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HomeMy WebLinkAbout040-1175-30-000 ~ 'O O O N ti O 6s v M c ° g o N > - O O o O ` N V O I b I, N CV N ~ w O O 04 to O C (O 3r O 3ao H > c c a)oco Ov OyJ Y N O O Q I~ 'I m2 CD a .O-.~ co O o6 U C N N _ y N>rr'vOi •O Z C CO C Co C C a) r O O td `nc3aoc 0 0) m w- O 3 Ora c a) V N O a) fN 0 E Q 7v~ ca0 U i I' ~ y E 4i 0 N Z Z E C a CO V N W N C (7 I O Z c V r N O m Z a C U) H r a) c E c Q) (V N ~ N 11~ y • d Oo O a) Q Q Z co z I a+ C N I o am, \l x O O II y d ~ .a 0 o a co U) U) H H O O`, _ !n N H CL N co O O O •YAW4 ;oaaa a o m 0) aa) N (q J U I' N O O - O O O O O N N N O O~ E M I ~ ~ N a) ~ N V7 V N Q > O O ' O ~i O N ` ~~pp Q O N a1 0 r O O _O U O 0 0 O 9 3 N a) W C V O O O O rO co r_: I C O. Y C -O N N N N C n p 0 p c rn rn o 4.w r N F. t ~d•, a r M co 10 wo O N T N CO 2 M~ ~ C O CO V O _ m O r O y E 2 (n • O N H I F- O Z MA =i € a ~ a Z. • a m m r o,`e X1:3 o' _1 A Ua~ !0 ~ ~ I o ~ I N y 00 0. O w ~ C b N c O v f6 O 0 c I ~ I c aD w z c r LLL c m ~ o m 3 E a r U M th I ~ y I N Z = O Z d N 00 N a m o I z a o V 4: ~ ~ ~ w m z g ° o m t- m z E M hh~~ v N rN y C CO N ~ y( a ~ r o O o aa) Q N z m z z c 1~~ c _°w o i m I \i E U d Z o ! y C7 0 a a` _0 ca U (nN X55 'A d !16-- 0 O O Z .mil o a a a N B to t~v a o y C, C. m 0) o v~~V rn rn z y M r N O O N O j O Go = O O _ ~ ~ CA 0) a) m 0 y d Q } cn m O 7 O L.,,,. U .f C TO M n C O O. CL C a 0 0 _0 C-4 ~I O n N O Y p p C O 0) a) ~i O 00 _ O N E E Fa L =5 =5 m it .O O N H H O Z N U) ~ I r m d a • a m m a E C .u C w 7 Y FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER AV,6 V Z /A -5 4V TOWNSHIP SECTION a4 T_ 2 N-R_ '_20 W ADDRESS o~lP~ o ✓E ~p ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT_Z,,Z_LOT SIZE PLAN VIEW ^,/Ore SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (f.qs7 0.v 1750 ~J ~EEVd ~o~ ,,~I /VF/~ SC 5/c~ L%FFut --T 41--l n 0.r--- CXiSTi G 100o G(:9.4z- Se~c ~i4NK (GJes ,5 aP S / ~cc ~r~ r ~.vSoL 14TiotJ AT U<E T B~u~p~N E'j Ftio of o A'-'r fi osi P wG`t p n Lei AL Oj /DO 2 7`'iPJTECTivtJ ePcm O'P/V CAE S2. 1,/NGS ~vSvL TeO / v GJ rN y„x /GJ` /f'vS T L' / • Y' / I 4~ !li vo rio v ~D Dt~Joe rY IN KATE NORTH ARROW BENCHMARK:Elevation and description:,94u~ r.4,NT To pj C ~F// E✓. ioo Alternate benchmark IVA EPTIC TANK:Manufacturer:- -I J A Liquid Cap. ~noc7 ~.ac Rings used:_.,3,_Manhole cover elev:Final grade elev:~.~ Tank inlet elev.: A/A Tank outlet elev.: g ©i" ? o. of feet from nearest road:Front y, Side , Rear Ft. l~ rom nearest prop. line:Front Side ~ Rear Ft. o. of feet from: Well Building: 1/3' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 7/-/VC Liquid Capacity: Pump Model: Cp- / Pump/Siphon Manufact.:-Pump S ize 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. ,O' Distance from: Well ~70Building Who' SOIL ABSORPTION SYSTEM Bed : ZL_- v.;17/S"Trench : Seepage Pit: Width:,/,,)' Length Sa' Number of Lines: Area BuiltG.?~s~.FT. Exist. Grade Elev. /0., 30 '-Proposed Final Grade Elev. /off. 3cD Fill depth to top of pipe: . S A vcP . No. feet from nearest prop. line:Front`~, Side , Rear No. feet from well: Sa' No. feet from building lr 3 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 : 10r', S c~ PLUMBER ON ~OB: LICENSE NUMBER: 1 p~s 33 2ig- t 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: SE4,NW4iSec.24,T28-R20 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound T3.41 h Co E eRMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ken Tilsen 264 Cove Rd., Hudson, WI 54016 