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HomeMy WebLinkAbout042-1105-20-000 N ~ 03 c c 0. ° � I e 0 N ti O V tl i h I a z° c LL C O i Q M 3 I °c° w o Z }% ° z O N W a m N F- Z O V y Z v Cl) CD Of N N 3 ° a y N N N C O z m Z N z U y C N Q d — c0 0 N G G d a h� a ° v> > o w CL a Z IL CL IL a �v U ° rn rn 'i ova : moo 4)i U) -1 U rn rn i CD A L _ O IVY � o o D m y c a co 'd N N °) .p+ � 0 co O m N C p O O 0 U O r N C C U a 0 1 O LO c ~ C C N N C N v cfq C y N � z Z :: 'p t co FBI N N fd yj w E E '� ,C I��! L O N p p U N U O Z N F- F- .G (n a fit a eat` CL _1 A ciao ', 0U) 0 Parcel #: 042-1105-20-000 10/12/2006 10:16 AM PAGE 1 OF 1 Alt. Parcel#: 20.29.18.582 042-TOWN OF WARREN Current *1 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 STEVAN C&MICHELLE L YOUNG O-YOUNG, STEVAN C&MICHELLE L 1085 89TH AVE ROBERTS WI 54023 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description " 1085 89TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.390 Plat: 2334-PLEASANT ACRES SEC 20 T29N R18W 2.39A PLAT OF PLEASANT Block/Condo Bldg: LOT 10 ACRES LOT 10 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-18W Notes: Parcel History: Date Doc# Vol/Page Type 05/21/2001 646028 1642/578 WD 07/23/1997 831/316 07/23/1997 831/266 07/23/1997 824/340 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.390 39,500 143,600 183,100 NO Totals for 2006: General Property 2.390 39,500 143,600 183,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.390 39,500 143,600 183,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 204 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 �c r I5fe115e r, TOWNSHIP I A) ok-vt-e.r` SEC. ?_ T ?,9 N-RZW ADDRESS RIQ I ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE �� . PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s c �oQ O 10 a Y b �I /6 INDICATE NORTH ARROW • / / '� '1710 / BENCHMARK: Describe the vertical reference point used 3'f9.j S+.L k e i Elevation of vertical reference point: X00 o Proposed slope at site: ( p SEPTIC TANK: Manufacturer: Pt,,e (`Q,„.,.t1 a Liquid Capacity: /gpo Number of rings used: _ Tank manhole cover elevation: 7 Tank Inlet Elevation: 961 7 Tank Outlet Elevation: C Dts ' Number of feet from nearest Road: Front Side 0 Rear, O p? feet From nearest property line Front,Illlll'O Side, Rear,O '9 feet Number of feet from: well _i�U��{- , building: s , (Include this information of th Tabo�ve plot plan)( 2 reference dimensions to septic tank) 1 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: ' 4 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 lot plan). P P i SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Length: Number of Lines: r-,") Area Built: / 6 f' Fill depth to top of pipe: =�C) Number of feet from nearest property line: Front, O Side, Rear,0 pt . Number of feet from well: Number of feet from building: 9 9 (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Ins P ector: Dated: �9— 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: Ntj,NE,%S20,T29N-R 18W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of WaAAen ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound MI OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dave ChAizteaon Route 1, RabeAt,6, W1 54023 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: Catvin Pownz It. 1563 St. ctoix 119402 SEPTIC TANK/HOLDING TANK: NUFACTURIER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ( -4A IJC:T eta 1u, U -05 YES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH t t ALARM: FEET FROM LINE AIR INLET: [--]YES ®NO 4 ❑YES ❑NO NEAREST�� ow-I �I Q N A. �cJ -- 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: L BER OF PRO PITY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN T FRO AIR INLET: PUMP ON AND OFF ❑YES ❑NO REST— SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH DI M TER TERIAL 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: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH /� TRENCHES: �� ATERIAL: PIT DEPTH: DIMENSIONS J 2b GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. S R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: AB VE COVER: EV.INLET: E PIP : FEET FROM LINEQQ AIR INLET: t} O O NEAREST—� I y 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 DYES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; DYES ❑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. I DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: O ❑YES El NO [--]YES ❑ O NEAREST- (). _ /0,Z / -- Sketch System on Retain in county file for audit. Reverse Side. ruRE: TITLE: Zoning Adm iniz tAatOtL SBD-6710(R.06/88) cAAl- DILHR SANITARY PERMIT APPLICATION CoU, C po/X' In accord with ILHR 83.05,Wis.Adm.Code J/ STATE SANITARY PE IT# / i.7 �0 �' —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION y� 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE 1:1 YES LEI NO PROPE PROPERTY LOCATION V 0 ,k �/a /a, , N, R (Or)® PROP Ty OWNER' AILING ADDRESS LOT NUMBER I BLOCK)IIUMBER SUBDIVISION 14AME CIT TATE ZIP CODE PHONE NUMBER 77 CITY NEARE T/RvOADD,,LAKE OR LANDMARK 0 VILLAGE: S 1-AA9 II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. � New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 50 seepage Bed b. ❑seepage Trench c. ❑ Seepage it 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(S use Feet): PROPOSED(Spare Feet): �v o� Feet %Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ga ons Total ##of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank &o0+=,1,9g2,c 1:1 1 0 L 0 L1 ift Pump Tank/Siphon Chamber Li ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plum er's me(Prin PI ber's Signa (No Stamps) MP/MPRSW No Business Phone Number: $Cj C Z- Plumb 's Address( treet,City, te,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certifie oil ster(CS ame CST# 'tom CST's A RESS(Stre ,City,Sta ip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No mps) NApproved F-1 Owner Given Initial CS S charge Fee c7��p�, /� ck)Adverse Determination 14c cW ,�I��" X. COMMENTS/REASONS FOR DISAPPROVAL: T 10.x. SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed . if there is a change in your building plans, system location; estimated wastewater flow (number of bed- - rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; Vill. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; , I I X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground --� included the creation of surcharges (fees) for a number of regulated practices which Wisco Er1' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r+eOsIit'e is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT S T C - 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. ------------------------------------------------------------------------------- r. Owner of property �Jd�-vim 0i/L Location of property 1/4 YU 1/9, Section , T_22N-R-1-1.2-1'W Township Mailing address f � . l/JL Address of site Subdivision name 0rk�3"1' Lot number � J Previous owner of property —Tz> o S+may Total size of parcel -� Date parcel was created \ ems. / F7 Are all corners and lot lines identifiable? _��Yes No Is this property being developed for resale (spec house)? Yes _ No Volume U 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 Mar 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 e d recorded in the Office of the County Register of Deeds as Document No. ; 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 o he C,0unty Register of Deeds, as Document No. ) . U Signature of Owner Signature of Co-Owner (If Applicable) / - / ``' Y� / _ II - RQ Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED y 44401- 00 BOOK r316 REC iS 8 IE- `ti OFFICE This Deed,made between John E. Foster, a single man ST. C+Cf:t CO., WI Recd for Record and David C. Christensen and Bette L. Christensen, Grantor, Qt 2:00 PM husband and wife as Marital Property with rights of ." o survivorship. Register of Deeds Grantee, Witnesseth,That the said Grantor,for a valuable consideration Here By RETURN TO conveys to Grantee the following described real estate in S t. Croix � 2 G County,State of Wisconsin: Tax Parcel No: 042-1105-20 Lot 10, Pleasant Acres, Town of Warren, St. Croix County, Wisconsin. TRAN 22.50 This is not homestead property. -(is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements,Restrictions and Reservations of Record. and will warrant and defend the same. Dated this 10th day of January 1989 (SEAL) (SEAL) • John E. Foster (SEAL) (SEAL) { AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix County. SS. authenticated this day of ,19 Personally came before me this 10th day of January 19 89 the above named John E. Foster TITLE:MEMBER STATE BAR OF WISCONSIN (It not, to me known to be the person – who excuted the authorized by§706.06,Wis.Stats.) foregoing i strtu nt and acknowl ge the same. THIS INSTRUMENT WAS DRAFTED BY //1 Patrick L. Yuengst . P.L. Yuen st Notary Public St. roiX County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: March 17, ' 19 91 .) 'Names of persons signing in any capacity should be typed or printed below their signatures. NF 3573 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 10208,Green Bay,WI 54307-0208 FORM No.1-1982 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I OWNER/BUYER (�" ROUTE/BOX NUMBER FIRE NO. CITY/STATE �Pl�l'r" ZIP Jd ' PROPERTY LOCATION: _1/4 �_1/4, Section ��, TN, R �d W, Town of LJ c� , St. Croix County, Subdivision AJ A- , 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 MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. V S I GNE 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN'RELATIONS (H63.090)&Chapter 145.045) LOCATI N: �'/ SECTION: u/D (o*OwqSH)P/MUNM4PALITY: �TiNO.:BLK.N .: SUBDIVISION NAME: C NTY NER'S YER'S NAME: MAIL G ADDRES ��� USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IA DESCRIPTION: PROFIL D S RIPTIONS: ERCOLATION TESTS: IXResidence New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system rZS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTE :(optional) oU ®S ❑U S ❑U D S MU EIS ©U / ilf�zf�r�,r� If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS l BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHIAI, ELEVATION OBSERVED EST. IGHEST TO BEDR CK IF OBSERVED (SEE ABBRV.ON BACK.) B- I .