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HomeMy WebLinkAbout042-1051-90-000 ~ C 3: C) o p Ln, N d0 I' N 0. O N ~ 1 f O O N y ~ I ~ I 'C ry '~I I i 6 z C _ L m C LL O 'O Q M Z E co Z 0 p I' 0 rn a m rn H w z 0 C o z ° v U O p cn F- e= N Z C N E ~ M a) co .N a N C •N d U L O C C O U 0 Z H Z = _ Z o C c ~ E N N E `rl M ¢ p = co M o d i N O a N ° o e CL h d a CO v~ v) U) _E E o Z v > CL 0 0 0 H Z° Z.; CL a. IL 0 Y) v~ U o rn rn >o PV N ° O ° e N O O E co 3 CL t ~ v 0 CD a) 4.i = a d 0 M N N J O ~ C O O M 3 C N C w C w ca I 'T 0) p y N O m a O. C\ V C ~A J C O O N 3 ❑ M N 00 N F N n a of `6 aTi v a y E E U o o z _ cn Q ~ \rI m E L `m ` a t ° L IL w • •C~ O. C7 V d C `dry r+ E L E C r p rT~ U p N 7 3 w Q U a 0 co 00 • FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER CA,ry e aa~ :Z e--4 TOWNSHIP Z~ rr SECTION TAN-R W ADDRESS ST. CROIX COUNTY, WISCONSIN Y& 43 SUBDIVISION ;jj LOT z7 LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM bl~ , 19 io 01 c \ ~ .P~i( ( 1 / 7 for, 2 h~rtc ~FS ~x ~ ~ ys Syr, - ~ INDICATE NORTH ARROW BENCHMARK:Elevation and description: / Alternate benchmark SEPTIC TANK:Manufacturer:~~ Liquid Cap. /U~71G Rings used:_QManhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:FrontzX/ Side , Rear Ft. p 7' From nearest prop. line:Front , Side , Rear~Ft. 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 1 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 cOc) Number of Lines: Z Area Built ~Jcl Exist. Grade Elev. /G j, 2 Proposed Final Grade Elev. /d Fill depth to top of pipe: 3 Z No. feet from nearest prop. line:Front , Side, Rear Ft.,0§*-t No. feet from well: No. feet from building 9 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 : PLUMBER ON JOB: ' LICENSE NUMBER: /~'~.Y 3'ZZ~f 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING • LABOR & HU*IAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION )\QAplS1V V11yV1,5 e c . 19 , T 2 9 - R 18 State Plan I.D. Number Town of Warren, Lo 4 CONVENTIONAL E] ALTERATIVE (if ssigned) Hwy. 12 Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPE TI N DATE: Lance Re zer 69 Terraea St. Roberts WI 7 / BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. Es ST REF. PT. ELE / Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: ,Roger Timm 3224 St. 149043 SEPTIC TANK/HOLDING TANK: 3 oa(-S _ ~.o([ 3 / MANUFACTURER: LIQUID CAPACITY TLEV.: TANK OU LEV.: WARNING LABEL LOCKING COV PROVIDED: PROVIDED: dl+ LJe~ t°S L G~~ C1J/• ~~3 F~ / D3.3~ Li`ES ONO OYES O BEDDING:s DIA.: VENT MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: f AIR IN T: [j YES L/d'INU ❑ YES o NEAREST /Ud &Z 2 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: PUMP AND CONTROLS OPERATIONAL: N PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATER MARKING: 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: LIQUID ) TRENCHES: C MATERIAL: DEPTH: DIMENSIONS S 66 a I' GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL, NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COV i E EV. INLET: ELEV. END: I I p12L U C PIPES: FEET FROM LINE: AIR IN-LEET: 2 / Gt J NEAREST E , 6 CD , / MOUND SYSTEM: 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 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: 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 AL & MARKING: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTI 7K ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPO ~TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NPERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDIN COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST lot ~,,y =101(09 I Y, C e4- I a i Sketch System on Ret n in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) r - SANITARY PERMIT APPLICATION 7 DILHR In accord with ILHR 83.05, Wis. Adm. Code CouN STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 9~~ 8% x 11 inches in size. ❑ Check