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HomeMy WebLinkAbout020-1210-50-000 ao 0 6e. o 0 I ~ I Iz Cb N erj N I i i I I I a 'a I m c I 0 d c z r Li c o f0 3 Y I 0 U CD I Q U I ~ M v Q) w z E z O Z d d ca m ~ Z ! a o ° I Y o zz N H r I Cl) N c n • -D (D m o N a O o z m z 0 0 N m z i O E O N m a ;a aci c `D 3 d y N O G o a .0I r N o ~o a. Lo a cn z ° 000 ° o • wi R a o. IL a L o N a) fA J U o°i rn L I !mil 0 0 o Y o 0 °o Q^I. Ilv~~ EC\j I = m c IL I y N y Ol ~ ~ ~ y d Q } (n co p L U) U) C) 16 2 E a O c W o c t~ l Lq ~2 O a co C 0. N N M 1 V w °oi~ c o o c !fern MO N 0 d N H F~ C N 00 C) C'! E E C14 o U ~ I v~ `m R € a Y dt a • C~ CL GI V d a C E c c ~1 A 0(L2 oU0 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERS TOWNSHIP 1-11,1s, 5e SECTION__Zj~o_T-2-dr N-R /9_W e 1'U- yL4 F7t,,, n 2_0 kj, 59-0 1(0 ADDRESS_&X z$Z. ST. CR IX COUNTY, WISCONSIN SUBDIVISIONPat~ "y LOT 5- LOT SIZE Z _ G S ~e✓~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yi , ,7 3s' Zi,T,p e~ E 1 = )00. oo' s s«r0- ►aI g you yp'rso 1vx 3a~ D, way ,e INDICATE NORTH RROW CL- I W-Ft ~~~r R cP E = f 00,00 BENCHMARK: Elevation and description of IQ~~M Alternate benchmark t-1,,,, -.e-' S 3 SEPTIC TANK: Manufacturer: WciS ems" Liquid Cap. 1100,0 Rings used:-L-Manhole cover elev: '~,.7Z Final grade elev: 3S 3 Tank inlet elev.: (.37 Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft. 11/6' From nearest prop. line:Front Side X , Rear Ft.1 3 y~ No. of feet from: Well (oS , Building: 11" (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: "Ilk 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 : a,l vs.y„ ;4,*, Trench Seepage Pit: Width: /5 Length 3 Number of Lines: Area Built,,-7 Exist. Grade Elev. Proposed Final Grade Elev.• S C) Fill depth to top of pipe: ~/O No. feet from nearest prop. line:Front , Side X , Rear Ft.1.14- No. feet from well: No. feet from building HOLDING TANK Manufacturer: A/A 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: ~ 6/90:cj gEPARTWNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING •LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION _Aa~,41SQL~VI Sec 16,T29-R19 Sfatss fined) 'Number: 1VW r„ CONVENTIONAL ❑ ALTERATIVE Town of Hudson LohS Fern Rd. Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: FB DRESs282, OF PERMIT HOLDER: INSPECTION DATE: A /r Sam Miller x Hudson WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT ~V.: I ST REF. PT. ELE i3 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: ,Doug Strohbeen 5432 St. ix 1 839 SEPTIC TANK/HOLDING TAN B 01 n Iw cul a.,r "14`1 yb " x.58' G COV R MANUFACTURER: LIQUID CAPACITY: TANK INLET E EV.: TANK OUTLET ELEV.: PROVID WARNING ED: PROVI LABEL LOCKIN DED: z4 G(~'f I G~C1 /o7a'>~ /dG•F~ YES ❑NO ❑YES NO Ot7 BEDDING: M614T DIA.: y~ T MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY' WELL: BUILDING: VENT T RESH ~.O C p, it 1 To , ALARM FEET FROM LINE: Y7 / AIR IN E~ ❑ YES NO 't ❑ YES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING UID CAPACITY: PUMP MODEL: MP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑ NO .a ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: N R OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET F LINE: AIR INLET PUMP ON AND OFF ❑ YES ❑ NO NEAREST MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIA91 or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) i CONVENTIONAL SYSTE 2S s- e<cd• _ JoS, /9 ~Y ' , l :>r J, INSIDE DIA.: # PITS: LIQUID -07177- I WIDTH: L O. OF DISTR. PIPE SPACING: C BED/TRENCH r TRENCHES: / MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR: PIPE DISTR. P E