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HomeMy WebLinkAbout030-2019-60-000 i 'D OO ~Y O I I N p 6a a C0 O N a I O a N li o Ij ~ I I I O i N O I I O 9 Z i LL c I 3 ~ ¢ I Cl) z 1 E rn Z o CC €M z a m o I c z v o z v c v ! o ) a~ Z c c fA F- m v ! N M N 7 y I N ~ N C C CL L O O O C w IC O Z F Z o Z C C l0 '(O d N y N d N cf- O O 0 o d .a 'm Z co > I o d. F- Z 0. CL M a Pita a Ii l o 0) 0 N N v1 J U Iv; rn rn 4) I ~ m (n CD CO Q CA N Q Co N to .2 CD r- w O U H E N O r O N N E N C O O :3 co 'c 0 O N N O M N V C 'D (p t=xi 00 d N N M p N m R U O G U 1 EE `L E " a d ld I ~k Q I L: M • Q m .2 m y c rra~t E v c c nc ~1 A vat; Oi i dw • Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 11,10 4si" w TOWNSHIP S Le SEC. T EL_N-R,,)C W ADDRESS 3l~c/P~ Cdea~ Or ST. CROIX COUNTY, WISCONSIN SUBDIVISION L ~~rl 1,16 /04 / LOT 3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V• ~cc~e ~ Q ~6oa yr.~ S.e~, f.~ ~ f k~s Sr 3 7q F • ~ r J I r C.~ r c O i 32 INDICAT NORTH ARROW ~ BENCHMARK: Describe the vertical reference p%~..nt used Elevation of vertical reference point: 40 Proposed slope at site: YCo SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: g~ Tank Inlet Elevation: 67 Tank Outlet Elevation: f J~. y2 Number of feet from nearest Road: Front, Side0 Rear, O l" feet -From nearest property line Front 10 Side 10 Rear,0 feet ~ Number of feet from: well ' building: .27 (Include this information of the above plot p1.10( 2 reference dimensions to septic tank) SEE REVERSE SIDE s . PUMP CHAMBER Manufacturer: y Liquid Capacity: ' Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len$th: 456 Number of Lines: Area Built: Fill depth to top of pipe: fD Number of feet from nearest property line: Front, O Side, O Rear,0 It .1'?o Number of feet from well: r Number of feet from building: ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Had either a drop bo)Z or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: a Inspector • l C=~~ Dated: Plumber on job: P✓~S 32 License Number: 3/84:mj A q6 00 a [)EPARTMENT 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: L NW 4 N[J 4 Sec . 1 T29-R20 El CONVENTIONAL El ALTERATIVE (If assigned) Town of St. Joseph Holding Tank ❑ In-Ground Pressure ❑ Mound R i INSPECTION DATE O I L ADDRESS OF PERMIT HOLDER: 7U _V1 Dick Hasselman 231 River Crest Dr. Hudson WI 54016,,9- cg> BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: T REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number. 135373 Roger Timm 3224 St. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER Q PROVIDED: PROVIDED: e S P r 1(J~-'v ~p 9 • / YES ❑ NO ❑ YES 2TNO BEDDING: VENT DI A.: VENT (~MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH I ( ALARM: FEET FROM AIR INLET: ❑YES NO CJ~ ❑YES ~O NEAREST-~ ~ d U >N~ UO ~°Z/ ~ fi DOSING CHAMBER: MANUFACTURER: BEDDING777P PUMP MODEL: PU P/SIPHON MANUFACTURER: PROVIDEDLLOCK:NED:OVER WARNING ❑ YES YES [:3 N❑ YES ❑ NO AND CON ROLS ERAT (DIFFERENCE BETWEEN NAL' MBER OF PROPERTY WELL: BUILDING: VENT FRESH GALLONS PER CYCLE: LINE: AIR INLET: FEET FROM PUMP ON AND OFF ES N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the ept O IOWI RCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction hall c ease un I AIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / TRENCHES: tNO.ISTR. PIT DEPTH: DIMENSIONS 5 U CD / PROPERTY WELL: BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: EEE BELOW PIPES: ABO E COVER: ET: ELEV. END: T FROM LINE: AIR INLET9 REST-~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: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. 