9--n-90 Jd~9 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plu ~er: MP/MPRSW No. County: itary Permit Number: Za Da Bros. Inc. 3395 San 5t. Croix 128731 SEPTIC TANK/HOLDING TANK: MANUFACTURERI e LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER I C PROVIDED: PROVIDED: 6f ~ I J C, f) 1, ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: Z ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON M UFACTURER: WARNING LABEL LOCKING COVER _ a PROVIDED: PROVIDED: / /I" G F-1 YES YJ NO C) iL,l2 -1YES ❑ NO E:1 YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) Z YES ❑ NO NEAREST -0 / Q Z 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 SYSTEM: WIDTH: LENGTH: BED/TRENCH NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS 11 1__) ) / . .1111 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D S R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELT PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPE FEET FROM LINE: AIR INLET: ~00,3J° UGl L(j NEAREST 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: 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 & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS E:1 YES ❑ NO COV ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES E:j O NEAREST G~ Sketch System on Retain in county file for audit. Reverse Side. SIGMA; RE: e TITLE: SBD-6710 (R. 06/88) _ALHR SANITARY PERMIT APPLICATION CouN In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / a lon ~ 8% X 11 inches in size. Check if revito previous 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 N, R a 0 E (orts ,rJ E.~ / SC '/4Nl.W'/4, S T TBLOCK# PROP RTY OWNER'S MAILING ADDRESS LOT # 6 T co va- p CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER osoti w~ "S4~o~ Sr C~'o ~X Co V~-~ 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE -7;~b y, :1 vder D JZ TOWN OF: . ❑ Public [K1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMBER(S) O~ICJ -l17~S 3C)- O4 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 1120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2..~Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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) ELEVATION 7` 0 1SSQ.r. (r? SV _Q. zr. • l>3 . -~S Feet O,?. O'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 orHold! n Tank Cx2o /Ot7O / ~/E56 Lift Pump Tank/Si hon Chamber rlSO 5v / 7/--7 C-- El I El IK 0 FELIL] F1 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 nat re: (No Stamps) 1MP/MPRSW No.: Business Phone Number: ,~1P~s 33gS 9~s s~~ -agso Plumber's Address (Street, City, State, Zip Code):I~ 7 - s ~ T /Lj W&A0:S O,v w,e IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing gent Signature (No St Approved ❑ Owner Given Initial Surcharge Fee) v Adverse Determination o d~ 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. 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'/s 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; distribulion boxes; soil absorption systems; replacement system areas; and the location of the building served; B) I-orizontal 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 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 to= tesals by be re ined and comet/conttwhentethsacproperty fists ld andssubmittedrto hthis officetawith the completed appropriate deed recording. - - - - - - - - - - - - Owner of property Location of property .__._..-1/4• Section Township d Mailing address _ o~lo Cd Ve- /Voci74(Z4 aIS'o/J GU1 Address of site Co v `l oa`b d 5 o h ' D ! 