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HomeMy WebLinkAbout002-1068-90-000 ti o a) 4 y oo q o o .•, 2 N 2 N C! N f0 4, cw co 3 � •. °O N O c @v ..ap O N e Z in o TS a ° • Ey0 o - c t.t. ~ gym I ooaa)icca aria 8 ' o-Qv c C 7)-0 1 7; of ac c 'o • 0 0 m c o 5 E 7 c N N ` O O f0 0— O E•0 co T•- w N O f0 a) N y CO c 0 U 1 • O. o.N O' a) C Z - c C Z a3 t @p U • ti c ai y a I iii c 3. E u0).° I • o c ▪ c.) 03 1 3 • a)cE > > Q o.= aw I Q F-2 215 M o v aa) I I 3W Z E z E I • `o. CO : •t: c 1 :: c I / .1. E 2 I 1 Z a m ) O. W RI N FN- CO I I o I 0 Z 4 c w 1 r 7 _ M H e- 2 G O i c) E o I I ` N a) 7 O [��•/J� c m a) a) I N y 0 • dN C L Om 'fl = Z 03 Z O U I 0 Z Z O N z co d d op y > N y 1 .. U) U .. H cu a o. R ..-. 0 c a .��. t�y N d e N O co N d N \l o c c a n y _� o O G a ° c ago z .- > !1015 o I - n.• a Z 13 aD I •1iaaa �, l a_ aaa co I fn J V N 00) 00) Z 3 Z 'mil O N N 1 0 N O O = O O 0. - C ii o y Q } c0 aa y d Q Qi Q Z U I • C = 7 3 N 7 .R • HO w N y o 2 c O m c a N N 1 co I a O O p �_ 3 N C C o n. a 1 f0 N C c 1•O V. I- ' O 4 F O c N - N O f2 V C m C ''II Z c NC CD c = N I C c d 0 N v o , c V •° °' '" qE °�to c °Cll Z icp O h N N O N O O t0 0 14 O N O EO I • o N 03 a <- o Z Z Z _' co o 0 z 2 Z I- O 1 E ✓ 5a 1 I a 1 L a I CO) Acia2 'I0a) c.) , 0v) ci J Pir\ II pr Form - ST - 104 frekol " �O- AS BUILT SANITARY SYSTEM REPORT OWNER E&. D C) p It' r rb TOWNSHIP 13 q ` Gfc;., SEC. 2-) T Z%N-R /6" w ADDRESS (5,1 c.rr %i J LiI ST. CROIX COUNTY, WISCONSIN SUBDIVISION 0/4- LOT I V / 4 LOT SIZE /l/ /t l T ` PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v \� 0 3D *. R `fir id I ot r c .3 Qg INDICATE NORTH ARROW ■ BENCHMARK: Describe the vertical reference point used oc rte,. l I (E / 00 Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: PC- P Liquid Capacity: b 0 O o Number of rings used Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: . Number of feet from nearest Road: Front,0 Side Rear, O 2, 7 u feet From nearest property line : Front,OSide,ORear,O feet Number of feet from: well / c- (5 , building: .1 / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) Il SEE REVERSEIDE PUMP CHAMBER N Manufacturer: 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Y Trench: 2 960 Width: ( Z Length: U Number of Lines:` Area Built: Fill depth to top of pipe: 2 Number of feet from nearest property line: Front, O Side, O Rear,OFt Number of feet from well: 125 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: i Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution boxO been used on any of the above soil 4 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: Inspector: Dated: Plumber on job: License Number: ( (0 3 3/84:mj i 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: CONVENTIONAL I I ALTERATIVE (If assigned)SW, SE, 27, 29, 16W _d A_ Town of Baldwin ,Lot 1 Holding Tank In-Ground Pressure ❑ Mound AJ,IV IIII vl NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO DA : . Nicholas Paron j` wy12, Woodville, WI 54028 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers, Jr. 55-531 St. Croix 119484 SEPTIC TANK LDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: LCXPoc l ii gb (18.5,i) .YES El NO El YES KNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: El YES 'NO `�' �-✓� El YES -NO NEAREST-- {r) 10 c, e' DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES El NO El YES El NO El 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) ❑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.) 