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HomeMy WebLinkAbout030-2020-90-100 § c . ® § % I \ . k ° � _ ƒ � I � k � ) u o I c \ 3 \ \ � � < � � � _t § � R R : E k � ; / \ a m i / § ) z :!t 2 / \ . 2 : = k / 7 { [ \ 4) E / 2 2 9 c CO. N ? } f � c 0 6. \ z / z O " .. k § \ La N ( / C, $ / § gg 92 0 o a f r . o o 7 (N I � k � \ \ , .. 0 0 0 k 3 3 9 § a a a IL : § J2 \ co § ° e ; ; = 8g R \ § e o o c f § § _ / E / / = 2 . r D / ) 2 0 � 2 $ � � 2 © k ) ° \ \ § 2 I 5 _ E « 0 0 2 6 3 / : 2 } ƒ = o \ 2 k k ' - . E ) § 2 3 / $ o � o a c ± e c - % 8 / o ) m - — z a ¥ , Cc") / \ § o \ / § c o m ; _ o z _ z w $ a k § I IL $ k a k0 a U) 0 . . , I Ali ; Form - STC - 104 R AS BUILT SANITARY SYSTEM REPORT OWNER jC ' o-rd am TOWNSHIP -57/, ` SEC. _ T : N-R 0) W ADDRESS ST. CROIX COUNTY, WISCONSIN 2 SUBDIVISION �r5J'� C / �- LOT 2 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tje ' 1 IV i A '3 '-1 Tbf a� roz I 1-61Z'n e i EL 4'07 � i k I a2 al INDICATE NORTH ARR W 4/ BENCHMARK: Describe the vertical reference point used 1 Elevation of vertical reference point: /60 Proposed slope at site: SEPTIC TANK: Manufacturer: I!Y Liquid Capacity: %�U Number of rings used: _�_ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side,O Rear, O feet From nearest property line Front 10 Side,O Rear,0 75 feet Number of feet from: well 04-5 , building: 2o (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE l i t ,r 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: Trench: �( Width: 146? Length: Number of Lines: ? Area Built; o ^ Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Ft . ao 11 Number of feet from well: Number of feet from building: yy� (Include distances on plot plan). SEEPAGE PIT � Size: / f�4 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: /y 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: SPY - Plumber on job: License Number: 3/84:mj 'UEPARTTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION ,LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 SW4jNW%,S1,T29N-R20W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.NumbeI Of assigned) Town of St. Joseph ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 2 Gov't Lot 2 NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTIOICIDATT: Richard BUrt Route 2, Hudson, WI 54016 .P� - Q. 3 BENCH MARK(Permanent reference Dmml DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber MP/MPRSW No.. county: Sanitary Permit Number: Roger Timm I3224 St. Croix 106138 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INL&T ELEV.. TANK OUTLET E LEY.. WARNING LAB L LOCKING COVER. PROVIDE . PROVIDED. YES ON 1:1 YES NO BEDDING: VENT DIA.. VENT MATE.: IROYES IGH WATER NUMBER OF ROAD: IPROPERTY WELL: BUILDING. A ALARM LINE.._ / Al INLET FEET FROM �✓� 7`./\ /_ jVENTTOFRE1. ❑YES ONO 1:1 NO NEAREST l� DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO DYES 0 N GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING AIR NLOET FRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES El NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at 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. LENGTH NO.OF DISTR.PIPE SPACING. COVER INVADE DIA ss PITS LIQUID BED/TRENCH TRENCHES /' MAT{RIAL: PIT DEPTH DIMENSIONS w_ �" l F GRAVEL EPTH FILL DEPTH UIS R PIPE DISTR PIPE DISTR.PIPE MATERIAL. NO D T+ NUMBER OF PR OPERTV WELL BUILDIy(i VENT TO fRESH BE LOW�F�Ei� ABOVE ER EI,E ,LET.�ELEV ^�D p �+L PIPES FEET FROM LINE 4f v...,, ,T L/J//Q I nly[T //��pp__ Ir ,.,,...�, �# �J.,J� ` NEAREST_, 4 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 SOIL COVER TEx TURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES El NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES El NO ❑YES 1-1 NO DYES El 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&M1IAHKING ELEV.. ELEV.. CIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLARITISCAL LIFT CORRESPONDS TO APPROVED OYES ❑NO El YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'. FEET FROM LINE El YES 1-1 NO El YES El NO NEAREST 7 7� 7, Sketch System on n county file for audit. Reverse Side. r-" TITLE DILHR SBD 6710(R.01/82) Zoning A rator QILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code STATE ANITARYPERMIT# A9 -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 1:1 YES ®NO PROPERTY OWNER PROPERTY LOCATION . � S W % d0l,, S / T "Z-�l, N, It v (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK U ER SUBDIVISION NAMEL AO'Z CITY,STATE, ZIP CODE PHONE NUMB R CITY NEAREST RQAD,LAKE OR LANDMARK 1a6 VILLAGE:TOWN 11. TYPE OF BUILDING OR USE SERVED: 1ea4_& 40`QO - /06 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. 19 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. ®seepage Bed b. ❑Seepage Trench c. ❑ See a e 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): L1' g Zig id Feet Private ❑Joint El Public VI. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Z� '�- ❑ 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: y- rsYr✓ -5-2--Z'4" /--; -7-31 Plum er's Address(Street,City,State,Zip Code): Name of Designer: Vlll. SOIL TEST INFORMATION Certifie oil ster(C T)Name CST# Q Z`7r CST's'A DRES (Street,City,State,Zip Code) Phone Number: 3 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Iss 'ng Agent Signature(No Stamps) Approved ❑ Owner Given Initial 1 '0,60 Surcharge Fee r1 Adverse Determination 1 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 l 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 per 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. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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 8Y2 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 i more Y � 9 9 s o e 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 ater included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure'. 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: 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/contxactQ , ("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 KV J 3L, Section j T N - R W Township ,J 7-• �� Mailing Address " Subdivision Name � 1L Lot Number Z Previous Owner of Property . A'71 _ Total Size of Parcel Date Parcel was Created gJ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _ and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION .ONE OF THE FOLLOWING: 1. Warranty Deed 2. . Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified , Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceAti,Sy that a.0 6tatement6 on Chia 60Am ah.e t ue to the beat 06 my (our) h.nowtedge; that I (we) am (are) the ownea(a ) o6 the pAopen ty de6 cA bed in thi,6 in6owati.on 6o4m, by ViAtue o6 a wa Aanty deed AeeoAded in the 066tiee 06 the County Regi,60A o6 Deeda as Document No. o� 50 ; and that 1 (we) pne�ente.y own the pnopo•tic.� 54te Son. the aewaoe capoa �y.�'^� (oA I (we) have obtained an eab emenat, to Aun W.Uh th.ee amevha a been bduty�AecoA�ed6�n the O s b�ce conat&ucti-on ,o6 aa.i,d 6y6tem, a,nd the 06 �e County Reg"teA o6 Deeds, a,a Document No. ) NA RE 0 ER SIGNATURE OF CO (IF APPLICABLE) DATE SIGN D DATE SIGNED e�R...w._�.................................................. .......... ........._..�... ............. ........ ... ..w... .... .......................................•... . ............. ........ .. . .............................. ................... . ..... .......... ..........• .... . ~ Y Nd as b i ........&3~, »f. 7.11X....................•SRI. Sat 02" of Section 1-29-20 der=ibed as 2Wn Fm ors pop 1585. &'=W Ap filed October 1, 410movant for INS sb� On aa13d� and Ss ass tine saste�rl ". Oertif3sd &ltveyr :�P, for aooess toylrot right of 'y on a strip of land 70 feet wide on C3bsd as follows n9 at an i>1an • Lofollows 4 . stld ruminq� �� aon�eint being 480 Est Abcti,on, 893.9 feet to amt thence d the 178 feet t0 an iron ao�t i+ dA* is the �`� this paint by a defbWtiaa Pout o! ldcly �+gttt by a �leot3on angle of 13 226 by t�1@ left �y 3.3118.0E wi 0onein State Hic3tasy 0350. 9* ingrese and sgr8ft Ovw a 70 Boat Ot oe , 'tit Of south line of dip no¢th = b; C. 'b`ulsos 8u+�e�nictls lobed o ,� � "�• rb. 245068 to �9ust 16, 1355 and 9rantars land desaibed in aaJ4 filed 00bober �u& to shsr+e egtewlly with fee title " . 1985 in Vbl. 6 o . PA9a 1585, tbsir cow= and Costs 0n that �s as depicted an Lot 2Portion of the �wqt lid of CM filed Oct. 1, >y� ....... Maw•...........................•.. .......y3�s. c C . , n s •...................�.. P ..... •!lifxlICA-2zo x A0s1I wLnaOiO ? .-.w...:..ww. arars or wiso xWjj ...-w.............�..,y� pie oars ...r•('w,.., OVWMWNWN .........................w....-----w...........w............w,.,, ..................... a.......................... .............. b be as mm ............................................................ 0.......................... ............ Mkt.. ........... ....... raw ... .......... ��, �NII��MdM t+�Mllr�y�rlr�a • • � ,_ n►. � CERTIFIED SURVEY NAP ED I N GOVERNMENT LOT 2 , SECTION I , T29N , R20W , TOWN OF ST. ,► Z:. F- r=H , ST. CROIX COUNTY, WISCONSIN. 0t4NED el' DON aND CAROLYN :ONNSON F ;E ;, c'JRVEY , VOL.3 , PG 666.1' RT. 2 BOX ILL RIVEF. VIEN ACRES HUDSON WI 540!6 — S-- 5NEET 2 0 F 2 FC'I, 0: 5�FrFTIDf:— ✓IU p. „ SIGHING I r} ES '••. .I:.��.xM.. ,� a. i LINEAL FOOT �j S• TB_K j^ x • x I I t:0 A PIPE F 01. N D • SPRING VALLEY 1 - P WIS. COUNTY SURVC7 NOAUNEAT. t c M. $A w�9ER 5 :ECG \,\ %� 10 E\c O°� v4 �"A 76- c:. -r:•c =,,•• OG� or a� Ic?5 ` I. rV .' 1,'.✓ 0�0 -LOZ eo / I,EV'S!:D CUG t5, 1ses. , . �S / c C.\ 2 / O 14 c al Z r 3 / r .z / 2 12 •� I. L Q ' CID % . • cl N o CD T y U, 0 r-) puo_r,t I I `• \ co o I ,1 t•; O N A � tr I Ol =m N) v Tr px m u jr T CL mon ' � �� C: -I tr• � tp C ' f -- r• C p N _ L v o. \ T z is Ir U = r :r^• m c :fir: "x1 w 2 _ /CN OD ko -•----\D r, / t} U t*. >r ' 90 w/ z wO \ \ �_ /i •� N_OTE ' BEOR KG_ r r c 9 _ 7G Tr!r- A -S CUGFTcR Q `t. 9 t G m y •� J i f QS9 .�O`` c -i rn r Z t. n is -y _.r �� I ; 2 0 1 10 1 n' p n _ E SIT ikC'• - A! 3: c H E E T It h y _C r• i z i -_ Diz STC - 105 y H • SEPTIC TANK MAINTENANCE AGREEMENT p Sc . Croix County v OWNER/BUYER ItOUTE/BOX NUMBER_ !i �=_. Fire Number CITY/STATE 'l.tP� PROPERTY LUCATION :_ $G-� %a , _ .1�. . SeCLion �:— T Z N , lt__2D..W, . Town o1: SC . Croix Coun'Cy , Subdivision _<11f -1�_ _ Lot number Z Improper use and maintenance of your sv_ptic system could result- in its premature "failure CO handle wastes . Proper maintenance con- sists of pumping; out the septic tank every three years or sooner , if needed , by a licensed septic Lank RMwper . What you pit into the system can affuCL the function of the septic Xank as a treat- . , ment stage in Lhe waste disposal system. St . • Cr.uix County residents maX be eligible to receive a grant ror . a maximum of 607 of the cost of replacement of a failing; system, which was in. operation prior to duly 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 . 'rile property owner agrees to submit to St . Croix County 'toning; a certification form, signed by the owner and by a maseer plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-.site• wastewacer disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'cank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days ,prior to three year expiration . O I/WE, the undersigned , have read the above requirements and agree x to maintain the private sewage disposal system in accordance with M the standards set forth , hu'rci.n , as Set by the Wisconsin Depart- ro went of Natural Kesources . CurLificatioll form must be completed and returned to the St . Croix County Zoning; Office within 30 ,days of the three year expiration date . .v/SIGNED -- DATE St . C.