Loading...
HomeMy WebLinkAbout032-1007-20-000 o o M ~ O vk y 4 o I 0 N n ~ M x .p cm ~ O M it N C I N z li c E _ O O 3 'v a•°i a I Q N 3 N ~ O z y (n 4i 0 i2 E v z a m c') U) : I oza 01)z I ° c N H ii c E F~ w N cl WJ I~~ N D) N ~ (V Q a C U) 11~ O O O O d ~ L N .U N O C 'D O wV . E N O N Q O N Zmz =Z° r aci ~ N Lo io 2 C-4 in 0 rn a> L: A2 a a o ~ O O a a~ I w Q o lA fA fA al 7 75 Z M> a~i 0 0 0 • Eaaa a n rn_ ' cm m~O N !A U rn OR } co 0 C14 0) co L O O 0 O O O O LO N N N W O O O O a N ems- N N O O C; •0 m N 2) N Q lA N N O O O N U) U) .a C O 0 oZS N O d O M a) o i F- dU c N a rn o 0 o O N _ 'y O• C 'O N N N I) O N Y C E C N (O M -t N ` a 0 O 7 N N O M y 7 L y 'M co 1..1 N M O Y 7 Z' ~ C N CO 00 E O rn L • O O fA (A O Z N M !n W 1 r ~n € L a 2L: a • a d m t`MV v c C t A c0 2 0 aic°~ FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ TOWNSHIP SO to e r Se SECTION_-~3_T 3N-R_cL_W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i t s INDICATE NORTH ARROW BENCHMARK: Elevation and description: C? (o 7 3 iP P e n e.d 7`1, p Alternate benchmark 7'0 {r~ o f f a u r~ d ; o ig Al o u s- e. SEPTIC TANK: Manufacturer: L-kj r t C- s c- Liquid Cap. 7 5 Rings used:QManhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front 3 0Q/ Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well N A , Building: /a ~ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAFER 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: 1/" Trench: Seepage Pit: Width: %-A" Length S J Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: 3&!l No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: Ij A- No. feet from building 3 %1 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: DATE: y/ PLUMBER ON JOB: q_,e LICENSE NUMBER: > / 5 6/90:cj ~ILHR SANITARY PERMIT APPLICATION :m 5 In accord with ILHR 83.05, Wis. Adm. Code COUNTY C 20 / ~C STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1q 963c? 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 L' APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPP R'TY OWNER p PROPERTY LOCATION 7U~-f 'S /OK,jV- Sr Y, Sw'/a,S/,,~P T3/ N,R / E(oro P P TY OWNER'S AILING ADDRESS LOT # BLOCK # x 3Z1017' CITY, STAT / ZIP COPE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER . TYPE OF BUILDING: 6heck one) CI NEAREST ROAD II rL~~J/ ❑ State Owned ❑ LAGS ~~Ytc°QS.c 3a N~ UL ~ 'N OF: PAR LTAX NUMBS ) ❑ Public 1 or 2 Fam. Dwelling-#~ of bedrooms all III. BUILDING USE: (If building type is public, check all that apply) Q 3 2 Q 'lV 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE O ERMIT: (Check only one in line A. Check line B if applicable) A) 1. EffNew 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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-Pr !zed Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION B Q , ..3,~7 l3 Feet -7. 1 • 5'OFeet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete glass App. Tanks Tanks ucted Septic Tank or Holding Tank 75 I e W I F1 F] 1-1 Lift Pump Tank/Si hon Chamber . El I El El El I El I F-1 Vlll. 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 $ig ature: (No Sta s) MP/MPRSW No.: s Business Phone Number: Plumber's Address (Street, City, State, Zip Code): P, 800 3 3 (10 (,e r l~ ~gleC, r-ji .r y~~ q IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature No Stamps) Approved ❑ Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. 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 by 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 information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data orha 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. I SBD-8398 (R.11/88) DEPARTMENT 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: Sr; TM4-Sec.l0,T31-R19 (if assigned) Town of Somerset CONVENTIONAL ❑ ALTERATIVE Aire - ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound .1 1 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: d*'~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT R PLAN: R . PT. EL T REF. PT. EL / CJC.. t /03•!09 o3. ,v 5. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: H. Selle Si S St ' Willis SEPTIC TANK/HOLDING TA ,28' ar5 T rrI a 7.7 r MANUFACTURER: LIQUID C ITY: TANK INL TANK OUTL WARNING LABEL LOCKING COVER g / PROVIDED: PROVIDED: . 