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HomeMy WebLinkAbout020-1270-60-000 ry o a°i ° I m N a c i t c N O v II ~ A 0 ~ c 0 c 3 LL 3 0 I Q i I M 1 , Z yj z 0 Z .y y I am o I O z a c m m z ° 0 v v M I N C O N Lo d N N C d v 0 L O ~ I Q O N C O Z co D v ° N Z Cl) N rn y m c C E O N c ` ~ O I a y C H o CD N p t_~ rG tG a .0 m U) U) E to ° C C = a n ° o 000 a z a c I •N c y o o to J U ~ rn rn ~ I Q co rn N w ° E Cl 'a AD m > co ) 4) a H H ~ v O p = M C IV E 00 Fn (O C CO It N Cl) to d 0) c, M j t°A V 0_ O O_ O rV\ 0 ^ I- N E N O C (A ° O C = c- C~ CN O 0 O d N C y O C,4 a) L •O ~,i O N 2 O Z C rL N U a` Y E V~ y a € a • a m 2 `m a w E c ° era A 0 IL o m ci .f s FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER___ Soy r,, Syr; &p.,' TOWNSHIP u~3 0 SECTION 1- 1 T y`f N-R Jt W .1338 "9L4(, t+"dY i qkzt 9U-1- ADDRESS L~oX L ST. CROIX COUNTY, WISCONSIN Guy 61A- l`7 o- 4 o--aQ5, SUBDIVISION J~a604,s LOT YJ LOT SIZE PLAN VIEW 3~~ 13 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM of X10 T - - - - ppr C~ _ ~O` F w D~ Ate-- yu a hi 3/'V N INDICATE NORTH ARROW BENCHKARK:Elevation and description: So-7- Alternate benchmark SEPTIC TANK:Manufacturer:_Liquid Cap. 10b-0 Rings used:--Manhole cover elev: r7(- Final grade elev: Z Tank inlet elev.: $ Z~ Tank outlet elev.: g 3~ No. of feet from nearest road : Front , Side, Rear /-MFt . / ;2L 0 From nearest prop. line:Front Side , Rear Ft. 116 r No. of feet from: Well $yJ , Building: ~ 4 (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: <owVR.Trench: Seepage Pit: Width: I Length Number of Lines: Area BuiltwNggo3? Exist. Grade Elev.-&. Z Proposed Final Grade Elev. Zb Fill depth to top of pipe: i No. feet from nearest prop. line:Front , Side, Rear Ft. No. feet from well: /D No. feet from building 4 r HOLDING TANK Manufacturer: 4~2 14~ 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: all LICENSE NUMBER: 6/90:cj l r 7EPART-TENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION SOAI MV4~, WI e c 21, T29 -R19 State Plan I.D. Number: El CONVENTIONAL El ALTERATIVE (If assigned) Town of Hudson, Lot Prairie Lane Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Box g Hudson WI 54016 /0//g C BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM WAN: REF. PT. EL V.: CST REF. PT. ELEV i , 0 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. 'x 135464 EPTIC TANK/H a . ioz.34 V MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET , WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: /lU - - O YES ❑ NO ❑ YES NO BEDDING: Y&N DIA.: VENT MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T F ESH ~t ALARM: FEET FROM LINE: r AIR IN T ❑ YES NO ❑ YES NO NEAREST -1111- 3a MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS CYCLE: PUMP AND CONTROLS OPERATIO NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFER CE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO REST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENG DIAMETER: MATERIAL AND ARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 0, 210' S em (~.J. - ' WIDTH: LENGTH: N OF DISTR. PIPE SPACING: CER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: r MOVATE AL: DEPTH: DIMENSIONS le, 3 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET ELEV. END:1 "f(J{r Cce SG;t PIPES: FEET FROM LINE: AIR INLET: II 99 O. 'D tfir. 7.1NEAREST /O /G~ Cv > go MOUND SYSTEM: a,x ' ' Mound site plowed perpen Icular 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 DEP R TRENCH/BED DEPTHS OF IL: SODDED: SEEDED: MULCHED: CENTER: ES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YE` ❑ NO PRESSURI DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL TH BELOW PIPE: FILL DEPTH ABOVE COV BED/TR CH TRENCHES: DIMEN IONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. D -MV71BUTION 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 C Sketch System on Ret in county file for audit. Reverse Side. SIGN URE: TITLE: SBD-6710 (R. 06/88) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code ~.,...