6. Subdivision name 5-t. C ro o U'C Lot number 7-7- ' Sw IV to Ptevlous owner of property 141err, I] ~dhna Oh Total also of parcel a -3&,00e) Data parcel was created 11,5-7 Ate all cornets and lot lines Identifiable? ✓ as c Is this property being developed lot resale tapec house)?_,_,_Yes 0 VOlUm Viand Page Number 1-7 C as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUMB AND PAGE NUMBER, and the ORAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if avallable, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Certified Survey Map, the Certified Survey Map shall also be requited. PROPERTY OWNER CERTIFICATION I(vel cattily that all statements on this form are true to the best of my (out) knowledge= that I (we) a ) the owner(s) of the property described In this Intotmatlon tot , b te of a warranty dead recorded In the office of the County Ragistet o ed No. S and that I (vol presently own t ropo site Lot the sewage disposal system (or I (we) have obtains a asemen to tun with the above described property, lot the cons uc of ssl system, and the same has been duly recorded In the office of h o y Reg of Deeds, as Document No. nn 1. s natu a of 0 net 'Signature of Co-Owner (tE Applicable) Date of Olgnatute Date of Signature nOCIJMENT No. STATE BAR OF WISCONSIN FORM 1-1982 i' THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED This Deed, made between , . MERRILL__ A . JOHNSON__AND__ DOROLE•S__K.,__.J.QHN.SQN.,....... t' corc! e) ,is 15th husband..a a..w fe C~Qy of June A.D. 1987 Grantor, 2:15 P o and...kCFaN~IH`~' ..F1.,...`~.~T N._ ANI~...R1~CH Ii..T.ILS.EN....................... AA. >LS.)??~d..~ ?d...Wife :y, mow. P4010M Ad DQWQ / . Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... Grantor - 'RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsin: Tax Parcel No:.......... Lot 22, St. Croix Cove Subdivision in the Town of Troy EXCEPT the Southwesterly 10 feet thereof. s-P&I0 FEES This 5...__...... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grant or warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restricitons and rights-of-way of record, if any. and will warrant and defend the same. day . 19.'x._:... Dated this of . . i .....................................................................(SEAL) ..................(SEAL) A. errs Y A. o (SEAL) x...----•• (SEAL) Doroles K. John n AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. . .County. authenticated this ........day of 19...... Personally came before me this .-...l...------- da of ..........:ells e. t~..........: .........^19.9.-C. the ,above named . `t~... * Merrill A. Johnson and__D.1~ TITLE: MEMBER STATE BAR OF WISCONSIN Johnson (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person a'...... who executed the fl going ' instrument and, acknowledge the same. i THIS INSTRUMENT WAS DRAFTED BY ( ~Q Kri.st].na..Ogg.and...LUrideen Alice J le 3ghauer.................................... Attorney at Law * ce • Notary Public L~ SCHAUER.County, Wis. (Signatures may be authenticated or aclcnowledgcd. Both My Commission is peM ~btqtb state expiration I are not necessary.) date. ........-U-..s, #at$d# 1~V~SCOF~gIA 19Sss~.....) it STC-105 c~ SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County r ro P. OWNER/ BUYER k~ ~ S6E. T~ rt ROUTE/BOX NUMBER be Opoa Fire Plumber a 4L d CITY/ STATE 7 u~Sb/'1.. t/U ZIP , hVQ /G PROPERTY LOCATION':'.' 