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HomeMy WebLinkAbout030-1086-30-000 M O m v ~ c I O 0. 0 ~ I c I N N v I I, a d I I I I I ~ I c z I tL 6 O 'D Q I v ° M Z Cf Z r+ O d ` O Z d m r°> H Z o "a co o zv' v 2 O o d c fn F rn N Z c E -0 cm N Cl) m m 7 N y I i C "4 0, • Ai L G o - a 0 76 o 4) F-Z w Q Z Z N I d rn E O N N l0 = O) ~ = d NN C a o, ,n I d O N O - (O y d ~ ON O '2 O ~ I w c o a ~ ~ N Zc) ncrnrrn~rn as o N 3 3 3 Z o 3 0 0 0 •►V a a a C C B 4.; 2 y J CO -o C. O (A = rn m Z _0 ' vMA ~ 0 O _ 0 E N O m E N O a 7 'p d Q Z cn io O V y N O ° 3 N C ai W ° 0 O y N E N r- 0 M H C C V a °O ° M O r, Cl) L = N N 00 0) V a O = O ° W O N U N w C~ M' c y d V C_ N ;^x!i N O R U • Q o a° O M (A O z Z cn - ~ d m € a I 0 EL ` IL • cl a d .2 m rr`~IV E _ 0 m 02 0 CL U) u 1 Form - S T C - 104 ► AS BUILT SANITARY SYSTEM REPORT ~OHNER'~'~ 1h(~ K) C4 Y1 c~S . TOWNSNIP SEC.-fo T1164 N-l~~H ADDRESS ST. CROIX COUNTY. WISCONSIN + SUBDIVISION LOT__- LOT SIZE PLAN VIEW Diestancea and dimensions to meet requirements of II.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i_...._ _ ~ , 1. •i. _;~cl. 7 i C . _ w... . . 1 :qtr .l _ INDICATE NORTH ARROW BENCHKARK: Describe the vertical reference pointrusedl, 1. • 1 Elevation of vertical reference points_ ° Proposed slope at sites SEPTIC TANK: Manufacturers- Liquid Capacityt '•'••'•Number of rings used: _ Tank manhole cover elevation: 3 c _ • Tank Inlet Elevation: =Tank outlet Elevations / 71 1 Number of feet from nearest Road: Front,Q9 Side o Rear, O feet From nearest- property line : Front,WSide ,VRear, O 4,241 feet Number of feet fromi•well ,building: ' -,A 2 (Include this information of-the above plot plan)( ' 2 reference dimensions to septic tank) SEE. REVERSE SIDE PUMP CHAMBER Manufacturer: _ Liquid Capacity: %Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of Inlet: Bottom of tank elevations Pump off switch elevations Gallons per cycle: Alarm Manufacturer: Alarm Snitch Types • •Number of feet from:nearest property lino:'. Front 0SLdeq O Rears Ft._ Y 1 'Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION•SYSTEM s~ Bdd:- Trenchs Width: • • fir • • Length: .-Number 'of Lines: _ Area Built: Fill depth to to~ of pipe: Number of feet f om nearest property line: Front► O Sides Raar,o It. N umber o feet from well: II N or of feet from building: f (Include di Lances on plot plan). SEEPAGE PIT Size: Number of pitss Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: t Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (C eck one). HOLDING TANK Manufacturer: Capacity: Number of'.rings used:. Elevation of bottom of tanks Elevation of inlet: Number of feet from.nearest property lines Fronts O Sides O Rears O Ft._ Number of feet from well: Number of feet from building: Number of feet from.nearest roads Alarm Manufacturer: _•d Inspector:. Dated: Plumber on fobs i License Number: 3/84.saj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICDIVISION ATION P.O. BOX 7969 -Plant D l s ec.30,T30-R19 (t ateigned).Number: Town of St. JOSep _ C /ONVENTIONAL ❑ ALTERATIVE If assigned) Ct . Rd. V Lot 3 Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Jones 751 Sandhill Pt. Hudson WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELE . CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William Pfannes 6222 St. C 'x 1 1 SEPTIC TANK/ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE TANK OUTLET ELE WARNING LABEL LOCKING CO 'R p / PROVIDED: PROVIDED: O. Gc/ie~e-✓ l obL) 96' .3~i 9ZI. DYES ❑ NO ❑ YES NO BEDDING: bDIA.: ~j MATLHIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH O. C,(!, ALARM: FEET FROM LINE: AIR INLET: ❑ YES NO a T E] YES NO NEAREST -111l MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL L CKING OVER PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: LINE: AIR INLET: (DIFFERENCE BETWEEN FEET FROM ~~0 r ti~~a ' ~S PUMP ON AND OFF) El YES El NO NEIAREST -,DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM:O WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS -7-T / 4-r- MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N DISTR. iAREST BELOW PIPES: ABOVELOVER: ELEV. IN~~: ELEV. END: - cJ(, 4O PIPES: ET FROM LINE: AIR INLET: Y/ PIIC ¢ TM D'y7~ o~ UND SYSTEM: 10~ MO Mound site plowed perpendicular to Check the texture of the fill material for FPR IDEA DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it EVERSE 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: TRENCHES: 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----* 17 tjo ~ eC✓ 9r~.a-4 ct4G-d 0.~,44:f Re county file for audit. Sketch System on Reverse Side. SIGNATUR TITLE: SBD-6710 (R. 06/88) ~S ^ ~7 L7lLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 5`/ /n 8% x 11 inches in size. ❑ C L re Isio Previous application wee reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPE OWNER PROPERTY LOCATION c_ A3011. 0%4 S 0 T N, R E (oryg) PROPERTY OWNER' AILING ADDRESS LOT # BLOCK # 7xv l D+- 3 C TY STATE ZIP CODE PHONE NUMBER CSM NUMBER YO L -Al 9 ` 01 (v S. II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE ' NEAREST ❑ Public Al or 2 Fam. Dwelling-# of bedrooms R T . NUMBER(b) 111. BUILDING USE: (If building type is public, check all that apply) _ QV 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 4.0 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 RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ,L ELEVATION ? or - -/,3 1D K J`~ Feet 9 9 / Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 6 e e _Z~_ Lift Pump Tank/Si hon Chamber I El I Li 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 Stamps) MP/fotFR8W!*).: Business Phone Number: Z 2- Z__ ` ~s 396 u 2r's'Address (Str t, City , State Zip code): bX, Z 0 Y~ ~e G- ^~<J~ IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A m Signature o Stamp XA'pproved El owner Given Initial Surcharge Fee) Adv rse Deter in tin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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 S 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, drawr 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-8398 (R.11/88) J ' v APPLICATION FOR SANITARY PERMIT STC-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 for resale by owner/contractor,(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 _L 1/9 /JL&) 1/4, Section 3b , TZ~O N-R-L2" Township ~G . 5p k Mailing address LL f-r Z-76 ~Address of site n Subdivision name Lot number r Previous owner of property Total size of parcel .42c eecs Date parcel was created _57e_xd ~-I © d .97e 4 Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes ~No Volume o- and Page Number 5- as 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed 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 run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Re ister of Deeds, as Document No. Siq Cure of Owner Signature of Co-Owner (If Applicable) ~g ~c) Date f Signature Date of Signature DOCUMENT NO. STATE 13AR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 458273 Vol -~"~Q~acE-Ql- REGISTER'S , F i This Deed, made between T. CROW CO., I Delmar--V,---Weiss-._and_-William_-P.