~....,...,~J_ Cou . STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 , 8% x 11 inches in size. chat i rewsiontopreviousapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OW,~{~~ER PROPERTY LOCATION .S~ / 1, '/4 IVU) S Z T 74 , N, R E (orfVV) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, S ATE ZIP CODE 1(306 )-2X01 PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER O S G b S L d-,, TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VIL WWW LAGE : cc~sc ITN2.,Lrlq~- Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(5) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo d 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) I~ A) 1. IL~I New 2.E] 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 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 RA4E 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION © 5 6 ` 0.7 Z L / CJ.00 Feet 0 - O0 Feet VII. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret structed glass App. Tanks Tanks Se tic Tank or Holdin Tank (~~0 ll~ i S G 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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Name (Print): [ I*jP_? Z4;7) Dac S her -s` Z 33 Plumber' Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing gent Signature (No S Approved El Owner Given Initial Surcharge Fee) Adverse t rmination ~z(5 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I I 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 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 (8.11/88) APPLICATION FOR SANITARY PERMIT 8TC•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 lot tesah by ovnet/contcectoc,(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 ,1///) /41, Sectlon _Z-T_71~y-Rd6/ Township A Mailing • dress Cd~•*Ti:0 - sor~ Address of site l iexj subdivision name ox c Lu-nc(i<d1 . Let number Previous owner of property Total size of parcel a487 4ec✓s . Date parcel was created Z / - e g Are all cornets and lot lines Identifiable? - =Yes Is this property being developed for tennis toper house)? as 0 Voles nd Page Number 24G Z as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TICS FOLLOWINCt A WARRANTY DittD which Includes a DOCUMtNT NUMBZR, VOLUMI AND PAC? NUMa[R, and the SEAL OF THE REOI8TER 00 DEEDS. In addition, a cettilled survey, If available, would be helpful so as to avoid delays of the reviewing process. the deed description tolerances to a Cestitled Survey Map, the Certified survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(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 ptopecty deseclbed In this lntotmatlon totm, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 4e3 SVI 7 • 1 and that I (we) Presently own the proposed site lot the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, tot the construction of said system, and the some has been duly recorded in the office e County Reg i s te`r Deeds, as Document No. SE3 f //7 . 6 signature of Owner Signature of Co-Owner (It Applicable) _I~_ 0 ate of signature Data of signature nocu6tt'►,i NO WARRANTY DEED 110111 SPA..c 11ES1.01vto 0001 01cr.r.01t„au uArA J STATE IS,11t (1F WI9I:(1NS1 V FOILM 'L - 11102 43541.7 ` r ~r~ REGISTER'S OFFICE `91~JrG ST. CROIX CO., W1 Reed for Record Virginia M. Hanson, a sinple woman « 8:00 ~ A ~M comr~s ;ulrl a..rr:IUl:s to Sam E. Miller, .1 Sillj;le matt In the foll01.vial des.•rihe•l rend estate in St. Croix t.,,tlr.(~• State of Wlaconrire: Tax Pnrcel No: West Half (WI;) of the Southwest Quarter (SW14) III Sectirm Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of tile i,ublic highway and except Lots S, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (W') of the Northwest Quarter (NW'L) of Section Twenty-one (21), 'township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin lying South of the right of way of the Chicago, St. Paul, Minneapolis and Omaha Railway Company. 8 'M S11h $ Y q 1,. ~ 0 EEF This is not hnnlretond pnyert.. totk l is nod ) Fetrel••.ion t•• warranties: easemr_nts of record and pro►ective covenants and restrictions of record, if any. oZ ~ T r 111111-11 this dad „f m 1+~1 ( 19 88 1 i F: a l.1 1 S F: A 1.1 Virginia M. Hanson (SEA1.1 ISF:ALI l 1 AUTHENTICATION ACKNOWLEDGMENT signature(a) STATE OF WISCONSIN s as, \ iv y( county. e ' authenticated this day of 19 forsilnally rnnte before m1- this day of 1^ / A ID 88 the above nariml Virginia M. Hanson r TITLE,: NIFNIBER STATE RAIL nF WISCONSIN r (1 f not. P nuthorited fi y 704.OG, Wis. Slab) In me Lemwn in hr the Heron will- rxoruled the foreeoin • I rumenl ant) : Kisowledpe the s11nlr•. T•r'S INSTRUMENT WAS DRAFTED nV t T Lois• A. Murray,, 11eyw~od, Carl & .Murray !',0.'llox 219, hudsfin. WI• jr . 