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HomeMy WebLinkAbout030-1087-80-000 p �» y a 0 0 N N y ti I pYa a 2 y ',St Ii y Y O m E off ` O Z .9--o O C C N C QZyv Cl) � I N 'i Z Iq 2' Z d' a m 0 U O Z O N M N (D N � O co Z w N 0 z .. N cc �ff � O In �y d p ice. w C O V ! GFy C a E m � N Z cnI� N i E p a w O O O •►v aaa N a 7 0 U) oo co tq _J U rn rn Z cl �V o c cl D w m N a m � — o ►� C o ! U y c cD _ _ 0 a> � o F- j d E v � a rn rn o ' p N VO N C 40. 00 r T"i O O L C�nO O O �I O M N N p N O la v • �' o con !n I Y o Z Z cn ~ C d C r A 00 ao J) L) Parcel #: 030-1087-80-000 08/19/2005 09:05 AM PAGE 1 OF 2 Alt. Parcel#: 30.30.19.315D 030-TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner MICHAEL E&DIANE L KUEHN O-KUEHN, MICHAEL E&DIANE L 346 CTY RD E HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description "346 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.420 Plat: N/A-NOT AVAILABLE SEC 30 T30N R19W SE NW COM SE COR NW Block/Condo Bldg: 1/4,TH W 300 FT, N 730 FT, E 300 FT,TH S 730 FT TO POB ALSO A PARCEL IN THE SW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NE DESC AS BEING PT OF LOT 3 CSM 13/3608 30-30N-19W COM CENTER OF SEC 30;TH N 00 DEG E 64.13'POB;TH N 00 DEG E 449.87';TH N 75 more... Notes: Parcel History: Date Doc# Vol/Page Type 11/08/2004 779192 2691/15 EZ-U 03/26/1999 600168 1414/18 QC 07/23/1997 814/62 07/23/1997 806/11 more... 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.420 101,700 227,600 329,300 NO Totals for 2005: General Property 5.420 101,700 227,600 329,300 Woodland 0.000 0 0 Totals for 2004: General Property 5.420 101,700 227,600 329,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges III Total 0.00 0.00 0.00 L Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP -�- -�� 7 SEC. T L*) N-R W � ,/ t/� ADDRESS ;1z -ej),ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - o�i�.-r �, G��y o as INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ; Elevation of vertical reference point: / L,.. Proposed slope at site: SEPTIC TANK: Manufacturer: 4L'I k`� Liquid Capacity: i Number of rings used: �_ Tank manhole cover elevation: Tank Inlet Elevation: .5� Tank Outlet Elevation: I- 4C Number of feet from nearest Road: Front,0 Side, Rear, O Af0 feet From nearest- property line ` Front,�Side10Rear,0 �a feet x/0 1?l Number of feet from: well building: / (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: e�!a Liquid Capacity: Pump Model: y��` r Pump/Siphon Manufacturer: !�Z Pump Size Elevation of inlet: • 02� Bottom of tank elevation: tee�-f-,� Pump off switch elevation: ���/ Gallons per cycle: ��3 Alarm Manufacturer: J74 y Alarm Switch Type: Number of feet from nearest property line: Front Q Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan) . I- /ov qra W egre5S�r SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Length: Number, of Lines: Area Built: / 5" Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, © Rear,OFt Number of feet from well: � Number of feet from building: 4,D / (Include distances on plot plan). G�r 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 DEPARTMEN-r OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING P.O.BOX 7969 S�t�WFII_I j'W OE;70 30, 19(V ❑CONVENTIONAL XXJALTERNATIVE N88-03110 e Plan l.D.Number: Town S�. Jah e h 'signed) El Tank ❑In-Ground Pressure ❑Mound Neane t Road Co. B NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK(Permanent reference Point)DESCRIBE IF DIFFERENT FROM PLAN: J EF.PT.ELEV.: CST REF.PT.ELEV.. I Name of Plumber: MP/MPRSW No.: County: Sanitary Perron Number: Bytcon Bitd ,Jt. 1125 S Cnoix 112769 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ONO DYES —]NO BEDDING VENT PIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: P . (VEN T TO FRESH ALARM AIR INLET FEET FROM DYES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO E:]YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VA ERN 7N FRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES ED No NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MAreRIAL AND MARKwG 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 77SPACING. COVER INSIDE DIA aPITS LIQUID BED/TRENCH TRENCHES MATERIAL• PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL BUILDING V NT TO F H E SH BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END'. PIPES FEET FROM LINE AIR INLET NEAREST—� 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- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSEHVATION WELLS DYES 1:1 NO 1:1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES , DYES ❑NO El YES ONO ❑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 M NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA.. ELEV.. PIPES PIA.. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY JUOVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS OYES NO OYES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS'. NUMBER OF PROPERTY WELL. IBUILDING. FEET FROM LINE DYES ONO DYES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLE SIGNATURE. DILHR SBD 6710(R.01/82) Zoning Adm%n.izttaton I - � 0 SANITARY PERMIT APPLICATION COUNTY � DILHR In accord with ILHR 83.05,Wis.Adm.Code C ro X Zm• +�- I R STAIESANITARY PERMIT# —Attach complete plans(to the county c0 PY only)for the system,on paper not less than TE PLAN I.D.NUMBER 8%x 11 inches in size. S o—?//o —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNS PROPERTY LOCATION s9;/a %, S T C, N, R E(or)o PROPERTY R'S MAVfING ADDR S LOT NUMBER IBLOCKNUMBER SUBDIVISIO NAME / r � v�r CIT ,_ ATE ZIP CODE I PHONE NUMBER CITY /�� AR ST R LAKE OR LANDMARK /o ! �,, ,w'67 VILLAGE:!N�„?O d- II. TYPE OF BUILDING OR USE SERVED: 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. w b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an tem 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 bA 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. ❑ 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): 11o2 f Feet Private ❑Joint El Public CAPACITY VI. TANK Site in ga ons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 0 El El Lift Pump Tank/Siphon Chamber O �L ❑ ❑ ❑ ❑ 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) MP/MPRSW No.: Business Phone Number: PluntWA Address(Stree,City,S ate,Zip Code): Name of esigner: r VIII. 901L TEST INFORMATION Certified So' ster(CST)Name CST# n CST's AD SS(Street,City,State,Zip Code) Phone Number. 0, !i- Alf IX. COUNTYID15PARTMENT USE ONLY 000r ❑ Disapproved S itary Permit Fee Groundwater Date Issuing Agent Si natu a(No Stamps) XAppro,ved ❑ Owner Given Initial J O har e Fee 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 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 privat:. sewage syster:i, 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 narne and mailing address Provide the legal description where the systern is to be installed; t T { ".� a �,. �ype of building or use served: !. public i; 4� �,cked, indicate .ype 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; 11 1. 