1 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID Q TRENCHES: / I ATERIAL: PIT DEPTH: DIMENSIONS 'n C�+ ©O .... 69 GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE}'O_W PIPES: ABOVE COVER: V.INLET: }LEVCEND: "'�• PIP S: LINE: ^ AIR INLET: FEET FROM l9tt � 1 .IQ 1,11 ,;•7 NEAREST-Po. O.5 .4 4 t 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 El YES El NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑N0 ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO EYES ❑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: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: ' OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM El YES El NO El YES ❑NO NEAREST . a / ) 3 7 , / 1 1 . ) . . ,� ' tom. Sketch System on �`\ Retain in county file for audit. Reverse Side. ATURE: \ TITLE: SBD-6710(R.06/88) J C Zoning Administtat)r Thomas C. Nelson ILIHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code cou►�TY� . STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than ❑ // ,y," 8%x 11 inches in size. Check if revs ion to previous application –See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. �� PROPE'TY OWN'R ' PROPERTY LOCATION / . b , .,'.��, t/a _ '/4, — . N, R 7 E(or 61 P-•• 747OyVNE MAILING ADDRESS LOT# BLOCK / Cl ,STA{E oC ZIP COPE PHONE NUMBER SUBDIVISION NA E OR CSM NUMBER !?�' if k21' I�S e I( ) i O /� II. TYPE OF BUILDING: (Check one) ❑ CITY NEAR S 'State Owned w VILLAGE ,,/f ❑ Public i 1 or 2 Fam.Dwelling—#of bedrooms eZ PA- EL TAX 1.UMBER ) III. BUILDING USE: (If building type is public,check all that apply) 0 o rt O& p _ go- o0 0 1 CI AptCondo V ,( 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 El Campground 7 El Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ r W 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 U0 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 M Seepage Bed 21 CI Mound 30 CI Specify Type 41 CI 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 ��© RE UI (sq.ft.) PROPOSED(sq.ft.) (Gals/ ay/sq.ft.) (Min./inch) 97' ELEVATION �e - • /! s Feet 129;LrFeet VII. TANK CAPACITY Site INFORMATION in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New fisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank (14t9O ^" /AC l 44ecoo..,a440 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's ame(Pri ): Plum 's Si nature:( A,mps) MP/MPRSW No.: Business Phone Num.er: ?� Plumb Addr s(Scree ity,#fp Code): '/ v del .s/.0,,-.vb kit r l� IX. COUNTY/DE ARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee(Includes Groundwater Date Issued -Issuing Agent Signature(No Stamps) 14 Approved Surcharge Fee) El Owner Given Initial �5 O 0 S--a � u� Adverse Determination / 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) 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. Y. •Type of system. Check appropriate box depending on system type. Vt. 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 . S T C - 100 This application form is to be completed in full and signed by the owner(s) of the the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this .development be intended for resale by owner/contract0 , ("spec house") , then a second form should be retained and completed.when the propertyiis sold and submitted to this office with the appropriate deed recording. S. - - . . Owner of Property icxtolas °`' .\111 r u ' . Location of Property • SW 14 5E 14, Section 21 , T 21 N - R lb W fbwnship 1a1(1.l18's'Yl.