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HomeMy WebLinkAbout020-1172-30-000 w ~ o y I O~ a c a O I I ~ I 0 N N v I C I 'Zt y I i ~ I ti I L z° c C LL O ~ w I Q I Cl) I Z a m o I o z a ~ Z ~ww n~i a aD L = O c a C N 0 z F= z z N ~ w N V y (D d Lo m c O ccCL - n 0 V) > L) bap_~ a. z z CL IL IL IL _ c N 0 co N V_ 0 cn a) ~ ~ } y N O - 0 a o a E 10 0 N c d v cn y m ~ y d Q } m p co O o l rn y c o E O CC o n e = v N' o O 3 a> c c v a r it M F' L t~ N N l6 N V C U N C Y 7 N ~ N N(Do s N Z Z C • 0.4 o 04 r*- S i 2 co 0 (n ~ 0 Z~ H F- ~ (n I Aft. € Old CIO at a d a C a r A tea 0 mu Parcel 020-1172-30-000 03/23/2006 11:36 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.1076 020 - TOWN OF HUDSON Current i X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SATTERFIELD, DAN S & KIMBERLEE F DAN S & KIMBERLEE F SATTERFIELD 916 RIDGE PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 916 RIDGE PASS SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.070 Plat: 2627-WILLOW RIDGE EAST SEC 17 T29N R19W LOT 77 WILLOW RIDGE Block/Condo Bldg: LOT 77 EAST Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/16/1998 581074 1332/127 WD 07/23/1997 864/557 07/23/1997 852/189 2005 SUMMARY Bill Fair Market Value: Assessed with: 92899 269,100 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.070 54,700 219,800 274,500 NO 05 Totals for 2005: General Property 1.070 54,700 219,800 274,500 Woodland 0.000 0 0 i Totals for 2004: General Property 1.070 27,900 206,300 234,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 w Fong -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER G ~Y r,AFIV TOWNSHIP Lye cr c D r O'IV SEC. T N-R W r ADDRESS !y ST. CROIX COUNTY, WISCONSIN SUBDIVISION OT ? LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i ti fl~ ~ 1 e ('W1' 0 r' INDICATE ORTH RROW BENCHMARK: Descri a the vertical reference point used )CW Elevation 5f vertical reference point: 9 pee?, Proposed slope at site: j - a SEPTIC TANK: Manufacturer: Liquid Capacity: /55'0O 5tg:e_ Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ' Number of feet from nearest Road: Front,(V Side,O Rear, O feet -From nearest property line . Front,0 Side,(DRear, 0 feet Number of feet from: well - , building: Z& (Include this information of the above plot plan)( 2 reference dimensions to septic tank) w PUMP CHAMBER ' 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, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: 3 c Width:_ ~S Lengkh:,.53 ~4 S',9 Number of Lines: _ Area BuiltSSA Fill depth to top of pipe: i, Number of feet from nearest property line: Front, O Side,( r ear,O Pt:~. Number of feet from well: Number of feet from building:, y (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: - Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems2 (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: A~ - Plumber on job: License Number: 3/84:mj DEPARTi!iENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'Car.BO'F I HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 . SW 4 t SW 4 i 153707 , T29-R19W 0 CONVENTIONAL O ALTERNATIVE StetasevPlan tdl Town I.D. Number Of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 11 1 Ride Pass NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: - INSPECTION DATE: Chuck Ha en 1221 Rollin Hills Trail nlz " ~'3 (3 BENCH MARK IPermanem a,eoce point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF PT. ELEV. Name of Plumber: 71MPIISW No. County. Sanitary Permit Number: S Henry Ne hville 3258 Croix 1 198662 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIQUIO CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: PROVIOEDLABEL PROVING OVER DED ~+7 ~QOCJ Q1 f~a 'l~p, DYES ONO DYES NO VENT TO F BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PgOPERTV WELL. BUILDING. AIR NLET RESH ALARM. FEET FROM LINE: 1 DYES I~NO DYES NO NEAREST 1~P 5 DOSING CHAMBER: MANUFACTURER. BE DFJING- LIQUID CAPACI/Y PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: DYES ❑NO DYES ❑NO DYES ONO RESH PUMP ANO CONTROLS OPERATI ONAL. NUMBER OF PROPERTY WELL JBUILDING AIR INLET GALLONS PER CYCLE: LINE (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LE N(i TH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH INI OF OI$7R PIPE SPACING COVER INSIDE DIA ttPITS LIQUID TRENCHES ( MATERIAL: PIT DEPTH. DIMENSIONS ~fT!