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HomeMy WebLinkAbout038-1124-80-050 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT l OWNER TOWNSHIP SECTION ,5>,~T_S'/ N-R_/ W ADDRESS ST. CROIX COUNTY, WISCONSIN 4L LIL- , SUBDIVISION LOTAZZt LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 40 7s. , I INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: ~~,zs &6-~64, Liquid Cap. iZAd Rings used: --Manhole cover elegy,;, Final grade elev: Tank inlet elev.: ~ Tank outlet elev.: i No. of feet from nearest road:Front , Side, Rear Ft. /_S O From nearest prop. line:Front , Side Rear.X-Ft. ~z/ No. of feet from: Well ' , Building:{ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 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 Number of Lines:_--.-') Area Built -2Z r ~ Exist. Grade Elev. Proposed Final Grade Elev.- Fill depth to top of pipe: _,--,-7--2 No. feet from nearest prop. line:Front , Side, Rear Ft..Z No. feet from well:--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: _ DATE : jO PLUMBER ON JOB : LICENSE NUMBER : 6/90.cj v Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix Safgty and Buildings Division (ATTACH TO PERMIT) Lot 3 Sanitary Permit No-: GENERAL INFORMATIONSE,SE,Sec. 30,T31-R18, 90th St. 149127 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: LeRoy Jarchow Star Prairie CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /0010 ~ 2e.~ 514 J TANK INFORMATION ELEVATION DATA 4?/ QQ ol-9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~~OZ1 Benchmark 'D d, Dosing Aeration Bldg. Sewer Holding St / Ht Inlet -7, I T 173"62-- TANK SETBACK INFORMATION St/ Ht Outlet 7 . 90. 7 8 Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Septic 9 ' y NA Dt Bottom Dosing NA Header / Man. 7, ~ 2, , V Aeration NA Dist. Pipe ?.9 a 9a, d 8 Holding Bot. System V-3 PUMP/ SIPHON INFORMATION Final Grade y.6 Manufacturer Demand Model Number GPM Friction System TDH Ft TDH Lift I Loss Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~d ___1 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of , Model Number: System: 75 y 1 t, 1,4 OR UNIT 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) v Plan revision required? ❑ Yes ❑ No / Use other side for additional information. 10%] '~o SBD-6710 (R 05/91) Date pector's Signature Cert. No. Y I ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: I ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouN Y TOILHR STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than /4 Z la lous 8% x 11 inches in size. ❑ Check if revision to papplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP RTY OWNER PROPERTY LOCATION '/a !Ze '/a, S , N, R E (or PRO R WNE MAILING ADDRESS LOT # BLOCK # I 3 Al /I CI , STAT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY ST RO D ❑ State Owned VILLAGE : NEARE ~ fV1 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TA~QWN OF'. X MB ❑ Public III. BUILDING USE: (If building type is public, check all that apply) .T Q`3a - !fa 7 - dt-~-Wv 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 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Off ice/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. )6 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 M 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 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 "Feet ~ Feet VII. TANK CAPACITY 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 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu is ame (Prin P ber's Si at e: o Stamps) MP/MPRSW No.: Business Phone Number: PTO, berddress reet, Ci ,State, Zip C e): IX. COUNTY/DEPA TMENT U E ONLY Stamps) ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature No Approved ❑ Owner Given Initial Surcharge Fee) Adverse De ermin tion b r 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 I INSTRUCTIONS r" 1. A saniiary permit is valid for two (2) years. 