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 o f 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'/2 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 Grdun, aW.r included the creation of surcharges (fees) for a number of regulated practices which Wiscor pint s ... can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried fe5t2l is used in your building is returned tcv 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(8.03/86) PLOT PLAN PROJECT //I 4,5ADDRESS cW,5g 1/4/P&) 1/4/SJ0/T�70 N/R/y W TOWN os� IiCOUNTY PRS Byron Bird Jr. 3318 DATE OZ5- BEDROOM CLASS PERC_-17/- CONVENTIONAL IN-GROUND 4KESSU RE_,,e _ CONVENTIONAL LIFT_MOUND_HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. O Borehole Well Scale = Feet 0 Perc Hole System Elevation %5= L i lf'G'w /.y� L 5)«l //' d(G1-3 > 5 V �, 0 AV �v 0 r I ,0 - Atli /G O 16 3 Page _ Of_ V ' Perforated Pipe Detail Eno View 03110 Perforated End Cop) PVC Pipe i . ego e pie Holes Located On Bottom, S Are Equally Spaced S Q PVC Force Mai ,7 Q PVC Manifold Pipe Distribution f Pi a P U L Fo ce Main Last Hole Should Be .Pipe t Next To End Cop ® �� �. a. cc P ay"),,Ft. Y 6 Si ned: Hole Diameter _ Inch 9 Lateral Inches) License Number: Manifold Inches Date: �, -7�� Force Main Inches # of holes/pi pe_,� Invert Elevation of Laterals 94-o;?5ft. w PAGE I'LtMP CNAMBER CkQSt' SECTIOiJ AA1D SPECIFICATIONS ^�VC'MT � � EfT PIPt: i. i WliA`i"NER PROOF APPROVED LOCKING UU C►1► �OOX,' MANHOLE COVER G15`' FROM `C1 * 00tC, t�,lt�4��J;_Of FIESNMi . f IK INTAwcE xr� � '� i B 'A 1 „" � H M1Wa Oil Eg 1 T ,JG� ly �'l" f•�'P14i ?tYI Y ,� � ,@`�' � d f�j 1 4 Y � �'�er. wr+r� 7j, = .lM�ET gig a SEAL « ilkie, 4w, le >FWOV `D .JOWT SEEP # APPROVED 1 �, A E Jo ►sT. zd P)PE y �� I ., w PIPE �IiAl }11�tf.'. 47' daa 4`'n. �"� ; '�S � Dl� 31 i`I" SOk tCi.>aC91L �' � r� ' ax'> � ` O TO 8041 SOIL ! E. �� r��" �Ft9�'� Y� i e +rd` i�` 9�� .�� ti� ��` � sappy !•,1� G Y Y ry.a t' t�� , 74 d R•ts V i f 1S �11"I P l Mi'T t 01A ;�P."i'AiJ���'lAIJ�tFACTUR R HAS SUCH AP RfJVAL AUU At ' i JUMBEK OF DOSES: PER OAS ' TAlkiK DOSE .VOLUME it 3 NCLU01U ACKFLOWk 41 AAUIJFACTUk& GALLONS k MQDCA- U � IES A: • INC4ES q R Gat_t OAlS ,CAPACIT t ,rl,1Wf'I'CW T zi, g-Lr-*� .lNLHES OR CvALLOJJS P MAIJIJPACT u KiI<lt IAILHES OR .1-59 CALLOUS. J�IODEL. IJllMElt: * , D=INCHES OR GALLONS . #UAP.AND At.ARM ARE TO BE MIAItIAUM.`C1CHAftU"RATl ..� GPM #NSTAILED ON SEPARATE CIRCUITS ° ,. . >+RTIttAI, tJtFFE;K6KiE ':SE'I'W E1� SUMP �#IF, ,A#J'"� Dt9TRlDU1'l�C M PiPE..�,._ FEET E' I+ Mi1:ttA+�UM' 04ETt+� dAK'!-`5lIPpI.y PRESSt3ttE :. ;, . . ,y '. ' „ . _.S FEET FEET Gf 1 aRGE 1 RIN Xyc �pFEFRICTIOU WTOR..._,�� FEET PQ#AL t3l04#C HEAD ° ^— MEET Ail } 1" $RiJAL I?IMEIUSIOIJS O "TAI�1K; 4 WCiTIi 1w OTH �t_t'QUID OEP7 H HEAD/ CAPACITY CURVE TDH ►- TOTAL DYNAwC NEAWCA►MCITY►EO wMUTE SEIItEf S747-S/ Is EFFLUENT AND DEWATERING I GAL GAL Oft (iAL OAl .a 24 SEWAGE AND DEWATERING '0 34 57 -of e+ 1 `,l lit- 20 s a w ro eo '—�-->-- —+-- r Js 00 - ---- — — - - 1--- 40 « ss so b s, w Is 20 30 163 % MODEL Lock *% fs EErw10E MO DEw mm"O0 16 I : 1 ' — DES sn sss s� s11 a �` y I sT Qft w. GAL a�► cup s 108 102 130 ,eo ` is 20 U 51 111 ! 12 --•- as MODEL .o « 293 --so 1 ! ! Loci NW. 1 10 21 26 34 8 MODELS i .1 6 —T-- - M DEl ! - MODE 294 4 MO EL ! ml OE<,S 2 °� r 57 M DE MO EL i 59 97 27 • r �'� , :tea.': off�d...#�p, 1 LITERS 80 160 240 320 400 480 5 O 0 FLOW PER MINUTE P� ` sunING BUREAU i t. 3M Old MWAn taro Abnb*chwm of. . . O, '0" Lo ubWM& KenlucR r 10216 O1 LLfP (502) 719-2731 Qi�EU7r Diuos �jNCF �.9�1:Q . , 1JPT10NAL WORKSHEET - - - (. MOUND SYSTEM " 11, IN-GROUND PRESSURE SYSTEM-Continued- ,1. Wastewater Load,Total Daily Flow= gal. 10. Force Main: Use section H 63.15 (3) (c),Wis. Minimum Dosing Rate= 2722-0 gpm. Adm.Code and PROVIDE A DETAILED Diameter= �-?