/ aaa. GRAVEL DEPTH FILL DEPTH JOISTR PIPF Df$TR. PIPE DISTR. PIPE MATERIAL. NO. D R NUMBER OF PROPERTY WELL. BUILDING V NT TO FRESH BEL W PIPES ABOVE COVER ELEV INLF 1 ELEV END PIPES FEET FROM LINE. nia lru4E.. 33gl IL Ilk AD 95.3 5 i dal C ^ l~ NEAREST---~ -An MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO OILCOVER TEXTURE =YES ENT MARKERS OBSERVATION WELLS ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH.BEU UEPIH OF TSEEDED MULCHECENTER EDGESEl NO DYES DNO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPAC NG. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE FAW FOLD MATERIAL NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA.: ELEVATION AN DISTRIBUTION INFORMATION P HOLE 512E HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VELARNTSICAL LIFT CORRESPONDS TO APPROVED DYE ONO DYES ONO PE IRLN MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY IWELL. BVILDING'. COMMENTS: //-11 FEET FROM LINE: S" a.v OYES ❑NO DYES ❑NO NEAREST °Z --~U DZ iv J ~ I 0 D `4Z Sketch System on Retain in county file for audit. Reverse Side. IGNA URE`. ~ TITLE. DI LHR SBD 6710 (R. 01 /82) • IS 70ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 5 Ce_00 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 8% x 11 inches in size. ec f revision to 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 LO ATION ei CK 114-6- 4F/(1 w '/a S '/a, S 1? T Z , N, R E (o W PROPERTY OWNER'S MAILING ADD LOT # BLOCK # CITY, STATE . 'ZIP CODE PHONE NUMBER SUBDIVISION NAM OR C NUMBER v L ~j /S • S' Co71~'~ 4 i ll6w &~IS' 7" II. TYPE OF BUILDING: (Check one) CITY , NEAREST ROAD ❑ State Owned ❑ VILLAGE RIVS p~ t Drr-E- PASS ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms - AR EL AX NUMB R( III. BUILDING USE: (If building type is public, check all that apply) 10-74 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TY E OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.F] 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 Z 61 41,E S ~.q ✓r ' )I/ Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 El Seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 177 REQUIRED (sq. ft.) PR POSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION yL r~ / J 300 , Y Feet d • Feet VII. TANK CAPACITY Prefab Site Fiber- Exper in allons Total # of . . INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 0 7 1:1 . [Ell - E1_1 F1 El 1 1:1 64r Lift Pump Tank/Si hon Chamber N 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' Signature: (No Sta ps) /MPRSW Business Phone Number: Plumber's Address #i~v y- 5 57 (Street, City, State, Zip CodeA ~i , JO L `T W. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial / / Gib Adverse De rminati n 91,9? 7 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 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. Chan in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submit} the county priorto'.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 administt•ator orthe T State o Wia eonsin, Safety 8 E3 ifdkfgs Divipion,4.W266-3815. ,N. To be cq hplete andacciArate this sanitary permit application must include: I. Property owner's name and mailing add`es~. 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, 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 ttheee surcharge are use4for monitoring grounywater, 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 for resale by owner/conttactor,(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 c i-146 c-'„ 4 J7 /4, Section 7 T~ LN-R Y 2K)p~ Location of propertylLAI Township v L- 2 x J Z 2 t Mailing address IL' H Address of site Subdivision name- l,1 /~1~1~1~ l4 S Lot number , Previous owner of property h`~ ~ U}'~~~)~i~L~/✓~ o ~-A) C Total size of parcel Date parcel was created ' Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? es No Volume ~2 and Page Number $ 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. ---------------------------------------------------------7--------------------- 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, b virtue of a warrant de d.ed in the Office of the County Register ofDeeds as Document No. ~ j7/ ; 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 u Reg ster of Deeds, as Document No. SignatIrre-af Owner Signature of Co-Owner (If Applicable) h-- 40 Date of 8 nature Date of Signature DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 ij ..B _&.A.Deyelopment, ..Inc..,.-.a..Wi.sro.ns.i.n..C.ar.po.rat.i.an j! conveys and warrants to Charles..Hagen............................................ r ~i i~ RETURN TO ~I the following described real estate in St to CrOi x ....................County, State of Wisconsin: Tax Parcel No: Lot 77, Plat of Willow Ridge East in the Town of Hudson. ~i i This is..not------------ homestead property. (is) (is not) Exception to warranties: Easements and restrictions of record, if any. S Dated this day of September 19$9..