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HomeMy WebLinkAbout026-1098-70-100 I o » rM Y o d ' o p E0 I N 0. 00 4i M I o O N I N ~ I C I ~ I C d I r C I I N N N C Z C LL E I LL 2 O v I I v z y I E co w O - o z € , z w a m o Cl) M F fn O I C C7 1° O z ~ c V O N O d z z m a~ E 9 I M rn 4 I a 4) y m o o . N oo`. ~ r I o a) Q N z m z z I Ni 1~~y (L a 2 C m v oo ! 3 G -V C n 0 bip Z~> 0 0 .N aaa N I IL I 3 a~ t'n-j jzrnrn o v z ° o ~1 o E o I 0 co N o I .D V QI ~ in m d R N w O y C O 'O C E N `n O O' -0 N C y V CL p 0 0 CL N E tC N 6 N r ~ i Q' E c a~ d C O N M N L d O I'- O C O E I> ao N H C N 0' " v N O N o E v I • o rvi cA o z z cn v ~t a ` a a m ' d `1~i +r E c c I ti.l -d FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION ;;?!Z T.3~ N-R,~?C W ADDRESS 44/0 /Q• ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ---LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Go 0-h INDICATE NORTH ARROW sejaf/c,~~ BENCHMARK:Elevation and description: on Alternate benchmark /1411 SEPTIC TANK: Manufacturer: Liquid Cap. Rings used -w*/ Manhole cover elev:,%/k- Final grade elev:_ Tank inlet elev.:Tank outlet elev.: 9 No. of feet from nearest road:Front__K, Side , Rear Ft.__ From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well -P-9 t , Building: 0?3 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE a. A 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:- X Trench: Seepage Pit: Width: l $ , Length Number of Lines;,3 Area Built_.~A Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: ~a No. feet from nearest prop. line:Front_~, Side , Rear Ft v&:E~J No. feet from well: /;/"4//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: PLUMBER ON JOB : k Xw ~'00~? LICENSE NUMBER: ~l 6/90:cj 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: Se 4f SEk , Sec . 34, T30-R18 CONVENTIONAL ❑ ALTERATIVE (It assigned) Town of Richmond Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT H LD ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Zt: 410 TJ JJU BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT 0 N: PER PT. ELE ~S REF. PT ELEV.: ~r /66 . & re. -,ol4vQ --l- s.-r z . q _ 92- Jo . Name of Plumber: MP/MPRSW No.: 7 County: Sanitary Permit Number: Byron Bird Jr. 3318 St. oix 128813 SEPTIC TANK/ r _ MANUFACTURER: LIQUID CAPACITY: TANK INLET TEV.: WARNING LABEL LOCKING COVE~1 PROVIDED: PROVIDED: 1,600 4 , YES ❑ NO ❑ YES NO ' ~)W.L BEDDING: d~IaT DIA.: VG'MI MATL.: HIGH WATER NUMBER OF LROAD PROPERTY L: BUILDING: VENT T RESH e . , C^ ALARM: FEET FROM LINE: AIR IN ET• 7 ' a3 ❑ YES NO tS 6 ❑ YES NO NEAREST -111" DOSING HAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PPUMP/SIPHON MANUFACTURER: PRWARNING OVIDED: ABEL PROVIDED:OVER ❑ YES ❑ NO [__1 YES E] NO ❑ YES El NO PUMP AND CONTROLS OPERATION . UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: LINE AIR INLET: (DIFFERENCE BETWEEN M PUMP ON AND OFF El YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue. CONVENTIONAL SYSTE ' - a, WIDTH: L NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / TRENCHES: , 6FilAL: PIT _ DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATE 'AL: NO DI TR. NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: E IV. END: v PIPES FEET FROM LINE: I AI LET: 11 f lT I NEAREST-411- o~S ~ 7TJ 30 9A I 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 ❑ 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: TRNO.OF ENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: 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 Retain in county file for audit. Sketch System on Reverse Side. SIGNATU E: TITLE: , SBD-6710 (R. 06/88) ` SANITARY PERMIT APPLICATION couN~f - D1LrHR In accord with ILHR 83.05, Wis. Adm. Code STATES NITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ e8% x 11 inches in size. Ch 2f fv1951o%'1us 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 e^ GoUI(~- F '/a ~~/4,S T70 ,N,R eE(oiil PR PER OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, S A E r ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER N10/td o / 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned VILLAGE X/ ❑Public 1 or 2 Fam. Dwelling-# of bedroom 'PCEL TAX AR NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) cy© 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 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 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 # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 KSeepage 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 ~J REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Y/ 1 41445-- , Feet S~Feet VII. TA K 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/Siphon 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 ature: (No Stamps) MP/MPRSW No.: Business Phone Number: Pltft s Addre (Street, City, State, Zip Cod IX. COON /DEPA TMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issue issuing ent Signature (No S m Approved ❑ Owner Given Initial Surcharge Pee) AdversaDetermin tin / 7cJ d f~ 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 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. I1. 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'h 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. i SBD-6398 (R.11/88) • APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be conplatod In full and signed by the owner(s) of the property being developed. Any inadequacies will only result In delays of the pzrmlt Issuance. -Should this development be Intended for tesale by owner/contractoc,(spec house), than a second form should be retained and completed when the property is sold and submitted to this office vlth the appropriate deed recording. Ovnet of property TlObe.T 1 F, dr a~~~e~ X51. Sco~1~1~~. Location of property _11- 1/4 S 1/4s 8ectlon -,y . T 3d 11-R V Township _ i c1~ mc~nc~ Nailing address nee. i1 ;C~ rnnilcA ~ \41"C_ 5yv0 Address of alto •ubdlvlslon name Lot nuaber Previous owner of property I~ec "-,on vti ~le.c- '2_W. Rt, rC\ m, K~ ~1rp Total rise of parcel Z A o_rP s Date parcel was created _ Vegb . (e) - 19 q n Are all cornets and lot lines ldentlfleblet yen _ 110 is this property being developed for resale (spec house)?- an No Volume ,Land Page Number as recorded with the Roglster of Deeds. - - - - r - - - r - - - - - - - - - - - r r - - - - - - - - - • r r r • - - - - - - - - INCLUDE WITH THIS APPLICATION TIIE FOLLOWINCt A VARRANTT DRI D which Includes a DOCUM2HT NUMBER# VOLUME AND PAOR NUMatR, and the Sit AI, OF Tilt REdISTER OF DREDS. In addition, a eettlfled survey, if available, would be helpful so as to avoid delays of the reviewing process. It the deed description taferences to a Ceitlflsd Survey Nap, the Cattlfled Survey Nap shall also be requited. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(Vs) certlfy that all statements on this form are true to the best of my (out) knowledge) that I (we) am (are) the owner(s) of the property described In this Intotmatlon form, by virtue of a warranty deed recorded In the Office of the County Register of Deeds as Document No. 1 5.56R3• j and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, lot the construction of sold nyetero, and the same has been duly recorded In the office o the oy t R later o Deadso as Document No. signature of Owner q aturn of Co-Owner (11 Applicable) ib -`.-~ifl 10-4-~0 Date of slgnature Data of Signature f I DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA I' STATE BAR OF WISCONSIN FORM 2-1982 Y. REGISTERr$ OFFICE ST. CROIX CO., WI I' Herman W. Keller, a/k/a Herman W. Keller, Sr., Recd for Record an B heIiEy eKe2'ler; FEB 0 f D00 . 11: 30 A. M - ct - conveys and warrants to _..Robp- >itF..-- SCOvi.1I.e..an~1-• ~7~a~1lie ..M..---Sco-v.iIle ,...husband-.and_.za_ife-,--.as.. marital. R~gid~rofDeeh ro ert --..wi.th..xi ht_s---of...suruiuozshi j RETURN TO j ~I the following described real estate in St,•... roix ................County, State of Wisconsin: ~I Tax Parcel No:..--•---------------------•-- i ii Lot l of Certified Survey Map, filed September 29, 1989 in Volume "8" of Certified Survey Maps, page 2157, as Document I" No. 451934, being a part of the Southeast Quarter of the Ij Southeast Quarter (SE4 of SE4) of Section Thirty-four (34), l Township Thirty (30) North, of Range Eighteen (18) West. ii i ►I ~I II This S...l1Qt........ homestead property. I'! (is) (is not) Exception to warranties: Dated this 31st day of January--•----------------•-----•------•-----., i` I -------------------•-----------•-----•-------------------------------(SEAL) (SEAL) „ Herman W. Keller (SEAL) C ✓•~~?!YS (SEAL) *.-Bonnie M•. Keller i' 1(1 • I ~ AUTHENTICATION ACKNOWLEDGMENT ii Signature (s) STATE OF WISCONSIN as. St. Croix County. authenticated this day of ..........................119 Personally came before me this ...31......... day of January 19-9-0.. the above named Herman W. Keller , j. TITLE: biE>`iBEP. STATE BAR OF WISCONSIN a1k/a Bonnie Kell er..•_-_ e...;.. , q. r W. r c ^(g,!rh, Wis. Stats.) ` to me own to be the person whp exfbuted the foreg instrume t acknowledge the,,i". r ,A UFO eo by (4cjC1 . ,any, S .C. _ : 2 7 Ruts- ' ~D . 