• . Mailing Address n, i,�2 . ff11,, ' O2$ . Ulilil 11 ' Subdivision Name . Lot Number Previous Owner of Property Arith i.) '4- Qea Tolle v, • Total Size of Parcel . 4,3p6 /-1f6c Date Parcel was Created Are all corners and lot lines identifiable? -'-----rYes No Is this property being developed for resale (spec house) ? Yea )( No (6I 102-Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: • i 1. Warranty Deed i I • 2. Land Contract .r' 3. Other recordings filed with the Register of Deeds Office • 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 the Certified Survey Map shall also be required. I i 1 PROPERTY OWNER CERTIFICATION .1 that at statements on this £anm axe tnue to the beat o'S my (NA)I Pe) ce; that o en t des c)c..bed .t n this know.tedge; that I (we) am (ate) the ownenls) o6 the pn p y .,nlionmati.an 4onm, by vi tue oli a waxn.anty deed xeconded �.n the 044.i.ce o4 the `� ti3$ ; and that I (we) County Reg-ia#en o� Deeds as Document Na. lv pxesenat2y own the proposed site On the sewage d.Apasa.t system (on 1t We) have obtained an easement, to nun wwth the above des cubed pxopenty, ion ) co natjcucti.o n o s aJ.d system, and the same had been duty xeeonded in the 0 ��.ee a4 the County Reg-csten o4 Deeds, as Document No. 43134,9 ) • • . 12 . �,►� R. Pa - ` � � SIGNATURE OF CO-OWNER (IF APPLICABLE) SIGNATURE OF OWNER 5-1549 5-15-V) -- DATE' SIGNED DATE SIGNED . k 1 �t e� 7 DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR—OP WWcOrSIN F� 2—1982 438496 BOOK 1 , Pt,;E __. - - REGISTER'S OFFICE Andrew M. and Ruth J. Tollefson, husband ST. CROIX CO., WI wife , . a/k/a Andrew W. Tollefson, and Recd for Record Ruth_ J. Tollefson ,IIJN 171988 r.' conveys and warrants to Nic-bolas '1 Paron and Jill R. at 8:30 A (N Paron,...hus.band_..and..Rite as survivorship marital property Register of Deeds RETURN TO ■ the following described real estate in k • Cfr O l x County, " State of Wisconsin: ` K. Tax Parcel No: e' Part of Southwest Quarter of Southeast Quarter (SW4 of SE4) of 'Al Section Twenty-Seven ( 27) , Township Twenty-Nine North (T29N) , ". Range Sixteen West (R16W) , described as follows: Lot One ( 1 ) H of Certified Survey Map filed August 16 , 1979, in Volume "3" , Page 838 , as Document No. 359089 . €, 'R N , r. V 44,ir 0 ..t,, C. FEE t. JT,S'- :` Fs f ec Vt:R4 t k r *" f .e, 4 r.. _ z ., ,..�_ te This i.s._not homestead property. x (is not) t Exception to warranties: Easements and restrictions of record. Fc r Dated this 14 A. % day of V G 6— 19$_8 / ..(SEAL) n (SEAL) ... . .. . ./. .._! _%. . .,.. .. .. t. • * Andrew M. Tollefson (SEAL) " `~�� �0 (SEAL) f . Ruth J ollefson4 °s t , yq ' Y 5� i f f 1 Y ,<,',.7(i4'4 r S r 0v IT to• AUTHENTICATION .&''A CKNOWLEDGMENT 1 Signature(s) STATE OF WISCONSIN 1 7 ' y nary� , y 89 ''P�l } t f■ . '.S t ,CX Q1 a� > 4 County �' ' r CI-- `�'' w, au lcated _ day of ;�19�1 � ,ems+., Person y came .e'ore me:, is " ' day of A` �5" `" ; .:, 198a...the above named AndxeW M To1:1.ef_aon...ans3 a RocearG• LtU, cz e- Ru'tb...a-. :MQllefa4n TITLE: MEMBER STATE BAR OF WISCONSIN kik4-Me ,r0 (If not, I yw ; authorized by § 706.06, Wis. Stats.) to me known to be the`person S.._::.. who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BYrf Thomas A. McCormack ldwin, WI 54002 Crgix Count Wis. Notary Public St• y+ es may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration ecessary.) date: , 19 ) . persons signing in any capacity should be typed or printed below their signatures. S T C - 105 r SEPTIC 'TANK MAINTENANCE AGREEMENT St . Croix County • OWNER/BUYER i,� `l TWA/ ROUTE/BOX NUMBERS �2 Fire Number CITY/STATE WoliV�I�e-1 ar ZIP 5402K PROPERTY LOCATION : 5u) Z , 45E 1 , Section 27 , T 2-I N , R lb W, Town of hIiYL , St . Croix County , Subdivision _ , Lot number I • 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 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 . Cr'bix 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 . • 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 Depart- 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 . SICNED`� GZ� DATE_—— 6-15-9 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 . h4 44,E ~'TT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS ' ,�; 7',RY, 4 DIVISION R AND PERCOLATION TESTS (115) MADISON WI 53707 *4 'HOMAN RELATIONS il �;' (H63,O9 1)&Chapter 145.045) 0, ' l 1 5(1/ S2T7/Tz N/R I(o TOWNSHIP/I9�Po LOT N�O.�BL � • SUBDIVISION NAME- ' ,.-�. + UNTY: OWNER'S/BUYER'S NI'ME: 1�`!W�l/� MAILING ADDRESS: //'V/� �f �•o' a v' �Arn r 4 13�/�.v/4, des . .5402, DATES OBSERVATIONS MADE NO BEORMS.: COMMERCIAL DESCRIPTION:" PROFILE DESCRIPTIONS: PERCOLATION TESTS: i Re;dence 3 New ❑Replace C� – /J — r7 –/l� – a 7 . Mj. r • ir, RATING:S' Site suitable for system U�Site unsuitable for system � t* ENTIONAL:. Mbsu. !N EIS Q� E. SYSTEM-IN-FILL� HO�LDING®NK�RECOM�ED SYSTEM:(optional) S U - #f Petpolation Tests are NOT required DESIGN RATE: If any y portion of the tested area is in the �� kl under s,H63.09(5)(b),indicate: ,y4l Floodplain,indicate Floodplain elevation: 1. PROFILE DESCRIPTIONS `r ,BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHES CHARACTER OP SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH '� NUMBER DEPTH IN, ELEVATION OBSERVEt) EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) D. ' , -4" 4,,04 e - .4. ,O' i"t" '/.-/41''DB s/-r. 3q 1, -r • . •e7' 75` 99'.3 ' 11 > . 5- :/ ;/. "8, ,•/ _ 8 s, •r' .o''L, s e " la 'C ' !/ ' 7' I, > .v' //'L/5 /./ " `, / ,,"r' . /7 :r ":, or Nil >'79� �� > • 5' L, PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER � I ,1 PERI9D 2 PERIOD 3 PER INCH P- / 2.5' , n.e /0 /,75'" /4." /��'' ____ _ 11 R. Z 2.5' /) /0 / `.. ..----/.0 P- .S _2.5' f/ /0 , " /, //' P- 44 3.5< '/ /0 3/,l/y'T" 7z• `/z ' 20 .p- rtw? 'P-Y -7-e.-7 7ee.4 c 1121" , er,s e r ,ye r- al 13-l .. 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; `, zantal end 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. i SYSTEM ELEVATION 97. 0 d j I I i { Ii.... , � 4. ,__, wt. , f i � i w,. l i i l �.__ l I , < { 1 a � 1 t } S _ } I l r 1 ; ( F . 1 E .. _ 1 i t . E 3 t � I 1 1 t i ,� t � �. , Y 1,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,end 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: • a/e .e.--, #(.,(0 .s0/2 ‘ - /47 - 711 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: 2"6X /9/-4' e - /I l/-5 . 5 `r2/Z. ,3 y/3 �FY-340 CST SIGNATURE: ,01 90T'RI8UTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILf R-SBD,6395(R.02/82) _ –OVER– r .---7N, g�" iI ,t, A CT Qom. ' `' ', It i1 It it fa t44 Int 'd ti 0 r. - .."1 t SQ Q .C9 cY`'a , --,', to ♦ i s Q ',' `, 4 x. r — , - __ - ' .,g , o n o fit L 0 !,r s s' "qh 21 . V , ,, r' k V � h • i. `1,; y 1 1 1 N t � �� t l q ■� yd� �a`�j .-,1 �§N yg + I I t rt I - j. 1 1 : 1 ..,H__,______r 1 r... _l_ ._,,s , ,,.____,...4 . __ _ i 1 - 1• 1 _t_--__± I -ice' ti4 AL 1 � ! 1 . ! 1 i ' 1 ' I I 1 1 - 401',�. ' - }--- 1 I --1- 1 -- i -! -+--1----I-- �- I I ii - ! 1 ' 1 ! T ' 11 1 i & 1 y I -,11/0-', 1 i I , I 1 ! 