-.. B -H DEVELOPMENT, INC.: -_.-(SEAL) ........j........... -..(/>.v 11 ---.....(SEAL) * Donald E. Bjornstad, President - . ~ ...(SEAL) ! 4e i ----(SEAL) . Ic° .1411e-19/11 * * Ali 11 i am-. C...- Harwell.,.. Secretary.. ,t AUTHENTICATION ACKNOWLEDGMENT i. Signature(s) ---------------------------------------------STATE OF WISCONSIN St . Croix ss. County. authenticated this -----.--day of 19...... Personally came before me this .2 day of ..September 19-89... the above named Donal d_E. arstad.&- Wi-]-]-i am 0. Har-wea 1 , Pres.iAent•and. Secretar.y..resper_ti-ve]-y--of TITLE: MEMBER STATE BAR OF WISCONSIN B_-$I--H-Qe.v_elopmeat,.--I-nC.................................. (If not- authorized by § 706.06, Wis. Stats.) to me known to be the person .S......... who executed the or-egoing-instrul ent and acknowledge th same. THIS INSTRUMENT WAS DRAFTED BY William J. Radosevi ch, Attorney at Law - ~lA ~s - 502 Second St., Hudson, WI 54010 - Gu.; x Notary Public 12 County Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If--not,stat re nira ion are not necessary.) date: 19--------•) i "Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Ilbtuk Coo. hie. FORM No. 2- 1982 Qlilwaukee, wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER 1 '2 Q / /S n°t1 FIRE NO. CITY/STATES ZIP PROPERTY LOCATION:_!~(l) 1/4 s 1/4, Section, T~N, R Town of Al , St. Croix County, Subdivision Ls,7'-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 Zoni g Office within 30 days of the three year expiration date. SIGNED DATE 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 r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDIJSTR't ; DIVISION LXBOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/RR+TY: I OT NO.:BLK. NO.: SUBQ IVISI N NAME: W l/4510 1/ /7 /TiyN/R E( ►W R01>S-0,J . 4,rl/0 e06-t IFASr COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: S4. G pot e4 ac,C W- 4,1r" J2-2-1 'k 0111' -~1.s /////S -94il, //e u c7c--) , Zvi S . USE F "lr7 DATES OBSERVATIONS MADE NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Iv Residence 3 4e I- N, ,Q 4 New ❑Replace ( S P Q 8g 561 T 20 `,ff / S~ s 58 3 e k hn r~D -F - D 1 ~41~0 ? .So:lS RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑u EIS ❑u ZS au ❑S R]u OS ou TAE-~ S If Percolation Tests are NOT re uired DESIGN RATE: 9 If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C 1--4 S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 3:&I •DE'Ci'Ai4I, fEET- BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Jc' f2r ~kQ- g S ' /O' '13l~S~l~ .G7'~~ I3N S. 2.33' $v. St/' y, s ' r,~N ~F-Y cs ~E'Ok- 6R ' Z- (l~~Gy~ ?~.S .33;3/eS' , .93'TK•Ba. S"/, I-?3''8N B- S S. S .1.U 01:X)( C.5' S ?CA 6-FL. r > e I • S B le v,;/, . S - PC- d., . Si ..2. o ' 3a - S//~kd ~ S , % A, GE~e r IC 5, ~l E Cr- - B- 7 9 1 3/,f. sr/ . S* ' jDjr. ¢a . s; 1.0 ' 'FA, S' 7, O AJ vtR CS f FR . . P 3 Ik I I. ! Tia S I G. 5 13-5 57 e 7q A.) Ut A 3 G -S 9-5' • S P•G > I ~ B. i PERCOLATION TESTS 10 U c R y C-S ? GR . TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D2 PERIOD 3 PER INCH P_ S- 71t, P_ Z 2 ' 2 y P_ 3 2 ' Z ~a P- P- P- ' I 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. !YO SYSTEM ELEVATION _ I l I T . J I t ` -7 L 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, 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: q HOMESITE SEPTIC PLUMBING CO. S ADDRESS: E~r Z I - I / CERTIFICATION NUMBER: PHONE NUMBER (optional): 06, MASTER PLUMSER UC NO =7 M.P.R.S. ROBERT ULBRIGHT y Y,~, 23 406 S MINK INSTALLER & DESIGNER LIC. NO, 00663 CS _ IG. 1z6e,_t- Zee DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - i L81 ~ ~l!53wOf~ ~ . y ; 1np O~~'vl5 o 1 ISZ r z y , o% OZ , Z~ pt { P • o o~ ~ r o.► ► 13 roe G- L C - +o-7 N, l v a , V v Fresh Air Inlets And Observation Pipe Q, Approved Vent Cap Minimum 12" Above Final Grade fv~Stf~v ~iPiJ~~ 00 IJAA t MVM p ri 4" Cast Iron Above Pipe - Vent 'Pipe II 'To Final Grade ~ Synthetic Covering Min. 2" Aggregate Over Pipe Distribution_. su -,f Tee Pipe 0 0 0 0 0 Aggregate 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At. 5 YS 7-e-,-1 Bottom Of System ep4 or Lo-t-- \ ~~Il0LO '~ip~t ST' '-Pfza c-r Cff-uolc /7(116- C 1-0 sc.tl~: / 3d • = /3A«lav-- ,ao,e.:v s Pt.pc S',"7Fs foci 3orte. rl~ea~-lie s y sT~'~-r F~€v~ ~~o,✓ sEr /y Pic P~ f.ce yh, h`o 1 Evit'I' i'o.J = /00. d s I ;Dl ~ ~ Go P ' y5 529).7-ic T• i y ~t,~S ~O-vG~l {P Co /~OfaES~TE ' 40 4l i 0 Igo PRoPpSED tab//