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HomeMy WebLinkAbout030-2016-40-100 0 3 00 h ~ O N c a O I I � I 0 N b N tl C �L II � I f0 N � C Z c 3 a I M z H � W E z a m 0 M H U) O O Z c fn P Z m J� N N O vd� c a co 7 •�� a � L o I O O N Q !6 Z m Z o N _ Z :: n m E N E t (p IL! R U C d o CL « c 0 w m .� 4) c g oo � 'ooa :2CL N z � > I'! o CL � NI z o co IL FL = co 00 co 3 O N fA J U rn 00 Z ITV a' r N N - 0 O O O m C 'C d Q } fn f6 w 00 H H O O O W C 0 O O co ` O O N C C V d 0 O O C 'O `- v � � � N N C N N C4) � try') Ci N •�V ~�y CD m z Z O M E E O M O O O y C R tci f/1 m 0 Z y H H (n O C� r \ E v C� I M y a ^" CL • cd m CL d E A ciao I,, 0U) U Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER LF�RR�I U 1'r1 E S��.R TOWNSHIP -t 1 SEC. 3�p T 3N-RW ADDRESS CUU t,) V4 'R� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT i LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Z O Aaoo /° 9 �dJ 31 ' J4 YO 3 Bt 1)0z oq l� , , 18xs6 BCD 49�' 4DICATE NORTH RROW 50 BENCHMARK: Describe the vertical reference point used FU he '1K) G R4 Elevation of vertical reference p oint: V Proposed slope at site: 'Sol, SEPTIC TANK: Manufacturer: l�E'e Liquid Capacity: Ij 00 Number of rings used: p� � � Tank manhole cover elevation: Tank Inlet Elevation: 103.0 Tank Outlet Elevation: 103- 33 Number of feet from nearest Road: Front, Side,0 Rear, O IN feet From nearest property line Front,O Side,ORear,® �s feet i I Number of feet from: well 5 a , building: Q 3 (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). %-,t: 11-55- 101.1y-IGI- I Y 10060 00.98 -106.98 SOIL ABSORPTION SYSTEM �� 10609 ' Bed: Trench: 11-7-7-64" Bid r , Width: I R Length:_,5 U Number of Lines: 3 Area Built: Voo Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, Ft . 1 V Number of feet from well: 7 Number of feet from building: 3 (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: C Q q Q Inspector• Dated: 5� I I U Plumber on job: -Bo License Number: SPRS C 1 G 3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,Ill 63107 SWM,S0%,'S36,T30N-R19W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: Town of St. Joseph El Holding Tank ❑ In-Ground Pressure ❑Mound of assigned) County Road E NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DAf), Larry Boumeester 801 10th Street, Hudson, W1 54016 <'✓ 9r Z D.�8' BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.: CST REF.PT.ELEV.- Name of Plumber: IMPIMPRSW No County Sanitary Permit Number. Richard Hopkins 1059 St. Croix 106069 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY. TANK INLET ELEV. ITANKOUT11TILIV.. W LOCKING COVER // PROVIDED PROVIDED: XyES ❑NO ❑YES NNO BEDDING: VENT DIA, I VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET,FROM t �-� LINE. AIR INLET: DYES O `✓`tom ❑YES ❑NO N /��0 -7 DOSING CHAMBER: MANUFACTURER BEDDING. LIOUID CAPACITY PUMP MODEL PUMP;SIPHON MANUE ACTUREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ENO Y S NO DYES ❑NO GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL NUMBER OF PROPERTY ELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) DYES ❑NO NEAREST'-1L SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I n+ JUIAMFTEH n TERI AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. L NO OF UISTH PIPE SPACING, COVER INSIDE DIA -PITS LIOUID BED/TRENCH THE �H/ MATERIAL: PIT DEPTH. DIMENSIONS 1� -� GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTH PIPE DISTR PIPE MATERIAL NO I I TH NUMBER QF PROPE RTV WELL. BUILDING: VENT TO FRESH BELO/W_PIPES ABOVE COVER EE EV.INLE f ELEV.END PIV LINE �/ AIR INLET.FEET FR to#I � O1 � . � (�_'�. � NEARfSTO--�► `/'V 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. 