- in LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor= ft. System Head= 2.5 ft 3. Landslope= % Vertical Lift= � _ ft. 4. Distance from Dose Chamber to Friction Loss= t. Distribution System= ft. TDH= `��s�t. S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System= ft. Pump will r I�discharge at least :Z4 /U gpm , 6. Absorption Area Sizing: at�ft.total dynamic head. Area Required= sq.ft. Pump model and manufacturer: -10-'A-e Bed or Trench Length(B)= ft. 0r A Bed or Trench Width(A)= ft. 13. Dose Volume: Trench Spacing(C)= ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines= / gal. Fill Depth (D)= ft. 14 5 09,Paily Wastewater Volume �T Fill Depth Downslope(E)= ft. 4 Doses in 24 hrs._ ' /l2 Sal, Bed or Trench Depth (F)= ft. Backflow= gal Cap and Topsoil Depth (G)= ft. Minimum Dose= gal. Cap and Topsoil Depth(H)= ft. 14. Dose Chamber: j� 8. Mound Length: Volume= gal End Slope(K)= ft. Agonreor Total Mound Length(L)= ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM" 9. Mound Width: 1. Wastewater Load,Total Daily Flow= �;_a I Upslope Correction Factor= Use section H 63.15 (3) (c),Wis. Upslope Width())= ft. Adm.Code and PROVIDE DETAILED Downslope Correction Factor= LIST OF SIZING ON PLANS. Downslope Width(1)= ft. 2. Required Septic Tank Capacity= gal. Total Mound Width(W)= ft. 3. Percolation Rate= min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in chapter H 63 . Natural Soil= gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required= sq.ft. SIZING ON PLANS. Basal Area Available= sq.ft. Required Area= sq.ft. 11. If Standard Tables from Chapter Length= ft H 63 are Used,Indicate Table No. Width= ft. 12. For the Distribution Network,Use Numbers 5-14 in Section 11. Number of Trenches= Trench Spacing= ft. It. IN-GROUND PRESSURE SYSTEM t/ 5. Distribution System: 1. Depth to Limiting Factor= _Z`�� *. Lateral Length= ft. 2. Landslope= % Number of Laterals= 3. Percolation Rate= min. in. Lateral Spacing= in. 4. Proposed System Elevation= ft. Distance from Sidewall to Pipe= in. 5. Wastewater Load,Total Daily Flow: gal. System Elevation= ft. Use section H 63.15 (3) (c),Wis. Adm.Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. �) Fill in All Items from S8ol� tts r� u Required Septic Tank Capacity= gal. 0 3 1] 1 0 6. Absorption Area Sizing: ,/ V. SEPTIC TANK Percolation Rate= •Y min./in. 1. Capacity= gal. Area Required= //. .5 sq.ft. 2. Manufacturer: System Length= ft. 3. Show Site Constructed Tank Details on Plan System Width= ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Sire= in. 1. Capacity= gal. Hole Spacing ft. 2. Manufacturer: Lateral Length - I'l. 3. Pump Manufacturer: lateral Site y(,� _ in. 4. Pump Model: Lateral Spacing ,�_ Il. 5. Operating Head= ft. I)islance Iro")Sidewall In Pipe- in. 6. flow Rate= H. Distribution Pipe Discharge Rale: gpm S 7. Show Site Constructed Tank Details on Plans Number of I lulcs I'cr 1'ipc 1 low I'er I'ipc • -n,7 gptn. VII. ItOLUING'TANK y. Manilold Siting: I. Capacity= gal. 1 Ype(center or end) -- ��/+ �ti(/` 2. Manufacturer: Length= 1 lt, 3. Show Site Constructed Tank Details on Plans Diameter= _ in. -SHOW ALL INFORMATION ON PLANS- DILHR SBD-6761 (R.03/82) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION PRIVATE .SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 13YRON BIRD, JR. Owner: MIKE K U E H N ROUTE 4 BOX 6 3858 MIDLAND