revisnt~previousapplication -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 T' N R or PROPERTY OW°NER'S M LING AD9RESS LOT # BLOCK # I CITY~T~TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER C 7" II. TYPE OF BUILDING: (Check one CITY AR ST ROAD VILLAGE I~ ) ❑ State Owned FA 4QWN OF: ❑ Public L's1 or 2 Fam. Dwelling-# of bedrooms J PARCEL TAX UMB ) 111. BUILDING USE: (If building type is public, check all that apply) ,c', I D 33 ''TTIIJJ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. YJ New 2. ❑ Replacement 3.E] Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 420 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 Meet /6.:Z c /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 strutted Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Fj 1-1 El 11 EJ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbq ' Name (Print): Plumber's Signature: (No S mps) MP/MPRSW Nn.: Business Phone Number: k; Plumber's dress (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Inc 'charge Fee Water Date Issue Issuing gent Sig lure (No S p P~Appr,ved ❑ Owner Given Initial Adverse Determination oo, 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 BAHITAAT PERMIT • RTC-100 This application form Is to be complntod In full and signed by the owner(s) of the ptoperty being developed. luny Inadoquacles will only result In delays of the pi rrnit lesuance. -Should thlis development be lntended for resell by ovner/contractot,(spec houoe), thon a second Loan should be tetained and completed when the propstty is sold and ■ubmltted to thla oLLlce with the Appropriate deed recordlnq. --------'-/-------/----------------.--~,-p---------------•--- Own:r of property /yC~ Location of property L.L 114 ~1/41 Baetlon ~•R'uw V T o wn s h i p Halling address / T /Q~s~ STS _ f o,B~R TS. ~Jl 6 ~~a3 • Address of site _ifi h~G(>f! /(:,2 Subdivision nowe Lot number _T ~T l/v; I/'O~/J/!7•~ J~ Ocy4~- Cp~~ c~oe.~~j/4S~o? Previous owner of property C"',4 , nom, Total size oL parcel 7/ ycI S _ Date parcel was created All all cotnets and lot lines ldentlllabls? Yes No to this propett belnq developed Cot resale (spec house)?- as r No Volnr.a ::1 and Page Number ~f An recorded with the Re 1sta --..•-------r•rr-r--r-•---...-•.-.. _i. -17 -..-------------------------r--------------- INCLUDE WITH THIS APPLICATION Till FOLLOVINCI A VAAAKXTY D4SD which Includes a DOCUKINT HUH01R, VOLUNI: AND PAOt WLrmaLR, and the BRAL OT TIIE 119018TIR OF DRRDB. In addition, a cartitled survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Cettllled Survey Hap, the Cattllled Survey Nap shall also be required. i 01MER CERTIFICATION ---r-- 1(Ve) certify that all statements on this form are true to the best of sky (our) Rnovledgtl that I (we) am (ate) the owner(s) of the property described In this Intotmatlon form, by virtue of a warranty de d recorded In the office of the county aeglatet of Deeds as Document Ho. a(P 7 ) and that t (ve) Presently own the proposed alto for tha now go disposal aysten (oc 1 (we) have obt■lned an easement, to run with the above described property, for the conettuctlon of meld nyetem, and the same has been duly recorded in the ottlce of a Coynt peglster of Deeds, As Document No. i~ signature of ner signature of C veer fit Applicable) Date of slgnalute DAta CL Signature oocumc JT NO. T"Is SPAM RcMli~ s 1 MII~ c STATE NAB,QY 'wMMSIN FORA 2-IM 467 VC: IAGE617 MUM ! ST. C"X M l R .C. Const.; Tnc. Reed for f 161990 2.05 P.