2. Your~sanitar§ 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 submitte_d to the county prior to installation. ' 5. bnsite sewage systems must 6_--properlyhmaintaitted. The septic tank(s) must be pumped bYglic' used` 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 cpmpiete`and,accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- 11. ll. 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; close 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 forge; and F) all's4ing. information. 1 l - GR,0UNDWATER'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- > `.r water contamination investigations anted establishment of standards SBD-6398 (R.11/88) APPLICATION POtl L:ANITARY PERMT.T S T C - 100 This application form is to be completed in full and signed by the owner(s) of the - I property being developed. 'Any inadequacies will only result in delays of the permit issuapee. Should this development tie intended for resale by owner /con tractor, ("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 Location of Property 14, Section T N R _W fAinship : kv Mailing Address • V ' C Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this prop rty being developed for resale (spec house) ? Yes No a 3 a- as-recorded with the Register of Deeds Volume and Page Number INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if aa would CertifiediSurveyyS references of the reviewing process. If the deed ption Map, the the Certified Survey Map shall also be required. - _ _ --T-------.-- - . PROPERTY OWNER CERTIFICATION I (We) cv tjy that aP,e 6tatement6 on th,i6 jotm ane t1Lue to the be6t of my (owc) knowEedge; that I (we) am (are) the owner(6) o6 the pnopenty de cAibed in thiA .injonmat•ion 6oxm, by vi tue o6 a wagAanty deed neeonded in the Ojjiee of the County Regi6ten o~ Deed6 a.d Document No. 1-196 V I ; and that I (we) pnedent.2y own the pnopo6ed 6.cte bon the sewage pod aydtem (on I (we) have obtained an easement, to kun uxith the above ducti-bed pnopenty, ion the. con6tAucti,on o6 6aid 6y6tem, and the name had been duey neconded in the 066iee o6 the County Reg.i.6ten o6 Deed6, a6 Document No. 1 ),1 12 SIGNATU OF OWN R SI NATUR OF C WNER (IF APPLICABLE) -I fA DATE SIGNED DATE SIGNED 3 This instrument drafted by Fran Bleskacek, Proj. No. 86-24-191 470`27 CERTIFIED SURVEY MAP Located in part of the SE'-4 of the SE- of Section 30, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in Volume 5, Page 1295 at the St. Croix County Register of Deeds office. LEGEND naa~TwM . Aluminum County Section Corner Monument Found i,Et~~ 0 111 x 2411 Iron Pipe Set, weighing 1.68 lbs. per linear foot • 111 Iron Pipe Found NE Corner N GEtJ N b Section 3C; pj d ( ) Denotes Recorded Bearing 7 I C; ON, f 41 0 0 SCALE IN FEET _ r~ I W1b• r~,' 1n Q 0 50 100 150 ~sp~ q hip SU KJ 0 r- too fnZV~ 4- CD -:r V o x I o z d ~ L L w ro W (n = Unplatted Lands C. s o 4J +W (N89o53150"E) 61 rn v- •0 S880541 3911W 257.69' M I ° @ 232.291 35.401 L d 7 .-I ro C N 61 ••y N d I p~ .-r ro ~ I rol n. I OWNER 100' d l LeRoy Jarchow Howse w h 1908 Raleigh Road Ln I W i 0 New Richmond, Wd 54017 C) ~ 10` LOT 2 a'° fT NI - _ NI dl 0.. 1 tD N, •1-a I Z I s F11- ED O Garage - ~ H I y N I JUN,2 ao I O 1 233.24 34.451 N `..00 ' 4 1991 JA&fES 01 . I N89°11' 2011E 267.691 = e91ste0 r0N LL I ^ ❑ Shed I c co 6 J I 1y v' OtCO., CL 0 in 004 A I V O 3C O L) I W~ I t!'1 = I : p J1 W aTiI y n 1 r\ 4 .4M1 -dl,p v I 7~ Op ~1 O 4]I C E~~ ~N C O Ln LOT AREAS v °rn I o o 4-1 0 4-I 7 N Lot 2 Including R/W: p_ z (/1 r L I m Z 50,922 Sq. Ft. (1.11 Acres) co LOT 3 - 0 Ln - 4 I Lot 2 Excluding R/W: 44,259 Sq. Ft. (1.02 Acres) o....._.....- 0 O 1 N O I ~ Lot 3 Including R/W: 77,737 Sq. Ft. (1.78 Acres) / Lot 3 Excluding R/W: 57,886 Sq. Ft. (1.33 Acres) / .