AVE NUE: AMERY, WI 54001 WHITE BEAR LAKE, MN 55110 RE: Plan Number: S88-03110 Date Approved: August 29, 1988 Gallons Per Day: 450 Date Received: August 10, 1988 Project Name: KUEHN, MIKE - RESIDENCE Location: SE,NW,30,30, 17W Town of ST. JOSEPH County: ST' CROIX i The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall. be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department' s approval. stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires . The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general Plumbing or in Chapters 50-64 of the Wisconsin Administrative rode. This approval. is for the following components only: •- NEW ALTERNATIVE Inquiries concerning this approval may be made by calling (608) 266--8230. sinc I^Ply, :. Nt'TH S"rIE:MKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 4 cc: MI:KE. KUE HN _Private Sewage Consultant _........._County _............UW SSWMP __.........Plumbing Consultant Owner Plumber Environmental Health SBD-6423(R.10/87) ,mss ST. CROIX COUNTY WISCONSIN N Z NING OFFICE . t y ST.CROIX COUNTY COURTHOUSE STREET 911 FOURTHS EE • HUDSON,WI 54016 (715) 386-4680 Juty 27, 1988 Divaion of Safety and Bu,itding,6 Buheau o6 P.tumbing P.O. Box 7969 Madi6on, Wl 53707 DeaA Sit: An on site inve6tigati.on Jots the Mike Kuehn ptcopeAty .located in the SE-1-4 of the NFU 114 ob Section 30, T30N-R19W, Town of St. Joaeph, Aeveated .6u.i table zoitz at a depth og 72 inches, below which .6ea sonabte high gAoundwateA ways noted. TW site shoutd be .6uita.bte joA an in-gAound pAeszuAe .6y6tem. Shoutd you have any que5tion.6, pte"e 6eet itee to contact thin o66ice. SinceAety, �k�".) Thomas C. Netson Zoning Admini stAatoA TCN:Amc I i �I i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, -_ DIVISION 'LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (1 HR 83.09(1)& Chapter 145) LOCATION: SECTION: TOWNSH /MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: /a /a N/ E COU TY: , OWNER'S/BUYER'S N IMATLING ADDRESS: c ,4AQ s /o USE DATES OBSERVATIONS MADE ` Z 7 NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: E�rResiclence ,, New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: N-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) S U �4S ❑4T XS ❑U ❑S CCU ❑S ,VU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: Q PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7 3 a,,� ; 77 5,�9 0 47 5L 9— 6 12R 6& h B- 702 �/� 7 7.Z alb /io -tea si�z- �d s ys- �/ 0!0 l8/9n ��/0-AZ 6h s yrf'�a - �/dZ ,(�A B- 7,Z ONE • ,- s B- Use Ifs/�`� j/'�&a.A � �/r_ 6Z_5 B- A PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IlrUMM S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- l v?p P_ .? 07, ,..Q 3 P- 7 P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION o pt r ff19 -, wh AntOL Ole tNr x ST ` f 0OUNTY 1 6 O 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): TESTS WERE COMPLETED ON: /1 ADDRESS: CERTIFICATION NUM ER: PHONE NUMBER(optional): CST SIGN R DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) —OVER — L J INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 5595 - To be a complete and ac€,urate soil test,your report must include: 1, complete; legal description; 2. The use section Must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; E. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASEL? ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Draining to scale is preferred. A separate sheet may be used if desired; S_ Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses,flood plain data,percolation- test exemp- tion, if appropriate; ' 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS Limestone �s Sarni HGW - High Groundwater cs" -- Coarse Sand Perc - Percolation Rate med s - Medium Sand VLF -- Well fs - Fine Sand Bldg - Building Is - Loamy Sand > Greater Than *sl _ Sandy Loam Less Than 'I - Loam Bn - Brown sil Silt Loam BI Black si - Silt Gy - Gray "cl - Clay Loam Y .. Yellow scl Sandy Clay Loann R - Red sicl - Silty Clay Loam mot Mottles sc Sandy Clay w/ - with sic - Silty Clay fff -.... few, fine, faint #c Clay cc - common,coarse pt - Peat mm - Many,medium m pluck d distinct In - prominent HWL - High water level, Six general s€:}nl textures surface water for liquid waste disposal BM Bench Mark VRP Vertical Reference Point TO THE OWNER; This soil test report is the first step in securing a sanitary permit.The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction, DIVISION PERCOLATION TESTS (115) °'� t'ttL�T10NS P.O. BOX 7969 (H63.0911)& Chapter 145.045) / q MADISON,WI 53707 L CAT10 SECTION:- �.�� ��/ ' SrsC'�7 ,�• �F N�HI�MUNI 'IPALITY: OT .:BLK. .: SUBDI ISION NAME: I C(jUNTY: OWNER'S B YER'S NAME: ' (� MAILING A DRESS: use �' �� I k NO.BEDRMS.:ILUMMER AL ESCRIPTION: -`—�" DAT S OBSERVATIONS ERVATIONS MADE, Residence PR FI L 1 S: N T STS: .� New �F] eplace RATING:S-Site suitable for system U=Site unsuitable for system r.-Os ONVENTIONAL: UND: © IN GR()UNaPRESSURE: SYSTEM -FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) u�" s ❑u� os �u as __ —_ �u os au Lrcolation Tests.ire NOT!'equire DESIGN RATE. __ _ [FloodPlain,an der s,H63.09(5)(h),iudica,e: �J Y Portion of the tested area is in the -- � indicate Floodplain elevation: Irn, _ PROFIL E DESCRIPTIONS :RING TOT P 'H TO GR U E l IM"ER Dt.FynL, VA IION _Q NDWATER-INCHES CHARACTER Of- OIL WITH THICKNESS, COL TE_ _ OBSENVED _�� T TO nEDROCK IF OBSFFZVED (SEE ABBRV.ON BACK.) AND DEPTH .) ------_ - !e_ PERCOLATION TESTS — f FESF DE FH VATI:R IN HOLE TEST TIME UMBER INCHES FTEHSwEL-LING INTERVAL-MIN. DROP tN WATER LEVEL-INCHFS RATE MINUTES I P - — n P I D 1 PER 2 P PER INCH AT PLAN: •'iow loc aion:. of p,:rcolation tests, soil borings and the dimensions of suita ilareas. Indicate scale or distances. Describe what are the hori -­al and ver cal a evition ,eference points and show their location on the plot plan. rnd slope. S o4V the surface elevation at all borings and the direction and percent "'OYSTEN' ELEVATION 4 YA � vd OCR/)/,>�.l Gr! $•i.�.E ;.f)� ��Ut�� � o C�ItNC30FFIGE ;� < I . l j-- 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 iministrative Code,amJ that the data recorded and the location of the tests are correct to the best of my knowledge and belief. hME psi t) ---- � TESTS WERE COMPLETED ON: ESS. / CE TI FICA I ION NUMBER: PHUNE NUMBERIupt,onap: - -- �T _ CS SI , IJRE: �i:TRIk:U71�)P:: ;)•iy-,.,i:, 1 ,.,� OdY tO 1_rr. I .,..,......„�,,,,. ..,,,,,,err-•. -r STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 7?2iC kw- eZ L, Xu-e- e'e I ROUTE/BOX NUMBER L? e i� H ff T -- FIRE N0. CITY/STATE h. � "S ZIP &,) v� PROPERTY LOCATION: 5,E 1/4 /Y W 1/4, Section ,30 , T 36 N, R /9' W Town of J{.- J o 5 'e , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED G DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address 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 5�,�1/9 ,) 1/9, Section _, T N-R_�1 Township 6'L{�vUS-'e.o Mailing address e L Address of site d o u- 4y r. �� _0 .