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HomeMy WebLinkAbout020-1183-90-000 o 0 CA f 3 m o C7 n 3 1 M CD 3 F Q N C C]/1 CD 7 •'Z (D 0- a L- C 0 Ul ` 7 O CD W O n C O r~ N CL 3 3 O c0 R O O n fD CJ1 6 3 CD va a O O 00 l~ 3 U) (D O 0 I m U) OD O R co N N (D a n m fD W I 3 o c c°n"=~ ~l 'ZZ N m o CL (O m a A r CA N ca°O m = 3 O z O O O CD 3 ~vo ~n ~ w m `m CD N I = ~ m S Z o C oa z I m C DD. fl+ o in o m m C v N C N W CD CL Z = (6 --1 CO) A z tD A z O 0 o. G) 3 0 Z N oov m~° (D , I t z M 3 ~ o z Z ~ W CD i a a ~ 0 m c z a m ur I A O I N O Y 0 A OQ o CD ti W ti a C) f p by Form S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER PT TOWNSHIP AL, A S oy SEC. Zn T L: N-R 4~W ADDRESS ST. CROIX COUNTY, WISCONSIN d®I 0V- l~~3 SUBDIVISION Oj` x ~T &YB, LOT LOT SIZE Z.~o /A ~70 r LL PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SCA LE rr ~o s °`AL 00 ~0 Ae" INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r~~",", ~A at E „ram' Elevation of vertical reference point: o o , ,s o Proposed slope at site: ao SEPTIC TANK: Manufacturer: Liquid Capacity: rs 0 0 C~ Number of rings used: Tank manhole cover elevation: Z, Tank Inlet Elevation: x Tank Outlet Elevation: 7 70 / Number of feet from nearest Road: Front ,m Side,O Rear, O feet 1 From nearest property line : Front,N)Side,ORear,O feet Number of feet from: well building: 12` (Include this information of the above plot plan)( 2 reference dimensions to septic tank) 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 plant-. SOIL ABSORPTION SYSTEM Bed: /drench: Width: Lendth: s' Number of Lines: _ Area Built: -.2 q Fill depth-to top of pipe: Number of feet from nearest property line:,,,. -Front Side, Rear,O O Ft Number of feet frq% well: A Number of feet from building::_ (Intlude distances on plot plan). t SEEPAGE PIT Size: Number of pits: Diameter: Liquid Liq clpths -Battom eyf sse`"°"v Lion: n_ 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: m om o "4 Inspector: Dated: )nR /Z Plumber on job : XeAd.At- ~&14 License Number : / ,,0, 5 -3177 3/84:mj r * R DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR b G Vodi'TY & BUILDING &VOR & HLtMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4, SE 4f S20,T29N-R19W [RkCONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Rudson _ ~ - of T ❑ In-Ground Pressure ❑ Mound 15 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jim Haupt Route 4, Box 94, Amery, WI 54001 5-_'), - 3 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: Duane D. Fansler 3177 St. Croix 119414 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /-0-0 ~y P OVIDED: PROVIDED: Cj 1A C/ Z 7 , J YES ❑ NO ❑ YES 0 BEDDING: NT DI VENT MATL.: HIGH WATER NUMBER OF R A[k PROPERTY WEL ' BUILDING: VENT TO FRESH ALARM: FEET FROM 0 LIN : AIR I ❑ YES NO ❑ YES O NEAREST l! DOSIN AMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP M DEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO f f) ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP A ROL O RATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) A 71 ON YE NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisturu Vtt e de th O pIOWI FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, cons n sh II c se until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: - # PITS: LIQUID BED/TRENCH TRENCHES / TERIAL: e PIT DEP DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BEL PIP S: ABOVE OVER: E EV. INLET: ELEV. END: PIP : FEET FROM LINE: AIR INLET: 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: 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-► 4,01 el, 7,11 fM 14L-i Sketch System on I ( f Ret in in county file for audit. Reverse Side. TITLE: SBD-6710 (R. 06/88) Z - .?w I SANITARY PERMIT APPLICATION COUNTY ~ILHR In accord with ILHR 83.05, Wis. Adm. Code sr. 6-fe .C .o ..,,.o . STATE SA~ITP~PEFjMIT -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑x NO PROPER Y OWNER PROPERTY LOCATION ✓!M u e%Se %,S Q Tz N,R j #(or)W PROPERTY OWNER'S MAILING ADDR SS LOT NUMB R BLOCK NUMBER SUBDIVISION NAME ~ Ca u f j/ I ~ Nl CITY, STATE C ZIP CODE 7PHONE NUMBER 77 CITY NEAREST ROAD, L1'14re QRI"liBM*RK /dj / VILLAGE : u 4(.54 1,41 c II. TYPE OF BUILDING OR USE SERVED: pAry uO. nao - Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): A1..4 III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. N New b. E1 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per i REQUIRED (Square Feet): PROPOSED (Square Feet): 97,o ,f3f- a/~PSS 3/,f! X~ / Feet W Private ❑ Joint ❑ Public Vl. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App- Septic Tanks Tanks structed Tank or Holding Tank Tanks r K El- Lift Pump Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in Ilation of the priv a sew a system shown on the attached plans. Plumber's Name (Print): Plumb r Signature: (No St pi s) /MPRSW No.: Business Phone Number: ~~as1 / Plumb e"' A;Vress (Stre t, City, State, Zip Code : Name f Designer: 4Lr 1 .503 Zs 116)1 ~D VIII. SOIL TEST INFORMATION Certified oil Tester (CST) a CST CST's ADDRESS (Street, Ci , State, Zip Co e) Phone Number: 1 / E7) M- o90 o 7, .v q LSf ~4~irr CV 7 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sa tary Permit Fee Groundwater ate Issuing Agent Signature No tamps) NA I Surcharge Fee ~1a Pj Approved I El Owner Given Initial 1 0 h Adverse Determination • C~-1 Q`h h • '1 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber . L I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION E , } TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper-whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact-your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Prcperty owners name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only, if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name: Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more °A commonly known as the groundwater protection law. This change in statutes was the F result of over 2 years of steady negotiation and public debate. The groundwaterbill Grounds ater included the creation of surcharges (fees) for a number of regulated practices which Wiscorisin'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried "reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) r 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 N'E 1/4 S 1/4, Section T N-RW Township LC 5 Mailing address' Address of site Subdivision name A~~trv-~2 Lot number Previous owner of property C_ ~C_ V_ 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)? Yes No Volume Z 3 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. 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.+5^~ 7 ; 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 Reg'ste of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) j Date ofSi nature Date of Signature T 1 , DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 44560' Iirot 834PAGE 326 REGIS!-ERFS OFFICE 7 ST CROI. ; CO.t ,III! R~("'HAI-J) 0. STOUT, JANET 1iC,UT and MAUI-*, H: STOUT s'~'s~,OTd r LL. i, conveys and warrants to J " o'' ~~!S~ .~.r Cl l.~s`i-t w Register of Deeds RETURN TO the following described real estate in St. Croix County, I State of Wisconsin: Tax Parcel No: Lot 19, Pinegrove Height;; I,'irst Addition in the Town of Hudson located in the Northeast ' u.arter of the Southeast .tua.rter of :.,ection 20, Township 29 North, Triange 19 tv;fest. TRAlV~ o~~ JLJ~ s_ This is not homestead property. (is) (is not) Exception to Warranties: Dated this 17th -day of Pebruary '19 (SEAL) (SEAL) Janet P. Stout, Richard 0(. Slt~outQ I - (SEAL) l 411~Q 1 1~ ~f C`~`C~' Wt 6r1C4 1 AW~(SEAL) P4aud 11. Stout by Richard 0. Stout, Power of Atty. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St . Croix County. 17th authenticated this day of , 19 Personally came before me this' Ur day of o brU a.ry 19 the above named Richard- C. Stoat and- , a.rre P. Stot.I TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person S who executed the authorized by § 706.06, Wis. Stats.) fo egoing instrument and ac wl dg he same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 6idre 0: L~ rsc-,-t Notary Public ' ~ ro ]_X County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, slate expiration are not necessary.) dater 19 2~1. ) Names of persons signing in any capacity should be typed or printed below their signatures. SB2 NTF 7774 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208 Form No.2 - 1982 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County S Vl S OWNER/BUYER ROUTE/BOX NUMBER Y"►5~ / FIRE NO. Sy l CITY/STATE J- r L'-1 ZIP Y PROPERTY LOCATION: 1/4 SE 1/4, Section T ~C/ N, R_L_?_`W, Town of 441~` , St. Croix County, Subdivision PJ ~1 , Lot No. f 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 cg ~l 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 1 i -A WILDINGS i Virt *;*VkiL. Ctr.Oh'taavik-A%o u.v DIVISION ri Y', LABOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) V L ATI tf` SECTION: WNSHI UNICIPALITY: OT NO.- LK. NO.: SUBDIVISION NA E: f ~bso - PNsUen~r /i/ Z Tzq N/R1 941 1o 4 COUNTY: WNE UY R'S NAM : MAILING A DR SS: 4J s[,g cMw ► L--d S yoaj X46 -.r-Cedox3twres~w IVIE1 USE DATES OBSERVATIONS MADE NO. RMS.: COMMERCIAL DESCRIPTION: OT Residence D 4~JNew ❑Replace P~fL B l~~ Aflel~ ►0 f ►0`La~ ~carL, &o 1C 4 S _ 2 E?Kh'i4C1J t tD RATING: S- Site suitable for system U- S_ite_ unsuitable for system;,- 1dl PC OO S ED LMO U S CCU IN-G S MD-PRESSURE [:]U :ISY S -INOFILL ODLOING TArI : RECQQMMENDED SYSTEM: (op iona~l) r 10S KU I CN V& kIT)ONAL If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5) (b), indicate: ~C riSS ( Il Floodplain, indicate Floodplain elevation: c IPT PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-W ELEVATION OBSERVED EST.HIG TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- G~.? /d , ~ c~lvr ~ccr; z~" r;~~ cs><G~ Q T S > 33 o~ B- /O,z4 9~. 1 > /d 2,r iS I cc.T; Z~3 L act Lr 1~Q M- B- S o~ p r oNG > OTS R~ «s 9"Bte~t Mss, ~3-~~k CS ~,e ~a qtr B- l b-06 q9, s' jNE I> /D.oO 1/+$«rs 3a"'ge CStC,rz -o, tr t? MS B- SO O ,i I > S,6tL.S 4a GTewv 5 B- PERCOLATION TESTS /I.ye i TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER V H S RATE MINUTES NUMBER lNeiFFS AFTERSWELLING INTERVAL-MIN. PERIOD -p-ER I PER INCH P- I A,60 cNL I; >Z -4 <3 P-Z ElO I: 16L ~Z c3 P 2.4 E: 3 2 P- P- PLOT PLAN: Show locations of percolation tests, tl borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori. zontal and vertical elevation reference points an show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Q~ o0 ,z4~ " SioPe ~4 3► p , S-gyp P. Z zc3 og o R. 4 ► At_T~~.Ntart N 7 d ~ ass I ~ r9 I P- C, LIZ _L_4T AT SG lD-r Q,6P'Ju - 6YaCAwlT Lor~ ~ICV~~/dN IOCa•Od I, the undersig ed, 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 Administrati Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME Wint►: \ TESTS WERE COMPLETED ON: .4Akj6.t JUttr1 ,t.~~ a ~'VLYI..y~ /n(C, /C~IJ I I o /Tiz ADDRESS: / CERTIFICATION NUMBER: NONE NUMBER (optional): d(p7 J~can16 ~T t~~Son/ tl/tf I t~1 $ Stu' 6 x~~7 CST SIG URE: DISTRIBUTION: Original arid one copy to Local Authority, Property Owner and Soil Toster. DILHR-SBD-6395 !R (Y)IR?l - OVER - J M E ~ c d iAA `z © sv Q 1 n ~ II r A; N 1P '~1 N 23~ M c~