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HomeMy WebLinkAbout040-1191-11-000 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1'/.s� TOWNSHIP SEC.,2,Z T, 1N- .2 W ADDRESS AK, ST. CROIX COUNTY, WISCONSIN J�J SUBDIVISION --� y4 - - LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM W INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used .A) Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: squid Capacity: Number of rings used: Tank manhole cover elevation: `J Tank Inlet Elevation:- Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side (D r feet From nearest property line Front,OSide,�Rear,0 feet Number of feet from: well 5l2 (Include this information of the above plot plan)( 2 reference dimensions to septic tak __ SEE REVERSE SIDE 1 PUMP CHAMBER Manufacturer: Liquid Capacity: y Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built �1 s Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,O Pt ._�L2_ Number of feet from well: 4P Number of feet from buildings (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: 1 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 tanks Elevation of inlet: Number of feet from nearest property line: Front, O Side, Q Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector: Dated: �� Plumber on job: License Number: fT�� 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 T�TT /� State Plan I.D.Number: SE4,,SW,-,S2/.,T28,1Y,-P7JL.f x (If assigned) JW 4 �'--FF O ❑ CONVENTIONAL ALTERATIVE Wfflnofia0Xd ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mart' , B. Blel RR, Hudson, 1-11I -L.-`6q ""30_ BENCH MARK ermanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. St. Croix 119481 SEPTIC TA /HOLDING TANK: MANUFACTUR LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 1Coo I ®.YES ❑NO ❑YES KNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH r ALARM: FEET FROM ` LIN : AIR INLET: ❑YES KLNO 4 l..E. ❑YES %NO NEAREST­1111" ��DC1i � 'I0 'TV DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO [--]YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAREST---00- 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 DIMENSIONS Z TRENCHES: I MATERIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW IPES: ABOVEVER: ELEV.INLET: ELEV.END: PIPF�S: FEET FROM LIN �j AIR INLET: I NEAREST 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 I 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 ❑YES ❑NO i ERMANENT MARKERS: D WBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: / �' EET FROM LINE: /,, C;, ❑YES ❑NO ❑YES ❑N NEAREST—� S I I � Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator SBD-6710(R.06/88) =aUILHR SANITARY PERMIT APPLICATION At In accord with ILHR 83.05,Wis.Adm.Code Cou S ATE SANIrARY PE I –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. PROP OWNE ,� PROPERTY LOCATION rjala,S .'Oc T �8, N, R �O r)W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK CI STATE ZIP CODE PHONE NUMBER SUBDIVISIOPOAME OR CSM NU BER 14� WC is J/6 1 ( C 11, 6 k�e J<t A 0% II. TYPE OF BUILDING: (Check one) CITY N R ST ROAD State Owned VILLAGE� Q) n `�' ❑ Public N 1 or 2 Fam.Dwelling—#of bedrooms R AX NU R( ) V III. BUILDING USE: (If building type is public,check all that apply) O y 7 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/C Was 5 El Hotel/Motel 9 El Off ice/Factory 13 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.%,New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 SeepageTrench 22 El 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 13.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6.Yy TE,M�LEV. 7. FINAL GRADE 9s© REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/da /sq.ft.) (Min./inch) ��ff�y ELEVATION jf Feet Feet VII. TANK CAPACITY Site INFORMATION in allons Total #of Prefab. Fiber- Exper. New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank O 1 -rS P• 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 Na��qq(Print): Plumber's Signa re: Stamps) .MP/MPRSW No.: Business Phone Number: ca(u t" To t...)-C_ Vrs Z-. !S(3 7/S` ay6 S/3s Plumber' Address(Street,City,State,Zip Code): � Lai IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanlfi Permit 8(Includes Groundwater g e ggue Issuin Agent Si r o S mps) P� I pproved ❑ Owner Given initial ff/W5 surcharge Fee) rs Adve Determin tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Ptb-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 sul mS ed to the county prior to installation. y , 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. 