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HomeMy WebLinkAbout038-1167-70-000 'Mn ~ 0 of M a O C � C h O O N M O � d s � X zo Y N Y O >N C Z > LL c fV O 0) O O Q ° 3 Cl) v Q Z y 0�0 Z 0 Z m d a m N H U) c 0 o z t v o w m z c ° rn (D Z E '2 N N 7 C � O G •N d r O �1 0 m 0 o CD Q w z m z .o N Z c m y ° 10 c !mil wj d - d p 1_� C O. .10. 2 c ti a. An O p S S S U U O = 0 0 0 Z •w A2 aaa CL 7 p N d rn rn p U) J U z rn rn } i N C 70 O N C O . O 7 a y N O Q } (n Q O +-+ p° 3 „ E O U > O cc IL l O O C d y R N N d O O LO U) 0 Z -=o N • O 75 p 0 p R O O N (n I- (n a L: a • L 2 v rr'I�v y E c �1 A C) IL oU) U Parcel #: 038-1167-70-000 06/03/2005 10:29 AM PAGE 1 OF 1 Alt. Parcel M 28.31.18.808 038-TOWN OF STAR PRAIRIE Current X' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner * PATRICK D&SALLY C GOGERTY GOGERTY, PATRICK D&SALLY C 1983 104TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1983 104TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 2.910 Plat: 2370-RED PINE ESTATES SEC 28 T31 R1 8W NW NW LOT 16 OF RED Block/Condo Bldg: LOT 16 PINE ESTATES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 846/357 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.910 51,900 175,900 227,800 NO Totals for 2005: General Property 2.910 51,900 175,900 227,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.910 51,900 175,900 227,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C 104 AS BUILT SANITARY SYSTEM REPORT OWNER &7- ©&,erP j ij TOWNSHIP ,5E44 SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION t/' � r. ELWAOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /�X36 SEC- ,PA /)AFI) S - -- n 1717 ���D �f•t�� ��. INDICATE NORTH ARROW NL /DU BENCHMARK: Describe the vertical reference point used TO o Lor S7Atrf= Elevation of vertical reference point: fQQ,�) Proposed slope at site: SEPTIC TANK: Manufacturer: �( J ' �S Liquid Capacity: /0010 Number of rings used: ---L— Tank manhole cover elevation: Tank Inlet Elevation: 0 Tank Outlet Elevation: 9Ji 2 Number of feet from nearest Road: Front Sideo Rear, O y feet From nearest property line Front 10 Side, Rear,0 _j�_ feet Number of feet from: well ,?O , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RF.VF,RSF. SIDE J ' PUMP CHAMBER Manufacturer: Liquid Capacity: Pum odel: Pump/Siphon Manufacturer: Pump Size Elevation o nlet: Bottom of tank elevation, Pump off switch elev on: Gallons r cycle: Alarm Manufacturer Alarm Switch Type: Number of feet from nearest perty lin Front, O Side, O Rear,0 Ft. Nu of feet from well: umber of feet from building: Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: �� Trench Width: Lenith: : Number of Lines: Area Built:_ Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, O Rear,0 Ft .1�/ Number of feet from well: J?Q Number of feet from building: 2 (Include distances on plot plan). PAGE PIT S Number of pits: Diameter: Liquid dep Bottom of seepage pit elevation: Area Built: Has either a drop box 0 o istribution box O been used on any the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: pa y: Number of rings used: Elevat of ttom of tank: Elevation of inlet: Number of feet from near t property line: Front, Side, ORear, 0Ft. ber of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 7 'Z Z:Z Plumber on job: License Number: 3/84:mj DEPARTMLNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING L/jBOR&HUMAN RELATIONS DIVISION P.O.BOX 77969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION J W,�W W�V71S 1, 18W State Plan I.D.Number: Town of Star Prairri,e XFK CONVENTIONAL ❑ ALTERATIVE (If assigned) Lot 16 Red Pine LJ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Patrick Gogerty Rt . 1Bx 144A Somerset, WI 54025 (?—aV 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: Donavin Schmitt 3205 t . Croix 119556 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1 n � C? ? Q C,r PROVIDED: PROVIDED: 1�/('�Jy"� / ✓ ✓V / � 2- DYES ❑NO ❑YES 5aNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WELL: I BUILDING:I VENT TO FRESH ALARM: FEET FROM 'L LINE: ET: ❑YES NO C I ❑YES NO NEAREST--� E AIR IN 7 S `3v t$ tp DOSING CHAMBER: MANUFACTURER: j BEDDING: LIQUID CAPACITY: PUMP PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO i ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PON 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---1110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID , J TRENCHES: MATERIAL: PIT � DEPTH: DIMENSIONS O _5 GRAVEL DEPTH) FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES:- ABOVE COVER: EV.INLET: ELEV.END: PIPE LINE: / AIR INLET: i1 $j FEET FROM / L/1 0 3 �7 NEAREST�� / � 3e/ 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: 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 El ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: [::]YES ❑NO ❑YES ❑NO NEAREST-� !v cll 6 / (a X55 l, Sketch System on ;'_1 Re in in county file for audit. V Reverse Side. SIGNATURE-.—"-.- TITLE: i SBD-6710(R.06/88) - f''-- Zoning Administrator '°`� oma s C. _ e son - R SANITARY PERMIT APPLICATION ILH y In accord with ILHR 83.05,Wis.Adm.Code COUNTY , WWII STATE SAI�jITA )Y PER IT# –Attach complete plans(to the county copy only)for the system,on paper not less than � 8%x 11 inches in size. ❑ Check if revision to previous application --See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION %a Ullk,S 8 T , N, R If E(or PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 0 CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Check one CITY NEAREST ROAD II. TYPE OF BUILDING: ( ) ❑State Owned 7 VILLAGE E El Public X 1 or 2 Fam. Dwelling–#of bedrooms s.L PARGEL TAX NUMBER(b) III. BUILDING USE: (If building type is public,check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 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. N 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 ❑ Mound 30 El SpecifyType 41 El HoldingTank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION Z150 V Q, Feet 4, Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank ` 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. Plumber's Name(Print): Plumb Signature:(No Sta p M4:RS N Business Phone Number: 3 O -6G Plu ber' Address(Street,City,State,Zip Code). � IX. COUNTY/DEPARTMENT USE ONLY Disapproved SaAltary Permit Fee(Includes Groundwater Date Issued issyIng Agent Signature(No Stamps) Approved ❑ Owner Given Initial {q/�//- surcharge Fee) 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 number(s) of where the system is to be installed. II. Type of building being served. Cheek 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 Location of Property k 1%9 Section !� , T,zj� N-R W Township 57/*n Mailing Address Address of Site Subdivision Name Lot Number /G Previous Amer of .property __101e_1<1 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 7Co and Page Number 3s- 7­88 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i "oel ceA-t16y that aCt etatement�s on tlws or�m ane xlcue to the beet 06 my (oun) hnowtedge; that i (we) am (aAe) the owneA(e� o6 the phopehty de�scAi.bed in thiA -in601mation 6o4m, by v-ehtue 06 a wahhant deed neeonded in the 066.ice o6 the Countyy RegiAteA o6 Veedi ass Uoeument No. , and that 1 (We) p4uentty avn -tl�e pnopoeed .bite bon the sewage duspoe eye em (on i (we) have obtained an eeu emcnt, to nun with the above dens CA-i.bed pnopeAty, bon the eon,6t Luc t.i.on o6 aa.id e ys teen, and the came has been duty hecohded to the 066.ice o6 the County Regia teA o6 Veede, as fl en.t No. ) . GNA O OWNER SIGN URE OF CO-OWNER (IF APPLICABLE) DATE IGNED D TE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1962 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 44SS67 -16PAOE57 I�. 8 3 MCASTIMS Office This Deed made between -----Richard J. Wier ST. CROIX 00., wt& and Diane M. Wier husband-'-"'-----and nd"-----wife- ------as---------------- ------ ---------_----- ---------------------I Rft'd. for Record tNs-- 21, ---j-Qint tenants --- --------------------------------------------------------------- -­-------------- -------­-------- day of July 1989 --- ----------------- - ----- Grantor, at 10-00 an.d-------Fa-tl?-i-OX----------------­ ----------- ------------------------------ -------- _ .A �e AL o 9 e r t y-, --------- ------- ------- and__wdf.e---------------------------- -----------------------------­ ------_ es O'Connell 2 -------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ......., Grantee, .Witnesseth, That the said Grantor, for a valuable consideration...... ....... .. . . ... .. .... .... ........ . . .... .... ... .. .. .. ..... - -- ------- - .... . .... conveys to Grantee the following described real estate in-----------S t Cr 6`ix RETURN TO County, State of Wisconsin: Tax Parcel No: Lot 16 , Red Pine Estates in the Town of Star Prairie, St . Croix County, Wisconsin This --------------_-----_---- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-----------­--Richard J. Wier and Diane M. Wier --------------------------------------- ------- -------------- -------------------------------------- ------------------------------------ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I i easements, restrictions and rights—of—way of record, if any and will warrant and defend the same. D4ateDated is dis ----- ----- ------ .... day of ......... ........ .... Jul 89 19......... ............... -------------------(SEAL) ...... ------ --- --- (SEAL) Ri h d J. Wier Diane M. Wier ........... ...........