44w, 8 A/ • ' 98.10` S ❑ NO ❑YES r ` 3 BEDDING: LWMF F DIA.: `ZJff MATL.: HIGH WATER' FFET BER OF ROAD: PROPERTY WELLjc~ BUILDING: VENTT ESH rU• ALARM: FROM LINE: (J/ / AIR INLET: ❑YES NO 7 YES O REST -97 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUM PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM AIR INLET: PUMP ON AND OFF PU ❑ YES ❑ NO NEAREST 1110, SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIALAND or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LID 12- r/ TRENC ES: MATERIAL: 1- DEPTH: DIMENSIONS -rv !r+' GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. P E D~I/S,TR~. iI~PE ATE A O STR. NUMBER OF PROPERTY WELD BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: EL V. INLE T: EL V. END: I `i'/r• " ' " -PIPES: FEET FROM LINE: AIR INLET " oiCJ 7~ NEAREST MOUND SYS M: $ Mound site p owe perpen Icuiar 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 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: D: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑ 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 DISTRI ON PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: R MATERIAL: VERTICAL LIFT CORK %ONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO COVE [__1 YES PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTV WELL: ILDING: COMMT,TS: r FEET FROM LINE: g yes YES ❑ NO YES ::1 NO NEAREST 2.1 z4 rC2 Sketch System on R ain in county file for audit. Reverse Side. ISIGNURE: TITLE: 1 SBD-6710 (R. 06/88) • APPLICATION FOR SAI(ITARY PERHIT • 9TC-100 This application form to to be conplntod In full and signed by the ovner(e) of the property being developed. Any lnadoquacles will only result In delays of the pzrralt Issuance. -Should this davelopment be lnttnded for reeals by owner/contractot,(opac houoe), thou a second form should be retained and co■pl.ttd when Lila property is sold and submitted to this office with the appropelate decd recordlnq. Own:r at property 5) US~~/ / 1 Location of property -5IV 111 5 1/1r section - 3 T- it _J_2 _v • Township _ Elj S~ Hailing address ~/,/L S¢Ci7 • Address of site 7'l/ i 5~~i /ass/~~1rf>~ aubdlvlslon nae►a_ Lot number 3 Ptevloue owner at property Awl'- f , tl ~Gi/AG.HTa/f h' Total slit of psrcal _ 6-:9 e Data patrol was created _ Ale"I", Are alU cotnats and lot liner ldsntlflsble? Yes No Is this pcopotty being developed ot rasala (spec house)? Yan X N VVItlAK and Page !lumber as recorded with the Reglstet of Deeds. -----.......•........-•..-•----....w-------- L----------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING) A VkARKYTr D¢ID which Includes a DOCUNItHT MUMHR, VOLVHR A11D PACK MUM11;t' and the eau Or Tlie RRaIRTER OF DRKD9. In addition, a certified survey, It available, would be helpful so as to avoid delays of the reviewing process. it the deed dsectlptlon references to a Caitlfled Survey Hap, the Cattlfled Survey Hap shall also be required. PROPIRTY OVMER`CERTIFICATION I(Ve) certify that all statements on this form are true to the best of my (our) AnovledgeJ that I (we) em (Ate) the owner(s) of the property deacrlbcd in this Intotrratlon form, by virtue of a warranty deed recorded In the office of the County Register of Deeds As Document No. 'S//df6and that f (ve) presently own the proposed site for tha tuctlo oewage disposal syaten (or I (we) have obt■Ined an easement, to run with Lila above described property, for the at the of meld system, and the Mama has been ul racorded In the 01tIce of the C jnty Reylater of Deeds as Document No. algnat to of owner Signature of Co-owner (11 Applicable) Data of elgnatura Date of Signature IRK t~3 dIR..>~rltli+~d! ~ ► timed ~ tw ` o of . ~ 17 r f t Dber 7 hl, wc~ IL 9r~ • ~t..ARA.. Jii~iY... .r}. v JCS. 2 a~•«' - ....aw....w . ~ i~saeass~o avsxowtissse~ . NTATB or mucomm 0800416 b*m la M r r" 660 ft •w r S101116 127 AW" M II IoiiMlir41~M 0000 SEPTIC TANK MAINTENANCE AGREEMENT w Sr. Croix County WE R/BUYER o ROUTE/BOX NUHBER ' ~ r 5%" Fire Number d zip- 54-,~ z_6 CITY/ STATE Ja/~~./~ ~ L~ l21 PROPERTY LOCATION: '.S'L` 2! k', 56" k, Section 33 T No RWe ~l d- ^ y~ St. Croix County, Town of Subdivision Lot number improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed's'eptic tank pum2 er. What you put into the system can a ect t e unct o- n o#cne aeptie tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-MAX be eligible to recieve a grant for a maximum of 607. of the cost.of replacement of a failing system, whic 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 .s't'erns agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a,mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2)•after inspection and pumping (if nec- essary), i-he 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. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed V and returned to the St. Croix County Zoning Office within 30 days of the three year expiration.date. SIGNED 411~----- :n :Z'~ 2U Gc~ DATE ! St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. CERTIFIED SURVEY MAP i Located in part of the SW4 of the SE; and in part of the SE; of the SA, all in Section 3, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. OWNER • U/~7J S~o~~ .N aro 1 d°Ss-hachtmr . /8///1 O/~7( ~7AGC, UR. 568`z'-3Pnd--stret~ lad ~ICh'M°NQ N} Corner of N Section 3 ,1" Iron Pipe Found C 0, 0 41 41 U w " o N _ ? JJ V) O - ~ Lot I -0 4- I w Lot 2 Certified Survey Map ° a ° °iO _ _ o Certified Survey Map -r - _ C> 7! Volume 8, Page 2155 " Volume 8, Page 2156 L \ f0 .-d - O r N89°13'01"E 634.83' z S0102011011W A ° 16.511 a 601.81' Q1 N s @ 33.02'- ' •L JJ ~ A L N M c m 33' 333 0 v 'c7 ' c - ny O r s * N n "1 1 LOT 3 c s t o a I ~ ♦J N 1 _ J 1 t° L u ° ) N 1 Area Including R/W: N z - Co 4-1 397,777 Sq. Ft. o r ni Acres- 0 I o 0 Area Excluding R/W: A~ 8 c d 373,844 Sq. Ft. Y . 8.58 Acres w / .a~aC 0 398.83' E F a F S89016144"W,' 636.541 Sj Corner of 11 South line of the SWj ti + Section 3 ~ of Section 3 ~ /,J Aluminum Cap in Concrete o" Found "'~_Temporary cul-de-sac to be removed upon --platted -La4ds extension of roadway. SCALE IN FEET 0 100 200 300 LEGEND ^`I~ i, Found Section Corner Jar 7` _ n • 1" Iron Pipe Found WHAGI'l 0 1" x 2411 Iron Pipe Set, weighing f 1.68 lbs. per linear foot. t1UDFON, r NDUS ll' N OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP : LOT NO.: BLK. NO.: SUBDIVISION NAME: SE INpw 1/ 10 /T 31 N/R 19 Somerset n/a n/a n/a COUNTY: BUYER'S NAME: MAILING ADDRESS: St. Croix Kurt Sroka IR.R.0, Box 328, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRI (PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: tesidence 3 n/a PTION: ~Vew ❑ Replace 10-12-89 10-12-89 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) conventional S❑ U x©S ❑ U [x S E:j U EA I 0c U I If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5) (b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 2 OnC2 BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTDM, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 6.84 100.23 none >6.84 .67bl.1. 2.50bn.sil. .42bn.l.s. 3.25bn.c.s. B_ 2 6.75 100.34 none >6.75 .67b1.1. 2.00bn.sil. .50bn.l.s. 3.58bn.c.s. 3 7.08 100.39 none >7.08 .83bl.1. 2.33bn.isl. .42bn.l.s. 3.50bn.c.s. B- B. 4 7.29 100.14 none >7.29 1.00bl.1. 1.92bn.sil. 1.75bn.c.s. .42bn.l.s. B- 5 7.17 99.92 none >7.17 .50bl.1. 2.00bn.sil. .42bn.l.s. 4.25bn.c.s. B- decimal' PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P_ none 6 6 <3 P_ none 6 6 <3 P_ none 3 6 <3 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 96.73 I , _ j I d I i _ 1 3 I F LVI L / 00 3 h a E t D r Ff I i 6 r7 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 10-12-89 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore dr., New Richmond, Wi. 54017 2298 I715-246-6200 CST SIGN E: 2=al DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - S BD - 61395 To be a ete and accurate soil test, your report must include; 1. Co - scripiion; 2. : 'i n must clearly i whether this is a t or comme 1 _r,;7ber commercial use plat ri es. A SITE IS SUIT,8 _ =JR A HCANK ONLY IF ALL. ~ JT BASED ON SOI! 'OITION 6)r uvriting profil e: scrip plat plan; 7. . ruing your test ations. ' t,,,JerrcuL A n et at, _ i a;e puma t; 3. as es, a(: 1 " Dod plain, dons n-1 plat,:r,ent A your I d Lite _l. ALL. TEST - BE FILED WITH THE IN 30 L A` ;OMPLEvTION. -"ATIOV- C:ERTI SOIL T Jures _ "ymbols 1- BR - d ock _ 10") SS - t tie 3") LS - HGUV - , it- Perc - W - BIdg is sl solsdy *1 Loam Bn-F s i I Sift Loam B1 I"ack Si - Silt Gy - gray Clay Loam Yell Sandy Clair t « - RPd Silty C, / f - idy Clay Clay rr; d p - I t HWL 1r -ral soil text+fr vaste di pc BM VRP - ` TO THE -r!°, c° to, /'1 eo~7" S 0 -ra &V /0 T. A-) x C°. 00 A) f DoT L~ti~ 0 jdC' a K, r r~ x 3 !o Prior t~o~y e set Pad L e l .Sa to CIA U Q 3 ~ o TURTLE LAKE A^t' PLUMBING & HEATING P.O. Box 93 Turtle Lake 54889 Turtle Lake, WI 54889 3 3 715.986.4138