� y Subdivision name Lot number / I Previous owner of property �f`jfc `- Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _LC_Yes No Is this property being developed for resale (spec house)? Yes �_No Volume el�/ and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- 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 warrant deed recorded in the Office of the County Register of Deeds as Document No. V3 �-y ; 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 Own4r Signature of Co-Owner (If Applicable) 2 -a -epz Date of Signature Date of Signature .� I•• DOCUMENT No. �I WARRANTY DEED I THIS SPACE RESERVED FOR RECORDING UAIA II STATE BAR OF WISCONSIN FORM 2—1982 1 �I p ii �II -- 43547 - 1 �oaK C1 4 PAGE 6 FFICE REGISTER'$ Q Barbara A. Schauer, a- single woman I! ST. CROIX CO., W1 -----•------ ' r Record it ---- ---------------------------------------------------- •-------------- - --------------------------- -- - � R®c d a ii ----------------------------- ---- --------------------- ---------------- -------------------------------- 9 ---------- --- -----•--------------------- �, JIM 16 conveys and warrants to ..Michael E. Kuehn and Diane L. Kuehn, 12.30 P buzb and_and.-:vile as.._.jo nt tenants---- --- ...... - at M ! ------------------------ ��Reglstar of De-- --- �I i -------------------------------------------------------- .............................__..__.-__...__.-_.__.... ._ _.. .... .. ._..._.... __._ ...............---------- i RETURN TO '1 _.-._...-_.._---.._.............................................................................................. I� I _ I' i the following described real estate in •-St. CrOlx___________________ ________County, I� State of Wisconsin: iTax Parcel No- ------------------------------ II Part of the Southeast Quarter of the Northwest Quarter of jl Section 30, Township 30 North, Range 19 West, described as follows: Beginning at iI the Southeast corner of the Northwest Quarter of said Section 30; thence West along the South line of said Northwest Quarter 300 feet; thence North parallel with the East line thereof 730 feet; thence East parallel with the South line thereof 300 feet to the East line of said Northwest Quarter; thence South along said line 730 feet to the POINT OF BEGINNING. It is a condition of this conveyance that the above described parcel will not be I; subdivided until after June 4, 2003. I�I ii l TRANSFER ID FEE This --------i --- s not- homestead property. - -- i ( (is not) Exception to warranties: easements and protective covenants or _restrcti:ons of record, if any. ,, 88 Dated this --------------------•---------•---fI V!!7 ---- day of ----------------- June ------(SEAL) -� �, _ '�/` ` (SEAL) .---------- " -------------- ----------•----------------------------------- *Barbar-a-A. Schauer•------------------------------ --------------------------------------------------.(SEAL) -------•-•-•- ---------• (SEAL) - ------------------- ------------ ----------- ----------------- AUTHENTICATION ACKNOWLEDGMENT I' Signature(s) ---------------------------------------------------------•-- STATE OF WISCONSIN SS. J _ I Croix °� �} ------------------------------- __St. County. authenticated this --------day of-_•________________________ 19------ Personally came before me this _.__.. _ ._.__ JI I J-V��.