1:1 YES ❑NO SOIL COVER ITEXTURE PEHNIANENT MAHKEHS OBSERVATION WELLS _ DYES ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OE TOPSOIL SODDED SEE DF1 '1:1YES MULCHED CENTER EDGES ❑YES. ❑NO ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: _ B ED/TRENCH WIDTH. LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR L;STIR PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING GRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES ❑NO DYES 1:1 NO COMMENTS: PERMANENT MARKER,: OBSERVATION WELLS: NUMBER OF -LINE.ERTV JW BUILDING: ❑YES El NO ❑YES ONO NEARESTM Sketch System on Retain in county file for audit. Reverse Side. SIGNATUR TITLE. Zoning Administrator DILHR SBD 6710 (R.01/82) SANITARY PERMIT APPLICATION COU �DILH� In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# /D&D �' —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 DI NO PROP RTY OWNER .5 h ery / PROPERTY LOCATION T3 Q N, R 19 E(or PROPERTY OW 'S MAI INCjADDRES& LOT NUMBER BLOCK NUMBER SUBDIVISION NAME OI V I I Y,ST TE ZIP ODE PHONE NUMBER = VILLAGE: S� NE REST R L MARK TOWN N (71Y )ML-SW 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): jd III. 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 Agreementto County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.Xconventionai b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 21 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(S uare Feet): /�Q '< 3 (\p S oO.v0 ❑Feet Private Joint ❑ Public VI. TANK CAPACITY Site Fiber- Exp Manufacturer's Name Con- Steel in gallons Total #of Prefab. p. structed INFORMATION New Existing Gallons Tanks Concrete glass Plastic App Tanks Tanks Se tic Tank or Holding Tank Lift Pump Tank/Siphon Chamber ❑ F-9 - VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plum is Signature: No Stamps) MP/MPRSW No.: Business Phone Number: I►C.6A d O )N OS IS 3 09%/D-90 PI ber's A dress Street,Cit State,Z' Cod Name oMAKI ner: e 1 O iN VI II. SOIL TEST INFORMATION Certified Soil Tester CST)Name CST# �, i CS 's ADDRESS(Street,City,State,Zip Co e)- Ph ne Number: `� 01 1611, 50 h1' c. 51016 5 1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee -Groundwater Date issuing Agent Signature(No Stamps) tAharFee Approved ❑ Owner Given Initial c ` / p � Oy) Adverse Determination 7 � l6 , X. CONSENTS/REASONS FOR DISAPPPROVALL: p 7 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 o this permit must be approved by the permit issuing authority. A new permit may be needed:t if there is a c ange 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 I 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; 111. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; W. 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'h 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 gears of steady negotiation and public debate. The groundwater bill Grbund r included the creation of surcharges (fees) for a number of regulated practices which Wisco ttt`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 0 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) r 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 L, 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 L Arr '4 16QUmeest2r; Sh erW 1 LIC G ©naC,gAe y Location of property 1/9 _1/9, Section T d N-R—L-7—W Township, 5t To s e U A Mailing address u 00 / /Di-h sli- Ui `s S�YO/6 Address of site R Q C"911-0,14-4 RA 9 Subdivision name A0h C'. Lot number Previous owner of property doh i A, Le y Total size of parcel 6 c Date parcel was created Are all corners and lot lines identifiable? A_Yes No Is this property being developed for resale (spec house)? Yes _ C No Volume Viand 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. ------------------------------------------------------------------------------- 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. q,30 4141/ ; 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. ignat a of Owner Signature q Co-Owner (If pl ,cable) r Date o' f Signature Date of Signature i' I DOCUMENT No, STATE BAR OF WISCONSIN FORM 1-1932 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED .430441 7`1 A'a570 BOOK--- - - - -- — - - --- ---- ­__- REGISTERS OFFICE This Deed, made between --John A. Let's,_ a/k/a_John_-_____ ST. CRUX CO., WIS. Adrian Le vs and as John Le s 23rd ----------------- ----'----------------------------- --fir Rec d. for kfl-ord this II ------------- of Sept. A.D. 1967 --------------------------------- -- Grantor, ------------------------------------ -------------------- J• 1.45 P and----La?ry__-R.