-i I u I 135.46' N8903015511E ~n 2406.86' _ RALEIGH ROAD - ' ~ SE C rner of M tO N8901112011E 267.69' Section 30 N8901112011E (N89°49' 2511W) S} Corner of ~}MVED Section 30 Unplatted Lands 6'1~ YGV L South line of the SEJ of Section 30 FSU N 2 4 1991 VOLUME 8 PAGE 2372 ST. CNsw COUr•.,;,' • L • H • a r ST C- 105 r a H SEPTIC TANK MAIN'CGNANCE A(:REIiMGN'1' o z St. Croix County a a . H m OWNER/ BUYER ROUTE/BOX NUMB R Fire Number tll'7 CITY/STATE Z I P PROPERTY LOCATION: &jE Section Y/ T ~N, R_ W, Town ofSt. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in I its premature failure,to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, i if needed, by a licensed septic tank um er. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Crolx.County residents may be eligible to receive a grant for a maximum of 60% 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. Cr'bix County Zoning a certification form, signed by the owner and by a master 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), 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. H 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with r-. the standards set forth, herein, as set by the Wisconsin Depart- .C ment 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. SICKED DATE _Cl I St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DSPARTM`~NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS 115 P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNTCI"*LITY: LOT O.:BLK. N SUBDIVI ON NAME: N/ t (o COU TY: OWNER'S /BUYER'S NAME: I LING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMME CIAL DESCRIPTION: PROFILEDESCRIPTIONS : LAT ON TESTS: Residence ®New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system 1 Le - /7~ Co 7~ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ® S ❑u U S ❑u ❑ S ©U ❑ S ©U If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 62 PROFILE DESCRIPTIONS WMAU en BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER O SOIL WITH THICKNESS, COLOR, TU E, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / h B- > O _ B- , Ndyk 2- 811 J1>14YZAIS B- BN ' T r B- n B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO T PERIOD2 P R PER INCH P / 'Ale 9-9 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. SYSTEM ELEVATION I 1 ? 3 i 4 ' TN I I I, the undersigned, hereby certify that the soil tests reported hNfform were made b me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the locatio of the tests are correct the best of my knowledge and belief. NAM Z TESTS WERE COMPLETED ON: 7/ ADDR I CERTIFICATION NU R: PHONE NUMBER (optional). CST G A R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - IN .JCTIONS FOR COMPLETING FORM 115 - SBD - To be a complete anti accurate soil test, your report muSt inClude: 1, Complete legal ascription; 2 re use se, clearly indicate ; tither this is t . or commercial t 3, ".XIMU" of bedroorns or 'cial use piai ; this a n( ernent system; 5. C )n- :e rating boxe< SITE IS SUITABLE FOR A HOLDING T, ULY IF ALL OTHER SYw1: E RULED OUT BASED ON SOIL CONDITIONS; 5. , ``.EASE r" is shown here for writing profile descriptions an(] c. ~ t' plot plan; T. AK'- -crurately locating y(-i::r test locations. Drawing t preferred. A sired; )d vertical elevation , point are clearly she 1 are perrnanrnt; 9. boxes, as to dates, narnr :food plain d tion test ex(,mp- 10. ch is flood pair,; to-tion) do.,, rsapply, place N_A, in appropriate box; if. CO your curre s and your certification number; and distribute require( 4LL SOIL TESTS MUST FILED WITH THE 1 3C 1-Y WITHIN 30 DAYS OF Ci '-,LLTION. ABBREVIATIONS _ _RTIFIED SOIL TESTERS (tares T Other' rmbols 10") BR - 1011) SS e u per 3") I ru - i x. . i t TOTHEO or : DE y request > nplr ivate er to I ;tion. R w ,c r.~~.p r 51ef>,7 s 'Al AXl - f.!