-A r - - - - - conveys and warrants to _ .Lance SA Reyzer and -Sharon K. ..Reyxe.r,.. husband _and..wi.fe as .marital .suaryi.vo.rPbip j~ ..Prope.rty... . - _ . _ . . - N._TI_RN To :f . ...R St-. Croix the following described real estate in ..County, - ; State of Wisconsin: ii Part of the NE'k of NW`-4 of Section 1~, Township Tax Parcel No 29 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 4 of Certified Survey Map Filed - June 21, 1978 in Vol. 3, Page 615, Doc. No. 349572. r. Also,a 1/4 intereFt in the 66 foot private road as shown on said Certified Survey Mar. 11RANSift w,. s 33~ ~ _ i. -N ct 4A y. This i s... not. homestead property. w. (is) (is not) 'ar • Exception to warranties: easements, restrictions and rights-of-way--' t of record, if any- 15th Dated this day of October Mgo c' R.C. Cons4., Inc by: homas Siefert),,, ~ f~Gloria Siefert ~ ~ a. (SEAL) tl AUTHENTICATION ACENOWLEDGURNT a r Signature(s) STATE OF k6 + W*k TEXAS 4 a. ss. - County. authenticated this ........day of . Pers+mally came before me this 12th 19..... . October , 19-90-. tba as". Thomas Siefert and Gloria Siefert TITLE: MEMBER STATE BAR OF WISCONSIN (If not... authorized by 1 706.06, Wis. Stats.) me know to he the ~i person -.5 tt6a foretro ing atrument and adt ""ay nowledlgfa the'bM - T-A:S INSTRUMENT WAS DRAFTED BY Kristina Ogland Lundeen - . • e ' - - - Attor..ne. at - L aw• .r , Not. -V Public . . (Signatures may be authenticated or acknowledped. Both NIy r^ ` ma r: are not necessary.) ' date: 7 f7GtititA 1, 9 ' Ihf emb- of P- **'W in Ms aioWiRr Auuld be Lrw or pe mt.d brd„w' th• ir e:iYnat '+A -.id ..tom! .M, _s. s. r r~a~w r,ira.,,....: _ n SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County p n ,Q.t.~ v OWNER/BUYER ROUTE/BOX NUMBER Fire dumber d CITY/ STATE ZIP ' Section r T N, R= PROPERTY LOCATION C: ; Town of St. Croix County, SubdivisionC_-)r"i Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licens'ed' •s'e' t'ic tank um er. What you p into the system can a ecC t e unct on o, t aseptic tank as a treat- ment'stage in the waste disposal system. St. Croix County residents'•m~ be eligible tofrecieve aggrantefor a maximum of 60% of the cost.of replacement sysm, whit 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 s_ t_e_ms 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), ',-he septic'•tank is less than 1/3 full30f dsludge andtscum. Certification form will be sent approximately ays prior three Year'expiration. y o I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- s ment of Natural Resources, Certification form must be completed b and returned to the St. Croix County Zoning Office within 30 days of the three year expiration.date. SIGN C71'rC' DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. INDUS TMEI~IT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (11 P.O. BOX 7969 HUMAN RELATIONS \ MADISON, WI 5370/ (H63.090) & Chapter 145.045) LOCATION: TION: TOWNSHIP/MWN I GI PALI T-Y. LOT NO.: BLK. NO.: SUBDIVISION NAME: NE 1/*w1 i9 /T29 N/R18 E wr)W WARREN 4 XX CSM Vol 3, Page 615 COUNTY: QWNmERWBUYER'S MA ADDR SS: t. Croix Laucs Razor 69 Termsa St., Roberts, WI 54023 U E Phone DATES OBSERVATIONS MADE NO. REDRMS.: C iMSnIA STS: Residence 3 XXXXXX ®New ❑ Replace 8-2'i-90 8_27_0 RATINO: S= Site suitable for system U- Site unsuitable for system ONVE A MOUND: IN-G -1N.- I,LL OLDING TANK: RECOMMENDED SYSTEM: (optional) s S U EiS ❑U 2S E] U E]S J ]U ❑U'I conventional 12853 bed If Percolation Tests are NOT required DESIGN RATE: Ploodplain, any portion of the tested area is in the under s.H63.99(5)(b), indicate: I indicate Floodplain elevation: n/a /a I PROFILE DESCRIPTIONS BORING TOTAL H AT INCHES HARACT R 0 SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DLR'1H IN, ELEVATION g E V TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B_ 1 90j,0 IQ3,3 none 90.0 7.5' ft ca w/ gr,cob, A. B-2 84.6 10.3.2 none 84.6 7' Bn cs w/gr, cob, rke B-3 157.6 101.7 none 57.6 4.7' Bn ca w/gr, cob, A. . I B- 4 87.8 102.3 none 87.8 .8' Bn is w/gr, 1.3' 11n al .8' lid el VW'_ ca B-5 92.0 103.4 none 92.0 7.7' Bt: cs w/gr,cob, rk. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR IN W S RA MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P PER)NCH P- 1 40 none 3 • P. P- 2 _ 38 none 3 > drop rag m tlt a perlod. .3 P-. P.3 20 none 3 . 