__Boumeester__and-_Sheryl••McConat�ghey_�-__-_••-_-.___.__- t ----------a�---.�-aa...x?t---t_en,an.�;s------------ Grantee, 1 Witnesseth, That the said Grantor, for a valuable consideration_.-_-_ - - ..___..__ _____ ____________ _____ __ RETURN TO conveys to Grantee the following described real estate in -------St..._(;rQ7.X--_-_.-- County, State of Wisconsin: L/ i A parcel of land located in part of the SW- of the SEA of Section 36, T 30 N, R 19 W described as Lot 1 of Tax Parcel No- ----------------------------------- the Certified Survey Map filed in the Office of the Register of Deeds in Volume 7 of C.S.M. Page1877,Document 429883 �I Together with a permanent nonexclusive easement to use as an access road and for the installation of utility lines so located as not to interfere with use for road purposes the 66 foot wide strip of land marked "Private Easement" on said C.S.M. and on the it Certified Survey Maps recorded and filed in said office of the Register of Deeds in �j Volume 4, C..S.M. , Pages 1114 and 1115, Documents 373626 and 373627. I I '19 This ---]_s-_x o-L------------- homestead property. (i:K,JF- (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And..Jabn__A... eys-,--alkla.J.o)i .Adri.aa.-Leys---and-.as.-John-_Legs,-.the--gxantar................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except the provisions relating to road maintenance as stated on the above mentioned Certified Survey Maps, the grantees' share to be about one-fifth. After building on the premises, grantees will also pay a pro rata share of the cost of snow removal; Grantor xmit will warrant and defend the same. September Dated this day of --•---------b -• ......, 19. ( ----------------------------------------•--------------------------- EA ) •- S L l� ­--------------------'���s'; =(;S'E'AL) *9jolh n A _.LeY_s-------- ---- 4�.=° • 't-r .� j ( EA � ---------------------------•------------------------------ (SEAL) \. * ---------- -----------•---•--------------------------------------- * ----------------------------------------------------- --- -----•---------------•--------•---------------•----">- AUTHENTICATION ACKNOWLEDGMENT I STATE OF WISCONSIN Signature(s) ------------------------------------------------------------ ss. •-------------------------------------------- -------------------------------- S' ` C��/X . ----•--- -• •............... County. pp li authenticated this ........day of--------------------------- 19------ Personally came before me this ----Q__-_ .---.day of I � �r-•-_---.-_-, 19�__ the above named -----------•---- -------------------------------------------------------------------------------- --------- ------- •------------------------------- -- ----- J--= � .__ �/'s --------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------------------------ -------------------------------------------------------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing jpstrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY it _..------ John_D.__Heywood, H);_YWOOD,___CARI__&_MURRAY_ ` Attorneys, Hudson, WI 54016 v--- ------------- ---- ----------------------------------------------------------------------------•--- Notary Public ------------------------------------------County, W is. (Signatures may be authenticated or acknowledged. Beth My Commission is permanent. (if not, state expiration it are not necessary.) date: ------------- se�---- ------ kn *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE. BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1-1982 Milwaukee. Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _L A rry ROUTE/BOX NUMBER FIRE NO. CITY/STATE H"J,! n,O" ZIP 5-VOL 6 PROPERTY LOCATION: 5W_1/4 1/4, Section 36 , T ;3 4 N, R Z9 W, Town of S 'f J4 b G'Q {1 , St. Croix County, Subdivision vI0-N-AL , 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS ' INDUSTRY, G DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIOIYS R (H63.09(1)&Chapter 145.045) SLOCATION: 1�4Z1� SECTION: 36 /T3QN/'Y° I(or w �+ 0o OT NO.:BLK.N .: SUBDI NAME: COU TY�: OWNER'S BUYER'S NAME: MAILING ADDRESS: !