/boa ' L.9,/(l~.c/ BaJ,tts Jib /,00/ sc¢/,Or ys- s to ?O i 9° jcr fon~ • C- r U S S ~J C I U r, C X / l zr o s p r en ~ w r• i ~ Fra►h Air Walk And OD►eryollon pipe Appvo✓.d Vent Cap r Allnlmum 12* An Or. ~i~,► 4,e ewa4w Flnol Grad. 7 • 20- 47ove Plpr _ 1" Carl Iron To final Grad. Vent Pip. Worth Hoy Or Syn1h•tk Covering 'wln 2' Aygregola _ . Over Plpa DIS111b.1100 Plpa 0 0 0 - Tee C Aggragota 9ane611t pipe ° Perloroled Pipe b.to. o _C0191ing 7-1-111911A9 Al Bouom Of Sytlam / Ij ~-'Itj'lon SOIL FILL DISTRIBUT101.1 PIPE r APPROVED SWTIACTIC CDVCR 20oF &GGREGATE AT ER1^L- OR 9 OF 57 RAVJ OR MARSH HA'J "P ~f ELEV. OF ~ EE 0 F12-zt/2 AGGRI- GATI- D15-rRIIjrJT11DQ PIPE TU 0E AT LEggT IIJCHES BELOW ORIGIIJAL GRADE AUU AT LEASTLO 11JCH[S BUT 1.10 MOM[ THA1.1 tit INCHES BELOW FIrJAL GRADC VIUM DWH OF EXOAVAT1100 FK011 OR16WAL 6RnK WILL BF- J _ MCHES f► N)rAUM CKPr►i OF EACAv/1T1c0 r•POM C,1,161I IAL 6RnDV- WILL BE - tNC/ICs SIGUCD: F LICCUSC IJUMBER: -1/-s zf DATE Ile This instrument drafted by Fran Bleskacek, Proj. No. 86-24-191 47072'7 O • CERTIFIED SURVEY MAP Located in part of the SE4 of the SE4 of Section 30, T31N, R18W, Town of. Star Prairie, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in Volume 5, Page 1295 at the St. Croix County Register of Deeds office. LEGEND Aluminum County Section Corner Monument Found uC 0 1" x 2411 Iron Pipe Set, weighing 1.68 lbs. per linear foot y !r NE Corner $!41{~~~'• • 1" Iron Pipe Found .r N ro ~ N GEN Section 3 ( ) Denotes Recorded Bearing w 7 y 3C ON, t o SCALE IN FEET : 1 • i r 4J . o - I WiS. ; 41 0 0 50 100 150 o p0 gU F;~y~.~'r. d is L z L W fp Unplatted Lands L d M 0 1 -W, 0 , W (N89053150"2) 57.69' 61 I _0+ S88o.54 39 W ro y LU 232.291 35.40' n m ro ~Q~ ,U~ ry 1/ a OWNER 0 f .1 LeRoy Jarchow House r, E• Q 1908 Raleigh Road ~ ^ w1 New Richmond, WI 54017 LOT 2 H N .I.+ c t 00 I v~ ro Q `h c i s l co 0 O Garage 41 of U N 441991 co I 233.24' = 34.45' ao v 1 ~M 4- J ~S 0'^OK F c Shed ; N8901112011E 267.69' o r1 Star pi J L ro 1 c~ ❑ - a0 . , I _°OD.Y J I UJ ~j In f0 1 • Y v N N I Ln a.1 i o t ro l ° L N v° CL O Cn I rn xx D o ° LOT AREAS a v i ,n o v 01 o 0 ~I Lot 2 Including R/W: °o _ 1 m' r o LO ^ LI z W of 50,922 Sq. Ft. (1.17 Acres) LOT 3 ' i lot 2 Excluding R/W: N ~ of Q ~ J o 44,259 Sq. Ft. (1.02 Acres) ' Lot 3 Including R/W. -j I 77,737 Sq. Ft. (1.78 Acres) ~ Lot 3 Excluding R/W: o r, ' 57,886 Sq. Ft. (1.33 Acres) , ;i u / I 135.46' , hI ~I N8903015511E © ~d^ 2406.861 _ RALEIGH OAD t° m N89011' 2011E 267.69' SE C rner of N8901112011E o , ❑ Section 30 (N89 49 25 W) S} Corner of Section 30 Unplatted Lands A Y G Q L South line of the SE} of Section 30 U U N 2 4 1991 VOLUME 8 PAGE 2372 81.=IX COUNTY ~ ANDZONM CO ! TMENTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS I i ;USTRY, DIVISION fJ A'3OR REDLATIONS PERCOLATION TESTS (115) MADP.O.ISONBOX WI 53709 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUMtetPAtITY: I_OT O.: BLK. N ]SUBDIVI ON NAME: '/4S' /T N/R E (o COUNTY: OWNER'S BUYER'S NAME: I LING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMME IAL DESCRIPTION: 1 rl,/- ROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence l~New ❑Replace I / RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®s au [Zs ❑uT s au as 0U as ©u y If Percolation Tests are NOT re uin DE RATE If any portion of the tested area is in the under s.H63.09(5) (b), indicate:_ Floodplain, indicate Floodplain elevation: '41 /d PROFILE DESCRIPTIONSyO BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER O S ~L WI~~THC NESS', ELEVATION COLOR, EXT-UF`E,yAND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 __22 S_ n y ' r s _2 V B, } /r 3 34 9e ..I B- 3 B - B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO r P RI oz P R PER INCH P- / 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. SYSTEM ELEVATION 9/ ° //YiPC 7.G S I i -yam sue/ O't' J t I l I ~ p 1Y w x 1,9 Fhts 1~s'b usc I, the undersigned, hereby certify that the soil tests reported form were made me in accord with t rthod,91,pecii the Wisconsin Administrative Code, and that the data recorded and the locatihe tests are correct the best of my knout efJq `a xl< NAM fi 1: TESTS WERE; ©~JPILETED ON: ADDR S CERTIFICATION NU R. PHONE NUMBER (optional): CST G A R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER -