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HomeMy WebLinkAbout038-1072-50-000 n ■ oi ■ ' 0 c o g * , c n %_ k ! F ) K . � _ � 7f � CO) 2 / o °7 ' m -4 S - 7 � ) a E g k 71 m &_ - / E 2M ' 7 ; § / / D ' ' � M / I ; f [ f ; \ § o § 8 r ; � _ § - w q t ■ ° 3 (n ■ kk E o E § & ' % © ® { ƒ% e \ CD CL c . _ _ CD § . g - w # CD CL \ j to C CD m » 5 g E . o » _ ; s IT cr o : 2 T M 2 : k �. 0 0 o . 2 \ # 3-1 3 ) C.* �_ ' ( § � � E < co / M B gam \ -0 9 CL Z } = 2 / g \ \ E e 7 @ § . ] C.@ ® k / ( \ 2 E c ■ _ / § K 0 M / q CL § / z 0 ® k Z %w ' � 2 . k ■ � i ƒ � 0 R ƒ \ � ƒ . � 7 � � 2 � ■ 0 � < \ � \ 7 « � Parcel #: 038-1072-50-000 05/08/2006 05:28 PM PAGE 1 OF 1 Alt. Parcel#: 17.31.18.301 E 038-TOWN OF STAR PRAIRIE Current �, 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 RANDALL J KIECKHOEFER O-KIECKHOEFER, RANDALL J 919 214TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *919 214TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 2.700 Plat: N/A-NOT AVAILABLE SEC 17 T31 N R1 8W 2.70AC LOT 6 OF CSM V Block/Condo Bldg: 5/1230 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 846/347 07/23/1997 664/202 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.700 35,500 191,700 227,200 NO Totals for 2006: General Property 2.700 35,500 191,700 227,200 Woodland 0.000 0 0 Totals for 2005: General Property 2.700 35,500 191,700 227,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 3 • Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ge e zh TOWNSHIP SEC. / _ T, E�� N-R tfeW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION � � LOT r- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I r i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: _ s� e SEPTIC TANK: Manufacturer: 9�� � Liquid Capacity: Number of rings used: �/, Tank manhole cover elevation: 'lee Tank Inlet Elevation: Tank Outlet Elevation: d T Number of feet from nearest Road: Front,Q Side,n Rear, O 1$�� feet From nearest pr©perty line Front,0 Side 10 Rear,(z feet Number of feet from: well '0 o e', building: // "..' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank 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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: / p� / Length: ,S;3 Number of Lines:_` Area Built: v2 /i Fill depth to top of pipe: L�.L Number of feet from nearest property line: Front, O Side, O Rear, Ft ./ Number of feet from well: o Number of feet from building: g' (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 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: , Dated: �� �'p I Plumber on job: License Number: 3/84:mj 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: TN , S64, 17, 31, 181J XMYCONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Star Prairie❑ Holding Tank ❑ In-Ground Pressure ❑ Mound r-In-rinnniin MA NAlVIEDF77RIMITTTOIDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Randy Kieckhoefer Rt. 2, Bx 246A Somerset WI 54025 7,.77—d 9 3° BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name o lumb : MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird, JR 3318 St. Croix 119531 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER Q [ PROW D: PROVIDED: 000 0 /� t 0�+ ES ❑NO ❑YES dN0 BEDDING: VENT IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WEL BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: p AIR INLET: ❑YES O 11 ❑YES gNO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PU M L: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO A I ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: P NO O TR S 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: I 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: BED/TRENCH WIDT LENGTH: NO.OF INSIDE DIA.: #PITS: LIQUID TRENCHE . S PACING: COVER M ERIAL: PIT / DEPTH: DIMENSIONS `�H - GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOV COVER: E V.IN,L�jT: EL V. ND: �i' PIP LINEf AIR INLET: 1 `7 t ' I a , NEAREST J V /V /J � ✓ MO MD 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 I 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: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: 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 y�7 Sketch System on Retain in county file for audit. Reverse Side. SIGNAT RE: TITLE: SIB D-6710(R.06/88) �(,,;1 Zan' Administrator 1W J DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code fro STATE SANITA�P�BM�#/ –Attach complete plans(to the county copy only)for the system,on paper not less than dif 8%x 11 inches in size. ❑ d 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 NER / PROPERTY LOCATION y,& %, S T , N, R E(Or PROPER OWNER' AILING ADDRESS LOT# BLOCK# CITY,STATE 21P CODE PHONE NUMBER SUBDIVISION NA OR CSM NUM�ER C�^/7!q e 1. TYPE OF BUILDING: (Check one CITY NEAREST ROAD III. Owned VILLAGE OWN OF: ❑ Public C& or 2 Fam.Dwelling-#of bedrooms A EL AX NUMBER( ) III. BUILDING USE: (If building type is public,check all that apply) 1 ❑ Apt/Condo �✓ v 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. W 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 Seepage Bed 21 [:1 Mound 30 El Specify Type 41 El 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 L REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) / ELEVATION / b dZ i L D ! Feet Feet VII. TANK CAPACITY Site in oallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. T nks Tanks strutted Septic Tank or Holdin Tank Q C 4�_ Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ignature:(No Stamps MP/MPRSW No.: Business Phone Number: A/Zo-o'n Plumbe ' Addr Street,Cl tale,Zip Code): IX. COUNTY/DEPARTMENT.USE ONLY Lj Disapproved Sa ary Permit Fee(Includes Groundwater a e ssue� Iss 'n gent Signature(No Stamps) Surcharge Fee) )(Approved ❑ owner Given Initial t 13 Adverse D termin lion 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 r 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 gubmitted 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 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 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 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 &Ja G J T /�i C GKhf3C Location of property fi_1/4 S j _1/4, Section 7_, T_3L_N-R_LB_W Township Mailing address S Owe w Address of site cert' F.�.3. sw �Q� Mho vGl.>.he S Subdivision name a. 0 4 N C--'—je it No, 107 Lot number l� Previous owner of propertyAOnai-� Gna Ce Total size of parcel 7 0-co-e S Date parcel was created A1°V Z292 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume LL6 and Page Number o5b �' 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 ecorded in the Office of the County Register of Deeds as Document No. 3 24� ; 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 Register of Deeds, as Document No. ) . Signature of 0 ner Signature of Co-Owner (If Applicable) 9 /0 7 ate of Signature Date of Signature iiun a"OF WISCONSINt pOltlt I--tMt' Tane waes ssslsavrs rar war.sssa�is sas>q► �i' , t WAMI&M W= a VOL 00 4 PAoE 02 ' . Robert W Kieckhoefer awis s OMCE aa� T *on A. ieck wafer, husband grid wife , x, _....... .... .. .............. 8lK CO.,W , t ro• C ' •' .114A.�St .eP$xits 9th „ .......... &*s d. tae k--=d this , Jr� t ._,. .. ....� Grantor, A.D Z9 ¢ a. . Y ..;. R dil�?� St �eP ��ck .. . . .. ... ngl.. .._. .. . i �- -�-- k hoe . : .... ....... y� er a s e k• &It P � ,. y, _....,.. . ._........ .. ........._... ....... _... ..... .. __ .-, Grantee, }, Witnesseth, That the said Grantor, for a valuable consideration. .... x _., N[TUgM TO eoaveys to Grantee the foflowini described real estate in St,. .0 PQ iX... .. County. State of wiscousla: � , . Lot Six (6) of the Certified Survey Map , 1 recorded in Volume Five (5) of Certified Tax Pared No:........__.......... 'a :K:. • Survey Maps on Page 1230 as Document No. ' 381272, being a part of the Northwest r quarter of the Southwest quarter (NWk of ' SA) and the Northeast quarter of the ri Southwest uarter (NEk of SWk) of Section ' Seventeen M) Township Thirty-one (31) North, Range Eighteen (18) West. oa y` yx=y. 5 t is not '- This homestead property. (is) (is not) .t} Together with all and singular the h m ereditaents and appurtenances thereunto belonging; And............. ....................... .......... ........ ........ . .... .. ....... . . . _... wanmats that the title is good, indefeasible in fee simple and free and cle: " of encumbrances except and will warrant and defend the same. Dated this __. .. 