1 I { f-- I y I ( I I - �- - K tf 1 / 1 t ! t i 1 i ! j I I TH- 1 I � �` ' 1i ! " 1 I 1_ I 1 0 --- 1 - +— i i ! I A 1- is■Li ii‘ t I •. - +- --1- 1 ( +—� __4_ _ 1 _� t _._ - I k �� - 1 - 1 1 �� 1 - 1- 1 1 1 I � I 1 1 1 I -; I - I i 1 I i - 11 1 I■ _ - 1 I -f-- - I I ,çL1H-HIIIHI -- -�- ! j r- - - 1 1 1 -_L- + -= 1___ m _ t - rt- F I ! I ! - � I - 1 } i t ,- 1- -4--- I � - I t 1 1 1 ! I fi 1111•4•11 I 1 -- - I -I- 1 1 1 { }I ! 1 I ! ! I I 1 ! I ! +_ 1 • `` PAGE OF C roSS Szct 1on oC A IJto Systern exe/a ASS' 44,,c1 • 'Jos /� Fresh Air Weis And Ob lion Pipe ����////(��tt''J�1I ! 1 i• Approved Vent Cop /(�/1 ,,// /// 7 Minimum 12"Above T~ "O�`t ��/� �� Final Grade 20-42"Above Pipe 4"Cost iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering Mln 2"Aggregate Distribution Over Pipe r—i Pipe —" woo ^— —Tee - 6"Aggregate Beneath Pip. Perforated Pipe Below o —Coupling Terminating At Bottom Of System Propose ID grk.cl< • `LicJr.T ton SOIL FILL DISTRIBUTIOI.I PIPE • APPROVED Si IETIC COVER -%V; —MATERIN- OR. 9 OF STRAW ZMOF MGR EGATE OR MARSH HAS ` (e E 'OF 12-21/2 AGGREGATE. o08 ELEV. OF2a FEET °-=c E-3 3� DISTRIR'JTIOM PIPE TO BE AT LEAST e INCHES BELOW ORIGIIJAL GRADE AMU AT LEAST 20 INCHES BUT MO MORE THAN 42 II`ICHES BELOW FINAL GRADE MAXIMUM ®EP19 of E% AVATIm1J Flom Of116waL 6KADE. WILL BE _ PL_ INCHES MINIMUM ®NPrlf OF EXCA"ATIoN FRoM 04‘14it4m.. c,R4D€ WILL BE INCHES SIGNED: • • LIG EA/SE AJUMBER: ' DATE : —c j 110 • EH 115 Rev.9/78 . ` REPORT ON SOIL BORINGS AND PERCOLATION TESTS � WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES, 50,,W W P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION: lh, 56%,Section .47 ,TJ,RIA (or)W,Township or Munieipal.i.ty, e-W Lot No. , Block No. County - 74' J3' ubdirisi Name —� ir" "` ,. Owner' uyers ame: ill e Q W y A✓ 0C.f-!,��/ n/t Pet 1 6 h r1 o c� ,i. (xC`�, �0 Mailing Address: IA )rloc�V// (�1 r•c in j9U TYPE OF OCCUPANCY: Residence, X No.of Bedrooms 3 COMMERCIAL _\ O� - ‘1,1- . •%' EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM _'\/ OTHER L DATES OBSERVATIONS MADE: SOIL BORINGS, 7- 5 - 79 PERCOLATION TESTS -- 1i"�'�-; Gam►` SOIL MAP SHEET a: - 7/ NAME OF SOIL MAP UNIT 5A' 4 S 7 'eAJ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- SINCE HOLE HOLE AFTER INTERVAL - BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- / cc '"So; c. 6" .Sf)N ,dy e.L L-(1 'I do JO ,M .. /3 P- If „ rr ft r O d2 /1/o 50 I eQ /41. P- 3 It if 6 " 'r g0 �/ MO CI /1 /1 / 30 P- yC i, If 1' , a o �o /� /i 1/.2_ co P- Ss II If n r O c' No 30 / 3N /* /� A P- >o , ►, 30 q /1/o ,3a I" dAo SOIL BORING TESTS • TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- / a 7,:g 75 7p .. ,.c..., A `l Spy LIL , Lo f9,11 66 V B- 2 'y. >5" II n /1 / / a B- 3 `72 y.C- II 6 " /r r;4' ,,-B- 4/ ?L >� re, G a /' �6 r B- 5 72- >5' 1, 6 t/ II 06 ` B- 16 72. >'S co " ,, h 6 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the Iocati9n and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy //a 5 d ,Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. r i, I r . � r \ , , ., , , , .mom _ e r . �. . � .. m ..__ , _ 0 I ` k t / , t 1 $ _`k � V Y/ r ._ cif C ex _ . to � l 1' S FIC9 � 't� ilia t'. 1 _� I, , ,. 6 & g I ,_,.. --,--, 1 ! A 1 1 , 1 i 1 , , , , I 1 i 1 d E try i j \1 { T y I k $ , L / C iv 1 - ' �_ k _� r / � ,_ _ A � q T fro , I I,*' •rsigend,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my i belief. 1 7 L_y e- 7-7 50 L-.17/c Certification No. 5S .S-051 X44( , .%) sown vele eff /�►oLc/f L 31o60- CST Signatur