4k, Section TR 70 W, Town of St Croix County, Subdivision 54 [Fo~J4 6 eve- Lot number '2- 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'e tic tank pumper. What you put into the system can affect the function o t e -septic .tank as a treat- ment stage in the waste disposal system. St. Croix County residentsmay be eligible to recieve a grant for a maximum of 60% of the cost.of replacement ofa failing system, wh E 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 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 fullof 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 ordance with the standards set forth, herein, as set by the consin Depart- ::r ment of Natural Resources, Certification fo must b completed .b and returned to the St. Croix County Zo fice thin 30 days of the three year expiration date. SIGNED DATE 7 - 7-Y - p a St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. INDUSTRY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DUSTR DIVISION IN LABOR r~NO P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/sue' ~^LC1RALa4: LOT NO.: BLK. NO.: SUBDIVISION NAME: sc 1/ Nu 1/ 'z4 /T-A N/R2d~(or i ~o Zz - STCPo Ix Covkc COUNTY: OWNER'S &bK-R=6•PFAW: MAILING ADDRES 1-/ S1 CPo W -Kis h Ti LS~ 2 Cave 1~ut,, W I S4a/6 DATES OBSERVATIONS MADE USE R NS: A ION TESTS: N DESCRIPTION: 0. BEDRMS : COMMERCIAL Residence 1 New 4fffReplace C) l SUIGS k Ci I JoJCS - MC. LA),N" FFIIt-LA RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOU D:Q~ IN-GRO NDP URE:SY~SjEM-IN❑FILLHO~LDINGTA K:REC'0'VVvV U~~ pti l ~ 'A If Percolation Tests are NOT required l/mar DESIGN RATE: If any portion of the tested area is in the N ~3S ) under s. ILHR 83.09(5)(b), indicate: ! Floodplain indicate Floodplain elevation: Dccr PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH RE ELEVATION pgSERVED ES IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 18,60 1101z9 KoNE >8.C7 i "8(.sc.TS 3z"9,Q,MSA7C,0, 58.,BIeNcs~(,~ B- B- 7.oc /oo.zz- NoNiE. 7.o0 /l""gcsf_TS z3'ge',,ms so' $QNCS B- B- 8.1'7 ~v3 6$ NoN,& > e,0 "$LsL-rs 3►~',ge>v~iS~~~ o ~,cs~CIR B- PERCOLATION TESTS DEc-r TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER jM=S AFTERSW LLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH P_ oS oNK 11 /nz •3a 3 > > `3 P. 1o 1.1 0 3 > 2 P- 35 o cr 103.co ' Z > P_ LCV41-I -J AT R-c_ 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. SYSTEM ELEVATION q4 Zs _ ~ t t I Td P 0 t 1n~-Lr~Z _0_ _ - ELEI~Alriofj I - f 1*~0 t s t _ i t 3 i t I C~~.jt~Q t' i L G I, the undersigned, hereby certify that the soil tests reported on this form were made b e 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. NAM (print : TESTS W RE COMPLETED ON: ~ w Joy S~~ 1~,~ r 199 ADDRESS: CERTIFICATION NUMBER: PHONE NUM ER(optional): 46-7 SEC C) ' <1 3F 6 ~o 9U tson'Y4 S4U>>; CST S ~ ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - -70 445' \t_ W,TiN /~QGaI STEAL ~xS7A1~ lpOp O S~vric T,q,. ~oOCPTY PLB 67 ~~NE PLOT & CROSS SECTION PLANS NINC ZAPPA BROS. EXCAVATING UNIT PLUMB 0 ` PROJECT Res' , , 50 3035/ ~YL ~ 1`t3` To fOyC ~ ~ L`(4U V `1 (a~ ELL ,Vc I. 4/a" OEE ST ~Q)X ~OUNTY L" )fsT 0.-DO4,f y "4T L %p b'/ 6 N~0/~ to ~ ~ ~~T ~VTG C Tiv.-J r. GJELL (7a' , ~~~0~ /Ulf,VElAJAY aaa~~ o 3C, &ZAA( )0o „J-r of o >k:... NO SCALE FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: MARSH HAY OR SYNTHETIC COVERING LICENSE: MINIMUM 2' AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE TEE SOILT STING BY: - dE ~AJSck~ ELEVATION BED 6' AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST IS COUPLING TERMINATING ~9 FT. AT BOTTOM OF SYSTEM