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---- 111110~ ~ sf 3 , Retain in county file for audit. Sketch System on Reverse Side. i SIGNATURE, TITLE: SBD-6710 (R. 06/88) C-" _ Y SANITARY PERMIT APPLICATION 1 HO s I 1 _ In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ! 7 8% X 11 inches in size. Check if revis ono wous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPF~ITY LOC TION 04--,_4 h- Lo-.t~, Z,'`, N, R Z ~ (or) PROPERTY OWNER'S, MAILING ADDRESS LOT # BLOCK # of 3( k. t J ~e 2,!i f 0 CITY, STATE ZIP CODE PHONE NUMBEP SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State owned 0 VILLAGE : 17-auiad 40-F.1 _I/tj ~r TAX NUMBER(S) ❑ Public P 1 or 2 Fam. Dwelling-# of bedrooms ~ -PARCEL QRF: ill. BUILDING USE: (If building type is public, check all that apply) ✓ ~/y G 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. 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 ❑ 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 RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) C~~ ELEVATION / 6 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 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 Name (Print): - Plumber's Signature: (No S ps) MP/-MSSW-No.: Business Phone Number: ~ ~ ~ L 7/~j 77Z Plum is Addres (Street, City, State, Zip Code): 7 Gc~/1 ~/©~7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial / q~ Q0 Surcharge Fee) f ! d Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS .Y } 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 onsi`te 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. 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 (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, spec Ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - C~ X'/ er of Pro ZIP ty Location of_ /J Section T H-R ,?ka W Township 71Z- 7 Z;; Mailing Address Address of Site Subdivision Naga Lot Number Previous Owner of Property &gag Total Size of Parcel, Date Parcel was Created Are all corners and lot lines identifiable? Yes No to this property being developed for resale (spec house) ? Yes No Volume J- and Page Number _~Zas recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Nap, the Certified Survey Hap shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION T I(k) cpA,L<6y that aCt' statementA on .thus ohm aAe tAue to .the best o6 my (ouA) hncwtedge; .that 1 (we) am (oAe) the owneh(s~ o6 the phopeh.ty descAi.bed in thib .i"AonmalAon 6o&m, by viAtue o6 a waAAanty deed neconded to the 066ice 06 the County RegiAteA o6 Deeda'_ Document No. ; and that i (We) pheaentty c.vn the proposed site bon .the sewage duspos aye em (on I (we) have obtained an CaAcment, to nun with .the above deg cki,bed phopenty, bon the eonAtAuction o6 said a ya.temp and the name h" been duty neconded .tn the 066tee o6 the County Regi4teA o6 Veeda, ae Docment No. 1. A/~ SIGNATURE Of OWNER SIGNATU OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I ~ ' DOCUMENT NO. n l ry A ~ ' WARRANTY DEED ;THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 --1982 j 447,2 K ~7 CZPA _ 6 REGISTER'S OFFICE C,---R._ _HA~KWORTHY__and__CYNTHIA__S.-_H~ICKWORTHY, ST. CROIXCO., WI !I husband.. anc _-wife. as__marital___survivorship Reed for Record >?ro_pext APR 2 519 89 cantor-.----- 10:45 Aa is conveys and warrants to ...RICHARD..R,~ RA,SSELIMN...arid.. µ t i! CAROL-YN.-.A....-HASS-ELMAN,-..husband..abd.-wife... as V .marital--- su.xv!soxshira..proper-tu.,---•-•-------------------•-•----•-----__ Reghterofpe~ Grant-ees-T--------------------------•--------------------------- ____RETU RN TO - -li - II i - - 1 . the following described real estate in .........St. Croix County, - - - - State of Wisconsin: Part of Government Lot "1" of Section 1-29-20 Tax Parcel No described as follows: Lot 3 of Certified Survey Map filed October 12, 1983 in Vol. "5", page 1356. TOGETHER WITH 66 foot private road easement as shown on said Certified Survey Plan. subject to a 5 foot easement along the Easterly boundary of said Lot 3, to be used for ingress and egress from said 66 foot private road easement as shown on said Certified Survey Map, for the exclusive use of the adjoining property owners to said roadway and their guests, to the 21-acre common area adjoining the St. Croix River. ik>~` ii E I This .------15 riot homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations, restrictions and rights-o.f-wav of record, if anv. I Dated this day of ....------......April 89 I (SEAL) = EAL) II C. R. Hackworth y..-----•-----------•-- SEAL ' ---.(SEAL). w . ( ) I~ * is S HackWQrthl' C AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNE A WASHINGTON ss. S i County. I authenticated this ........day of_.-__... 19...__. Personally came before me this ..2Qth._....day of i; _____....April-_-__•_--•_-_---_--.., 19.9_.. the above named C_•___R:___Hackworthy- and Cynthia S Haelcworthy1 husband. and wife - - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, S authorized by § ?06.06, Wis. Stats.) " . to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ' Robert W. Mud e Attorney n ' . - - . . GILBERT, MUDGE PORTER & LUPdDEEN *.._Karen__D.__Miller______ Washin on Notary Public •••-••-••County, (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ~c4:kat~i~".,°+:a'~@1~cti* ld?dp~Q--•) ~i. x. .Names of persons signing in any capacity should be typed or printed below their signatures. d l _ ~tnltt' PUk?~L^IC - kliit'4N!EXTA 4 r J. r l i~.r'ic, litl •~Ln i C.~.II,~ Cool y WARRANTY DEED STATE HAR OF WISCONSIN i'r} p'y u , roRM No. 2 - 1982 ~e kr~:•., t b~:C~'. ~ a ni9A0r, inc. .Ig 4. • - H G N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d H OWNER/BUYER /ax/ ROUTE/BOX NUMBER ail iy~/J 2Z/1° Fire Number CITY/STATE &15017 Z I P PROPERTY LOCATION: Section T J ~N, R W, Town of ig:~;d St.. Croix County, Subdivision - , Lot number .3 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, I if needed, by a licensed septic tank pumper. What you put into ` the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive 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 systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. y 0 I/WE, the undersigned, have read the above requirements and agree t4 to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. P SICNE1) DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. INQUS T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN6~USTF~*'1t, DIVISION 'LABOitAND PERPOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS `T 1 / MADISON, WI 53707 3707 (ILHR 83.09(1) & Chapter 145) LOCATION SECTION: OTOWNSH IP/MeNtetPALLT-`4: OT NO.:BLK. NO.: SUBDIVISION NAME: IN lb, w'/ /Tz4 NI" (or )T Jp>s4Pq 3 Cs~~ y COUNTY: 7NG ADDRESS: Sr ~ bIOL 144A&S&Ln,AN USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DES RIPTION: S: Residence ZNew ❑Replace utiK Lz 8Z ro i4 -x 9 UC 41 Sobs _ LMLr -Lt,- rkY RATING: S= Site suitable for system U= Site unsuitable f r system n/h 10, ONA M 1A ~ST❑IONAL A • M _jV~. Q~ IN-GROUND ~ESSU E: S STEM-INQFILL O~LDING TA K: R~oOMMENDED~S AS~EM PlE ti onal) 11 IPercolation Tests are NOT required DESIGN RATE: If an any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: CL14- S Floodplain, indicate Floodplain elevation: ,y PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO R UNDW TER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH'% ELEVATION OBSERVED HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 4- 1-7 0 d tag ~g o >F7.ov C'BLLTs iz "BaN L 66 C-<51L 2 B- .11 9S.A r~ oKiI_ 7! 