MATERIAL: N DISTR. NUMBER OF PROPERTY WELL: r BUILDING: VENT LE FRESH I BELOW PIPES: ABCOVER: ELEV. INLET ELEV. END: S CEO PIPES: FEET FROM LINE: i AIR INLET: L SJ /OG. 5~ /O(r 3 Cf eg (jr ✓C~ NEAREST /O MOUND SYSTEM: ' o ' 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 ENCH/BED DEPTH OVER TRENCH/BED S OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: 74<~LOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: IA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: CAL LIFT CORRESPONDS TO INFORMATION APP LAMS ❑ YES ❑ NO NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST --1110 i. in in county file for audit. Sketch System on Reverse Side. SIGN URE: TITLE: .01 4L 2tzl SBD-6710 (R. 06/88) ©ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Cou STATE SANITARY ERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ f 0 8% x 11 inches in size. c ec ~f reels on pr wous 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 F- S 14 T N, R for PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 7- T' Z s CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER S}~vi'~, 7 -261 7" o 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD yl ~o; r N l~~y ❑ Public `f' 1 or 2 Fam. Dwelling-# of bedrooms -PARCEL TA NUM E 111. BUILDING USE: (If building type is public, check all that apply) /7-o7 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 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. F New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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-Pressurized Distribution Pressurized Distribution Experimental Other 11 W Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 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 t~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7'~ SD G /s~ (o ~7 Z 4-3 0 Z/, 66 Feet /07. 5'0 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 OOO 1 U,& Sd Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume-responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: if) c! <J G /o' 1(.2 ~ 7 - 3 1 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss iing A nt Signature (No Sta Approved El 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 subny~tted 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. Vlll. 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; Jose 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 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. SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be complatod in full and signed by the owner(s) of the property being developed. Any lnadoquacies will only result In delays of the pztmlt Issuance. -Should thla development be intended lot tesale by ownet/contractotp(spec house), then a second form should be retained and completed when the property is sold and submitted to this office vlth the appropriate deed recording. Owner of property Location of property ~1/4 1/4, Sectlon /G T oZ. q~.W-R Y Township ~z_A0Vx„ Melling address _H.Dy Z- ~~ort Address of site 3tr"r.4 0'00' lubdivlslon name-- [i~ay A~ Lot number S Previous owner of property _ GJazelmu w, 7cKsi Total size of parcel Z . L S ~Q✓ Date parcel was created 4/ra Are all corners and lot lines ldentlflable? -S- Yos _ No Is this property being developed for resale ('spec house)? as _sN0 Volume ZLq_(j2_and Page Number -5-1?7 as recorded with the Iteglstee of Deeds. ................w-------------------------------------------- INCLUDE WITH THIS APPLICATION TITS FOLLOWINCt A WARRANTY DRSD which Includes a DOCUMXNT NUMBXR, VOLVMX AND PAO= NtlMaRR, and the SRAL Of TILE 118018TRR OF DSBD9. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. if the deed description taterences to a Ceitifled Survey Map, the Certlfled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(Vs) cettlfy that all statements on this form are true to the best of my (out) Rnovledgel that I (we) am (ate) the owner(s) of the property described In this Intormatlon form, by vlrtue of a warranty deed recotded in the Office of the County Register of Deeds as Document No. z12.s 1[~ ) and that I (we) presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to tun with the above described property, for the construction of sold system, and the same has been duly recorded In the office of the County Re 91 tAr of Deeds, as Document No. t Sf! tA/ signature of Owner Signature of co-owner (If Applicable) IF r ~ _ 9 Date of lflgnature Date of Signature Y •Gk n..~ r;+1r'w ~i ♦ 7 1* A.: " ~ „ e ~~o •h1lMasad..asad. ~IL:...::.~ 4 , SIA wUnSk a ..2AM.s...1~i11j.,..asiosL.................... . . M 9t4S d ! mO a .....MNN..HM.NN...M».NN.N..NN...N.•. N..Nr....N». NN.•NN•.N».. N.NN•».N Jill . N. NNN... .............NN............... NN..N NN............................... R d r . ~w........... ....N................................... »....N............»....... ........:........»..»............N.........» ne*uat » rN...a...N•N .......•...w......»...... k ii ...i.y...i ..................NN..»..Nw Qom...... . d~flhM nd eetMe In ...Pi•.» ..CnIft, Teti P~pwl Not I~et Qrrter of the Northeast Quarter of Seetioa 169 Toraabip 29 Noetb, ,19=iwetO' 8t. u Croix Cbunty, N1800003s UCRPT Lots i throulb 4, incltrire of f 149=rWt @P tilad,July, 239 1964 in Vol. "S", Pap 1447, Doe. No.39SM oet'to t" Dselaratioa of Protective Covenants dated February 13, 198S9 seesrMd.S ttbe offiee of the.Nasister of Deeds on February 18, 1985 in Vol. 706 Faq e~ • No. 3"M. 4ant., to aea-etoaiwlVe eae~ Lg of to"" for use of tbs 66 foot road iipe G of ~1 tYM i sieve a boned Certified survey Map. tO "1811astitieo Feaoe Agreement between the stets of Miseoneia ,F of il:-Msouso« dad Mosher Fero dated &*teaber 13, 19790 recorded" P 2i, 1979'ia'Vol. "601", Pep 6399 Doc. No. 360128 for the osinteosace of tree ` bewean tlsisf , sY k of 82 k of sectioa 9-29-19 and m k of Ns k of w~nwte.a a: ) r. to tW ....~wanwout 1~1.....N of u I! .N,.. y , .N ..................(aZAL) ' ....~*~1frP/ a~►L) ..........N • J./i.im ~~rn.. } r,; , wr! ISZAL► V Faro . (asAL► N.w.,..•, . Fero r= 4 ' AVTXNNTICATZOX AOSICOWLRDGMXNT alpritunlr) .....N..N.... N.NN.... » STATZ OF WISCONaIN H tlde ...NN.dye[............. H...... P#Mnaliy pae......Coontr. before me the ...doy K named ...........-».-N _ Manley .fora. ad a. Y..Fara nod. Y f TITLiit YZ1[R14N aTATX RAN OF WIaCONBIN Mar1az a..R ulna. RaTt►~ N,[k,( .1~T34 jam.. lit 28L . ty" by . "I•M.,w'k. ata.► to I" known •t0 M.the per~en !b~ •.Re the same. THIS w.n on•~rso w t... . fig I ' 2.0...3ax,....NtIA~o►~...li ...J!9~. $c.. Nato«y rUnne Croix /MaMlrne troy M "04nuedw or ask .........Cernty. Wis. py~~) newled, Roth NT C*ntmi*dnr b ex irot dote....... . ..IS~~~► d MM.Mt1re 10 W ttttt.ely aAtnrN M 17..y1 wr nrlMwi Mmr t1Vir .Lt-t.t". •AMAtI~! e® eTA Von" H. Ne1~/ wtK.wrU t..e.l wafth Cm t.r. l SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County OWNER/BUYER 5'~-iyl o~/~,[%r o • ROUTE/BOX NUMBER 9o X ~z' 2.l Fire Number ZIP S r W CITY/C TATE ~ • S PROPERTY LOCATION: k,MfLk, Section/41T_!E~EN, R11 Town of ,i. St. Croix County, Subdivision Ark Lt~a.,v Lot number S_ 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'ept'ic tank pumper. What you put into the system can affect the .unction of the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-may .be eligible to recieve 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 'sys_t'ems 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 inspection and pumping (if nec- operating condition an essary), ~ and ( )-after 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. 