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HomeMy WebLinkAbout020-1171-80-000 N* 14Z g m 0 7 � ~ � / A � § � 2 � $ � \ � � 2 � % ) LL 0 � k � 7 . z B « 0 z ( 2 / \ . a ■ § � \ z 2 / t $ § a g { § � \ ) ) \ - ) k § £ � I � k � j 2 ^ 2 0 C % / ( 0 § f § k a 1 2 2 § I CD / m k \ } § � R k K k CL U) ) " § a a a ) 2 o B co 00 m Q : « CO § ƒ 6 & 5 = @ j0 \ { = \ E \ c .. � 4) .2) a _ � W_ E n \ o , � G § § 6 o u a « o o / \ k k k,4C. § (D C*4 04 2 K J 2 =_ / / -� � § 2 2 ƒ § 0 2 f Q 2 U © © � 7 2 L I .. i a v � � \ Ez � � � � 5 c J a 2 ; 0 3 J Parcel #: 020-1171-80-000 12/13/2004 04:07 PM PAGE 1 OF 1 Alt.Parcel#: 7.29.19.1073 020-TOWN OF HUDSON Current ❑ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): "= Current Owner *PLAHN, GREGORY JAMES GREGORY JAMES PLAHN 314 EDGEWOOD DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description `314 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.040 Plat: 1932-EDGEWOOD ESTATES III SEC 7 T29N R19W LOTS 116, 117& 118 Block/Condo Bldg: LOT 116 EDGEWOOD ESTATES III Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1102/198 QC 07/23/1997 791/210 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49114 201,100 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.040 27,500 128,100 155,600 NO Totals for 2004: General Property 1.040 27,500 128,100 155,600 Woodland 0.000 0 0 Totals for 2003: General Property 1.040 27,500 128,100 155,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 108 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER7� g�s TOWNSHIP z,J=;oi i SEC. 7 T N-R / 9 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIONCt Ca, LOT �( _ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I.HR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i Ilj � Sz' �r _4�, a < . o I � �•rs �4 Zv 1-114 Jj I pr'rv� wt� INDI-CATE-NORTH ARROW BENCHMARK: Describe the vertical reference point used '2_' ���dt 'P�� SG(>lot�aih¢✓ Elevation of vertical reference point: Proposed slope at site: ? SEPTIC TANK: Manufacturer: LtJa,g A' Liquid Capacity: /0(:7?ef` .! Number of rings used: (f) — Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: (� Front Q Side X.J Rear O feet From nearest property line . Front,0Side0Rear,O /DO feet Number of feet from: well CvS/ , building: 54z-_ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 7 PUMP CHAMBER t Manufacturer: A/A Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: m Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Con �7a�{�i o KoT Trench Width: / Length: Z . Number of Lines: Area Built: T Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ©Rear,0 FtaG7_ Number of feet from well: Number of feet from building: S� (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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj L Q�PAR,W_NT OPT INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION rBUREAUOF PLUMBING P.O.BOX 7969 MADISON,W 1 53707 State Plan I.D.Numbed CONVENTIONAL ED ALTERNATIVE ill assigned)SW%,NW%, S7,T29N—R19�rJ []Holding Tank ❑In-Ground Pressure ❑Mound Town of Hudson INSPECTI DATE: NAME OF PERMIT HOLDER:• ADDRESS OF PERMIT MOLDER: r Greg Plahn Route 2, Box 333, Hudson, WI 54016 30 REF.PT.ELEV.: FRIEF PT.ELEV. BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN: Name of Plumber Number: MP/MPRSW No.: County'. Sanitary Permit Doug Strohbeen 5432 1St. Croix 106120 ''SEPTIC TANK/HOLDING TANK: LOCKING OVER MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. ROV ID DLAB L PROVIDED ) 00U 0`0 .3 b PR ED ONO DYES �NO PROPERTY WELL BUILDING VENT TO FRESH BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: LINE.OO �� �� IAIR INLET C ' ALARM FEET FROM OYES NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACT4OF WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ONO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTRO LS OPERATIONAL. NUMBPERTY WELL BUILDING AIR INLET FRESH FEET(DIFFERENCE BETWEEN ❑YES ❑NO NEARPUMP ON AND OFF)SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing ENCr" ER MATERIAL AND MARKING FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LIQUID WIDTH: LEN TH NO.OF DISTR.PIPE SPACING COVER INSIDE CIA -PITS DEPTH BED/TRENCH / a S� TRENCHES 61, MAT�ry� PIT DIMENSIONS J �,,/ GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET EL E D/`✓( �- Z ` PIPE LINE) AIR INLET/ rr l � — f' MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ONO ' PERMANENT MARKERS OHSEH NATION WELLS SOIL COVER TEXTURE DYES ONO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. OYES ONO OYES ❑NO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBOTION PIPE MATERIAL.