28th day of ... April ............, 19.. 83 (SEAL) ��K . ..(SEAL) Bober.t_M.....Kieckho,efex...... .. .Coll_een _A.. Kieckhoefer....... v' ' . ..................... .._(SEAL) _ __ _. . -----• -..... ._...._(SEAL) ek AUTHENTICATION ACKNOWLEDGMENT of Robert W. Kieckhoefer STATE Or, WISCONSIN { sigaatare(s) ................................. ;. . NSA , ,. .............. . .....................County. authenticated this .28_.day o ._April 19.83 Personally came before me this ________________day of ..._.. 19........ the above named Cherrill Hirst -----------•--•.............. ... ............................... ............................. .... . .............................................................................. TITLE: 'MEMB9%B'FA'IWiBAR 9F-W19GONS4?i (If not,_..-Notary Public authorised by § 706.06. Wis. State.) e the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY pOARA..LRILL, &-_SPV1..-S•..._�. .-.. . New Rich.mond;....1Jisconsin.... Public. • . . . . .... . (Sitrnatur.i may he authenticated or a knowledged. Both 111 • Commission is permanent.(Tf not, state expiration are not necessary.) date: ...... ........ . .. ..... ......._._, 19......... ) ;} oNamas of perarns signing In any capncity should he typed or print..j b,I.— th.'ir signs Uir.:. a WAI RANTT DEED STATE BAR OF WISCONSIN W bennain Lraal Blank Cm.1so. ' FORM No. I—asst ',ail-sutras.Wis.. 3+ +' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER f' 0.f C� t f /<I"P of,rho" ROUTE/BOX NUMBER �� 13 c��C a `��, FIRE NO. CITY/STATEb Yln 2.t(- S °-� LJ T ZIP S114 0'2-S PROPERTY LOCATION: N W 1/4 W 1/4, Section / 7 _, T_2_LN, R_4 R W, Town of S fv,._ro Pro,"r1 P , St. Croix County, r *'1> /Vo. S 39/a7,), Subdivision P" #_ 1a30 as ncc c rt N°', 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 MIRY 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 JE� 7 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 f ' a I DEPARTMENT OF REPORT ON SOIL BORING.? AND SAFETY& BUILDING; INDUSTRY, DIVISION LABOR AND HUMAN RELATIONS \PERCOLATION TESTS (115) 96 P.O. BOX 7 (ILHR 83.0911)& Chapter 145) MADISON,WI 53701 NO WNSHIP/ NICI LIT,Y: OT NO.•BLK. .: SUBDIVISION NAME: / N/R for COUNTY: /� MAILING AODR/S — 1 I't0 _ USE 4 °L 5 ews- O DATES OBSERVATIONS MADE I0ResWence - S; �--� New ❑Replace —/ — y - 4 RATING:Sm Site suitable for system U-Site unsuitable for system ICQ-NVEINTIONAL MPUND:__ IN-GROUND-PR VA 00 2S ESSLJRE: FILL OLDING TANK. R COMMENDED SYSTEM:loptional) If Percolation Tests are NOT required DESIGN RATE: It an under s.ILHR 83.0918)Ibl,indicate: y Portion of the tested area is in the Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS MJIV189i DEPTH IN. ELEVATION BS V D TO BEDROCK IF 3F SO1t WITH THICKNESS OBSERVED(SEE ABBRV.ON BACK.)URE,AND DEPTH 3d -- s :'7'tr- 0 -Lt- /o g a -0 S� �o• 0"t t� O—//t / /�' �. 37" 2 _ ran PERCOLATION TESTS TWIF R H O TEST TWI AFTER SWELLIN V -I H ATG NU PER INCH o� G i G L- 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- PtIntal and vertical elevation reference points and show their to of lend slope• cation on the plot plan. Show the surface elevation at all borings and the direction and percent SYSTEM ELEVATION _ ! I 64 4F L � CC i i o le"i row _.' j. A. 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 date recorded and the location of the tests are correct to the best of my knowledge and belief. PIAME (print v �.. TESTS WERE COMPLETED ON: CERTIFICATI N NUMBER: PHONE NUMBER optional): CST SI TURE: (DISTRIBUTION:Original and one coov to l..oeal Authn.4t-, Aa., ,.....r,__.--_ PROJECT n ADDRESS ,.�l_,7 1/4 17 /T2/ N/R/� TOWN -e COUN �-0 5'44° PRS Byro Bird Jr. 3318 DATE — BEDROOM CLASS PERC,_„L_CONVENTIONAL I -GRO PRESSURE CONVENT NAL LIFT MOUND HOLDI G TANK SEPTIC TANK SIZE IFT TANK SIZE DOSE TANK SIZE _ HOLDING TANK SIZE ABSORPTION AREA PERC RATE _BED SIZE /,-ZX S� 1L Benchmark V.R.P. Assume Elevation 100' Location of Benchmark To,o 6 S- * H.R.P. o, 7«- o 4t-: /04• ate., Cl Borehole Q Well Scale = Feet + O Perc Hole System Elevation Uent t2* GraLde i` TYPAR COVERING f 2- 4 12- 3- 4 6' 4O 3' 6- Sewer Rock : 1 12i 0 ,ql Rr: I1$ 3 a` 1 �o w 1 1'