7./7 B- ~•SO iz"BeN L 73` &aCS(4,, B- B- B- PERCOLATION TESTS TEST PTH , WATER IN HOLE TEST TIME DROP 1 WATER LEVEL-INCHES RATE MINUTES NUMBER S AFTERSWELLING INTERVAL-MIN. PERIOD t P RI D PER INCH P- i -L .6a KnN L, .io 3 y >-Z > ~3 P- z 3.60 rJNA 10o,/0 3 > >2 > P- 2,70 99.zb >Z > 2 <3 P- P L14 Al 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 then location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. R( .Svl O 4T .iS WA N M -T I I 78 4~ . , i i D ' , J-""' E 4 s A h ,DL- AT ~Lrq _ 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 locati~n of the tests are correct to the best of my knowledge and belief. NAME (print)' TESTS WERE COMPLETED ON: pp I f'f 4t2Viry JC~NNS~R, TiUSCU u~V~ / /MCP c)"-CIE B P, 4 e9 ADDRESS s ---Ti - - CERTIFICATION NUMBER: PHON/E NU BER(optional): 34p~O4- 4O~;O CST SIGN TORE: DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. L DILHR.SBD•6395 (R. 10/83) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SArti f3 J N DllST'R Y, - DIVISION LABOR HLINIA AND - PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 3707 )V'T LOT 1 (1-163.090) & Chapter 145.045) LOCATION: E~T6A- TO SHIP/MUNICIPALITY: OT NO.: BLK'. NO. SUBDI VISION NAME: my '/mV 1 /T29 N/R20 YmW St. Joseph 3 - COUNTY: OWN ZJYF_R'S NAME: MAILING ADDRESS: St. Croix John $ Carol Landry 1595 Mallalieu Rd., Hudson, Wisconsin 54016 USE DATES OBSERVATIONS MADE NO.B MS.: ICOMMERCIAL S RIPT'ON: U PROFILE New OLATION TEST S: Residence 3 N/A UNew OReplace I 11/2/82 N/A RATING: S- Site suitable for system U- Site unsuitable fors stem ONVEN I NAL: MOUND: 16•G7ROIJN-D-:P'R-F.ffU S N.FILL OLOING TANK: RECOMMENDED SYSTEM:(optioo . 12'x801 S []U ®S []U []x S [:]U lg ❑ S ®U ❑ S ®U Conventional Bed Alt. 181X551 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: N/A Class II Floodplain, indicate Floodplain elevation: N/A PROFILE DESCRIPTIONS BORING TOTAL _aEPTH T R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION QBSERV O EST. H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 84 105.0 None > 84 12, Bn Is; 12, Br sil; 60, Bn s &1 gr. B_ 2 84 105.4 None 7 84 18, Bn Is; 12, Br 1; 54, Bn s $ gr. B- 3 84 104.5 None 7 84 12, Bn Is; 12, Br sil; 60, Bn s & gr. B- 4 84 98.8 None > 84 18, Bn sl; 66, Bn s & gr. B- 5 84 98.4 None 84 0, Bn sl; 54, Bn s & gr. g_ 6 105 102.1 None -7105 4, Bn sl; 81, Bn s F gr. PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P_ NOT I RID UNDER s . P- 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. ORIGINAL 102.0 SYSTEM ELEVATION -ALTERNATE 96.5 i ~ NW OORNER 'OF i1OT 3 , B-2 5601 143'. i ORIGINAL 12'x80' l B-1 B-9 • oa 2021, . 6 10% SLOPE N 1 B 0 LEGEND o~ X0,'1' IZZ, ~~o O 1" IRON PIPE. y BUNCH MARK p4 B-1 SOIL BORING NLMBER TOP OF PIPE 18 x Ss' B C] & LOCATION. ELEV. 100.00 SW !00W~R OF LOT 3 B- S SCALE 1"=40' 1, the undersigned, hereby certify that the soil tests reported on this form were made by one 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 : --~.~^^--y~ - TESTS WERE COMPLETED UN James T. Swanson November 4, 1982 ADDRESS' CFRI IFICA1ION Nt1MRER P i6NF NU116ERInptionn~l. 123 E. Elm Street, River Falls, Wi. 54022 J5-2152 ((71.5) 42S-7631 ;CS0 SH TUHE: Job No. 82-1394 i . Q~ck A4 55 eL mcc.m 3o - }~b~iev ~hrv~ /YJP,t's ~22~/ y /6/ y ¢ ; 71 ItB~ ~0 80 S - L !b Tai J \ B6 35~ n. 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