•• .................................... ................................. ........... ......... ------------------------------(SEAL) - _ .......................................(SEAL) ...................... --_-----------_--- ------------- ------- ..................................... ......... --------_---- AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------ - STATE OF WISCONSIN -------------------------------------------------------------------------------- St . Croix ss. -- -----------------------------------County. authenticated this ---_---_day of--------------------------- 19-----_ Personally came before me this' t26 _day of .......... ........Ju.1y--------------- 19...89- the above named -----------Fichar_d_J__._Wi_er...and..T)iane...K_ -----------W-:Ler--------------------------------- -------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------------------------ ---------- ------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person - --------- who executed the - W i �g6 THIS INSTRUMENT WAS DRAFTED BY J.oggoin, instru en a" d n ledge' th ame. .. eiS h ................................................................................ JA i-s h - r------ - ------------------------------------------------------------------------------- -------------------------S C'ka_J:_FLEJSr,�_A-------------- Notnr�, Public -_----------- , A� ---IYOM s. (Signatures may be authenticated or acknowledged. Both Alv Commission is perma-ne'n .1, expiration _(PMW e,�ira are not n0ceasary.) date., ----_-_- -----7-1.2-9-3=10 Of Wlsconsfq,--------- -----------_---- -Names of persons signing in any capacity should be typed or printed below their signatures. TATV P.An 0Z, IV19CON9131i H z N H a STC - 105 cr- a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x d a OWNER/BUYER ca 60,j—/�ROUTE/BOX NUMBER Fire Number .CITY/STATE ZIP S�lOa PROPERTY LOCATION: 16, , Section , T N, R W, Town of IRS , St . Croix County , Subdivisio9&/3 0 `J t Lot number 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 . Croix 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. H 0 E I/WE, the undersigned, have read the above requirements and agree z„ to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning 9�krpe within 30 days of the three year expiration date. SIGN it DATE 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 . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUM RELATIONS (ILHR 83.09(1)& Chapter 145) LOCATION: SECTION: WNSHI MUN ICI PALITYI OT NO.:BLK.NO.: SUBDI VISION NAME: /T N/R!�'E for .t — OU�r T 74_ MAILING ADDRESS: �yl w `�D .,- USE DATES OBSERVATIONS MADE NO.B DRMS.: COMMERCIAL DESCRIPTION: T1'i . Residence New ❑Replace RATING:S-Site suitable for system U•Site unsuitable for system lax ONV T A MOUND: IN•GROUN : S E •FILL OLDING TANK:RECOMMENDED SYSTEM:Ioptional) ES LU OU I ®S ❑U I 0S El 2U I If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.ILHR 83.0915)(b),indicate: lFloodplain,indicate Floodplain elevation:, PROFILE DESCRIPTIONS BORING TOTAL 12EPTH IgSRUP DWATER-INCH S CHARACTER OF SOIL V41TH T41CKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E TO BEDROCK IF OBSERVED ISEE A88RV.ON BACK.) B- 02 /0��/�5��/i2—�� �n 5 ,2 G- /,20 4" yn B-� /b- �5 /l/at. i' � O—/o / :5....sp/6�.,5 f6-8' is sy.••• B- xa—y -09— 57, B- 7 ii,,,� y6 o is 4 714;; 07. 4 o -,5 7.7a orwv B- 1-7 �C B- �t PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME D WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIQP t PERIOD PER INCH •�" o� P- i 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• :ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION v�tto_!_ rr Ili Ad i : i Sj y I I O �Qi /oo i i I,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 901-6 l �� TESTS WERE COMPLETED ON: n .4 i1 11 r. 41_ •-$r ADDRESS: l000, CERTIFICATION NUMBER: PHONE NUMBER(optional): Alt t � . • ,�Ydam/ 3 4 "7 CST SIGN AT RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. nu U.cnn cnnr ,o •mm�, it i i v) 1 M v U� I �a s I � sx l 1_ ! I I I I - I , I I 6 1 I 1 , I I I � I I I L I : C I � , I � j I I , I I I I Apr- + L - — I I , i I f 1 � 41- I sT 6S r lo' T , oi r I I r P 0 Q � } � 1Gd191V �� II r I 1 � I I ; I j - � � I I , r ' I Joll r. -- - - I - 1 ! I r , ' I I I I. f IIII : � I f I I I I I r I I --1-fit , (•-; _, � ; _ � ! � _ - ; I _ I I i t 1 I I - : L f r, C� tA ' QX C tN s E � 3y 97 _ i N f r7` k , It I O , W 9 I _ �� � {; i i i a ._:_ L j � .4 .. _ �. ... .. � ,.. L � . 9 ' _ .. . . �, _ S$S Y M L __ - _ .. , .. i � '- -. _ � • _-' -.. � f: � .Zip �� - 1 Z 0 o m S: X J5 N. o• men _Iw OW �. 3 a.a,da _7 R• s.a a _._. ra a a.�•.na- LJ Li rf, Q _ 1� _ N e i . 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