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HomeMy WebLinkAbout040-1189-20-000 ° : § 7 ~ o ® e & m \ k _§ \ § _ / \ , � §x 2 (D ( \0= g £ L) . R \_L CL LO $ m9.� 22 � j 76 )�) ƒ a)c ) / )= o 2 § 2f% D /2\ § < 0- CL « ) _\ § 2 § z - k « A / \ a m _ \ E § k k k / ] 7 2 � CD C § k § § G & ) @ / t j k / \ § ) § q . 7 \ / 0 2 - / j k M k & / CL § 7 j a o o a E $ / \ @ j2 _ $ £ v > o o o k $ � \ a a a IL k g B j m « u j 7 \ \ ƒ L3 _ 0 & aa $ _ « { � » c ® / 8 k 4 ƒ Cl) a a ; m e E ( Q r 2 § r S I / \ 2 _ - c k d } ( 7 § \ ) ) - \ k / . k $ o co e ) 2 0 2 = ) / / k L L: (L CL 2 CL E J I r a § /v m o A o . i Parcel #: 040-1189-20-000 01/18/2005 08:50 AM PAGE 1 OF 1 Alt. Parcel M 36.28.19.833 040-TOWN OF TROY 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 * PATRICIA A BELFIORI BELFIORI, PATRICIA A 62 E WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *62 E WOODRIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.629 Plat: 2237-OAK RIDGE ACRES SEC 36 T28N R1 9W LOT 80 OAK RIDGE ACRES Block/Condo Bldg: LOT 80 ALSO PT SW NW DESC AS COM SW COR LOT 80-POB TH S 48 DEG E 26.88;TH S 85 DEG Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) W 20.32';TH N 00 DEG E 19.30'TO POB 36-28N-19W EXC AS DESC 1131/101 ALSO PT OF LOT 81 DESC AS COM NW COR LOT 81-POB TH N 89 more Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1131/103 WD 07/23/1997 1131/101 WD 07/23/1997 1131/100 WD 07/23/1997 1104/182 QC 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 27624 203,900 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.629 35,000 169,300 204,300 NO Totals for 2004: General Property 0.629 35,000 169,300 204,300 Woodland 0.000 0 0 Totals for 2003: General Property 0.629 26,400 158,000 184,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � ��D1LHR SANITARY PERMIT APPLICATION �+ry In accord with ILHR 83.05,Wis.Adm.Code couN STATE MIT -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ /IT a SANITARY PERMIT IT8%x 11 inches in size. chec evisioe�to pre sous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Bruce Rossinc SE % NW %, S 36 T28 , N, R 19 R(or W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 62 Woodridge Driver East, River Falls, WI 80 --------- CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER River Falls, WI 54022 715 425 "PARCEL ak Ride Acres II. TYPE OF BUILDING: (Check one) ❑State Owned NEAREST ROAD Tro �/oodr/o� vr. ❑ Public ®1 or 2 Fam.Dwelling-#of bedrooms TAX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 040-1189-20 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. ❑ 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 93 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 RE UIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Mi1n./inch) f c�ELEVATION 00 73"6 /04cif h M60 Feet 92, Feet VII. TANK CAPACITY Site in asillons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holdin Tank VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plu 's Signatu e: o tamps) MP/MPRSW No.: Business Phone Number: Paul C. J. Steiner MP #6780 715 594-3032 Plumber's Address(Street,City,State,Zip Code): Rt. 1, Box 138; Bay City, WI 54723 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial A � Surcharge Fee) �Lf4 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 t 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: 1. 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. Vill. 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, Uuilding sewers: �,elis; water mains/water service; streams and. lakes; pump or siphon tanks; distribution boxes; soil absorption systems: replacement sys^em areas; and the location of the building served; B) horizontal rind 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 (fee;) for a nurnire:r of regulated practices which can effect groundwater. The monies collected through these surcharges are used for r�*;r Loring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) r As-Built Sanita SysteD. Regort OWNER BRUCE ROSSING TOWNSHIP TROY ADDRESS 62 Woodridge Dr. E. , River Falls, WI _ T ----- 2g N R_-19----W SEC. 36 ---- I River Falls; WI 54022 ------------------------- SUBDIVISION---Oak Ridge Acres _________ LOT__ 80________ LOT SIZE------------------- PLAN VIEW Distances and dimensions to meet requirements of Ij11 83. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (Indicate North Arrow) BENCHMARK: Describe the vertical reference point used ��pQ. F1ct _Q.tL-�°�s� Elevation of vertical reference point: � �_ Proposed sloped at SEPTIC TANK: Manufacturer: Liquid Capacity:___ -------- Number of rings used: Tank manhole cover elevation:______________ Distance from vent to fresh air inlet: ____ feet Number of feet from nearest road: Front_____ ft., side_____ ft. , rear_____ ft. . side ft., rear ____ ft. From nearest property line. Front_____ ft , _____ _ Number of feet from: well_________, building----------------- I (Include distances on plot plau' and 2 reference dimensions to septic tank cover.) Manufacturer'____________________________ Liquid capacity:--------------------- Pump Model: Pump/Siphon Manufacturer:______________ Pulp size______ Elevation of inlet: Bottom of tank elevation:____________ pulp off switch elevation: _________ Gallons per cycle:___________________ Distance from vent to fresh air inlet: feet Alarm Manufacturer: _________ Alarm Switch type:___________________ ------------- ,side ft. rear ft. From nearest property line: Front_______ ft. , _______ � ------- lumber of feet from: well ______, building---------- -------- ( Include distances on plot plan. ) ,�Q.j,j,, ABSORPTION SYSTEM Trench:__X=---------------- Kededl----------------- Width: 5' ft. Length:___75______ ft. lumber of lines:-2 It I ------------ yP Fill depth above cover: yb Type o f cover:----f2±CC—CLQZL----------- ---�---- Gravel depth below lines: ft. Spacing between lines:__ Line elevation(s) : _______________inlet s outlet(s) Role size'---------------------------- Hole spacing:---------------------------- Distance from vent(s) to nearest fresh air intake:______— ----------------- ft. From nearest property line: Front_______ ft. , side_______ ft. , rear________ ft. Number of feet from: Well Duilding--------ZZ--____—_______ (Include distances on plot plan. ) , sa�PIT Size: lumber of Pits: ______ Diameter:________________ Liquid depth'--------- ------ Bottom of seepage pit elevation:----------------- Area built:--------------------- - -------------------- ----------------------- Ras either a drop box________ or distribut box________ been used on any of the above soil absorbtion systems? (Check one.) I Hanufactu _ - Capacity:------------------------- • Number of rings us ____________ Elevation of bottom of tank:________________ Elevation of inlet:---------- — ---------------- -------- --------------------- From nearest property line: Front____ _ ft. , side______ ft. , rear________ ft. Number of feet from: well_______________ ____ building------------------------ Number of feet from nearest road:__________________ ----------------------- Alarm Manufacturer: ---------------------- ------------- (Include distances on plot plan. ) Inspector:__IP-�L19 qM. ----------------- ,,cc'� / : PAUL C.J. STEINER Dated:__.1.�1,� ��-- Plumber on Job ------------------------- ____—_ License lumber:---rP#6780 ---------------------- Tian NOu�,e. �'ySis�iw � $r New 1)ra%nV1e1d A m e cA o l d I I Trenehe s Dra;n Vie-►d �- -- - - - - I I ® fix i I I I Sys�en1 I I , EIevcv+io-n Scale I" = a0r � M o; .51 divt-j on hcu5� rah/ ,GFI �YUee�os� �n? ,DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS -LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SE 4,NW 4 j Sec. 36 ,T28-R19W ❑CONVENTIONAL ❑ALTERNATIVE State Plan Number Town of Troy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Woodridge Dr. - NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION Bruce Rossin 2 ° ' °?