54016 ~:01to uAl'P y f f (i. , r 1'0101011}•. tt'i~. (Si~nnturl•s nlny he authenticated or arknowledGm11. Both )1.• 1•...n•Ii-=tpnM to,%Aanrlll.I If lent, slate e*m r:lti01q ,i are not ntressary.) D- •Xarnm ne p•ra,m ,inniner lot any rel.srity •1....,'.1 1.. 1>, ..r , r•ro•.1 1. ,..w ,I.:1- WARRANTT DELI) STATE nAn Of %l%Cf1N7-#V p1-••.nnn I.*el 1!1:,• r vnrlM feet 2 - 1 • tI II STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT r St. Croix County w OWNER/ BUYER Q ROUTE/BOX NUMBER Fire Number 0 tv CITY STATE ZIP ry______~ / PROPERTY LOCATION:' l k,"34, Section Z/ .,.T- 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. Proper maintenance con- sists 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 t e .uncti.on 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, 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 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 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 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- went of Natural Resources, Certification form must be completed •a and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. -Y~ )L SIGNE~~ DATE - St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. w U ~1 sh O LJ 5 O w a = v w uj~ F a~ 4 J W cr- Z O > ~ C9 Y (n 0) 0 41 0 O ? ~ V- 0 n O d' X.8 R 77 z I a j I M z a ad i Z I I I I a I ~ I I I 4 nCL I I I O I 1 I wa i I ~ U I I I O ~`•r, I i I z I n. _0 I i I Q w I y. F-- I I I i a j U I I Lli 1 > I i I f is ~ I ~ I ca I ZD I 0 f i CL I a I j IL i L9 1 j 3 LLJ i o i I 0 w I m j I I O 1 I I I aU U I I I I ~ i ~ I I ~ I i I I I ~ ~ " 1 i i I > s I z0 I i 1 ~ LA z a ~ d kA 14 'A \A ~lk r DFPARTNIENT of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,, ' DIVISION LABOR BOX HU AN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53969 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWN'S HIP1M44 W_LRAtfTY: OT NO.: BLK. NO.: SUBDIVISION NAME: SV, Nw'/ Z 1 /T~ N/R 0 E (or W o~~;;t S O 8s LA Na,NG COUNTY: MAILIN ADD; S: 'Sr Ceo 1) SA K, M i LLIL t2. ►1e~ut ,~c~ Pored ASO USE DATES OBSERVATIONS MADE rrte~{{ NO. BEDR : COMMERCIAL DESCRIPTION : PRO IL FERUCI N ,IResidence UN'Neva ❑Replace I Ae►/ur 19gU. 7AT Z 97 0 RATING: S- Site suitable for system U- Site unsuitable for systm f~ /l ~ CONVENTI❑Nu. M2S 0U r-GROLIND-PRESSURE:RMS IEJULHaSGZU :RED-C1N1/I~NTI0Na1~(optional) If Percolation Tests are NOT required DESI RATE: A If any portion of the tested area is in the Al under s. ILHR 83.09(5)(b), indicate: LdsS Floodplain, indicate Floodplain elevation: 7JV1 PROFILE DESCRIPTIONS BORING TOTAL P H T R N WATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH. NUMBER DEPTH tK ELEVATION OBSERVED H T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ,.s% ~vz.~F > B.S$ c.s~ 7~"$Qti St o''$t,, M5~(4R Is'~BaNCS~Gb B- 2 ki, A -L foo.V, Nom a BAZ- !0 BCSCTS 6 ~ Sr 5t /9"$gtiCSi GIt S6~$eti11 9" &-os n "BleNst, 8° 3oN cs~ 4tic B-3 19-1-7 /00.10 > 91 z3"'BaN tul it"6aN CSyGe 40"6aN>ti1S _NogyE B-4 17.&7 9~.0'Z NdN ? 7. IZ'' CcTS f~ "I~a~ S,c. ° ~Fti CS~((,,,~ T 9C LTS ~a QN > ! r?N {~~~t B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERS ELLING INTERVAL-MIN. p 1 PERIOD PER INCH P. / 4,80 No 162.44 3 > > Z > ? P. 2 7.0 b Oq. I V 1? > > z > 2 < P- 3 z.av No r4 I- ►c~o.Fso 3 >2 > > 3 P- P' LiaAT Iq V - [Ac_ 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. Q 8. ~O C E Krr tL ? LI IlL I LA WZ 100 ! 1D0 ~ v P ► \ - TN ' v p 3 SC.a l e 4-71 ALT&R.N►~'T G. M_J QPIc SA KC. _rw _ _ gox L ce L~cva~ /o i 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. vAM (print) - TESTS WERE COMPLET DON: i ~P,fEY JONNSo JINN a ~;/+Q ylNC, /z 90 ADDRESS: CERTIFICATIO UM ER: P'O-NE N MBER(oolional): S C I J EC_o" ~ J-T ku tdJ(iN IN 6 ~ 0 1 k ~4~T >G(- 4QZ(S 7SI N TORE: DISTRIBUTION: Ong-nal and one copy to Local Authority, Property Owner and Soil Tester. )ll_HR.SRO?i?QS IR in/R]t - .+..cn - J 'Ile 23G. 3c 'lye S4/QJ IN (A kA OD vi p < P ~ ~ P a- +J J S --V Vo ~1 < f p O m m I^ a r ~ 40 1 m_ )f ~ v o l/ co, A, 0 ~ d a r77 x r` o A A P _ c A d I s U I p A ~ 1 D o , I u'/ a, s 3 Q ~~a/ M -