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HomeMy WebLinkAbout161-1095-30-000 -0 0 Q h ~ O 1 0. o I a > N y L a) U O Y N > Q U ~ U O a) (d U ~ C C = Z C M N O E S 'O lj oa N (S E m 0 w O - E --O LL O O w O w N C E a c is m o a`) Q o w LL a 3 Cl) 3 Z iii O U) = 00 V E s. Z d d ~2 04 1 CL I O N O Z dt I' c w U Z p C p N z c E 'o O U Z co z p O O O a N Z d it , R E N N (mil (n N L! f0 Mir X d J C O O •O CO d O W 0 0 V a Q E N N N N U) U) U) (n M LO H F H O CO = N N O O O FE 0 Z O O CL CL CL C a c o , o o fA J U = rn rn O Z N LO w o ro May ° o 0 r• N N C O O E N i' O m CO CU 'p N N [n O Q Q Cl) M 7 y O O N H C 00 L a C E N LO 00 O ~i-+ O O E C N 0- O O O N N it °m r z E CL a L O O C N E V N w O N 4) Q h - N~ A r- V' co n a> -a f- a) nr N c6 U') Oi O E U • Mrj L. c° ~2> a o N Z=3 U) r"t a a 3 IL CL z .2 ca "1 E ` S= c 3 .0 3 y ' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING DIVISION ig~BOR & F{UVAN RELATIONS P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION SW/ Mf~~4 ON$WI 537Q7 State Plan I.D. Number (UUl 1 © CONVENTIONAL El ALTERATIVE If assigned) YT29N-R20W T. aj N.Hudsan ha~,x Station ❑ Holding Tank El In-Ground Pressure El Mound St. C NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: James Pid can 11072 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EV.: T REF. PT. Name of Plumber: /MPRS No.: County: Sanitary Permit Number: Lawnence DahmA 5 135457 SEPTIC TANK/ ~'~~,l G' rYt. „4ta LuJC r = ^ , 3 „ MANUFACTURER: LIQUID CAPACITY: TANK I7LET~EOAD: TANK OUTLET ELEV.: WARNING LABEL LOVER P OVIDED: ROVIDED::,,/n ~ kre C& ca /a &D , YES ❑ NO ❑ YES NO BEDDING: htTDIA.: MATL.: HIGH WATE NUMBER OF PROPERTY WELL: / BUIL VENT T FRESH C.O, ALARM: FEET FROM LIN / r AIR INLET: ❑ YES NO ❑ YES NO NEAREST __10. DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKNG COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO PUMP AND CONTROLS OPERATIONAL: NU ROPERTY WBUILDING: VENT TO FRESH GALLONS PER CYCLE: AIR INLET: (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF ❑ YES ❑ NO NEAREST ~ SOIL ABSORPTION SYSTEM. Chec the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND or excavation. (If soil can be rolled _to wire, construction shall cease until MAIN the soil is dry enough to continue. CONVENTIONAL SYSTE S'" Q E 6o at^bed• ~ . WIDTH: /LEIqGTR: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: JLIQUID BED/TRENCH / TRENCHES: , MATERIAL: DEPTH: DIMENSIONS PIT GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVE ELEV. INLETS ELEV. END/ j PIPES: LINE: / / AIR INLET: /err S Q.~~d✓a= ~ ~ / g: FEET FROM '>so x~~ ~j 1101,93 / 9 "0"'1-6 NEAREST _ MOUND SYSTE . yL" 6'~'. Mound site owed perp ndicular heck the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unstop mound systems to make certain that it ON REVERSE SIDE. SHOW EYES ❑ 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 8 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 4 6) 6, 1, W1 v Re ain in county file for audit. Sketch System on Reverse Side. SIGNA RE: TITLE: P L Za SBD-6710 (R. 06/88) n ing Admivi iZraatc SANITARY PERMIT APPLICATION ouN LHR In accord with ILHR 83.05, Wis. Adm. Code . 