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HomeMy WebLinkAbout040-1192-50-000 4 o a~ I M CD a 0. 0 o ~ h °o I .y I i C O) i cc I o 'o w ~ I c I L m co CD y Z C LL O Q ~ O I Cl) Z y C,j m o V Z N N a co w ~ N N H fn i o I O Z a c N O Z c E v v Cl) N t c to y cn d • N y c d O O 1 o 0) O Z m z z N ~ N N R f6 ;C III Ny d ` = °oo` $ ° x a o •N aaa Z u, CL LL in J V rn rn 0 ti > O Co c O d co N c nom. N~1 m y~ Q in 0 I *a p a 10 U) W m y C 04 G p CO i O y C CL O O > _ 'O N 04 r a) CD w ~ N H ~ fD U ~ 3 ~ 00 U) (D N C M N T (0 co 00 • ~'~1 H Y N O N O Z C Z .rt fn O y R a as a is d • a .2 m = E o ~1 A ciIL Io~NCi FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER c /-ez-A- TOWNSHIP SECTION TZA --N-R_20_W ADDRESS-~~y ST. CROIX COUNTY, WISCONSIN SUBDIVISION C~toi~iCuP LOT1-5- LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I V)C .e m r/ ~r 6 D 9 a K{/ INDICATE NORTH ARROW BENCHMARK:Elevation and description: . riot Alternate benchmark SEPTIC TANK:Manufacturer:4lZe4 Liquid Cap. /26V Rings used:,Manhole cover elev: Final grade elev: Tank inlet elev.: r' Tank outlet elev.:.8~ I , No. of feet from nearest road.Front , Side Rear Ft. From nearest prop. line:Front , Side , Rear ✓ Ft. 2" /00 No. of feet from: Well > 25' , Building: lL (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: I/' Trench: Seepage Pit: Width: nj~_Length Number of Lines:_k'_Area Built s2 Exist. Grade Elev. Proposed Final Grade Elev. ,1 Fill depth to top of pipe: Z,/1. No. feet from nearest prop. line:Front Side , Rear 1/ Ft . > &'D No. feet from well: >SO 1 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: Z PLUMBER ON JOB: n ~ LICENSE NUMBER : 6/90:cj q 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: SE14SW14Sec. 24 T28 R20 (It assigned) ' ' ' ❑ CONVENTIONAL ❑ ALTERATIVE Town of Troy Lot 1~] Plai i w Rd Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Steve Kosa 324 Vine St Hudson WI a4 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: PER PT. ELEV.: CST REF. PT. ELEV.: Name of lumber: MP/MPRSW No.: County: Sanitary Permit Number: David Fogerty 328 St Croix 128886 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ccII PROVIDED: PROVIDED: 2 P i O O Ct 3 y G r~ eD ES ❑ NO ❑ YES &NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES Ll NO `1 C ❑ YES L1 NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: E] YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS Mo T L: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU ❑ YES NEAREST 1110' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth o I In ORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall ce a nti . MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PI SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL PIT _ DEPTH_ DIMENSIONS GRAVEL DEPTH FILL DE TH DISTR. PIPE DISTR. PIFjE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH 11 q BELOW PIPES: ABOVE OVER: ELEV. INLET: ELEV. EIN PIPES. ; FEET FROM LINE. AIR INLET: r g l 4/ NEAREST 5 `7 V , 1 Io MOUNDS' STE M: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST j Retain in county file for audit. Sketch System on Reverse Side. ~)f SIGNAT RE: TIT A~~ SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION [raDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ATE SANITARY PERM -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / g 8% x 11 inches in size. c i revisior7n t8pr sous 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 Steve Kosa SE t/4 SW %4, S 24 T 28, N, R 20 (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 324 Vine St., Hudson, WI 54016 15 x x x X x x x X x x x CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR SOM 1111-10.186. lintlisted Croixrid e II. TYPE OF BUILDING: (Check one) F1 State Owned E3 VILLLLAGE NEAREST ROAD Plainview ❑Public ®1 or 2 Fam. Dwelling-#of bedrooms 4- PARCEL TAX NUM ER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑Assembly Hall 6 El Medical Facility/Nursing Home 10 El 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. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. I] 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 Eli 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 600 820 840 .73 .5 90.1 Feet 94.1 Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 20 Weeks Ye e F1 F1 I [I 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. Plumber's Name (Print): Plu 's Signatur • o Sta ps) rP/MPRSW No.: Business Phone Number: David B. F® ert 3289 (749-3616 y ~ ; ff Plumber's Address (Street, City, State, Zip Code): Foterty Hats, ltd., Roberts. W 54023 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved SarW' ary Permit Fee (Includes Groundwater Date Issued Issuing ent Signature No mt Surcharge Fee) Approved ❑ Owner Given initial J/// f, Adverse Determination X. CONDITION P40 44,~L'" S OF APPROVAL/REASONS FOR DISH PROVAL: e,2 SBD-63 8 (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 tanks must be pumped by a licensedv pumper whenever necessary, usually every .2 to 3 years. 6. If you have questions concerningyouur onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. 4Mn 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. Ill. 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 rnains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; Yeplacement 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) soT test data on a 115'form; and F) all siiing information. - GR61jF& liWEA WNICHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of I regulated practices which can effect groundwater. The monigp,golleatpd through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. 'Y r `'iv`'. SBD-6398 (R.11/88) I 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/contcactoc,(spec house), than 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 fir' "R- V Location of property _,_,_1/4 /4, Section U- --2Q T Township Mailing address A L?~ Address of site subdivision name Lot number Previous owner of property `F S K QS& Total also of parcel 6t ~-y'~ _ Date parcel was created _L.-~ `7-EC' S Are all cotnets and lot lines identifiable? ~es o is this property being developed for resale (spec house)? Yes 0 Volume and Page Number J~) t as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SNAL 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 Nap, the Certified Survey Map shall also be requited. PROPERTY OWNER CERTIFICATION f(We) certify that all statements on this form are true to the best of my (out) knowledge= that i (we) am (ate) the owner(s) of the property described In this lnformatlon form, by virtue of a warranty deed recorded In the Office of the County Register of Deeds as Document No. -I;'~'l QIs and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to tun with the above 'described property, lot the construction of sold system, and the some has bee dui recorded in the Office of the cc my eglster of Deeds, as Document No. 3 V/ 2- J. signs t o owner Sign tune of Co-Ot (If Applicable) Date of signature Date o sl nature i -DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1 THIS SPACE RESERVED FOR RECORDING DATA 982 WARRANTY DEED 431910 vc: / 96 PAGE 131-= - - _ REGISTER'S OFFICE This Deed, made between AleX S. Kosa and Edry L. Kosa, ST. CROIX CO., W1 Recd for Record I I I Nov. 6,1987 i Grantor, and-------- Stepphen-A,-Kom.. pf 11:40 A M N' Grantee, pipN Of Dledi Witnesseth, That the said Grantor, for a valuable consideration.---.- - X--.__----__- RETUR o conveys to Grantee-the following described real estate in - at- Q-- County, State of Wisconsin: I Tag Parcel No- I ~I Lot 15 CROIXRIDGE Addition located in the Southwest Quarter (SW4) of Section 24-28-20 Town of Troy; Subject to easements, restrictions, reservations and covenants of record. !i i Acceptance of this deed shall be indicated by its recording i with the Register of Deeds and shall automatically and irrevocably make the Grantees, their successors and assigns a member of a non-profit, non stock corporation known as CROIXRIDGE HOMEOWNERS ASSOCIATION and entitle them to the benefits and privileges of said association and bind them to the terms, conditions and obligations of said association. i c ( i 1 This 1s-riot-------------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And------ Alex.S,.Kosa -and .Edry L..-Kosa--------------------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except none and will warrant and defend the same. Dated this 5th 19..- ------day of Nov- r I -----------------------------------(SEAL) - - (SEAL) Alex S. Kosa (SEAL) - - - - Gs2q„/ (SEAL) - Edry L. Koss AUTHENTICATION ACKNOWLEDGMENT Signature(s) _of Alex S. KOSa- and STATE OF WISCONSIN EdrY.L Kosa $S --------------------------------------County. authenticated this 1912 Personally came before me this ----------------day of 1 19-------- the above named s TITLE: MEMBE STATE BAR F) SC N (If not, & a. 16 - authorized y § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Alex S. Kosa, Attorney at Law - Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) ) date- -------------------------------••----------•-----------p 19 *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN WlsconMn Lean) Blank Co. Inc. FORM No, t - 1982 Slilvvaukee, W.is. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~'iCCts ROUTE/BOX NUMBER FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: 1/4 S 1/4, Section q4f' T_2- V N, R 00 W, Town of St. Croix County, Subdivision C ,,efE~1y 3 , 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. SIGNED 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.090) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNIGIPAW-W: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE SW 24 /T28 N/R NE (or) W TROY 15 Croixridge COUNTY: OWNER'S MAILING ADDRESS: St. Croix Steve Koss 324 Mine St, Hudann. WT 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: -PROFILE DESCRIPTIONS: PERCOLATION TE I New ❑Replace I 2-18-91 2-20-91 STS: I ®Residence 4 X X x x lx x RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: MIS TEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) Fil S ❑U 0 S ❑U ©S ❑u 0U EIS 0. 1 conventional 24' x 35' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate:n/8 1 Floodplain, indicate Floodplain elevation: none PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HIU-HEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 137 97.6 none >137 XTS 2.7'Bnsl 3'Rdls w/gr 1'Rdfssil 3.9'Bnfs. B- 2 108 99.5 none X108 1'TS 1'Bnssil .9'Rdsil 3.1'Rdcs 1.3'Rdssil 1.7'Bm s 4.7'fs. B- 3 146 99.0 none X146 1'TS 2.5'Rdsl 1.4'Bnls 1.8'Rdcs w/gr .8'Rdssil B- 4 138 98.4 none X138 PTS PRdsl 2. 'R s 1.2'Rdfssil ' ' Bnf s g- 5 131 100.5 none -z-l 1 2.1'Bnsail I.I'Rdl-q 3.7'Anm_q ' ' b g_ **N TE: So is showed to highly variable and very irregular, therefore tester went PERCOLATION TESTS down to fs. 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_ 90 none 3 .5 P- P_ 3 107 none 3 > 6" drop in 3 min. .5 P- P_ 100 none 3 .5 LP- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe hat 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 90.1' scale 1" a 30' projected - 41 = BM, assume 100.0', top hse.site. of steel pipe located at base of tree marked with marking ribbon. 41 zy~ boring. o = perk. ALT. d s' i TH 7 5' cut: mat. o9v /2;-i5~o be used at hse. ` site. _ ~01 I~ ~e3' L 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: DAVE FOGERTY PLUMBING " ?c r/ Tes ADDRESS: ce #3233 #er & Rk-mber CERTIFICATION UMBER: PHONE NUMBER (optional): 3289 eights Road Fogarty H. 23 ROBEWS,-WISCONbIN Ow CST SIGNA UR~: Phone 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - u I o~ e n lull i - - 41- - w i w j n~ Sw- 4N 1 cl~ CL ol I o W i i I j i I I y r~ ~ 1 ~ ~ ~ ? ~ . i i ~ i j ~ , J i ,a 1 ' ~ ' 1 .i i a t I ~ ~ I ~ ~ ~ ~ r ~ 4. V~ rr, , ~ ` ~ ~ ~ i S`,` ~ '~a ~ y ~ ~ ~ i / I 1 1~. t , ' f ~ ~ ! ~I ~ i ` ` I, ~ ~ ~ ~j---- ~ l ~ ~ ~ .G , ~ , y ~ ~ 1'r- RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS FHUMAN TRY, DIVISION P.O. BOX 76 R AND PERCOLATION TESTS (115) MADISON WI 53707 RELATIONS (ILHR 83.090) & Chapter 145) LOCATION: SECTION: TOWNSHIP/4t601 I Q1 12.4 614;V: LOT NO.:BLK. NO.: SUBDIVISION NAME: SE 1/4 SW 1/4 24 /T 28 N/R 20 E (or) W TROY 15 Croixridso COUNTY: OWNER'S MAILING ADDRESS: St. Croix Steve Koss 324 VIne qt-. Rtidognn WT 5401f, USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DE CRI TIONS: PER OLATION TESTS: ®Residence 4 x x X X X X CNew ❑Replace I 2-18-91 2-20-91 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS ❑ U Z S❑ U ®S ❑ U ❑ S E]U F] S❑ U conventional 24' x 35' DESIGN RATE: If Percolation Tests are NOT required I I- If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate:n/S I Floodplain, indicate Floodplain elevation: none PROFILE DESCRIPTIONS kB4 TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH EPTH IN, ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1137 97.6 none ? 137 .8'TS 2.7'Bnsl 3'Rdls w/gr 1'Rdfssil 3.9'Bnfs. 1108 99.5 none >108 1'TS 1'Bnssil .9'Rdsil 3.1'Rdcs 1.3'Rdssil 1.7'Bm s. 4.7'fs. 1146 99.0 none --146 1'TS 2.5'Rdsl 1.4'Bnls 1.8'Rdcs w/gr .8'Rdssil 138 98.4 none X138 1'TS VRd sl 2 4'Rdls 1.2'Rdfssil-1'fffBn--s4.9'Bnf8 Bnf s B- 5 131 100.5 none X131 ' ' 3-719nna ' b B- **N TE: So is showed to ighly vari ble and very irregular, therefore tester went PERCOLATION TESTS down to fs. TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 9 none 3 •5 P- P- 3 107 none 3 > 6" drop in 3 min. .5 P- P- 4 100 none 3 .5 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe hat 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 90.1' scale 1" = 30' projected - - -y~ B-t sme'i lo-t-a se.- te. of stee pipe t td at base of tree »arl ed = with markfbo - I7 . ril0g ! 3 3 ~1 v 2- Ow park. i E t ~ t, 3 k r ~ T ALT - - E f 57 IN E be used at hs - k t E e 3 k 3 I4 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: DAVE FOQ►E~iTY PLUMBING 2 /7'P9/ ADDRESS: Ce #3233 (*3289 CERTIFICA ION UMBER: PHONE NUMBER (optional): Fog" e' hts Road ROBE S, WIS CST SIGN U Phone 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER -