS aNO y a~i ~ d - °OOn. a > u U) U) w E 'I 3 0 0 0 a Z •N =0.aa N _ o N ~ o 0 U) M C)) U) .i U W rn rn ~V 0 M (D II[~~ 1 C 0 0 m y C a O y N O) I'U•~_ Q}tn o 0 H U) 3 +'r a Co O J O N d 7 °O~ _ C c,CL CD G y R V o ° oa _ W O N p N .~y. a (O G N O yO y N a Z = (D MCI p' M 7 L f=yam,) ov) O y O O R o • ~ ~y O N O s U) 'ii CO O Z y z s~ fn O v 0 u ° e a a CL 2 rrww ~ s _1 A cia~!',Ov'~iti WoKonsin Department of Industry, PRIVATE SEWAGE SYSTEM County: La6oranditmanRelations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Se'- NW Sec.26 T26-R30 Co. Rd. E 149159 Permit Holder's Name: ❑ City ❑ Village [fj Town of: State Plan ID No.: John Brown St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 500-B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. hp Septic Benchmark 7-3 Dosing ~a} /j-o . Aeration Bldg. Sewer Holding St/ Ht Inlet /O/. y TANK SETBACK INFORMATION St/ Ht Outlet //6y v 05~ Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic 63' >D S ' NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System q I PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss H Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER Model Number: INFORMATION ypem c I ~ ~S-0 OR UNIT System: S DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~D7eprth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 'B~d /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: 4n dg,.Ncpde discrepancies, persons present, etc.), Wl!_ - , IO! r _ 41_~ ~'ybw El, P ,yu G` Plan revision required? ❑ Yes ❑ No $ `A j -y r Use other side for additional information. zt. 'T (p ray }p SBD-6710 (R 05191) a Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION QILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~5/9~~~' 8% x 11 inches in size. ❑ Check 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. PROPERTY OWNER os ~p ; S~ 3r~ rv! i= s ROPERTY LOCATION -_3' 5X '/4 IV W'/4, S N, R ;?b E (o W PROP TY OWNER'S MAILING A9 PRESS LOT # BLOCK # o x 1,5- 7 CIjY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER e_V,5,_yAr~ 11. TYPE OF BUILDING Check one CITY NEAREST ROAD ) El State Owned LAGEN OF. kow ❑ Public 2 Fam. Dwelling-# of bedrooms- AX NUM C 111. BUILDING USE: (If building type is public, check all that apply) S00 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 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. rffNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 E ySeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 91,0 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTE El-V . FINAL GRADE p~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATI OVS0 ^ Ali 7S` 75~ • ~ Feet 9S, et VII. TAN CAPA I Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete, Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank D $ © f 1~_~ Fj n n F] I LJ Ej Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s) M MPRSW No.: Business Phone Number: Plumber's Address (Stre''t, City, State, Zip Code) `f . IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) f4 Approved ❑ Owner Given Initial V 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 APPLICATION FOR SANITARY PERMIT 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), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - -----w------------rx---C~p~, c5's Owner 9f property ~ o N -kl,.o aJ Al Location of property _ r 1/e1/4. Section ;I, , T~ N-R-20~ Township ,S?G. Malling address 9-©,X... ~7 Address of site subdivision name Lot number Previous owner of property Total size of parcel X Date parcel was created Are all corners and lot lines identifiable? ____-~fy`es _-Yo Is this property being developed for resale (spec house)? as -t10 Volumes '57-1," nd Page Number :!~IP as recorded with the Register of Deeds. mm - INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DRRD which Includes a DOCUMENT NUMBER, VOLUNR AND PACK NUMBER, and the ORAL 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. 7 PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (out) knowledge; that I (we) am (are) the owner(s) of the property described In this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. -3 ,aA 77 ; and that I (We) Presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the office of the Count Register o De s, as Document No. s owner Signature of Co-Owner (If Applicable) na~ u e of iq t Date of Signature Date of Signature 5 yy W~1A1 6 ; 1 { Tl~ yi,a ~~tU •R .i"91 4r y ter a;~313'"~;:t I 's'y~~~-n~'l, tV qfq' ~ ~.~MI'~" 41 von`; ~a~ 4 0' 77, 1 a~ BY THtB DEED, J061e9h "Q=IL rt REGISj9R" ST. CRP a k Recd, for Jt~tor ` antcc awtveya and warrants to Elwg C Gibson day of d t x at 1:00' P: k. tr rt _ f"4 a w ~t.+ Grantee_^ „t Y41 ~pfy+ vslµabit eonsldentiop One -Thousand Seven " Hundred RETURN TO 4 r Fiity Dor~_ "4k! lollnWin# described real estate in s GT01X _ County, StateofWisconcia ` y '4 fV ` ' ~ AFa t' 4f the,, Southeast' Quarter of the Northwest Tax Key r! a QuRn~ter~`(SE;N11~) of Section 26, Township 30 Thla is not b;paA Range 20 West' described as follows: .x8eg~up ug,a a paint on the North line of the Southeast ,Quarter ~e ot'tith~;"Northwest Quarter (SE1 NWD of said Section 26 one.,huudre4;,a sixty-five'-`- (165) : feet` West of. the Northeast corner of said''Quarte j' 4 w bencp-South, par~illelto the Eatat line of said Quarter a distance, 'o «tn ~ ►ucdred `s~xty,~four (264) -feet; thence West parallel `with~,the. tk~ l~•ne`of said Quarter eighty-two and 'one-half (82j) feet; :thenc ^ } Xgrthaparallel to`,the'`last line of said Quarter two-hundred sixty" , *N!~(204)eetthence Bast `eighty-two and one-half (82) feet along~xhe: cline of , saidQuarter , to the place of the beginning + Pubject'-'to existing highways and easements of record. 1 - ~j 1j}~~ /Jy r*YT ,u Exception to warranties: S Executed at-.-1W4, t SOn. Wiw='"~iTi __day of SIGNED AND SEALED IN PRESENCE OF +s osepWD Heave 'T Signatures of authenticated this ^ day of_-.T.___-._____._.____.-__ , 19-. Title; Member State Bar of Wisconsin or Ochar' Authorized under Sec. 706.06 vii. a-&, STATE OF WISCONSIN ii Peisonallr came before me, this C~~ !t. day of xa the above named __.__._.___r10S_~j2tL.D.._.~@nlle__._-_. to me known to be the person-, _ who executed the forega,dp,isAlrhment and acknowl ed the same to, ` hl/ „t This instrument was drafted by jam;' • V $L;R?9 Anders ~j Hugh F. Gwin, Attorney c Hudson.y.IKlsconsin. Notary Public , ..$t - ' C jf lot k:' r f . t p a C , SUSAINk F. WD i Tho use of witnesses is optional. 14 4 ~ My Commi s) EIa x S • 1M Corvu u~..an q* Names of persons signing . in any capacity should be typed or printed below their signatures. ~ t WARRANTY pL6A-sTATR BAR OV WACQNS1N, FORM NO, 2 - Ip9i , ct 030 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St Croix County D um ch ©Al( s , c~V/^D OWNER/BUYER ROUTE/BOX NUMBER-it, 1s- 7 FIRE NO. CITY/STATE 42Z A/ GU6©d l ZIP S~yO/ PROPERTY LOCATION: a,, l/4 1/4, Section T Z 0 N, R~ Town of 7e- St. Croix County, Subdivision Lot No. 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the'undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth,} herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30'days of the three year expiration date. ; SIG: DAT St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address JNDUSTRY., ~ VIi 1 ZIP L7Va~as ~t.+v r~s Is 0.0 DIV151UN P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADIS ON WI 53707 1-1 MAA► RELAi,LQNS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHI UNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: .1/ NW 1/ z6 /Pm N/R ztE (or SC~PTI - - COUNTY: MAILING ADDRESS: B03< S-C'. C-~SJIX SOt} l~ BRUWN GLI~Y.~oOD C1'1 t1 l c~ s vw 6 USE DATES OBSERVATIONS MADE NO. B DRMS.: COMMERCIAL DESCRIPTION: I PROFILE NS: _A TESTS: 13Residence 3 H [QNew ❑Replace t z4(_!~/ RATING: S= Site suitable for system U= Site unsuitable for system t r ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑u ,®S 0 u ZS []U ®S [:]U ❑S ®u Z`~- LcN 5 ~x~$~LO~G 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: 01 ._N 5 5 1- Floodplain, indicate Floodplain elevation: , V PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 8 8 3. b 1vo> 7 8 S pnGE F > 86 B- Z gb a~-C) B- > 87 B- y 8`l G3 y > B- CY 14. C/ B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD PER INCH P- P- P- 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. 6~ 7 ~U1c}{Z~~ =~k'E C ly`lI~C E}( SYSTEM ELEVATION s p~tse z t I I ; { ~ I _7 tN I ' n - - I - 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. WEGERER SOIL TESTING NAME (print : AND TESTS WERE COMPLETED ON: SERVICE ADDRESS. DESIGN CERTIFICATION NUMBER: PHONE NUMBER (optional): P.O, BOX 74 421 N. MAIN ST CST Oo0 S 7 6 )S- y2 S- 0165 RIVER FALLS; W154022 CST SIGNATURE: 715-425-0165 DIST)"!QUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~ 68 DILHR-Su ' nrnZ) OVER - ~ ~cG!✓ ~ OF 1 S cF~ t~ ~ = 3 0' 8 z. so ' i, 3 ate- D2N ~'.~'S l D~.~t_CY` M t N y tvo~, w LLB.. To 3t t}T L. ~sT S o' ~W iL1T1 of -Ck1 CH CTS Rrv~ RT Sal S 1S~1 a1.~tikT7UJ L S T ZS, F-R -I Q 4 Z. C) S' n c l'RNh GZ q l.3 ® g f. (:g) cJ V ~ • / 8•I ~ b ~ b b o 1 I I ~ 11 1 B. I 11 5 Cr Qr7 . 9Z.5' ~2.so' ~6t'1 - Ls1., lOU.p~ O/J 1~~Gt~ ~ 2vu 1 PN 1~A G~, 2 of 3 SOTt DESCRIPTION FORM (Attach Soil Protilo Location Mao On a Suoarsto Shoot) _ WENT *71 RywN LINEAR LOADING RATE: 3 • O PURPOSE: ~~A LURTF -O )U C-o1j S U C Q OP 6// DEC-ipT1oN eY• WE-GG'IZQ=R ASPECT S°UT-)A wc-sT-em LCr w S-V T DATE -V TV t r Z ~l 19 4 CURRENT LAND USE,. COUNTY/STATE: gr Cxq-UVC C4b\,N L j VEGETATIVE COVER: `MTES ~R.V S11 - GRMSS• LOT DESCRIPTION:* 1~- i ' OF S~% ' KY.) 'I She 26, T3t1►.I, R %A) W DRAINAGE CLASS w L-IUL ~ ' AJ JBM LOCATION ~NN O ST• SO tTf~N GALLONS-PER 39. FT. PER DAYi 01 1643 PARENT MATERIAL s /DEPTH; 0 SERIM Sftlllzl~ M•C'k HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS P11 'BOUNDARY REMARKS ;n. moist G St. Shp. COATINGS 3-9 t~`GR 3 )'Z- S `~S bk ~►7 V ~Y~ CLA z. ~I3 tio~rR 31 - `Fs 1 ~sbkf~ C~v - NA 9- V3-6 -88 bOyR 3/(a - S O S M 10`111 3IZ - `~z ~bk. mU'F,- cg Z 8-Z$ ~`,IR31 ynI h ~S 3 $-$b lu~itz 316 - S g nl 80 1J G 3 o-a 1o~23/z - X31 ~~Jbkc mv~~ cs_ lvt'~ h C S c~.a bb b~ es ~ . $ - Z3 SOH R :5 - 1 s ~sb1t -`-S 3 z3- LILI 3 IL yy- 60tio~-~R 3 16 - S S In C S 6v-~~ 10`7R yob - TS d S rn i ~R11~ 6 1 b= ~o~Q 3 JZ - s i) l'~5b m U fF- ~ o° GC-Q bl'L U Q S w Z ~-Z~ 1o~iR 3I - 5 1`~sbk ~ 3 Z~- 0 1~~R 316 - 1S 1`~Sbk MU~'h ~S NG S p lo`iR 31Z - S 1 1 ^Sb v'F►, CIS Z g;, b to1-M 31 3 ?j6-y1 ti0`'1R 316 - 1'-s li)b m U~^ ~S Lp- &8 lo~~ 3 A - S o S OTNER SITE FEATURES/NOTES: 2-V- 9j 00056 nn~~ 3 of 3 LIMITING FACTORS Signature Data CST N - - 43 z. So M 15-~ N tvo w LL~.1~ tit F}7 ~--4 ~_7 lo~~ L SST S o /W tZ1'Ti OF t'R-Ck~ CH C S C-N X-5,6 RT SL~fS `E" I L ~-U k77lYJ _ L S T Z S }~R "1 O R Z, D 5~r~ S'T1 c T-hivFc qo.6 Drop pox C7~ 010 1 \ o~ °d' -tom r° ya ~~omv 9,2. 00 1~2C"-hJ C t~ ~ i a ('I o o Q~ ~-.9Z.5 ~ O OWN P'~GL~ ©w 3Jy''o.a. 1~~ uN lC'~.u~ ~~rp~ 1~'AG~ Z of Z DEPARITMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / (I M ~ION, 53707 (ILHR 83.0911) & Chapter 145) `t ~.:C' • , LOCATION: SECTION: TOWNSHI UNICIPALITY: LOT NO.:BLK. NO.: SUBDIV ION NAME: 1/ NW 1/ z6 /T-zo N/R zr)E (or S;-T. os N - - COUNTY: MAILING ADDRESS: Box 'i S7 ST' e. ~lX =6'tA lv S3Rt~wfv G ~E? oOD (21W W S V O) 3 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: H PROF IONS: PERCOLATION TEST Residence kNew ❑Replace S: 'a V_ 91 RATING: S= Site suitable for system U= Site unsuitable for system 0 ~IJJ 0?._Uu 3- g~ ONVENTIONAL: MOUND: T N-GROUND•PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ~S []U ,®S ❑U MS ❑U ®S ❑U ❑S ®U Z`Mgj=.t~- GfVcH S 'yc7S'L0MG If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the tom, under s. ILHR 83.09(5)(b), indicate: G~-R 5 S Z Floodplain, indicate Floodplain elevation: , V PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 8 8 g 3, b 7 8~ Pr~~r 3 o F B- Z 86 (Di _)-o > 86 y B- ' 6.0 > ~-1 y B- y 89 C~t3-V 4 B- C~ y-q > gg fr B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3- PER INCH P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dista cribe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all IN s n ction and percent of land slope. ~t~ 6~ ~U i $ ~C Ex SYSTEM ELEVATION s p~ksE z ' ' S 1 I { f - C'r I 6 , c , TN L - - - - E s i E i i a , 2 t ~ 1 E , i F i SAC„ Z6 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. WEGERER SOIL TESTING NAME (print): AND TESTS WERE COMPLETED ON: DESIGN SE _ zV 91 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): P.O, BOX 74 421 N. MAIN ST 01-01T_ 000 S-) 6 1-11S- 42S- 0165 RIVER FALLS. WI 54022 CST SIGNATURE: 715-425-0165 G1, 68 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 1~- Pt6C I OF S DILHR-SBD-6395 (R. 10/83) -OVER - - s 30 8 Z. SO 3 ~2N Re's t D~.~~ M N I L~sT So' ~R~ of -Ck1 CH CTS ~v~ RT Sal s Tsul EL.--UA-T7L*j L ~h S 1- -zs' pp.w-1 Q 4 Z. o S "n c MP JVK a , H.~ 11 ~ 1 1 a. J s 1 1 cr- o ~ Ll.. too.o' cvv P> GUZ- otii 1 C'~.b~J t P~ l~A G E 2 of 3 SOIL DESCRIPTION FORM Attach Soil Prof lu Location Ma On a Su orate Sheet) LINEAR LOADING RATE: 3 O C4 T, PURPOSE: ~a LhR-TUI c.° OAJ S U C z1N SLOPE: U)d __TriION BYR.T?-1UR L I.yEGMc.~R nsrrcT: Sou`ti~wc-sT~L'Y _ OESCR DATf.: N e Z L g cl CURRENT LAND USE: w o O7Z) T V COUNTY/STATE: S~ UQJUUC C()& ~ I VEGETATIVE COVER `YZZ S'- ~R'v S1.1 - GRkSs LOT DESCRIPTION:' ~KYA)/~ g(g_,Z6,T30N,RZ.uw DRAINAGE CLASS: w~L ~RAIJ~I~D O ' 6 O LOCATION: GALLONS PER SO. FT. PER DAY I ~1= S T • N PARENT fWERIALW/DEPTH 50TL SERIESt HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII -BOUNDARY REMARKS in moist Gr. Sz. Shp COATINGS > 0-9 I;`tR 311- s 1 `~S ~k m v f v- Gw Cif r~~~ ~ v t.~i ~ S Z 9- ~I3 V)-M 3) - ~g 11 1'~sbk 7'►1 ~ 3 X43 8 goy 31to S o S M h~u~h cg ~ O - $ 111 `'1.2 3 ~ Z, - ~S ~ ~ g blc z. 8-zg ~,o~LR31 - ~sl l~sbk m~~ ~S 3 ll~`1(Z 316 S O g >n 8o W G 3 0-8 10`12 3/i - ~s 1 1~ gbh m v~ c S Z $--Z3 lo~R 31 ~ ~sl 1~Sbk c s ~b~tes 3 i3- yU 3 IL - 1 s 1` sbk ~n ~ ~-S L1y_ 6o tio~-i~ 316 - S o s ,1 e'ti S ~i~l N 6 1 b w~Q 31z - s j) l`FSb rn u rs Sob x,41 12~~ Z - z~ 1t~`-i Cz 31 - g 1 `Fs k M w co b 3 Z~- 1AyR 316 - 1S 1`~Sbk Mu~'~ 05 SID- $9 ~`lR 316 - S o S _ S "~o GT^~'ut*~ $b NG S 1 O-~ lo~R 31z - S) 1 Sb~ v~h cS 3 2b-y1 lO`lR 316 - FS 1 'b 3iI u cS yf - g8 lo~t~ 31b - S o s w' ~ OTHER SITE FEATURES/NOTES: , 6-2.y-9l o0o s~6 ~n~t 3 IF: 3 LIMITING FACTORS/DEPTH: Signature Date CST k DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHI UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1/ NW 1/ zb /T3o N/R -zoE (or' ST. 3 osN - _ COUNTY: MAILING-ADDRESS: 'BOX 1 S-7 ST', e.~lX To t} ~ ~3 RUwly G ~ o Ci`I~! lc~ S ~ O l 3 E~ OD USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I DESCRIPTIONS: 'PROFILPERCOLATION STS: Residence New ❑Replace -z4,(_ 9/ RATING:.S= Site suitable for system U- Site unsuitablefor system CONVENTIONAL: MOUND.: IN-GROUND: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ,®S ❑U ZS ❑U ®S ❑U EIS 0U ZJ-JZGO r~S- ~ H S rx~S'LWG If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the • A under s. ILHR 83.09(5)(b), indicate: 0__NS S Z- Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 88 q b > 8& SQ)~i pn6E 3 OF B- Z 86 a--o > 86 It B. B- C~ y 9 'r B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN ER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P- P- P- 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. `auV_k 'lM0T- n ~'E ~1 F~ Fk SYSTEM ELEVATION s P`'`sE z I ~ _ i l E ICE VE~_ I G~ ~y - T G ' ' ~.ST OiY. I coor i ;ICE C-6 M, 19 { i I I x f S ~C , Z to 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. WEGERER SOIL. TESTING NAME (print : AND TESTS WERE COMPLETED ON: DESIGN -SERVICE 6-2, ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): P.O. BOX 74 421 N. MAIN ST C° s.r 000 S 7 b }S- yZS- 0165 RIVER FALLS; WI 54022 CST SIGNA URE: 715-425-0165 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - OF3 • Y S c~ ~ « = 3 0' I 8 z, so 3 ~02Jr1 R~~s)De~~ M N 1 ~-ST So'iZTN of 1 R-Ck1 CH C-S RAvb RT sy S TE9LI LSL ~ti kTzc L s T z s' F-R uwi a 4 Z, o S' 'r c Tati,h 0 (ID '14 7--t cues s 1 0- rn Q~ t~L. 9Z.5',~ 82.so ~.~y Q)(3,(:3' ON J-,),JGC.~ o01,3 3/y''o.Z, ti~UN VAG~ 2 of 3 f• j SOIL DESCRIPTION FORM (Attach Soli r u o a io map 0 a Su ar to Sheet) LIN I T 3.0 N OLC.) IJ , PURPOSE ~A ~uRT~ F:6?- yl SIR " CoAiS CV 0&1 SLOPE. DESrAIPT ION eY A R.'T?413P. W 4~-6 M%Z9M ASP v Nt-= Z l q CURRENT AND U• w e va 1~•v T DATE: VEGETATIVE COVER' '7T?-(FeS 'a Ry SH - GR4-SS COUNTY/STATE: LOT DESCRIPTION:' 0~ S~// g Z6,T3qu,R2uW DRAINAG SS' GALLONS-PER S FT. PER DAY 8 O L T10N PARENT MATERIAL (s)/DEPL SOIL SERIESt goil class WRIZON DEP111 MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CCLLAAYSNGSS/ PORES ROOTS PII -BOUNDARY REMARKS in. RID!St G Sz. O pi- ~3U 3-9 tiG`GR 31Z S bk in U- V- G(.v CLV f-~ 1 ~-~~'s Z 9- ~!3 tioyR 31 - 1 1 sbk m~►^ g M C) ~l~ IJ G Z C g 1 0- S Lo`tiCL 3 !Z - ~S 1 sbk m u Z, $ - ~A~►.g: 31 - 5 L 1 '~Sbk 1'n• 'F h a s 3 316 - S O 3 rn Bo ~ G 3 ~ 0-8 1o~tz 3/z X31 1~ m v~~ c s 1~J 6'' - 1 z • 3 Z3- uu 3 IL - 1 s ~sbk m U LJy_ 6o tio~-1R 316 - S o S M ~ C S 6b-~-~ lu`1~Z y/6 - `Fs O rti I ~1Z1 N 6 1 Q W`1Q 31 Z - S t) 1 `F 3 b m U -f S W 5 `i b1 Z ca 3 I - u 1~4R 316 - 1S 1'`~Sbk Mv~'~. oS S o s ~ J ~ ~~•,w~ ~ - $ ~`1 R 316 - - $l~ IJG S p - CC,) lo`iR 31z - S) 1 sb m vh as •Z,.. ,$~Z•b. 10`tC~ 3/ . ~ `FS~ ~-~-s~k m'f~ 'c.(.v.-;. 3 Z/b 1 Q)'l R 316 - l ~s 1 9 b ~n c S OTHER SITE FEATURES/NOTES: C' ,~f'U. 6-zy-9l ooos~( nnGe 3 of 3 Signature Date CST N LIMITING FACTORS/DEPTH: k V• i TO rl c4 do 5 z$ - - I a 0