•oix County ,Zoning 'Office P . O. 11ox 96. llammo-pd ; WI 54015 715-7.j6-2239 or 715-425-8363 Sign, date and return to above address . $NTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION P.O. BOX 7969 f 1D ION TESTS 115 MADISON W153707 , RELATIONS PERCOLATION 45 045 (H63.06(1) & Chapt er 145.045) / B IVISION NAME: TI N: SECTION. Q TOWNSHIP/f►4Hf3tC1'!xtt-13- Y: LOT NO.:BLK.NO.' SUBDIVISION o # Z , L t s A 7- 007 Z07 t sT: {f- f / / /T :TN E (o UNTY: OWNER'S/B'b-rE'R•S NAME: AILING ADDRESS: S� •Got 'JDN ° CAR,PiE- f/�vfon7T EI�y.3S �iVEf? VfE� Ac�es - DATES OBSERVATIONS MADE USE PROFIL DESCRIPTIONS: ��ROLA�TION7�yp NO.BEDRMS•. COMMER IALDESCRIPTION:Residence /�O"[ N New ❑Replac � N + if — O7- iAvTi6—O SCS y9 sf/ows f75 /3 RATING: S-Site suitable for system U°Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ® Sou osoU ,mss ❑u 0S3u ❑SRU �D,UUEv7i.*Am !f Percolation Tests are NOT required RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Cv/! SS Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS lA.) -Z£Ci HAL 'IF jr BORING TOTAL D PTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF 0 SE VED (SEE ABBRV.ON BACK.) t .S� .o a• , . 9a y ' r •`67' f3a . S1 / 33 •Ll v - 6y Si D / B. 2- 9•0 �'SS/ r- • O 13a v c �fe . •S �Dom. (3�3• s i 1, . �,3�/.�N. '�y s;/, "d 70�r_- S p` .D�Qa. S, ►, /. YZ' r�.Ra. y'RA11 s; -2. il v B- �• 5 9s B- - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD 3 PER INCH P. I 3• , _ �0 '1 P- I 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. s�srr h To G ie i N Ale,+ [31- r3i3- C3 y • 13 oT To M o F SYSTEM ELEVATION JJ - - �d O • ' BACk Heir: Pf-Fs -y - t � _ i � � i / � I x 1 4 � 0 / D,p i _ u 13 .3 i P a 90 f P` s V - - - _ - ° Y - - : I � � I J ' t 41 Ike ,� S _ 40odD yP4i e_ ell, OLD L 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): r!(1^r1tSIfE ifPilC Rumui5c.l..i. (TES WERE COMPLETED ON: ;ti. �'NilL Q.HUDSON: V41S,a'0:,. l v�J"• ADDRESS: CERTIFICATION NUMBER: PHONE NUMB Rlootional): i i.15 `dA."ER PLUMBER LIC.N0. .1`01 M; ' !� u ,., nlofAl Ff? 1"c CU!i,' ,If) ^nc•;: Q fly i CST SIGNATURE: i DISTRIBUTION: Original and one copy to Local Authoritv.Property Owner ar.d $oil Tester. 01LHR-38D-6395 (R.02i32) -OVER - MFRS 3224 WI MPCA 696 MN JOB is lti, 1 'TiTSHEET NO. OF� � mm s_ CALCULATED BY �'� DATE Z S"ir8 Excavatin g Co. CHECKED BY AAU5, 322 �E R I, Box 192, Wilson, WI 54027 SCALE 715-386-5443 .. /' f•J,rt, i1 ROGER TIMM 715-772-3214 p AP . G r ............ I j f �+ ..... 11 t ... ... _ _ t 3Z - - �, L ; Z-4 t�� r,dC I. ._. � I . I � i3I i . 291 GmW,%K 01471, QQ PAGE Z OF Z Y CfoSS Vr-� p � /"1 Urt7 �ys �en-1 Froth Air Wells And Observation Pipe An^ { �11-Approved Vent Cop Minimum 12"Above Final Grade 20-{2"Above Pipe _4`Cato Iron To Final Grade Van# Pipe Marsh Mar Or Syno CoverMq In 2°Adgregole Over Pip. W.trlbvlbn ' Pipe —' 0 a 0 o 9 Too 6"Atgregote a Pertoraled Pipe Below B.Maln Pipe o Cppllne Torminotlnq At Bottom or syelem 4�. o Pro PoscD ftna, 9rAd< SOIL FILL DISTRIBU71003 PIPE • APPROVED S4WT4ETIC COVE' OR 9" OF STRAW ZMoFmoRmATE —�'� �y OR MARSH HAY two-F'1� -z1/Z AGGREGATE ELEV OF L-0 FEET, DIS'T'RIBUTION PIPE TO BE AT LEAST _s Z_ INCHES BELOW ORIGIMAL GRADE AMU AT LEASTPO INCHES BUT t.IO MORE THAI) tit IMCHES BELOW FINAL GRADE 11AXIMUM 061't1i OF EXCAVAT160 FROM ORIGINAL WK. WILL BE 3r5lo� Ijt_-"es- PRIA M AEPr1f OF EXC.AVATIoN fK0^ a1kl4INgl. (iRADf- WILL 15E L�s- SIGIJEO: LICEMSE AJUMBER: / S :?Zzq( DAT E '110 _ ..