__-Turcotte-,__________ ,d for Recorel _.tenant.s---~.n_-c_o.mingn--------- - - Rec it i t Grantor, at f~ AY C ~ SU i - and----- JohnP. Jones and JoDee--Jones_,___husband........ 1:25 P M and wife as marital survivorship-property - I~ - - - - ~ Register ofDeeds Delmar Weiss That the said Grantor, for a valuable consideration tQe- and William Turcotte - St • Croix RETURN TO iI conveys to Grantee the following described real estate in ii County, State of Wisconsin: ~I I rNo~th, the NW3,r, of NWI-4 Range 19 West~f Section 30ountynship Tax Parcel No____________________________________ 30 ' ~j Wisconsin described as follows: Lot 3 of Certified Survey Map filed February 16, 1978 in Vol. '1211, Page 549, Doc. No. 346685. ii ~i 'WINS i This - S__ not-------- homestead property. (is) (is not) i Together with all and singular the hereditaments and appurtenances thereunto belonging; And....... Delmar Weiss and William__Turcotte warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except j easements, restrictions and rights-of-way of record, if any. 'i and will warrant and defend the same. Dated this day of May 19 9 (SEAL) (SEAL) I~ Delmar---V.---Weiss-------------------------- * W lliam._P~...Tu . ott-e.................... li ---------------------•----(SEAL) ----------------•----•-•----...---•------...---•------------•-------(SEAL) - ~I AUTHENTICATION ACKNOWLEDGMENT j Signature (s) Delmar V. Weiss an_ d STATE OF WISCONSIN j William P. Turcotte ss L/ --------------------------------------County. authenticated this-dd/a~y of-------- a.Y 19.9 P_ Personally came before me this ----------------day of 1'7------------------------------------------ F 19-------- the above named Kristina O gland Lundeen ---------------------------g TITLE : MEMBER STATE BAR OF WISCONSIN j ii (If not- - authorized by § 706.06, Wis. StatsJ g i to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 'i Kristina Ogland Lundeen -----Att o-rne y-- at---Law--------------------------------------- Notary ` are (Signatures es may be authenticated or acknowledged. Both My Commission is permanent. ([f not state oexpiYration I' p• i j necessary.) date: 19......... ) *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1- 1982 Milwaukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _1L O IRIJ 0 N) ROUTE/BOX NUMBER 757 A (:-~i ^JbY6 GG An FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: A)JA 1/4 A)CJ1/4, Section T_2!Q_N, R__L C, Town of c % c~1f-'rte , St. Croix County, 6Ga Subdivision 8n 5!/9, Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department 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. SIGNED DATE '3 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address INDUSTRY, ■t►rrr yr♦ ■ 'yr/w vwrr. vvr%arv%wv 9'168rt✓ DIVI510r~ LABOR P.O. BOX 796L_ HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON, W1 53701 (ILHR 83.0911) & Chapter 145) L TI N: SECTION:- OWNSHIPiMWN0GWAAL~T.Y: OT NO. LK NO.: SUBDIVISION NAME: A/- l'0/4 o /boN/R1lEto Sr• aosep't~- 3 CS 3y~6es sy COUNTY: o ar-R : MAILIN ADDRES : 54 X Poi X so f'l,J ~o.a E f 76-14- moo H • I l r. N oso-,.