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HomeMy WebLinkAbout161-1092-60-000 CD 0 6n� 140 > (D C4 cz m 0 'Rip mo 0 0 }\ c 0 (D 0 ID 0 Z Z U. E o CD 0 m 0 0 (D z CD E Z 0 I LU CL ■ c 0 E 0 z :i U) 49 Q) c E z V) C E (D CL 0 z In z z 0 CM E m x CL c 0" ci .0 E cL U) 0 ca CD N m U) 0 z 0 o o o if CL IL IL IL l.; U) Z 00 00 0 0 ; 00 00 0) 0) c 0 z tt= a) a E # / . @ a. c 0 0) ■ -a C4 o m CD E U') 0 9 t -5 a) 0 :3 0 C) c, o CD CL 0 z 0 C -a 04 C*4 0 CD 00 o C4 0) Z ■ 0) Go (D 'a ,..4 clq .2 E -r- C-4 o w L) co cl) (D ;: > LL 0 z z CL u E E 0 m CL LO) Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER (/j(/r,, �f/V/' TOWNSHIP Vrr,ioyr oral!/,/ s SEC. T R 0W ADDRESS 9--?9 ,f'T.o7-_-6,v Go IV, ST. CROIX COUNTY, WISCONSIN SUBDIVISION �(`�, ,Q y �T,�71,2 / LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1, HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l��St a� •I i I �\ WEcL ,P/QOPO,co 39' 1 I i I I I I ZA sT" 93� SPiKe` /,v ©A K 'rR cE Sc�u-r I-F INyyD//ICATE NORTH ARROW µ BENCHMARK: Describe the vertical reference point used SpirE reset /vArs til 0,4r �EE Elevation of vertical reference point: /OD Proposed slope at site: SEPTIC TANK: Manufacturer: Ly/ Std Liquid Capacity: 4?SO 6k4, Number of rings used: / Tank manhole cover elevation: Tank Inlet Elevation: 9.S OS` Tank Outlet Elevation: Number of feet from nearest Road.: Front 10 Side,(D Rear, 0 / yJ� feet From nearest property line Front,0 Side 10 Rear,� �� feet Number of feet from: well �4 building: �4�• S ` (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: G 1OV. tT(7. 3 Trench Width: o{y Lee'th: -T 9 " Number of Lines: 'f Area Built:- Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, (Rytear,0 Vt . �� Number of feet from well: Number of feet from building: (Include distances on plot plan). i 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: C Dated: �Qp Plumber on job: License Number: t" 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION 6MADBOX ISON,W,WId I 53707 BUREAU OF PLUMBING MAD Gon't Lot 4, S12,T29N-R20W XXCONVENTIONAL E]ALTERNATIVE I State Plan I.D.Number Town 06 Hu on ❑Holding Tank ❑ In-Ground Pressure El Mound (1f assigned) Lot 6 St. Dtoix Station NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: John and Many FehA 239 Station Lane NoAth, Hud�svn, WT 54016 4— 96 /Jo BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT,ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No. Cnu my Sanitary Permit Number: Gaty Za a 3300 S ctoix 112808 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER �j n PROVIDED: PROVIDED `°� 'o I �1 GQ TES ❑NO DYES RKNO BEDDING: VENT DIAS VENT MATI HIGH MAT H NUMBER OF ;qOA D: PROPERTY WELL. BUILDING: VENT TO FRESH I/ ALARM 19 PEAT FROM )4 LINE_ AIR INLET❑YES �NO ❑YES I_+?NO NEAREST 4 DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACI TV=CONTROLS E L. PUMP:SIPHON MANUt ACTOE WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑ ES NO DYES 0 N GALLONS PER CYCLE: PUMP AND OPERATIONAL NUMBER tIF PROPE/V[fi EL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEAT FROM LINE AIR INLET: PUMP ON AND OFF) ES ❑NO NEAtiAS3---�1� SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE Nt.T+ JOIAMF TEI 111AT NOMAHK 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 ILENITH NO OF II PIPE SPACI N( COVER NSIDE UTA -PITS LIQUID DIMENSIONS 37 THEHFS MATERIAL' PIT DEPTH GRAVEL DEPTH ((FILL DEPTH STH PIPE UISTH PIPE DISTR.PIPE MATERIAL NO ( -TH NUMBER OF PROPERTY WELL. BUILDING VENT TO FRESH BEL W PIPES ABOVE COVER E)EV INLET ELEV ENU PIPES LINE AIR NLET// t ���i ��r�� a7a 4 FEET E$ is (� 4a �o t 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PEHnIAN1 NT MA11 KFHS oBSEHVATION WELLS _ EYES ❑NO 1:1 YES NO DEPTH OVER TRENCH BED fEPTH ER TR ENCH HEU DEPTH OF TOPSOIL SODUF U SEEDFD IMUDYES LCHED CENTER ❑YES. 1:1 NO ❑YES F-1 110 ❑NO PRESSURIZED DISTRIBUTION SYSTEM: .I WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH eE LOW PIPE FILL DEPTH ABOVE COVER BED/TRANCH'' TRENCHES: DIMENSION : MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DI STH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. CIA. ELEV. PIPES D A; ELEVATION AN DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED V PLANS DYES ❑NO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OI- PROPERTY WELL: BUILDING: FEET;FROM LINE J DYES 1:1 NO DYES 1:1 NO NEARESTL- s Sketch System on ,� n Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. Zonin tli��t�,atan DILHR SBD 6710 (R.01/82) 9 DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code 910— Roa ....�..o. STATE SANITARY PERMIT# /iaBU � -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 5A7J NO PROPERTY OWNER ROPERT,`!1 CATION .�. .R.^ /S- 2 /aL o '/a, S c� T , N, R �O E(Or) ROPERTY OWNER'S MAILINQf ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME - CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK ,�. 1 r! TOWN® VILLAGE: / D fDN t n.f II. TYPE OF BUILDING OR USE SERVED: U Number of Bedrooms if 1 or 2 Family 1 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. 9 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. M seepage Bed b. ❑See a e 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(Square Feet): C Feet N Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank "D AS70 o ❑ Lift Pump Tank/Siphon Chamber I I 1 ❑ ❑ 1 ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,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) 4*WMPRSW No.: Business Phone Number: OO umb 's Add resf treet,City,State,Zip Code-): Name of Designer: ✓ N v>6 6V VOL SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# G v� �WC Zic �4 Z� CST's ADDRESS(Street,City,State,Zip Code) Phone Number: L ,., 6 s- e` 0 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial charge Fee V Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: 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 lumber requires a Sanitary Permit Transfer/Renewal Form SBD 6399 to be 9 P P q y ( ) 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; 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 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 art @t included the creation of surcharges (fees) for a number of regulated practices which Wisco fh+S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried fe�stsre is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. a 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 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 John U. and Mary M. Fehr Go:&t�.fiFn.T Location of property L.7 1/4 Y 1/4, Section IX , T 0 N-R 2,0 W Township %ot 6 . St. Croix Station in the Villase of North Hudson. T Mailing address 239 Station Lane, North Hudson, WI 54016 Address of site 239 Station Lane, North, Hudson, WI 54016 Subdivision name St. Croix Station Lot number Lot 6 Previous owner of property John M. Griffith, Jr. Total size of parcel 1 . 1 acres Date parcel was created 12/01/1977 Are all corners and lot lines identifiable? XX Yes No Is this property being developed for resale (spec house)? Yes XX No Volume 817 and Page Number 420 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. ------------------------------------------------------------------------------- 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 deed recorded in the Office of the County Register of Deeds as Document No. 439783 ; 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 of the County Register of Deeds, as Document No. ) . Signature of Owner Signatu a of Co- wner (If Applicable) 09/28/1988 09/28/1988 Date of Signature Date of Signature *j " MPY* ''!' 7'3.1 # 1 t >{ ! >fli '1 1MOc �`! ,l1 VV twe : >SA'! llll�l WANUOry ow rw• 817 440 T _ , This Dead. D O& I+sewes. John M. Grif f itb Jr. .... ......... ...•. • •• •------•........... .... .... ---...................... 1 .................... C:ra+ttnr. -JUL f• .4;. ��ea...._... ii autsria�orsbip rtritsl..Aropsxs=---..--.•-------------------- ...._ d i0s0?i' ' .........................................•- - . -•••-•-_....•...•. --- --•........ ., Grant^ � V � 1= �+ •F Wl ,'Act the said Granter,for a valuable consideration...... MgMN► � a ............................................................... .................•......•... is fie slltss the described Beal estate m 8t; a ........... eaereeya leiisldag amm To Ce.aty, 81tle of Wisconsin: in the Village _ .Lot 6, St. Croix Station ag a of North Hudson. Ta:Pared No: .». r �¢ r s FEE J y ye§ This ........."..not....... homestead property. �1 (111 not) t Together with all and singular the hereditament and appurtenances thereunto belonging: �." And...........1Qbn.Xw..Gr J1fith,._..ar A..................... ......._ ......... ........ ... ............................ '.. •c. a warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except :t easesents, covenants and restrictions of record, if any, MF and will warrant and defend the same.. Dated this ------------------------------------ ....-.... dram of .......... .........m W. _.. 1888.-.. ar .(SEAL) _. . . .. (SEAL ..........................•----.... .............................. -- John M. Griffit Jr. .(SEAL) .. . ........(SKA]W ...................... ............ .. ......... . \ AUTURNTICATION ACRNOWLRDOMRNT #' ;. SigDatare(s) ............................................................ STATE OF WISCONSIN ......� - ...... St. Croix nun y sutbenticated this ........dsy of........................... 19.._._. Personally came Wore me this ....1 S ......day of -•---.. Jui j"............. 19...of. thw rhnve named ------ ----------------------- ---jrl...... -•-•--•-•---•---•-•---------------- .......................................... ---------------- .................... ........................ ;• TITLE: MEMBER STATE BAR OF WISCONSIN --------------- -----• ••.................•... (If not-.............................. 1." ri^t1 .... .- ... - - . - �. .; apthorirwl by ?fMS.(IR, Wis. Statw.) ._-. nhn everntM the F..1 I.'.•.. ,Lirin me known to }.e •he saran-► .. repo' stntmrnt ekn a darn tl a sAme. " TMIA INSTRIIMENT WAS Dn AFTPD AV _ 1iEYW00iD, CARI i MURRAY by Samuel R. Cari P.O. Box 229 Malry M 'Fi,IU>< Hodsoni;-V1------•-540%----------- - --------- Nntn... Public .. St-. Croix. County,`Rill. (Signatures may he authenticated or acknowledeed. Bnth My Commiacinrt is nermnnent.lif nut. atntw etn2T#1(on . eve not neressary.) date: _. ............ ... oxam"of nersnns Amin*in•nr e.nAeity h­14 W 10!!ED aTATR DAR OF WFArONt"Ai Nivennain Jwhral Bisslt Oa;111t. ° FORA lire.I—uss Ililwaaksm wiw a v r STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ?.nhn U and Mary M Fehr ROUTE/BOX NUMBER ?39 S.t @ t n r ane ,-, FIRE NO. CITY/STATE r udson' W1 5[ 016 ZIP GrL°•.w�etiT , �i _0 PROPERTY LOCATION: 1/4 1/9 Section T N R W r► of St. Croix County, Village Subdivision 2t,Croix 2t2tiQn Lot No. -6 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix Count Zoning a certification P P Y 9 Y g form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE OgI9811 ARR St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address ' DEPAR ENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTR DIVISION HUMAN BISIR A RELATIONS PERCOLATION TESTS (115) MADISON W 53 07 (H63.09(1)&Ch tar 145.045) SECTION: TOWNSHI MUNICIPALI OT NO.' LK.NO.: SUBDIVIStO NAME: Lo~e-"%y1 �, %T z9 N/11i (or) V►�-I,MQ TN '5�4, sTcQp►x��rirt0 COUNTY:/4'1'/� W NAM 6/ zNO ST o 1<4 X40 E DATES OBSERVATIONS MADE NQ : CO IP ON: • Residence /��V, I New ❑Replace MAY /? /986 • I wf /4 /9ta Vl 156t-s K a�49 So,�s ,cflcg- vQ$d /�1 RATING:S-Site suitable for system U-Site unsuitable for system V : MOUND: IN -FILL OLDING TA 14 ECOMMENDED SYSTEM:(optt nai) ' S DU f'S 0 S. ❑U I ffS ❑!! 10 S C6NVnrr160VA if Percolation Tests are NOT required DESIGN RATE: a`A eq If any portion of the tested area is in the .`l under s.H63.09(5)(b►,indicate: C(�d�s ! Floodplain,indicate Floodplain elevation: c PROFILE DESCRIPTIONS BORING TMAL T I CH A SOIL WITH THICKNESS,COLOR.TEXTURE,AND DEPTH NUMBER ELEVATION y TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) Ica b .r B. IZ.91 12"6�sc r�"�e$a S+C 23"&BONP& B- 3 t 3,t7 gb S4 Nam; Q /o ksl-> , 116 'a t all 140 ri gr /ta'"pL%TS " " a F'S 63hLr B- ��•1-7 �7.�5 1 /�/ayt� >/2r/'7 iz'gc sTS SI BQMMS /6'QaFS 7r�rP B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME RATE MINUTES NUMBER iii?.'TiBFa AFTERSWELLIN INTERVAL-MIN. PFAIOD I PfiFlIQQ2 PERIOD 3 PER INCH P. P- tNaro ti s.4 3 < P- c.4 3 *> 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. y ft",A,Pv- SYSTEM ELEVATION i I � SoPK �} + it's $ w bbr&o &L 'BoRtw;t34' Ckc,EAT- 950,1144� �.1Qo(}S op svt�'4&N1,'`t ANA IS 47' + r D_ TI-•C 4F : -nAE " IScoAL'- T14 r- sYsT6k\ i °y �,q q�W-4IWI&tV_- ►K.e- IN ChAY,. rs ?s_Att is A? IAN J tU.`1A-t'lON To al, 3 1 -rkt fN ALT&NAYC Ate/ r g- (3z' t< N �OO.ot� M StxON 4R'C �, NC 10%AR k `To P OV 'E4AST- ALT SrroP� 1 svirw of LaT F_LEVAn-IbN 2 /07.41 _ l4 z4'•� $-`� ��`�� AI i 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with*.. =a nd methods specified in the Wisconsin Administrative Cade,and that the data recorded and the location of the tests are correct to e t o y knlief. NAME(print); TESTS W E COMPLETED ON: /1. a►t)1 `�GrV ,tJ ud '•lo MAY'- 14 l g ADDRESS: /, CERTIFICAtTION NUMBER: PHOUNE NUMf�BBER(optional): •gr"j ST SI ATURE: 1 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and$oit'rester. 131LHR.SBD-6395 IFI.02/62) ._CVER _. . " or / -LOT /JlvD C.rtols' /Y9"TV Nc/Tii opito%9ATY lznr - or�� In��LL r J,E C TZ"o/v PLio ry S AESZDENCE i f iio,pvSED p Qd�/ �—.fcwF2G �/lipPoShJ� /&so CAL. 6ronAG6 .TE/°T LG. fi TANK LsNr //Zo 705C- + /-- r<l DAMVEtvAY IJUJ✓N / kIVA .rLvPB� /3a � /1/�'L✓ .�>'STLI'yI vEniT STAGIC � a3 p V 11 A G t' of IV, A✓uo.fOtU r W--1.3A SS J'fz)e zw T-atE �j Sni /aLT SSTE' ELEV� =/on.00' `� / LAST /9,,- ,Ty ALT. Ls"r S`rTE 67. _('Lope y LoT bl ay A p wr�.c-r fhoPE�7Y /_sNE ✓O J 1YLA-rTLl,4 LANE l./VL5 MESH AIR INN FT AND OBSERVATION PIPE r SCO.E F it'AL GF f.JE i �:. CAST i~tiON 'rE74T PIPE &O.'X Ifu4 JM 0-F 4 Rc'V-,+ I I I a A fYY'.SSCl 114J4 Y OR ,1°i 11 MG 1 F{s p.s+.i4 F11a`f;ul- }� i_'[CF..N E. 1 rl_____�_.�� I41iFiit��f_Jlv�it�-" �by�a+"�F�Ea.�r�-iF i i y r: C;'.TT: ___,✓� c>4�ER 3'I FE 1 i DISTRIBUTION PIPE g � iEE ELE a i!'?P'+R 6ED 6" t'1A4.7F'e& f t'iT0'�.!id PER 011- �Fhdk._,$�1!F►��E � � �+� -I- FYEFFrJl-iA IUD PIPE c r °® 9 I r_f'-,U FL MGs TERMINATING G