•�� BENCH MARK IPermanem reference Pomtl DESCRIBE IF DIFFERENT FROM PLAN R F.P L V.: CST REF.PT.ELEV. Name of Plumber V MP/MPHSW No County Sanitary Permit Number: Paul C. J. Steiner i 6780 ISt. Croix SEPTIC TANK/HOLDING TANK: MANUFA RER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCK NG COVER PROVIDED: ROVIDED: DYES ONO ONO BEDDING: N VENT DIA.. VENT MATL.. HIG WATER UMBER OF ROAD PROPERTY WELL: BUILDING. VENT TO FRESH ALA M FEET FROM LINE: AIR INLET. ❑YES ONO YES ONO NEAREST' DOSING CHAMBER: MANUFACTURER BEDDING: L P PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO OYES ONO GALLONS PER CYCLE: PAND ON OLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING V NTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑ ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil olsture t the d pth f plowing LENGTH JOIAMF TEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a w ,r constr ction s all C se until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH NO.OF LIST .PIPE SPACING. COVER INSIDE DIA YPITS LIQUID BED/TRENCH s" j / TREN ES TE I L PIT / DEPT DIMENSIONS ...7 4 GRAVEL DEPTH FILL OF DISTR PIPE ISTR.PIPE DISTR P E MATERIAL NO l TR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH 8 LOW PIPES A[�(VE C V ELEV INLET ELEV END r P,IIPPE / LIN r INLET: f11 _ i �L9 . �J �, v� �k� Y NEAREST OM LJ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES E:1 NO SOIL COVER ITEXTURE JPERMANINI MARKERS OBSERVATION WELLS _DYES ONO DYES NO DEPTH OVER TREN(H'BED DEPTH OVER TRENCICHED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES 1:1 YES 0 N 1 1-1 YES ONO ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: ,'BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR )ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. DIA. ELEV.: PIPES DIA.: ELEVATION AN DISTRIBUTION INIFD IMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES 0 N OYES [-JNO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIG TITL DILHR SBD 6710(R.01/82) :, �" ✓�/ ry t 1- It day - ............. 4'x.4 -• 3tx1 ew kA Ua pied lfe¢ 4 r .�I,'- a�3' 01 #.h MMI s e and tteel � "•: , .._.. ........ ry of . . , !Vr . o- 4 - '77 - ' XUWle-C. .M=tel f � ...�»w}.. ..„... STATS OF WI$WNSIN Ala • k� c ykq a �> 3 Of V-A 1 S a to me known to be k • NoRa"9F i1 APPLICATION FOR SANITARY PERMIT STC - 100 his 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 "Kwu, Location of Property "Lc_;i fit, Section s-, T N-R 2_ w Township p cl, Nailing Address R7- (yG 6(,&)C)Q Q E Dr? � 5 Address of Site Subdivision Name _ ��Q� �! /J('� A ce s Lot Number Previous Amer of Property (/Q L4.41 Total Size of Parcel Qr 2 l A Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes No Volume _ /677 and Page Number M5 . 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 Seel 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 (Wel cuLU6y that a.te a.tatements on this olcm ahe tAue to the best o6 my (oun) hnowtedge; that I (we) am (ahe) .the owneA(•b� 06 the pnopehty de�sehi.bed in .tW im4almati.on 6onm, by viAtue o6 a waAAawty deed neconded in the 066ice o6 the Cocmty Reg.i�s.teA o6 Deeds as Ooeument No. .589Z.� and that I (We) pne�sentty aon the pnopoaed Aite bon the sewage dispo4 bya 'em (on I (we) have obtained an eaa c-en t, to nun with the above dens cA bed pnopen ty, bon the conA thuCt i on o6 6 aid aya.tem, and the dame has been duty neco)tded .in the 066.ice o6 the County Reg.c,a.ten o6 Vttda, a,8 Document No. ) . SIGNATURE Op OWNER SIGNATURE OF CO-0 ER (IF APPLICABLE) c, !9'�"� IE SIGNED DATE SIGNED H z a ST C - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER/ KZ DC)I),-2,0G.( /j • � Fire Number &Z CITY/STATE /�"z ZIP PROPERTY LOCATION : I)(-) 14, Section i T N , R Iq W, Town of St . Croix County , Subdivision 40-12ES, Lot number '5"0 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 II 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. 