� B > f,/ B- Ald B— g9' B- V BLL r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I"e#£+S AFTERSWELLING INTERVAL-MIN. PERIOD.1 PERI D PERIOD PERIOD2 PER INCH S' P- P- S P- S, / 42 2 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 � zy "F- 1 E r t ..__ _.,..w.. __ ,. _...... _ ... . ._..7... ' N t E ( � w __ ,r� t / L m_�___d__. 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 Wisco Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME rint . TESTS WERE COMPLETED ON: IoA A CERTIFICATION NUMBER: PHONE NUMBER(optional): Y CS N T e, DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — a y INSTRUCTIONS FOR COMPLETING FORM 115 - S1 - 6395 To be a complete and accurate soil test;your report must include: 1. Complete iel;al description; 2, Tie use section trust clearly indicate whether thislis a residence or commercial projgCt; � 3, MAXIMUM number of bedrooms or,commercial use planned; 4. Is th4s a new or replacement system; 5. Complete the suability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT LASED ON SOIL CONDITIONS; d. PLEASE use the abbrevi,)tions shown here for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately locating your test. locations. {drawing to scale is preferred, A separate sheet traay be usead if desired; S, Mal«e sure Yortr benchmark and vertical elevation I eference point are clearly shown,arid are permanent; 0. Complete all appmpriate boxes as to dates, names,addresses, flood plain data, percolation test:exemp- tion I f,approrli late; 10, If the information (�rrch as flood plain,elevation)does riot apply, place N( A. in the appropriate box; 11. Sign the form ar;d p!acc> your current address and your certification r3umtrer; 12, Make legible copies and distribuNe as rettuired. ALL SOIL TESTS MUST BE FILED WITH THE I_.00IAL AUJHOR1 1 Y WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st:. _ `=tone (over 10") BR Bedrock °oh cc l bie Ili- 10") SS - Sandstone t Gravel (under-3") LS - Limestone 's Saud H G W High Giotmdvvater t,s C arse Sand Pere -- percolation Rate r e(i s - Pvit;tlium S,3nd I's - fir&, Sand Bldg - BU.1Idinct is - Lt,imy Sand _ Greater T;at3 sl - Sandy Loam < - Less Than Lcatn Bn Breuer? s-1 ., Silt Loam Bl Bl1,ck ;i Sift G G;'ry u, - t'lay Loa? 'r -- e[lc�r sc l r:ny Clay Loam R - Red I,,,' r 01y Clay Loam mol - Mottles is - l"',i 1 ty C1>Iy tff - feav, line,faint t _... cagy ?,:#; - C?:)mnit2t7 C Oarse' - o'l ._ pe-s n,rn - l°Many, rnedium n. scsc;lc, d 3istirrst Is - prorninem HWL - High water level, E Six general soil textures surface Water for liquid r_vaste disposal BM - Bench Mark VRP - Vertical Reference Point z TO THE'`ONER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request vt rification of this soil test in the field prior to permit. issuance. A complete set of {Mans for the pr vati sewage systern and a Permit applicati€era Must he submitted to the appropriate local authority iii order to ohIain a permit, The samt;ary permit must be obtained and posted prior to the start of any construction. r= # 3r or RY TV Ar 1�1"w" 7¢VVNS ltPtA�rl 7 Y O 3 f d 14K, oFl �/iAl1't M�►Qi ' pe IMA i C 1 M/ -r S"+ afar Sysetgm Site prie °rop s 6ii'q ,r 1 �k .y N Fi 4 !P1 Nt2 t+# "'V tptragn: tEs TregNlrn aSl PA TA: ' �.fpfSitQn 1{t !f i pf Yt►e Loci area{&;fin the di4ete: . 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OVER � + jA.•e '„.. -7, �'j'� � ',^ '9. •. .gyp."R ;11 Af i JJL � ✓ � r 7S' C'L 93,7 a/h 71 1 + & t r + f ., / Fresh Air 4RIn11' Pfd Vent Gop MlMmwn a Al>aHa A"Coat Iron t.,. 2U-42 Apns'a'Pl�,r To Finoi 041t ' -'' AAY►R h1A Or S Rtluatfu i+ a+tr4� + ' (Sven )"I'll 5 01 ate Ib.Ii'n tm_` - Au2t4go!t, & r Peatloraled pipe aslarr ry o��rkp2 Tertnlnaling Al + ,3t e if Pau 03 4 D P1 A"fi y . �tSTKlf4l.1"?"1C1¢.1 ''ii'"�. AFFItflVEQ sj��t17'111�T►C �$tIR, act 9" qF ��I ► n i M. n ,, ...,�.........,, u ,? �, Br-LOW QRiGIUAL. &BADE . a. ' [315TRIP�LJTjeDM PirE TO eif AT t1,iTC�4_ w AMU AT LEAST40 IIJC:NLS N()? ;.lr? t4L1f? „; 1r. !'uf_k�:5 HELC?W FIklAI C,RAOE u + * 1'1WtUhUA DEPTIJ ©�F E%C, ,�+�'���a �'�, 00,t(It-WAL MAK WILt ruMmum Orp ro O g��{/”. ,�c,�'s ( i�t lza.#,=< ''��Rb .. r:�, 1 . WILD BE 11 .its s LI C E w S c AJ U M B E R ------- � , ? I� �� DATE :