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. By 12 SYSTEM ELEVATION 100.0 TE~ ID E OF P T.1 i ~ ~ ~ 1 + ~ ~ ~ I I I y t ~1 B t, o nail !at iba e t N j-; of ee►, ilOC}.0 I i_{ T 3 i x _I ! a rid ( j 7o _ _ rge of~i~ree 1 { r I t ) 1 1, 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+thv best of my knowledge and belief. !NAME (print : TESTS W RE C MPLETED ON: U"r41 d I~(0 Teener & pwnur ~7 d AD F H Road CERTI ICAT O NUMBER: HONE NUMBER (optional): Phoft 56 CS SI DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DfLHR-SBD-6395 (R. 02/82) - OVER - JOB L4 ~cc e ✓ TIMM EXCAVATING SHEET NO. I OF Z" Route 1 Box 192 DATE ~J - S / WILSON, WISCONSIN 54027 CALCULATED BY (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE Y ,c~ _ Y < , . l i j / .F. /BrC C 1tJS........ J Y P - 7to . . , / y . 0f c , - L I i ~Y\ - t 4 PRODUCT 205-1 Inc.,Groton, Mass.01471. To Order PHONE TOLL FREE 1-8Oa225- 00 r JOB Y7 l 1 iCt Q ii -7 P✓ TIMM EXCAVATING SHEET NO. OF • Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY ILL DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE SCALE „ s. t . r, ` _ r (~i b~ r - d_ - g ~n D t_.... / i - PRODUCT 205-1 ~ Ina, Groton, Mass. 01471. To Order PHONE TOLL FREE 1.800-225.00 DEPARTMENT OF REPORT "SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 796 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53 09 HUMAN RELATIONS (H63.0911) & Chapter 145:045) LOCATION: SECTION: TOWNSHIP/""ro"",~ ,a,o.PALIT Y: IOT NO.: BLK. NO.: SUBDIVISION NAME: NE tw1/ 19 /T29 N/1118 E (or) W WARREN 4 XX CSM Vol 3, Page 615 COUNTY: BUYER'S NAME: MAILING ADDRESS: St. Croix Lange Re zer 169 Terresa St., Roberts, WI 54023 USE Phone 749-- 368.: CO DATES OBSERVATIONS MADE r~I NO.BEDRMS.MMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: L=TResidence 3 XXXXXX ®New ❑Replace 8-21-90 8-27-90 RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 1_x1 S ❑U ®S ❑U 0 S ❑U ❑ S x❑U ©S ❑U conventional 12X53 bed 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 j Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 90.0 103.3 none 90.0 7.5' Bn cs w/ gr,cob, rk. B-2 84.6 103.2 none 84.6 7' Bn cs w/gr, cob, rk. B-3 57.6 101.7 none 57.6 4.7' Bn cs w/gr, cob, rk. B-4 87.8 102.3 none 87.8 .8' Bn is w/gr, 1.3' bn sl .8' Rd sl 1' Rd cs B-5 92.0 103.4 none 92.0 7.7' Bn cs w/gr,cob, rk. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 1 40 none 3 •5 P- P- 2 38 none 3 > 6 drop ring minute per o . . P-_ P- 3 20 none 3 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. Hy 12 - SYSTEM ELEVATION 100.0' I f I a - ) _ E. tot I E ' a lie j _-NOTK BORE ..HOLES` ARE_.LOCATED III KIDDLE OF l'GRA)IVEL PIT C~ ITT 1CHED . 3 E I - 1" = 40' = BM, top of nail at base 1 ' --4, _ ~N of tree, assume 100.0' _ 3: o x X _ - - boring ~ a plerk 70' = large cotton wood -tree i E i a _s. - E rails t aek>_~ T-F I__T_ I i! ) T 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): DAV PLUMBING TESTS W RE C MPLETED ON: Licensed Perk Tester b Plumber 2 , 7 ADDRESS: Fog#3233 #3289 erty Hei hts Road CERTI ICAT O NUMBER: PHONE NUMBER (optional): Phone 749.3656 CST S DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SBD-6395 (R. 02/82) - OVER - -J rev J; ' Cl~ ..CIU VwITH SO MUCH DOWN, SUCH ~ - ER,. UNUSUAL ASSUMPTION REQUIRE LJ •C ~ S V~ r C~ 1,~ 1f f ' R Sri ! ' Y'iY"[ ~ N gi T E - I ~ 1i :4 r w ~ / ra x 1 i y4a tl° A ^ r h ~ a J r ! w _ .`j r,. z .i a t'4 ~ F' f 4, T 1 L. ar 4 a ` a „i .k F a r~ . w„ k C ime' 1 ` ' s - t # 4: r. ` 1 . w j~ .4'+... ~..+•„K, l~ reJ^ r'r"•> ate,^, , r w. 4 ~ r. f - ~ F a 4 A s 4 ,t $ 1 f ~ r RTI. s. .w_ S JY 'r f ~~F~ yaa';ry~ .`_r K 4+~ • r r R t4 w~ ti c~5a = et.va {yy i.d ~sx.r I ~ j w''.y~'~ to a E w3J~ ZJa+v~CJPcdW~i ,f'9. iy~.'!,•a.sr 'y C/aif wiz 04 p.KJ' /J7 Y j _ ie° ~a Jms f~se , 3 f~ °i. q~M erok VeweJt ~ ~t.•.«in Ft;a a ,9wty Fa ~ `t eygsf>oye oF s tiya~tyd~a i Ni' o~ rive