/ //,tr// 15;4(�`�� GAi'i' ��NIMreS/r� ©/ /��y� S �7�eGl USE DATES OBSE VAT ONS MADE p�Residence �fVew� NO.BEDRMS.: COMMER ESCRIPTION: PR"�I PTIONS: ER A I TESTS: VV 1 ❑Replace L/ Ly 8$ RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:fpti al),/ RCS ❑U LJ S ❑U �S ❑U ❑S ❑S ®U If Percolation Tests are NOT required DESIGN RATE:? If any portion of the tested area is in the ^/� under s.H63.09(5)(b),indicate: < 3 / Floodplain,indicate Floodplain elevation: `v r.ee PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH jo. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) ` s7 f/ S/a%�'IJhS f�•i D;OYl6.l LSD A//LL p 8�7� ! r p 3 .�r 77 �(7 h.� ')/f 7J�hJ _S Jr�5"6 8'(J. C. y a�7 r w C'L B- Z rZS 10[. 33 > �zS Y,/ {TS r,TN/+Kt " 0'8//, ,W6, . ejw'7.- 1 u E190 0S4 41 a.- 4 B- 1 3 > g3 C C.eSS d Off"0B/ �,d7��� �ZtahCSt�grA G[ a. WIxWSVe B- 7o ' Q �S S dr t'-Wff 7 s- I CL at 5 h 01 re- R4 40 A., 61� PERCOLATION TESTS TEST DEPTH ATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IAW.W" AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ ,S LVIX z G 6 G < 3 P- d' L. G 6 G < 3 P- 67 y b <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. SYSTEM ELEVATION ��D8'' l� 3 T..._,...,...._...._. ._ ...,. __ .._..4. 1�_y... _� -w t i ..... E 3 ` T-7_ 7 a p -i 6 1 t 4 ; 3 1 t 3 i 77 1 - r 3 t E t i I , I,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(pri t : / TEST^WERE POMPLETED ON: zy TI ADDRESS: CER IFIC ION NUMBER: PHONE NUMBER(optional): Vol Nft t W11 5Y01` 003YY7 f AG CST SjGjIQ E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — r ` INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a reside=nce or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; S. Complete the suitability rating boxes. A SITE dS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. 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. Drawing to scale is preferred, A separate sheet.may be used if desired; $. Make sure your benchmark and vertical elevation reference point are clearly shoe ii,and are permanent; 0. 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 net apply, place N.A. in the appropriate box; 11. Sinn the form and l:rlace 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, t ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR -- Bedrock cob - Cobble (3- 10"j S - Sandstone gr Gravel (under 3") LS Limestone s - Sand HGVIf - High Groundwater cs Coarse Sand Perc Percolation mate med s - Mecdiunn Sand W - Well Is Finn Sand Bldg - Building Is - Loarny Sand > - Greater Than s Sandy Loam < Less Than 'I - Loam Bn - Brown sil - Silt Loam BI Black $i - Silt Gy - Gray el - Clay Loam Y Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay wl - with sic - Silty Clay fff - few, l'irie, faint x c -- Clay cc -- corT➢mon,c€,irse pt - Peat mm - Marry, me dium m Muck `' d distinct p - prominent HWL - High water level, Six general soil textures surface vvater for liquid waste disposal BM -- Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soil test report is the, first step it) securing a sanitary perrnit.The county or the Department may request vo ;ficatio?? of this sm 'test in the field prior to perrnit issuance. A complete set of plans for the private sge s°ysterrr and a per-rnit ,r,oplication must be subrnitted to the appropriate local authority ill drder to I 3.4�.a i tr perrarrt. ��he sa€-,rt:ary permit: mast bes obtained and no,,;,ar; l,�r�ror to the start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,. DIVISION LABOR AND PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RE�.ATIpNS \ / MADISON,WI 53707 (H63.090)& Chapter 145.0451 LOCATION: SECTION: TOWNSHIP/MA:l*feWAt_1 I-I-: LOT NO.:BLK.NO.: SUBDIVISION NAME: W %410/ .3 N/R/11P(or COUNTY: OWNER'S BUYER'S NAME: MAILING AD RESS: C✓�; L.Z.r•r �,�t.nea.s fc l: �/ ���.�� S f �_�<<.` a l-%,' S� G�� USE 5 f - e4e,"CiAev DATES OBSERVATIONS MADE NO.BEDR : COMM RCA ESCRt TIO : I PRC�' PT ONS: O,LATIOAI TESTS: Q'Residence �r 2�4ew ❑Replace L� !� z RATING:S=Site suitable for system U=Site unsuitable for system b CONVENTIONAL: M UND: IN-GROUND�bRURE: TANK:RECOMMENDED SYSTEM:(optional)2s au Ns au �s s RU ���,,.r., kb �.1 I�.e l s,z F rcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the r s.H63.09(5)(b),indicate: < 3 Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTA DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH4*t. ELEVATION OBSERVED ES GHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- J C, ,GS�3r :� ll�c�Wy F'Ff- �3W//, �.S �;�s 9g �, 7s`&I I., B- �� /pS.£'�' Sr3 % `�"�3i� , 91'B:•S�rl�.-, d, 9 Z(�';, �s.�S'' '•' rz�'�.('�1 Y�' J. LS 'Qi� S{f�1Y Jn/�titGl� /�t�r /•T`F, B- cd2• /C � �� g. 7� / 9L�Q�/, • �Bsl 5/�y 2,yZ'B.+ S'rj7 �; �yl�Q�, c'�4�f B- C PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INGHEe- AFTER SWELLING INTERVAL-MIN. PE I D t PERT D 2 PERIOD 3 PER INCH P- P- Z c ' 2- 3 P- f3 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. SYSTEM ELEVATION 0 J t r� S��e/ ( . i r)V 1-26, o i 3es1 $I I il IVJ . ._ . . _. , 1 v ' N i —.X, , , , , 1 � 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 ( TESTS prin E CO LETEO ON: t djlocl 314K_10 7 ADDRESS: CEI. FIC ION N ER: HONE UMBER(optional): Intl, 611 w C/G rcl ?�,Y/P73�� 1l CST A U 4 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER— DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IN[�USTRY° DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN REI�ATIQNS \ / MADISON,WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M61N+etPAt-tTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: tt1 1/;,0/ .3 c, /T 3t,N/R/j V(or� .S�r 10J1-?J,0 dt / COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: S - C ✓�; L Z-rr ,�t.n��S fcr� 11/ r� �� S f. fIL<<:ls a �✓,. USE S tj eAu/ -(,"c v,c a v DATES OBSERVATIONS MADE NO.BEDRW COMMERCIA ESCRI TION: IPRO D ONS: A STS: Residence '2 �/ ew ❑Replace L .. RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: M UN IN-GROUND-PRESSURE] EISEN SYST M-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)Qs au R1s:au : .9s ou a s ku t,.►.T., �iD,,, �r ,�If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the / under s.H63.09(5)(b),indicate: \ 3 �i� Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING1 TOTA DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER IDEPTH4R. ELEVATION OBSERVED hST.HIGHES T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- I f' cl. 93, to S: OS`&_r/l 9z '8,i cY 'lj,rGS�gr IrFr- B- Z 2s' lei, _?3 - w 3 , � /,a`i3i� , q1'B:•s/rr�r, �, 92�';, �s'�s,- a rz�d-,C'�1 Y' B- Y' '3 ,�s ov, B- �� r /��Ls.° 67'/.3;�/� S. t5°'L3,t 5�1�,r �,/�ti:c Xdl f'F l , • /B,t S1�yr Z,�Z'B.r S'¢q r V21"6,v C'S4T/' B- jr YY�' /o .d7 > g. 7 B- PERCOLATION TESTS TEST DEPTH/°' WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ING+4E3° AFTER SWELLING INTERVAL-MIN. PERIOD 1 PER10132 PERIOD 3 PER INCH P_ I s' �_ G 3 P- Z C ` L C3 P 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. SYSTEM ELEVATION C I j3* f 6 r /ti7 « i ii. c;le _ _ j 1:' ._.. 0 a - IN U 1 1 �- r P V. I _. t i 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(grin 1: TESTS E CO TED ON: R 3 ADDRESS: // ZHEI.I-IFICAflON NlffittER: LPHONE IJUMBER(optional): CST SI C�,AIA U ' DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— 1 _ P. Q. L. ' 67. PLOT A (,Jr, (.: I' 0SS SECTION L 0C AT 10 .... � _. K _ �- 1 C E N S E E 3 8 .�.. . _._._ -. .... .L ' gy � EW • 0 l�It�RNAI � 83 0, 30' 0 6� IaxS� QeD P1 ' RA I [�"1"' St��I �s� i►� rid 0� °J N� C01ZWK Ic �(-100.0 o Ipuc� f 0 9a 0= 80r-,ZW t SiteS - x- peRc hoc No�.e : Yak f Sysferh lies w A ll 61.1e S 130robr►1 eF- rkw4 6 ,r,, WeI1 Home IU��e 0-o( S 01k, �dJAcstNl, IatS ARk MaRQ -A (Q0 f 1t. FRESH AIR INLETS AND OBSERVj\t10 U P IS?E CROSS SECTION Approved -Vent Cap Minimum 12" Above F,Np} C�Ri�f .Final • �{�'� mix'' 4" Cast Iron Above Pipe Vent Pipe To Final Grade y. Marsh Ilay Or Synthetic Covering Min. 2" Aggreg��il Over Pipe Distributi.� Tee Pipe �t .._..__.. l Aggregate Perforated Pipe Below I Beneath Pipe Couhl.ing Terminating At Q'doM BAD --� /__. .. _._ . Bottom of System