~ , w ; S- Syo1~ E DATES OBSERVATIONS MADE BEDRMS: r OMM R IAL DESCRIPTION-] I PROFILE Residence 3 -b i/ . New ❑Replace 1 /ee~ 1 - yo DESCRIPTIONS: 1PERGOLATION TESTS: vwe~ / 7- Yo i RATING: S- Site suitable for system Us Site unsuitable for system ✓ C y (tl/e~/ ~~i~ ONVENTI NAL: MOUND: IN-GROUND-PR E: SYSTEM-IN•FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) S ou o s ou o s r-10' I []S ou []S ou z 7*E-uLA-es *#,v C - w i K Fud:er's. olation Tests are NOT required DESIGN RATE: C L~ s,s ~ If any portion of the tested area is in the ILHR 83.0915)(b), indicate: Floodplain, indicate Floodplain elevation: !(lbTF,e a5r cowwrowrs 3y4 u f• Surt~Ny 1z PROFILE DESCRIPTIONS / r FROST BORING TOTAL DEPTH TO R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE. AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED I H TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) r r r G7 'O/!/3v• /f. .S'~ d... /,~.;~R'fiP S 2;Q e-.~ 9 0 5~ sy > 9, D ;41.4'e - Qa. T., y,o •,.,%J(. oat 94A S/ i 7.4-.1 .r.~.P• s. p C r i G7' Irf' i1w • , , ~ L/.Q,,. r /'0 r OR. 6.0 Of Mjx7VJPC B- c.Y a .,5 ~ I • JC~ ~Q ~ •s • f o R- R r:O ~e eR lrc. SI ? o Q.. Q fD /w.•el . S. k+t'df~ ~•l~. r >d ' ' Co, O 'rI~7uRt'yof QScS. Qa I.G' TMN s~ oft . 51 .&V I. T-s , . S ' N• R,v . 1.83 ' o 0 c s s B. 9. ' to l ' 3 ~ ~10 > 9, D ,.t„< . rNr~-c, PEa afR, T rv c s 3 G /Z e-9 q.o f /0.2.09' y, r i,o' By. 1. rs S 10-a4,. I,a' s.o g.3 0 - ;13 B'. 1., 41 S,"- i, 1.33' 8N-S',) BRNoco otP. S1 w1 -FRI., Sn - Ot'ST aR~6r• ro ~S PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DR IN WATER LEVEL-INCHES RA MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -P-E- 4Q_] PER INCH P. S' Q +E 115/ S 'y 6 30 P- P- - rN .S'-i+y y STR~ i 4 s PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indi scribe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the vatton at all boring8 an rection and pereen of land slope. SYSTEM ELEVATION ' i i SSE' ~~oT ~ Lsf,t/ l i ( i Dw o-a w/rr- _ s c; ,ue. f s o.o a This test s to p PRbVECI for a conve~ti n 1 septic ys ~en i. i f 1 ~ I I _ _ _ - - T~~►~~s AFT 4itle- - .44i et ~ tioT 1, the undersigned, hereby certify that the soil tests reported on this form were marlc 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 (print): TESTS WERE COMPLETED ON- HOMESITE SEPTIC PLUMBING CO- c 655 O'NEIL RD_, HUDSON, WIS. 54016 ADDRESS: ROBERTULBRIOAT CERTIF F2- UMBER: PH ONJ NUMBLR(optional): P. B ,,AS. MASTER PLUMBER LIC. NO. 3307 •P•R66 dJf(J fr! 14. I 00 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L DILHR-SBD•6395 (R. 10/03) - OVER Sava(% LOT $WJE i APPROX. 300' 01- sy HOMESITE SEPTIC PLUMBING CO. 9 6W O'NEIL RD., HUDSON. WIS. 54016 1 ~ ROBERT WRIGHT C S r (op . ;A& MASTER PLUMBER UC• NO. 330N0. PP.R.S ' 6'N. INSTALLER & DESIGNER C. .2090 w 2 O 14 Q O A 1.TE12ti1/!Ta ~p 1 Sy F} P- I_ A- S y ~0 9 Z ~ D ( _ f This test site APP DYED 90' for a conventional se tic system. r p3r. 137 s ~ Sy$T£~^ PLOT PLA/J ~S S2 5 c,4 tk : I 3 a o X _ peac SrTIES 3 4 = VV-Pr. Rrf. '?*r- 3 5 w»u,./PI ~Q .SET Nj a F-'' `i1af 'r'VYti; TD pow6(a pole 1 If IC VA-now3 C\9 ,o . o~ , t • B q Sec 12fpo#?r o'~ HARck S x A, I~' ~ rIIF Ii Y F F-- I I~ ~ z ~l { cn~ MI I ~ 4 rI ~ t T r MINNEAPOLIS • 1113 East Franklin Avenue, Minneapolis, MN 55404 Phone: (612) 871-8321 6444 COM-PL~ LAKE ELMO BRANCH • 9242 Hudson Boulevard, Lake Elmo, MN 55042 Phone: (612) 738-0173 L WHOLESALE DISTRIBUTORS OF: FARGO BRANCH • 6 North University Drive, Fargo, NO 58102 Phone: (701) 235-0230 Comfortnwker ST. PAUL BRANCH • 1535 Marshall Avenue, St. Paul, MN 55104 p Phone: (612) 646-6537 U`-11-bb 4,) Co c' t L°'C`Cc 2 rl k e j~:..i, Q.✓n?sJ 4 " ~ocK s r-/~dJ ti ~b Sc-5a' ~$9 SO ~6 1 I ~S O N ( `fro L____25-'~` 67 L) el- /00 v -H<Z?t- PRINTED BY THE STANDARD REGISTER COMPANY, A