6~~ EC: STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ZUZ - 8% x 11 inches in size. vision toprevious/ application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE TY OWNER PROPERTY LOCATION _P a Al -194J % 7&j %4, S /3 T.9 , N, R ~ O E (or)o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 107A &C-C5 e, 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER i~So~iJ©/ 3 Si ~i22/ 1641 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State owned VILLAGE ❑ Public 541 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUM R( ) III. BUILDING USE: (If building type is public, check all that apply) 9~ 3d 4-75 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPPEII OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. L?5L New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit # -13,545 Date Issued 9a 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 42Q 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) Lj ELEVATION U® / Ztflp l Z icy O / 8i r Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App INFORMATION Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber El I LJ I RTH n Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P PRSW No.: Business Phone Number: Plumber's Name (Print): Plumbs signature: (No Stamps) 7 1 (74r) Z-S-06-Sl Plumber's Address (Street, City, State, Zip C 0 ?Z IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued ssuing gent Signature (No Stamp Approved El owner Given Initial Surcharge Fee) (o/d~s~gd Adverse Determination V X. CONDITIONS OF APPROVALIREASONS 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 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. 11. 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 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 (R.11/88) A • APPLICATIONFOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the ownezls) 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/contractot,(spee 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 7SA%6s ~iD&Aa-&`1 - Location of property -i x..1/4 /4, Section Township - "ailing address •~'-4T~~~ Address of alto - z -TV Subdivision name 6'12 6 i~_ Let number ;z2- Previous . Previous owner of property Total miss of parcel I•o g A Date parcel was created Ate all cornets and lot lines Identifiable? _Yso o Is this property being developed for resale ('spec house)? Yes No Volume and Page Number _ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION T11R FOLLOWING: A WARRANTY DRSD which Includes a DOCUMSHT NUMBER, VOLUME AND PAOR NUMaslt, and the ORAL OF THS REGISTER OF DSSDS. 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 Map, the Cattifled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(Ye) 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 Information form, by virtue of a warranty dead recorded in the Office of the County Register of Deeds as Document No. ; 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, got the construction of sold system, and the same has been duly recorded in the Office of the unty Re Isto*- Deeds, as Document No. 1. gnat to of Owner Signature of Co-Omer III Applicable) 4-41`.90 Date of Signature Date of Signature - DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA • WARRANTY DEED 4571-83 867PA'v r- 9 - REGISTER'S OFFICE This Deed, made between ST CROIX C©, Nor_ber_t---T.._R0ch,--.Jr........ Recd for Record ~ Grantor, (it ~ if ~J~~ and- _James--$.__Pidgeon.-and-Nave-y_.J.__P.idgeon,--husband..and---- y ------wife-as.marita.l__survivor-ship.-property----------------------------- a Grantee Re913terofDea Witnesseth, That the said Grantor, for a valuable consideration Norbert--T•--•Kochr--Jr------------------------------------------------------- conveys to Grantee the following described real estate in St.,..roix......... RETURN TO County, State of Wisconsin: Lot 32, St. Croix Station in the Village of North Tax Parcel No: I Hudson, St. Croix County, Wisconsin. i I~ l TRANSFER i I ; This ----15 not homestead property. (is) (is not) Togethe wi h al d g lar a hereditaments and appurtenances thereunto belonging; And ~or..e-- . T`oc°h, J'r. . warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this 4th April 90 day of ~ (SEAL) (SEAL) * * orbert T. Koch, Jr. ----------------------------------•-------------------•--•-------.__.(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF WISCONSIN ss: St. Croix County. authenticated this day of___________________________ 19 Personally came before me this 4th---- day of ___________________April 19.90_. the above named Norbert T. Koch Jr ------------------------------------I----- A---•-------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person Who executed the foregoing instrument and ack edge the same. THIS INSTRUMENT WAS DRAFTED BY Krist_ina Ogland Lundeen - - Attorney at Law Terry r us----------- Notary Public -----------St.__.CY'O].X......---County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 1!Ilay_•30....... 19___93,) -Names of persons signing in any capacity should be typed or Printed below their signatures. I; WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1- 1982 Milwaukee, Wis. STC - 105 w _ SEPTIC TANK MAINTENANCE AGREEMENT w St. Croix County w OWNER/ BUYER g/I~I~S „2i~G o ROUTE/BOX NUMBERo735~- ~'7r riQ L Fire Number, :J 1b CITY/ STATE ZIP rt m , PROPERTY LOCATION : 11;J* k,,_k, Section I T, N R W, Town of St. Croix County, I Subdivision'f, Lot number Improper use and maintenance of your septic system could result in con- its premature failure to handle wastes. Proper maintenance sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 'septic tank um er. What you put into the system can aTfect the .unction o t e 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, 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 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 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources, Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIG F D T ~-~~U St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON- SOIL BORINGS AND SAFETY & BUILDINGS IND'USTRY,', DIVISION HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCAL IO CT ON: T49W!1SriIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME, _---*-J/ /T NI R or W W U-6 Z - ,l . COUN BUYER'S NAME: A D Fi SS: r USE z ~Z DATES OBSERVATIONS MADE NO BEDRMS.: COMM R ESCR PTION: ST QResidence _ ~'ll~ew ❑Replace ,s l i RATING: S- Site suitable for system U= Site unsuitable for system CONVE~+NTI N MOUND: IN-GROUND-PR UR : S TE -IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optio al) CAS ❑U CAS ❑U PS DU CDS ❑U QJS ❑U .ly'rs~' -,~u.' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the • under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ~0 PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 2 - 71 /-'a:,a > . 3 ' B- 3 f > , B- [r 7 / 02 ? Z S . ' B- 5- S"Y e } 3'Y 8K t r Ih B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL•MIN. p Qp p R PER INCH P- r- d y /6 / %P P. 2 g > > z P - P- 3 i 3 /d' 3 1'/iC Pa l ' _ ''r 4 " y . s / Pf/ /may t+ s,./:~t T ' --,e erc!4 a+ e/ . 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 l i l l l► i I ~ i i( i i ~ l; l l l!~ i ~ ~ I ( ! I ; ; ; ~ I I i j ( ~ I 1 ~ I ~ I I I I i ~ i ; I i I ! I ' ~ i i ! I ~ ~ ' t I I i ~ i ; I ~ I I ! i ' i ~ I I I I ~ 1 r I I I I j ' I ~ ' ' i I I I ~ I ~ ~ ~ ~ d~ l~cLcsc2 , ~f` Sf+2~t / /lsts4f ~ ~ I L/G f i I ~ Lt Itn %h /-/t.~•G~^ G r ~f'! R i I. 7rif N i /rf /N/II'r s.~'n.' ~ 17<<!rL ~ ~ I i i ~ r I~ I i ~ ~ ~ i I I I ! 1 I I ~ I i I ' 6f J> l: !.'/'Gr+'t/a E y!6/rtdi) e /fit ~fsr L7' I ~~t l . ~0 Jn t! ~ I ~ pCa-t/st I ~T~R'Y~f ^ 1vvf' o' f~ i I I ~ i ! ; I I I 1, the undersigned, hereby certify that the soil tests reported on this form were macde 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 (printl: TESTS WERE COMPLETED ON: PAVE pOGERTY PLUMBING ~~~r~_ ADDRESS: ir{Cef1SQd#3233 a 032 9 PIW17ta9t' CEI1Tl C/1T1(3N NUMHFI27 PIIONE NUMBEIiloplirnr;dl: N3233 X3289 Fo,~~yye,rty Hei hts Road R ISERS, WIS~SIN 5402 CST SI 'NATURE: Phone 749.3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester• DII_.HR•SBC 6395 IR. 02/82) -OVER - _ P. B-L.'67 PLOTA N 1) R1 0 SS 5 E C T I 1\1 i N A M E Ern ~z ► h ._,..._.~j A M E T ►y) 6 re ~Y-e L - 0CAT I 0 N S ~ z~x st t . L IC E NS Er// YU I)ATE PLO Not ' A P,e,it I ~t(/ U e 11s Arzk © D f3.lh, A rs G r' e 100.0' loo ~x~►, lI Tdp o-~ NS P PAD Se~~ S S M T 6eDRnn r-~ S T~omQ Cl (3ox) N N6tt ; We 1 l. s P d= P~rz k s Se~i ~ a S4S~~e1~ J r b DYx53 6oc ' F,~,A 2 Q 34, o f . a 00 AQ)~Af' i-- - - - - - . ~P • Q (jeN Man K 14 3 KRe►~icy AN FRESH A! 1, INLETS -AND OBSERVATION PIVE CnOSS SECTION - Approved Vent Cap Minimum 12" Above /Oj.UU Final Gr h1hX 4" Cast Iron Above Pipe Vent Pipe To Final Grade! Marsh Hay Or Synthetic Covering Min. 2" Aggre~~',.~ _ Over Pipe Distributio_L~~ Tee Pipe Aggregate (D Perforated ed Pipe Below 98 8 Beneath Pipe Coupling Terminating T Bottom of System • w i c L « C d w c c Wur n of o Q ; c CL ° 10 mnE « °m to E' Q ° c g E E F.~. u m 51 LLJ c a c cE o °~_10c m 0° r ° Q E u N o m d 2 oa ?tc c Q ~ _ N m m c Q a l ~ m~ d N N m ~ ~ N r z ° ° Q w N : ip CL - m ai r U ym a °E 2, 'a E « m« a`~L O N a Y E L E c o lz .0 LL Ln W~ c ~w0 c `N =c «c I- r-~ a) -,g ' d E ° a, ou ■ . M t m~ 1 w N m and O r mu «ai 'cmt o= EM cc «v OR a` E« m2 is aE 0 W dd = aa~ 5c «m >o Nc J m w '00 E d m~p~ m u Q nN Gip 'cELm -8° ip cc my co 0 CL Co 0 c V 0 ~3 tE C„ .cc wa f- w F umi c d C° U M N F N - Q m o m m w V u c rn m , ,'G Do„od v, _,ad =N a z z z v c / U o o L 0 ~ O (1) (D oc :D D D U) a U) O O D ° Z CMOs U) N a: 4t: ui O z o w v b ~ ~ = z Q Y Q ~ J U U 2 D O O C) m LL w J U C/) VJ w'^ c > VJ w ■ w O ~ LL J ~ C=) w O w r co W N%.. U) c L cU z D co O z = y s CL O d- Q IL coe3 A t > OC z w zv, O w w > m z , o z a Q o # ° b co w a Q Z - > o cc e. w ' m d w wa w N > w O U ~ z m C7 2 - ca 0CL Y W ~ a ~ U D. 0 0 Z t w ODUU Z g 4' - w D) T 0 a Z U O Q O oC Z y °S (n H y cc OC co LU cc to Q Z W ow0 co ow0 H I_ O a 2 2 ti J Cc U Q y °C y J z ° CL CL a cn (n W 1 }w U- (n > O Ora aZ z~5azcc w T N a w w a~ ^ ~0 w z Q~ a a rr`` ~y \ O >F Z o O V LLJ w S QW J co E LL. a a c a ZQ ° z Q z ~ a a °T o t%1 = ° 0 4 ° LL a Y w T 2 w w z I- oC cnn a j 0 1 z 2 z > x a ` :c cc co Z a) a . w N E O E p CL oC cnn H ~ w d ° w > > cD \ ~ Q _I d N f/1 Z H lSi! w V o\ w ~ Y z T ti O m Q Z" (n F- w .w N cd 0 -1 O O y a CC Q m Q U V) - cu w m c ( `0 DD x o co Jai w O Li > N cn Z ~ ~W~ z J vw w co €a w } co om to w w [C H N Off" OC I- cn 0, a~ py co N a a oC w30 \ o z m: a z p O a. C7 in o T OJ a I II cc O ~ a O a Z a .y HALVERSON BROS., Inc. Plumbing and Heating JIM DG11~00 36 P/ IL -f' L')-T- 4~L 4-AJ \ MASTER PLUMBER NUMBER 5666 2J ii I 3z' \ I I ~rvF ~ x i i PHONE 235-0651 1020 NORTH BROADWAY MENOMONIE, WISCONSIN 54751 III DATE:PRIOL. F HALVERSON BROS., INC. Z ~v El URGENT! R Plumbing, Heating & Air Conditioning C~~G FILE NO. 04 ` 1020 North Broadway 'I . ❑ SOON AS POW E M ' ` - MENOMONIE, WISCONSIN 54751 kepV ❑ NO REPLY NEEDEV, III ATTENTION: (715) 235-0651 ...~/V.I /V. _ SUBJECT: i-') . . 46-S q~'77 x45 M S S G E 12.1 S ✓~c ~~d .CJ - '7; SIGNE DATE OF REPLY: REPLY TO: E P L SIGNED: I?!ENT WHITE AND PINK SHEETS. DEPAR°I-MEIJT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION LABO.^ ArNPI" PERCOLATION TESTS ( 15) P.O. BOX 7969 HUMAN RELATIO~f , MADISO 53707 (H63.09(1) & Chapter 145.045) LOCATION: 'SECTION: TeWIVS"P/MUNICIPALITY: LOT NO LK O.: SUBDIVISION NAM COUNT BUYER'S NAME: MAILING ADDRESS: ` 7 / .!~k Ix &221 USE V Y2 DATES OBSERVATIONS MADE We_ rr~yy NO. BEDRMS.: COMMERC AL DESCRIPTION: PROFI DESCRIPTIONS: PERCOLATION TESTS: lJHesidence [Kew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYS~TEM-IN-FIILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) Ps ou 2S DU DS DU U V E1V FDA U V EIIJ .7 $ c If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ` under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: f~/rL J PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _ r B- Z 7Z /'a, y > ,.3 / c 775, B- 3 1 13k 7-, _s . e .7 ' B- 7 / 02 7i 5.7 ' 13 j, _f B s' S}' a }sY 3 8k yS' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAI Eli LEVEL-INCHES RATE MINU1 ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI D t PERIOD - PE 11M PER INCH P- I - 6Y P- 15r- P- 2 6 > > 3 P- P- 3 Z -Y 'Ile P~~^! - / n -'d lea / y I S / ~ S/ ~,r.7.oc cv/sit 3 ' k-ut tScECw i 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 .'77/4{ hl~p s T i BT Are- ba'-C.~'vt ~T~C-F /.'.2c-!f t' L! _/Eet✓ C!G r / i f '/7 ~Ls ' l ~~G7 ee ~/Glrtdt e ~ /t«,rrS~ 1.~ ~ 1' ~c i 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 hest of my knowledge and belief, NAME (print): DAVE pt3GERTY PLUMBING TESTS WERE COMPLETED ON: 3 ~ j he.- ADDRESS: LiCenW {p,80,, Stef-Be ~~UGI~ie1=- CERTI CATI N NUMBER: 14 PHONE NUMBER(oplional) #3233 #3289 Hei hts Road : ROOM. WISENSTN-5402 CST SINATURE Phone 749.3666 l~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Testes. DILHR-SBO-6395 (R. 02/82) - OVER ~I o y ~ =1 o \ 1-4 o A