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 Depart- W ment of Natural oStCeCroixeCountyaZoningoOfficetwithin 30 days and returned to the of the three year expiration date. IL SIGN DATE / - L St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEP:.i;T'11fiE=fv, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY' 1 c DIVISION 69 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUf.1"~f~J RELS (ILHR 83.09(1) & Chapter 145) LOCA I ION: C ION: TOWNSHI Mb1Nf- tT4: LOT NO.:BLK NO.: SU IVISION NAME: Me /`i / ~ /Tz9 I!/R/9E co HutpSOti S t~'AQY. WAY COUNTY: J''.iJER'S%Bt$Yf=R`5-NAME: MAILING ADDRE Q LL1C P -rp C)T D Ai.tSS61i W) USE _ DATES OBSERVATIONS MADE G[DRIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: dence I Cia: kP.1S.: COMMERC •TNew ❑Replace Qc-,,, 3 111l !O /~/OV - - J,5,t_s EVKx r, S-8 SO I LS - V hd ko7- r1 , \ RATING: S= Site. ~Aitahle for system U= Site unsuitable for system CONY iJT10fJ'.L l;.', tIND: IN-GROUND-PRESSURE: SrSSTrEM-IN-FILL HOLDING A K: RECOMMENDED SYSTEM: (o ional) If Perco'ation T r: NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR o (1)), indicate: (IILASS ' Floodplain, indicate Floodplain elevation: AM PROFILE DESCRIPTIONS BORI?dGj TUI'r ( DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NU,T; -LENATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B' ' -7. = JJ!. ,9Z j~~nr,lC > 7.Sa 7~Q<SGTS /S" 9QNS( 0", n /)7-CS-1 ;12 B q^-._ - ,L ~1oN q.9Z 5'?cs<~59.~~5~8. yStC 33°gc C`~f!. ~g~~~c„1`ts B 76 B ~t4E > OD 11'~Bc~7s Z~ S,C Bs"6'~NCS~E~~ B 5 ~3.G _-i..-./1 n(t:~T~'Ir 7 U.~l~ h~~f~<CT5 Iq°YgRwSIC f2d~'~vCS~G,? .f ! B_ PERCOLATION TESTS TEST- DEP.i IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUP.1P:=ii % '_TER SI^JELLING INTERVAL-MIN. PERIOD 1 P RIOD 2 PERIOD PER INCH C >-Z P_ N7, P_ 7., I S.5 > Z > Z < P_ P- _j CLEV,a-rf nl AT hC, P- PLOT PLAN: Sh(_% !--_L,tions of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and verticai eI .:uicn 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 F _-VATION 104 .(XS~ LoT : l S ' 1 b "T' f -1 T- I, the Under$Ign':d, certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Co;: that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME tprint): TESTS WERE COMPLETED ON: ~lr?~;'t - =~C,:} QNI~$Cj/V JU►:t: /f1VG / Y dvemp R / /996 ADDRESS: CERTIF CATION NUMBER: PHONE NUMBER (optional): 4v7 l - /JUA-sa?v V1 4o16 3&Ao"6 CST SIG URE: DISTRIBUTION: C and one copy to Local Authority, Property Owner and Soil Tester. DILHR-S13D-6395 lT .2 `33) - OVER - 1~ar k'W~~ Aid - ~fi -A7 S- t, ~zo.oo CNo sum /Vo►'Y I off" ~ ~ btc..~ • ~ 3 Svst~n t I = I oq,oo, NE Lot Cn/ f3.M.Top of I$".cm Q / Eiv. ~ Ioo.oo' (13a~k~`oe~) Ul-IS orc 5 4 ' ~a.rc s ~ T` 'sfi Ba'tC` 1 = I o Z- Co''y° I B ~ ~ ; ~ cal - ~ 3'3 B.M. P oP o~ 14 c ~ Cwl~~~ ~hd~r loao o 2v pbk S A- 2 $y1C~ro ~l r ~ o i L~Yz.k Dr:ra y T / v C- OL 4), A w l' ~ Y N w O v Z 1 w LLt o 0 0 CL LL. CL Z O _t LL; 0 X ( OC.~,/ '}i Oj4. r O O ~ ~ r xQ' O X .`j 'r 1 t I b U ~ j r'J Z I I w ~I I ~ ( I 1 Qa,. If n ~ 1 1 I r`.p I it W ~ ! j I ~ II p U l~ j I ~ z r, I ~ II~ ~ 11 { I tl~~. CL 1 Il' I II a ~ L.Li I l I O I Q { ( I ~ I io ( l C9 I 'i I I M II CL 02 I j CL I I 4. I' ( A 1 I I 7 O I I O i .fl I O l ~I I( I U 0 I1 ~f 4 U , I. W ~ I z • ~~I ~j ij > II O ~ . t