&MARKING ELEV.. ELEV.. CIA. ELEV.. PIPES CIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO JAPP INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRE CTLV COVER MATERIAL PLANS ❑YES ❑NO OYES ENO COMMENTS: PERMANENT MARKERS: = NO ELLS: NUMBER OF PROPERTY WELL: BUIFEET FROM LINEYES ❑NO S NEAREST-, jq10. 0,3) Sketch System on Retaiffi in county file for audit. Reverse Side. SIGN ATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator SANITARY PERMIT APPLICATION COUNTY LDIL.HR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# lill Zt- —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 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION �,� RLaA 64v '/4/YW '/a, S Tot , N, R /�'I E (or PROP TY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME RX Z- x`333 //ZI/Se7 uJ� // -//F� — ED�oE woc�ms s CITY,STATE ZIP CODE PHONE NUMBER CITY N//EE�AREST ROAD,LAKdE OR LA DMARK E:1 2/ VILLAGE 41S.0', 11. 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. IX 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. le%j 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. X seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Squa a Feet): S of ,7 /`r g?_3o Feet Private ❑Joint ❑ Public VI. TANK CAPACITY ` Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks Tanks ❑ Septic Tank or Holding Tank X I Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: zV 32 33 PlumbereO s Address(Street,City,State,Zip Code): Name of Designer: oe- T //.w ;c A rn o !.v Vol 7 .moo e4 :57�,pA b d¢01 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# #0 rY4z mhv+S0 ev 3 $ y CST's ADDRESS(Street,City,State,Zip Code) Phone Number: o s�Ge.�d sT f-�d/ZC1r► 4e_� Sao/� is 3�L- Spa fia IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) gurcharge Fee +Approved ❑ Owner Given Initial ' ^\ kt M c Adverse Determination X. COMMENTS/REASONS FOR DISA PROAL,: 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; 11. 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; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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 tank:>; 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 At included the creation of surcharges (fees) for a number of regulated practices which Wisco !T 'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried resure a is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 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) I y } w 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 S w 1% /V4/ , Section , Ta,,�;' N-R /9 Township ��so�, Mailing Address ���` Z go r Address of Site Subdivision Name Lot Number i!e- Previous Owner of Property Total Size of Parcel Z- >� �� ✓5 Date Parcel was Created 3 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes �_ No Volume -7 and Page Number _--) /l' 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION i (We) eeAti6y that a t statements on this 6onm eAe tAue to the best o6 my (our) hnowtedge; that 1 (we) am (are) the owner(.a) o6 the pnopen ty dens cA i.bed in this in6o4mation 6oAm, by viAtue o6 a wa Aanty deed neconded in the 066ice o6 the County Reg.i,6ten o6 Deeds ad Document No. 3�0 _ac� ,— and that I (We) pneaentC.y own the pnopoded site bon the sewage didpowae byb • (on I (we) have obtained an easement, to nun with the above de cA bed pnopeh ty, bon the eon6tAuc ti.on o6 baf d dyd.tem, and the bame had been duty neconded in the 066ice o6 the County Reg.ibten o6 Veede, ab Voeument No. 4 3 O Z a 5 J . fly 27 SIGNATURE OLD OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) -r oz� DATE SIGNED DATE SIGNED ' .a r H` Y ' :»• - 64 4 '{ y • ....«a♦♦Yw... M.. ..M ..KQ ....1f K y ' .........-.......R.....iw..«..........i.........i.«.:• -„ J S iTgs..W l.. ...y.•.w.W...•..• .... ♦ .;'.M • • '�-'•• <. • alga-aid tira"w.'aor a vabow! -..... - '' .................................. .................»...., � ..do"0 a 4000" 4.. Lots n6,- 117, and -118 Edgerood Estates 'Town of Hudson, Sti Croix County, Wisconsin. ? %vv �` .. ..nor► .... bumeb"d pe pull 1 (ii) it �) aid Swww as bwomm ma aid affun aamm *we=" # a � -Almd. _ -. watefalr tMt IM tMb is • iadetatoWt y��M iw and feet a"ebw Of easements, restrictions and rights-of-Man of rood, IR r L,rwt. .............