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 7.0 g Office within 0 days of the three year expiration date . ` SIGNED 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, , c DIVISION L-ABOR'AND PERCOLATION TESTS (115) MADISON W X 7969 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK.NO.: SUBDIVISION NAME: SE 1/4 NW 1/4 36 /T28 N/R 191(or Troy 1 80 --- 10ak Ridge Acres COUNTY: MAILING ADDRESS: St. Croix Bruce Rossing 62 Woodridge Dr. E, River Falls, WI 54022 USE DATES OBSERVATIONS MADE NO.BEDRMS.:1COMMERCIAL DESCRIPTION: I A TS: ®Residence 3 ----------- ❑New ©Replace Il 9/30/89 --------- RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEcM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) El S ❑U EIS oU MS E]U EIS MU OS aU Trench Conventional If Percolation Tests are NOT required re DESIGN RATE: ch If any y portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: < 10 Min/In Floodplain,indicate Floodplain elevation: --------------- PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIff—HEST— TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 92.08 B- 2 92.22 B- 3 92.00 B- B- B- PERCOLATION TESTS F TEST. DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES F NUMBER INCHES AFTER SWELLING INTERVAL-MIN, PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- Soil Survey hotiTs less than 10 Min/Inch Water drop, rhich is Class I Perc. P- P- P- 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- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 86.80" ( g l._ — L__ f ar F f p_ j tH_ 3 i 3 < E , t F 3 t 3 E , : 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 TESTS WERE COMPLETED ON: Paul C. J. Steiner ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): Rt. 1, Box 138, Bay City, WI 54723 CST #3074 715-594-3032 CST NAT RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R. 10/83) �...� OVER — INSTRUCTIONS FOR COMPLETING FORM 115- SBD -6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations.Drawing scale is prefered.A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all apropriate boxes as to dates,names,addresses,flood plain data,percolation test exemption,if appropriate; 10. If the information (such as flood plain,elevation)does not apply,place N.A.in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3 - 10") SS — Standstone gr — Gravel (under 3") LS — Limestone •s — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand — Greater Than 'sI — Loamy Sand < — Less Than •1 — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint •c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance.A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit.The sanitary permit must be obtained and posted prior to the start of any construction. � Y W W C r� O i N Fl N N W N Z N Y N �+ 4A ►" < ~ U Z Z W NSI SI N � ?4 4a � 4-4 tw kA N 4-) 9 CL A In (n U) r ~ N y 44 W 1 � N � 4-4 N w N N r I O N N N . 1 O O �4 W �4 W S4 9 U] U] O W" m m .-I u ►- m m m u N IQ J � O M I Z ' � O M Lf�C l40 OX4 pp O Eli O O O O O 1 CW��W O 01 --1 # > N co# b0 M O d 0c v !$O 1 N O W N OI l0, co O 7. Ln C 2 g IA .. .~.. .1+ F-N rn m T O w O #x \ T N �po1 ' fn .r .. > 2 S o ' 4 ° ? r g `o < sd n • (D 4A I = w �� O r• (D V \ N zz trJ N C. N O O O = 00 n7 0 G O 0) ct N x (D O F_ F r. p n , \ \ \ �Q A w U1 N Owi I F--1 (D Ul N (D (D ((D O O O O O O n ((D (D (N ((D (D r F- N � n . m m T + • Ij• �• x ►J Fl -+ L4 O F- N N 7 N N . • "� O I I h F h IA r N V U) Ul Ul U] N C N H �r rXi I:Y�r m r r IA O m C H r rh Fh Fh a pO rr 0.4 Z m 4 -.4 f11 7 CP o tA c �+ T N N ; f c s « o 0 N t V g 01 L Z 2� N A m N ! IA � I H 0 /000 9Q� s e�f%�/akk New I)ratn�IeW I S X'15 e.cA old ( I I Trene.he s Drain viald 132- H- Lot Line 11 t -��ys}em Ele�a�io� � Seale � M / oo. 61c'lirtq on ` ��� �✓ ��/�^-� �rue e I�o s� i n