1 Notary Public . St. Croix------------*...._.County, Wis. 1 ror.mission is permanent. (If not, state expiration Stock No. 13002 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ti- 0 ROUTE/BOX NUMBER Fire Number S. ZIP 5yO/7 P3 CITY/STATE Q,,~'hrncsc~ T1,~,1 PROPERTY LOCATION:' Section 3L T_,_N, R_J W, Town of St. Croix County, 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' *s'ept'ic tank pun Ter. What you put into the system can affect the function o. 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 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 o to maintain the private sewage disposal system in accordance with 9 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`. SIGNED DATE d Ci-'O St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. CERTIFIED SURVEY MAP Located in the SE1/4 of the SE1/4 of Section 34, T30N.R18W, Town of Richmond, St. Croix County, Wisconsin. Surveyed for: Robert Scoville EI/4 CORNER 410 West 4th Street SECTION 34 New Richmond, Wi. -T30N.RISW -54017 3 : o- ° APO!. IED LANDS N"' I w g---------- 100' T 65 I o n O In I fw ;I: N H I N 09° 59' 36 "E 435.60' F~ 335.60' 100.00' I- ~ 1 w r y' W x~ I •r z m 3 N Y. I m o -0 &L 0 ID w-• W 00 o"N 0 l0 I I. s ~-I = o: s O H+. r o O W ;=w 'l'1 N N. O N Z I 41 : O Oj O O W I ip O Z SI/4 CORNER g p I SECTION 34 - 335.60' L---- 2205.42' S 89° 59' 36"W 111~~ I _ S 990 59' 36" W 435.60' - SE CORNER t SECTION 34 N 09°59'36"E C LEGEND I SECTION CORNER MONUMENT SCALE IN FEET I"= 100' O 1"x 24" IRON PIPE WEIGHING 1.65LBS./ 0' 25' 50' 100' 200' LIN. FT. SET. j POWER LINES DESCRIPTION A parcel of land located in the SE1/4 of the SE1/4 of Section 34, T30N, R18W, Town Richmond, St. Croix County, Wisconsin, described as follows: Beginning at the SE Corner of Section 34; thence S89059'36"W 435.60' (bearings referenced to the South line of the SE1/4 of Section 34, assumed S89°59136"W) along the south line of theSE1A of said Section 34; thence NO°18'28"E 300.001; thence N89*59'36"E 435.60' to the East line of the SE1/4 of said Section 34; thence SO°18'28"W 300.00' along said East line to the Point of Beginning, containing 130,678 square feet (3.000 acres) more or less, and being subject to all easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of `gC0NS' the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County subdivision ordinance HARVEY ARVEY and the Town of Richmond subdivision ordinance to the best JOHNSON 8-1890 of my professional knowledge, understanding and belief. HUDSON wig Harvey G. Johnson S-1899 < Rusch Surveying, Inc. .D }t y1t ENO SURj 407 Second Street r~~/~ /c sslssMSM~ Hudson, Wi. 54016 366 - `I o$o Vol. g VOL DEPARTMENT RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION LABOR 04D P.O. BOX 7969 PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS L CA 1 SECTION: IILHR 83.091) & Chapter 1451 4 HIP/ t~,NICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: ((V'*-WWNS Cl 4~g 1/4,~ 1/4 ;alT. - T 7AIRA LA A*7 25 COUNTY- MAILING ADDRESS: .crt Grp il& USE DATES OBSERVATIONS MADE ? NO.BEDR : CO M AL DESCRIPTION: LE DESCRIPTIO COLATION TES Residence ;Kew ❑Replace ~ ~ ~ RATING: 9- Site suitable for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM- N-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) S❑U ®SDU ®S EA IM Nu ❑sEU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0915)(b), indicate: Floodplain, indicate Floodplain elevation: • PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) D wig -5 o '2 - 07 B- 47LJ. 8-1 2,2 f 6-5- W 13-3 B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP-IN WATER LEVEL-INCHES RAT ES TER INCH NUMBER 1%ftW$ . AFTERSWELLING INTERVAL-MIN. I P RI D D y P- .11 :3 '30 P- 0 P- P- 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. 0 SYSTEM ELEVATIONS S Go ~4~ s' Aly o 410 A 1 I + f L MI;_ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord G/ ,he 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: Z 7-- / CERTIFICA ION NUMBER. PHONE NUMBER (optional): ADDRESS: 7 i CST SI N UR LLIHR-SBD-6396 TR1BUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. (R. 10183) - OVER - PLOT PLAN . PROJECTS oU/~e ADDRESS '1/4S 1/4/SWIT~pN/RI~W TOWN COUNTY - vo 5 MPRS Byron Bird Jf. 3318 DATE - - a 110 BEDROOM,-]F CLASS PERC G CONVENTIONAI_,-~IWGROUND PfkESSURE CONVENTIONAL LIFT_ MOUND_ HOLDI G TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark /z/a ( / ,42~ * H. R. P. C] Borehole Q Well Scale = Feet 0 Perc Hole System Elevation S Uent 12" Grade TYPAR COVERING 2" 12" 3' 4 g' O 3' 3' O 3' 1 6 " Sewer Rock 12' 18' y~o I Imo' UQ fto #16, 10