11. 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'f 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. H Location of property x_1/4 S_1/4, Section ��, T,2f_N-R..,7&1 W Township Mailing address �N Address of site JQA Subdivision name Lot number Previous owner of property ��'►u"l kS 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 N0 Volume M_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, by virtue of a warrant de >d4 corded in the Office of the County Register of Deeds as Document No. � le!V� ; 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 scribed property, for the construction of said system, and the same has ee duly recorded in the Office o e C my R gister f Deeds, as Doc nt Signature of Owner Signat a cl o-Owner ( plicable) rate of Signature Date of Signature °—^—.+�-r- --•--+.+.r y..�..*■ y,r ",rf k4i!!YYla...w.�f! fetlF °t DOCUMENT NO: . iTATg rAt ���t rOMe t .`719 ,+,� PAGE 538 '04799 I_"~TNt.Nate assswvse.ea a�ooaaate OATAiI 4i ---- f. wGisrats or"CE ` 1 This Deed, made between ......Alex S_ I(Ro..................... ST.CROIX CO., WI& _.. ............_.........._...._............_.............................................................. ;{ Reed. for Record this 30th � -- —........._.........._........................................................•----._..........-------- !; day o[tftgu _A.D. 19,_,05 Grantor ....................................................:......................•----------- 1.45 P and-------RflY_�l:.M�Best and Paulette M.Best, husband and a! .M. ............. UALAs joint.tTW.Vt.............•----.. ......................................... James O'Connell ..................... ..... ..............................._................................Grantee, ......Wi'tnessei•.h, That the Said Grantor,for a valuabis consideration...... 'I deputy conveys to Grantee the following described real estate in ..Sts_.�r0)�.............. 1, a$TURN TO County, State of Wisconsin: TaxKey No........................_...._.». Lots 1 and 2 of CROIXRIDGE Addition located in the Southwest Quarter of Section 24, T28N, R20W, Town of Troy; Subject to easements, restrictions, reservations and covenants of record. 1 Acceptance of this deed shall be indicated by its recording with the Register of Deeds and shall automatically and irrevocably make PAN SE the Grantees, their successors and assigns a member of a non-profit, $2.Z__too non stock corporation known as CROIXRIDGE HOMEOWNERS FEE ASSOCIATION and entitle them to the benefits and privileges of said association and bind them to the terms, conditions and obligations of said association. This __...1S nQt..._.....__. homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_...._...Alex.S..._K.O,SA................... ... _.. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances 4*JW* and will warrant and defend the same. ' Dated this ........14th................................ day of .._......August a ...... ...(SEAL) ... .............(SEAL) Alex S. Koss ................................................................."..(SEAL) .. .. .. ...........................................................(SEAL) • .................................................................. • AUTHENTICATION ACKNOWLEDGMENT i Signatures authenticated this .................. day of STATE OF WISCONSIN I ..... ... ..................................... 18........ ' St. Croix as ........ ....... .................... f .........................:...................................................... Personally came before me,this .....1.9_th......day of • ...August.1.9.85.. ......................... . the above named TITLE; MEMBER STATE BAR OF WISCONSIN ...Alex&-KQsa . ..: ........................... { (If 1:0t. ............. .............................................. .... ............................................ ............. ............ i authorized by $ 706.06, Wis. Stats.) s ............................................... tl rNIS INSTRUMENT WAS ORAFTEU aV tU .me known to be the person who foreeoin- instrument and actnowl dygjthe1unie. ke s ............A.1,E.X &.KOLA.............. . .. . ... .. . ........ ._..-- ..• .. ._................ .... i �.. _.. . ` ......... ... . ........ ._ :dry L.•'kosa _ 1 (Sicnntures may he authenticated or acknowledtred. Loth �'anrp Public .Sir• POI '� ~ 1� .� are not neceasan.) 11y (ontmission is permanent, (�f , et�I Q;pirat(oIi' (Intc. ....June 191.. ......... ......�.�' ..�.a�a �4►: j , •Nani• of per.nn. Pinning In any capacity ahnuld b. :,I-I nr priw,vI 1,0,- :h•v a.91 a" WM ,••'••••.....0,•�•,, W AFUtANT! DEED STATE DAR OF WISCi)NSIN "%I Rtank Co. Inr. FORM Nn.f—1977 XIIwaaka., Wte. Idol+%3118) r F. • STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER FIRE NO. CITY/STATE ZIP S PROPERTY LOCATION: �SJ 1/4 /4, Section i ��? , T42?44—N. R_Q?.dif _W. Town of , St. Croix County, Subdivision -��� D6E , Lot No. I 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.0 of u ty Z n Office within 30 days of the three year expiration date. SIGN 0i 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 I i - J9 VD I I - i I : : I I r -I- I a � I I I I I I - I I I i I I I I I I I I ' 1 I _� i - - } - I- �---- - ---- I - ' � I T i. i I i I _ I I I T--r-- I I r rte-- - ,-�--i--r-T-t-- ' -�--+----�- --� -r--fi---�- - I I f I � - I v: PAGE OF Cr c) 1JCl) Systems—ti r Fresh Air Iniels And Obcarvallon Pipe / Approved Vent Cap MIAI 12"Above Fi �OTT`lll /✓ Flnol Grod• 20-42"Above Pipe _4"Cost Iron To Final Grad• Vent Plpe Marsh Hay Or Synthetic Covering Min 2"Aggregate Over Plpe Distribution —Tee PIP, 0 0 0 0 0 6"Aggragal• Beneath Pip• a Perforated Pipe Below o —Cowling Terminating At Bottom Of Syslem SOIL FILL DISTRIBUTIOLI PIPE APPROVED S49PETIC COVER ° "`MATERIAL- OR 9"OF STRAW 2M OF his GREGA?E. — OR MARSH NAy e l01 OF��2-21/Z AGGREGATE ELEV. OF FEET DIs-R191UTI(DM PIPE TO BF: AT LEAST INCHES BELOW ORIGINAL GRADE A►JU AT LEAST20 INCHES BUT KIO MORE THAI) H2 INCHES BELOW FINAL GRADE MAXIMUM DEPTH OF CXCAVATiawi FKOM bFZ ttwu 6KADF WILL BE INCHES M141MUM ®EpTr of E'XCAVATIOW FFo/A: 01KI4.11WAL (aRAVE WILL BE INCHES SIGNED: LICEUSE. AJUMBER: ' DATE : ._c,�' 110 DEPARTMENT OF REPORT ON SOIL .BORINGS AND SAFETY&BUILDINGS INDUSTRY, 4 DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMS"J RELr'aT10NS (I LH R 83.0911)&Chapter 145) LOCATION: SECTION: TOWNSHIP/ tt Y: OT N0 BLK.NO.: SUBDIVISION NAME- /4 5u)'/ ba,N/Uo E (a W T 9 O I N& I r to,x I COUNTY: ('Wtney MAILINU ADDRESS: St CR 0 I as USE DATES OBSERVATIONS MADE esidence NO. RMS.: COMMERCIAL DES RIPTION: PROFILE DESCRIPTIONS PERCOLATION TESTS: VA IJNew ❑Replace RATING:S=Site suitable for system U-Site unsuitable for system ON__VEJVTIO�NAL: MOUND:Q� IN-GROU �ESSURE: SYSTEM-IN FIJ,L OL�DING TA :R�ECOMMEGNDEY��ECM`(opt a1) UQy� IOKa If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the `/ under s.ILHR 83.09(5)(b),indicate: �Floodplain,indicate Floodplain elevation: /7 PROFI E DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-1PIGHES- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH-04, ELEVATION OBSERVED FEST.HIGHEST— TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) TS /. n J=.r B- I ,b' �.�o on e_ �5. B- �L S.g� ,gyp 1-7 B-3 90 If > 6, �- '3.o ' ) SL Ts i:3" .8►, s I I-) 16A Ms B- Ll 1,S.ql ,, 7 5.(7 s.9 ' 8 i 5t_ o f, s,s ms's 81 :SL �}' SST s /.o „S11 •�(' MS .8' L SL D 013�4F B- w ,� 103. q 11 ,$' !excb PERCOLATION TESTS ii DEPTH• WATER IN HOLE TEST TIME DR I WA LEVEL-INCHES RATPER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P. 3— / P- p- P- ti l� P- O p_ JD PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hoi 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 percei of land slope. A q ..;)C) C I.)..5— I .��f A► e� Re 1 Lr_Wehf �Irra b q.o, p SYSTEM ELEVATION `i'N�r L�t B R 3 ��o PT 8 7 .__ . - - S ..._._ .__ ... _ .._�JC �r1... _.�.�.. { 1 .61,8 . B, d 1 Sl s n S 8' y'&. _P i E _ 4 I R&s Mo h>ot .� ti -_ I 1 , I l � o - -I I 7 �) - - E f � . _ # 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 WisconsiE { Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. $$$� NAME(prin_!L ITESTS WERE COMPLETED ON: ADORES': r CERTIFICATION NUMBER: PHONE NUMBER(optional) CST SIGNAT RE: a; DISTRIBUTION: Original and one copy to Local Authority.Property Owner and Soil Tester. DILHR-SBDS395(R. 10/83) -OVER - a L MEMMOMMOMEEMN mom MEMMEME ol ©■■■■M■■ME■E■SS ME M S ■ ■MONSOON ■ ■■■ra ■■ ■� �� ■ ■ ■■■■MMES ■■ ■■■MNMERNMEWS, mE l� ■. 0■O■■■■■■■■N MEMM■MMMEMMEMMUMMI■ i oIIl;�•�!om I.1 NEON ®swan"Z! 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