-day of 'I June 19$$__•_ .the above named --------------------------- Barbara A. Schauer, a sin le_'woman ii --------------------------------------------- g- ------------------ ------------------------------ ----------------------------------------------- --------------------------------------------_: ------ j TITLE: MEMBER STATE BAR OF WISCONSIN - ' ---- ----------•-------------------------- (If not -- --- �' r1 `:' - --- - - - - �;.: i authorized by § 706.06, Wis. Stats.) to me known to be the perso --jwl�xecufd_the foregoing instrument and acknowle home; Syr'• ' ,r THIS INSTRUMENT WAS DRAFTED BY ��•y� V r rl.,�(, '�•y '\�� � O;'• __ _t7�--_1__!.i°-_1�-"�-=-=--Jr���-'-•1 C i°�-:°:'--------- Lois A. Murray, HEYWOOD, CARI & MURRAY ---------------------------------------------------------------------- i; P.O. Box 229 , Hudson, WI 54016 - = --- -- ----- ._: St. Croix II ----------------------------------------------------------------•--------------- Notary Public ---------------•----•-------•---•---------County, Wis. i (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration r Ii are not necessary.) date: ------------------------� ---- I-•`� ....... �I i *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Thank Co. Inc. FORM No. 2— 1982 Alilwnnkee. Wis. \ 0 2 CD § � ) 2 � § b C W 0 \ � ; (D \ )CO 7 0.0 R E \ 00 22x0E § CL % 22222 �$& f 8. 25E G 2 Cc fEgL )\$ c0 ) E/ 0 M z $� oo§ � ) rC-- �2 3 \ §f2 �\ <1 2 ikq § « $ i \ E § � § / § 0 0 @ k } 0 t ■ e G { 2 § § n j { ) .� ] c & 0 US 2 a � C? Z j a = z Go CO � I / CL c : U) k R § o a .0 £ B Z r k . � k k L 6 § 1 � Em 2 � - k / a a a IL � � 2 0 v � � k k ' CF z \ § \ § 0 \ ' moo = _ w V 2 4 » Cl) k ° §o k\ 2 f) 2 c .m E S o E J 9 Cli 0 E § 2 e a o c _ 0 o 0 / S . ® z 2 a ¥ § . - 3 q 2 : % a S E Cl) R e 2 0 z ) z co ■ � al $ $ k a 2 2 8 . U) 2 , k ST. CROIX COUNTY (" WISCONSIN Ml 111` ° Ii ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH-STREET • HUDSON,WI 54016 - (715)386-4680 June 20, 1988 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Mike Kuehn property located in the SE 1/4 of the NW 1/4 of Section 30, T30N-R18W, Town of St. Joseph, revealed suitable soils at a depth of 2.33 feet, below which high groundwater was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator rc DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION -LA OR AND PERCOLATION TESTS (115) °x 3707 HUMAN RELATIONS MADISON.,W( 53707 (1-163.090)&Chapter 145.045) 4101 —yp2 '- _Ssre7 LOCATIO SECTION: pD TOVyN HIP/MUN IPALITY: OT .:BLK. ]SUBD,1VISI ON NAME: 1/4 /T /11 E for �¢ 0 NE B 'S NAME: ADDRESS: G UN i , 3 5 !k AT KS OBSERVATIORIS MADE` IND.B ORNIS :rCOKM E R L D IPTION: O N T S (,�f*clence ®New ❑Replace RATI G:S=Site suitable for system Um Site unsuitable for system NTI AL: MOUND: 14-GR- Nf 'RESS :S S IN-FILLHOLDING TANK•RECOMMENDED SYSTEM:;optional) S O US QU ❑S RU [:]S ®U E S ®U m 1f Percolation Tests are NOT requirecy DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS OfRI G T AL P T UN A ER-IN S HARACTER OF OIL WITH THICKNESS,CO , TE AND DE TH R DEfritifltl, ELEVATION pBgERV HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) ' PERCOLATION TESTS DEPTH WATER IN HOLE TE T TIME DROP IN WATER LEVEL-INCHES A N UT ER INCHES AFTERSWELLIN INTE VAL-MIN. t PE P R C H YIJ AiZ 1460 MA&Z Pi.QT' LAN: Show locations of percolation tests, soil borings and the dimensions of`suitable soil areas. Indicate scale or distances. Describe What are the'j+ori- 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 I"slope. A;' � SYSTEM ELEVATION Sall , i• i i I /�tJi M /77 } 1 i x !�.. Fa � . of f � F f 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. A pri t; -- - -- TESTS WERE COMPLETED ON: p gS; CERTIFICATION NUMBER: PHONE NU �ER(optionel): `frr�di T )RE 2:1 : pIST.FtIBUTION: Original and one ci>py to Local Adthority,Property Owner and Soil Tester. DILH'H-SBD 6%95 (H� OVER