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HomeMy WebLinkAbout020-1152-30-000 � I I p6 o I N N m WW I a� N C U N V C N E � C E I C v v c C y w�c E y I to y y c$ I �m9y.° I v N 5,L a N. 'C Z .O U^C N I U. C m 3 N N O dD N L CO 3 p X 7 U f0 a co or= cu m a L O v L ✓ I M CJ Z E o c d m o D z I o z c a� Z � � I N U ( 5 O O L z co D � _ I Q _ d LL 10 E Vl � d m a Y > � M aN a a a �a, a o •� � 00 00 � U) ro co J U = rn rn } N o> .0 0 co ooii o� COIN a md ii:l z iD I I 0 U �l C 0 Q N_ H H �i +r ° L °D y C CC O H N U o N � y C of 0 .� co y z ~ O N q) 0 N E O N 2 a �2 0 Z c F- O � S v C/1 d ip I d CL v r A ciao 0U) ' /niKE_�f JU��C- L�N'Elz Form - S T C - 104 fir►. AS BUILT SANITARY SYSTEM REPORT OWNER ��-�/C �t,yy-O TOWNSHIP / t(,0 S0/j SEC. .?, T �l N-R /GI W ADDRESS V/dlj So,N/1tER S+,V. ST. CROIX COUNTY, WISCONSIN AI19 t oiU SUBDIVISION f-ox VlLt�S� LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM p,{o aERtr 1�RoDE�TY (,/NE Cue( r Acovos6n jj PR�PE� INDICATE NORTH ARROW No Sc,ALE BENCHMARK: Describe the vertical reference point used 6J0WQ,9_N 's7-,�K✓ � E�pr�/, Elevation of vertical reference point: J00 ' Proposed slope at site: SEPTIC TANK: Manufacturer: jes'E' Liquid Capacity: /000 49,44, Number of rings used: _ _ Tank manhole cover elevation: _J0 9. epff Tank Inlet Elevation:/00. 90 Tank Outlet Elevation: z0 co, rJ�/ Number of feet from nearest Road: Front,Q-7 Side,0 Rear, O J � feet From nearest property line Front,0Side, Rear,O d/0I feet Number of feet from: well _45? / / f (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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: . /�!V g'9 Trench: Width: �g� Length: 3G Number of Lines: 3 Area Built:G4/Ts9.-P4 Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,0 Ft . Number of feet from well: /,3 I Number of feet from building: g9 (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: 4 Plumber on job: License Number: 'Q 3/84:mj DEPARTKENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS 4AeOFT-&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 an SW-14,SE�4,S23,T29N–R19W CONVENTIONAL E:1 ALTERNATIVE I.C. Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 3 Fox Valley NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION ATE: Dave Pientok 606B S ✓0a BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN'. REIF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: lGary Za a St. Croix 102864 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV: TANK OUTLET ELEV_ WARNING LA L LOCKING COVER t PROVIDED'. PROVIDED'. '. DYES LINO DYES O BEDDING'. VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING. IVENANL.ET 1RESH ALARM FEET FROM '� LINE / AIR 1`_ OYES SIND CZ ❑YES 4NO NEAREST 4 DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPE RATIONAL'. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH INE AIR INLET (DIFFERENCE BETWEEN FEET FROM L PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check thesoil moistureat the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: JILENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA rt PITS LIQUID BED/TRENCH Q TRENCHES / OVER PIT DEPTH DIMENSIONS Q co GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL. O T NUMBER OF PROPERTY WELL BUILDING VENT TO FHESEI BELOW PIPES ABOVE COVER. LI! V.INLET ELEV.END'. ['� ^ PIPE LINE + 2 AI��j INLET LP 4-II W , 6S /� NEAREST M d' 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. DYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OeSEIiVATION WELLS DYES ONO OYES —]NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES ONO OYES ONO E:1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.' ELEV.. DIA.. ELEV.- PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS VERTICAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: INUMBER 01 PROPE RTY WELL: BUILDING. FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST y Sketch System on Retain in county file for audit. Reverse Side. SIG ATUR E. TITLE Zoning Administrator DILHR SBD 6710 IR.01/82) `"'��.�. _ Call*— (�, DILHR SANITARY PERMIT APPLICATION COUNTY L In accord with ILHR 83.05,Wis.Adm.Code 5T STATE SANITARY PERMIT# )&0 —Attach complete tans(to the county copy only)for the system, on paper not less than n 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 RNO PROPERTY OWNER PROPERTY LOCATION PROPERTY OWNER'S OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMB//ER CITY NEAREST ROAD,LA E OR LANDMARK �JyO 6 s W(p�o� ❑ VILLAGE : OY�/ 11. TYPE 6 BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. 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. 19 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(Square Feet): �1,s el�ldp 9,9 00 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank v O Lift Pump Tank/Siphon Chamber ❑ ❑ 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*P/MPRSW No.: Business Phone Number: Plumber;6 Address( t eet,City,State,Zip Code): Name of Designer: l✓r. 1 o G VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zi Code) Phone Number: viv — IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) EpVj> Su c arge Fee Approved F-1 Given Initial /��� y�(� Adverse Determination C� 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 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 whengver 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 _Atel' included the creation of surcharges (fees) for a number of regulated practices which Wiscortstn car) effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasutft 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_ 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) 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 nn S Ic S 1�, Section a 3 , T .9 N-R9 W Township _ t"&So nI Nailing Address (013(. 6/ Sp�,reii2 Sr N 4L".05,,,,,--it/! S—Lf01 L Address of Site /­2�> `F- Ct &AJ- � Subdivision Rase F.y, A Il -� �Y . Lot Number 3 Previous Owner of Property Total Slue of Parcel 3 . 6 Ck eS Date Parcel was Created —. ry Are all corners and lot lines identifiable? Yea No Is this property being developed for resale (spec house) ? Yes _� No Volwse _ 93 end 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i loo coJ_Li 6y that as stqtfmvnt6 on thus ohm wee thue to the beJS t o6 my ouh kncwCedge; that 1 we am ,the own b o6 the pnopehty de�sni.bed in t .in6olmati.on 6onm, by vixtue 06 a wamanty eed neconded in the 0661 a o6 the Cou�tty RegiA ten o 6 Deeds ah Do eument No. Q ; and that I we) pnea en t,Py avn tJwe pnopoaed bete bon the selvage di�spoIs eys em (on I we have obtained an fdAc cn.t, to hun with the above deAcAi.bed pnopwif, 6o& .the�m6tAucti.on o6 aaid eyetem, and the game ha.e b_ een dm, y neconded to the, 066tee o6 the County RegiAteh o6 Ott , Doc men t No. SIGNATURE Old OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 10� . DATE SIGNED DATE SIGNED DOCUMENT No. WARRANTY DEED IFTNIS SPACE_RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 X30908 ------.-___ __ __ __..--____--BOOK ���F��t�_.�_______ REGISTERS OFFICE ST. CROIX 00., WISE► Jo_1i�._.........MAB aV r----`-?r-.-,•-a--single_.person._...... Reed. f" Record ft 7th .....-----•--------------------------------------------------•---------...--•------......_ .... of_ o twA,D* 1.9 7 ------------•---••-------------•--- 9:45 AAL , --- -- -- - ---- ---•-------- -• ------•---•---•------•-----•-- ............................ .... ....._.. conveys and warrants TQm Sk toanDd••Vll--P- -•-P • ntOlt--and_-Laura J. A61k 16_ __ . anl__wife,...survivorshi _ ca=�;ks mar i to 1p . p Emmet s ._ ... ... ... .. ........ ----------------------------•-----•------...---•-•---------•----•-----------•---.....---•----•------------------- ---------------•-------•----..............------------•----••----••---.........-......--•------.....---•- L Ac-�.... ................................................................................................................. RETURN TO ...........................................•--...._.._-_.................._.................._..........._....... ........................................................ the following described real estate in ........ .....Q- QiX.........•_.,__-__County, State of Wisconsin: Tax Parcel No_ ______________________________ Lot 3 , Plat of Fox Valley, Town of Hudson, St. Croix County, Wisconsin. I FEE i I This .......is not homestead property. - (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. �tX. Dated this ..----•-. ..--•---•-•-----••---•--•------_. day of ...............•.••--•October--......••....-•----.......--, 1AT..-• I i ..................•----••-•----•----•-••......•---........(SEAL) ----- - ---•---------------••------•---...----•--•-•---...-(SEAL) i ••----•. • Q DSHAW r Jr .................. •-••••---•-------....(SEAL) t4��' - -• ------ ---------------------(SEAL) I I; I *; ............................... ------------------------------------------------- -----• -------- il AUTHENTICATION ACKNOWLEDGMENT Signature(a) ............................................................ STATE OF WISCONSIN ,i it l - St. Croix...... County. as. authenticated this ________day of___________________________ 19...... Personally came before me this ----------------day of Qe ober......................... 19-.8.7__- the above named ------------------------------------------------------------------------------- John Redshaw. Jr-. ------- ----- ----- -------------------------------- ;I : jl ii TITLE: MEMBER STATE BAR OF WISCONSIN (If not, --•---•------------------------------•-------------...--•--•---------------- -- authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the i foregoing instrument and-acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ' ,l. STEPHEN J. DUNLAP • © - I ...hudson....Wisconsin-------------- '-- ------ Notary P lic .._ k__-Cx M.............County Wis. +I; (Signatures may be authenticated or acknowledged. Both My Commission: peel en .((I not, state expiration ; are not necessary.) CC sJ aQ 1.1 date: ) t *Names of persons signing in any capacity should be typed or printed below their signatures. 0 d'C . t ; Mi � STATE BAR OF WISCONSIN KGWINrCflrryiry nn VIIe.WN.M.N FORM No. 2— 1982 Stock No. �3002 H H 9 STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z v OWNER/BUYER st (1_444,K4 ROUTE/BOX NUMBER o ) 40p) Cw,�M�r Sf �l/• Fire Number CITY/STATE /�GlcC.joi✓ G4/� 'LIP 3-yo/� PROPERTY LOCATION : , S� Section 3 , T c� � N , R W, Town of ��5-0 , St . Croix County , Subdivision OX 114 Lot number_. 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 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 I E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- �v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoni ffice wi Vday of the three year expiration date . SIGN DATE d?a 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 RE03RT ON SOIL BORINGOANQ SAFETY&BUILDINGS DIVISION INDUSTRY, DiV)SION , LABOR AND C P.O.BOX 7909 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 .(Ht43.09(1)St Chapter 145.045) LOCATION:s UNCIPALITY: Z Dx I o�vv _2 %TZ UIO �N1.4E COUNTY: -5T cenix cq. T-o oiCA 'STN obso S'4o�b USE two _ t DATES OSURVATIO M MADE W[ResidsUN ❑Rspls ~r )CS k mss[ SFs Sr��l.s �Z $uR� NASD i RATING:S•She wlsoble far soses U-a"dnwilabla for system $ a� E IN C ED SYSTEMaop iorq I IN 11 io L Reb If Percolation Tests era NqT reowked RATE: If any portion of the tested area is in the A under s.HB3.09(6)(b),Indicate: f,M4SS ' Floodplain,indicate Floodplain elevation: K �1CL r PROFILE DESCRIPTIONS BORING L TEXTURE,AND DEPTH NUMBER ELEVATION DR K F OBSERVED E ABBRV.ON BACK.) B- I q•1-7 Q2,7Z 0r4 Ir > 9117 9`9LI-TS lf&444 73 S cob 9 75 g,' t.t.-rs ''Q StGre Vcqlo 85"1_T9#t )►tS>rG /o4 .69 NO NC >9.33 ,r DTs if S-f 6 k(-&k4m i ChANSt6st 6&wt7• 11S ®- 4 /6.4-L /oz•99 r4GN& /0,47L 111,L-rs z/''Be L 3o 441"St4f-63 Sa TMS+,Q N B- //.,So >l 1.50 �6" St W& S46 ►�ob 77 LT %i4l. B- �- PERCOLATION TESTS TEST DEPTH- L NUMBER AFTER LI RVAL-MIN. PERIOD I PERIOD 3 PER INCH P. 10 tihw& 161-C-7 P- P- 2 0 y C P- LfyA% low PLOT PLOT PLAN: Show locations of percolation taw, soil boritt�yi and the dimensions of suitable toil areas. Indicate seals or dfatsttcxr.Describe what are the hors• rental and vertical elevation reference points and show location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 3 SYSTEM ELEVATION 9, ��" � I - �- f i { O � 1 oe i I_ .._ _._ i_, _........ xz - Nt? k4-E gkr,4--4 ; _ i _..C_ T j i I -­4 t 1 , ' 1 _ N 1,the undonigned,hereby certify that the soil tests reported on this form were me*by me in accord with the pr ras a nd'hhh�CipecifIod in the Wisconsin Administrative Code,and that the data r000rded and the kxstloli of the tests are correct to the best of my kn belief. kk 44 it 14 NA rint : OMPLETED N: A opt U So ry hyc 4A 26 190 ADDRESS: // CERTIFICATIO NUMBER: P ONE NUMBER(optional): Q6 <,&wN� S; /� ubl oN S4oi� S&6-4 b A URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. / DILHR-SBD-6395(R.02/62) —OVER — / 6o'ro �vo2Thr /°�oP.EiLTY Lz..,,E' )) /� �L UT AA1,o C/Loxj i` S�r-T--oti 102,9A,,s X133 i QoIQ ALT Sl;r "C,Z. /.SLOG,S,5 k.,E2 � � BitnPaSEO /,EW /DObGAL GgRAGE �� ,rEP7Y'G Tiirvli ovL-n. /oo ?0 6✓ PADPEtZTY lsvE y EAr'LNE � LZrvf_ /�jiopoSeO %\ T wiV OF Amwory RESIDENCE / \ Sl_ Crrarx CUr,IrvrY f1vp�� c G 36' WELL ^ Q P/Zo/'DSED fo/LZvtw Y-� a/'1. Z3 TOP 6r- WOO 14Ug Bzx,-r[O OAA,,)GE ELEV /UU.00� WILL- = P1wPE/z'fY /� lk)LWay LSNE 'roaTN /iZoPE/L,TY LZivfi /5ASr A1'T Nv JC19LE FRESH AIR INLET AND OBSERVATION PIPE rte' APPROVED VENT CAP W.M"M 12" ABOVE FINAL GRADE 4" CAST IRON 'VENT PIPE tvW.X.IM M OF 42" ABOVE PIPE TO FINAL GRADE SIGNED: IMRSH HAY OR SYNTHETIC CO ERING LICENSE. MINlIv1LM 2" AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE TEE SOIL TESTING BY: i # i i ELEVATION BED 6"AGGREGATE • 8OTrOt%4 PER SOIL BENEATH PIPE PERFORMED PIPE BELO"' TE eTI$ _ I • r._,'D!IPLING TERMINATING FT. A :,T BOTTOM OF SYSTEM