� ......... ...... dad � .....-.... -B ,g H De . . ...pment, Itlo * �,• � ��; • .,y ............................................. • . .. ... ...........:. . aftsssxc�:=osi ao=xowtrr � '$ = l+rt te4l �%... t.�AAG, WA" off Wal col a2 A- ct of ..1.7 is ......,�lgr�[. ...................3l...... ar boom tr ss�s•.r✓ ....-... » - «..... • +Q/5 t!tfiA- °�l'l..l.7....t..: m ►� v b cC..v✓ ..E�✓ .. .. .........� _Y� R��llN*1&0! ..,.... _.. .. ............................ _._........ . x , ..�.. ' (ita........ .....• --•..... ........ ................ :--.. ......... ......... ....... ...,..._ . by a 4l6 ia.ww StatsJ 4 - to me twerra to M t4 ip"+ a ......... arlw arMiwiMS MMr � _, l�eeaaiaC:�Rtse`at and euulpoNMY�e MR. TtaS WWRL AgHt WAS OWARKO Or Rr sxins lana Lunde*n fg " l' tarney,d ` ..................... ilsip► �a"0 aaith �tkMed or .d"Wiedget soh► . xvar ra. a air,o.t+�to.rraa date `�` *�IilAlit Riw�rr, is ees arlA�ltf�#wti M e.e•d•►Ir�M�MO i+�ne+�► `-_ ?` TM'` - G N H STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z tv 9 OWNER/BUYER PIcckr! ROUTE/BOX NUMBER Qe'�Z,Bo a33 Fire Number CITY/STATE ZIP Sy le- PROPERTY LOCATION : ! ,4/ (J �, Section _, T a g N , R /f Town of /�`4/✓.3or7 St . Croix County , Subdivision gEalyz good gry�5 , Lot number//G-/M- . improper use and maintenance of your septic system could result in I 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 •cn to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- w ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office ithin 30 days of the three year expiration date . SIGNED J 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 . DE°ARTIyIENT O'F REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, �------ DIVISION LABOR AND PERCOLATION TESTS (115) MADISON,WI LABOR RELATIONS 09111&Chapter 145.045) LOCATION:4 SECTION: rr WNSH UNICIPALITY: T NO.:BLK.NO.: SUBDIVISION NAME- 4W�/ �/ 7 /T vi R/9 j,ori W / UDS6 1M VP — E s-r T COUNTY: OWNER' Y AM : MAILINU ADDRESS: T 0() /h Ge(C,OIRy P IN USE N DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DE CRIPTIO TESTS: PResidence � New ❑Replace �/ f /9e 7 3 /9 e7 -!SOILS k AGE 49 Slots s 'kL"Z1-'T- RATING:S-Site suitable for system U--Site unsuitable for system NV gN• IONAL:IMOL(� IN-G S(�E -1 -FILL OLDING TANKK:RECOMMENDED SYSTEM:(optional)/ k- l O 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: LASS Z (Floodplain,indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL H N R UD ATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER EPTH Ai. ELEVATION OBSERVED EST.HIG TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 .17 90AG '`:, N L > 10,17 9 ccTs ib" R 2g„BQ M516k 6a” MS s B- 7 >9.08 5RLI s /-7*90 'Si4k GOA S4„915 MS'4C & m. B- 'N"QeNS,L Z?'i" CSfGR 30"'& sMS I2" c_,L rS C Q q%,L s%ejy Ao-r O' 37 Gy St B- ` Sf3\ '0,q.1-7 / ': r > 8--'s RN&Y MQT Cot- / "I&e S - P G B- j 8.33 v,9 I 8 33 IL TV 2 S[C 2 3., S tC„e Is eA,I& S C, B- r PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP .WATER L V - NCHES RATE MINUTES NUMBER 1_- t a AFTERSWELLING INTERVAL-MIN. PERJQQ t gE `D PER INCH P_ I 6,59 �9.$ �_ I' 4 1'� ' + 24 P- 7 Sv >� Z < 3 P- .3 A.(-,I , - 61-x1 I 2 /S 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. �flL 83 '90 PalMdRr SYSTEM ELEVATION ALT+r�eN>a AQEw MOON4,'SYisTEM. o •SLopc r i I I , _ GIN • � _ i , 10 r 1 .rr a .c�� biro a11fM � 2 q IRON PIPE �^ CLEW IO�.00) , �►P'( � \ � � I ''`'f c $,;y 18-7 F38 /3 Al. � UDSON i(iodf I,the dersigned, hereby certify that the s tests reported on is form were made by me in cord ' h the procedures and riietfidtls slkr t,w n e trn cvnain Administrative Code,and that the data recorded and the location o'g2tie tests are correct to the best of m nowledge and belief. NAME ''pr/Iint): TESTS WERE COMPLETED ON: y HAR✓C`/ J�WNSnrJ QLf tt SuQJfi:I►nl�� /a &usT 13 087 ADDRESS: 1 I CERTIFICATION NUMBER: PHONE NUMBER(optional): 467 Sc����nla ST 1�/�� N 1�/1 54�►G X484 ?8G- 4o�v — CST SIG ATURE: DISTRIBUTION:Original and one copy to Local Authority.Property Owner and Soil'Testfrr. DI LHR-SBD-6395 (R.02/82) -OVER -- J yr . r 6 H cr d • T . J. � J Q O 1" ;.> IL i ko 3 � a . . e 1 :� a A ( d 41 d 1 J 14 • � o ' C �q r ' Gre9 (, w0oA F_ 5T4Lt'I?- systa FIV. Scala x!14 d g. M, z /mfi % P� s .w. *S s a n)QGl f. = loci.0 f 3 �3 It, 44 oA0 A ors Al e `' 81 B► T M ` 4r4s2 vX3o� H°4 sQ a r SOU "� 7 l,'t/C.— I .e , , . ` �+ .. t �R" 0 �'