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HomeMy WebLinkAbout038-1148-45-000 4 0 "0 °o, p c EL o C b N I I o I C r I I aNi I Z LL c Q 3 " � � I z y °�° LU c N Y Q z r 11 y y " ce) z a m o ozv' 0 1 1 a�i Z o c U) F- c E � � M ` N N 7 a7 c y •� d r O !V � O N Q ° z m z 16 Y O m z i+ N Cb N t `° E a c o c 3 G G a` a m g j1 3 N co fn fro �I v iO z ° CO � aaa y CL 3 o N y o o U) J V Ern rn U)0 N o = 0 m 0 � I _ D m o w > m Q >- in ca O o o H c w °o O $ j L Q to N ~ m c c c�i a °o N Y N N V �O ON Q O C N N m — � z p Mcl m l y N p o R s Q O U) M r O Z N F- C V � dF a � aa rr`Iw�i E 'c c _1 A c0 ao !, Oy0 o Parcel #: 038-1148-45-000 05/08/2006 05:16 PM PAGE 1 OF 1 Alt. Parcel#: 17.31.18.642 038-TOWN OF STAR PRAIRIE Current FX-1 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 ALAN L&DIANNE R BEELER O-BEELER,ALAN L&DIANNE R 970 BRAVE DR SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "970 BRAVE DR SC 5432 SCH D OF SOMERSET SP 8050 SQUAW LAKE RHAB&MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2617-WIGWAM SHORES SEC 17 T31 N R1 8W LOT 7 BILK D PLAT OF Block/Condo Bldg: D LOT 07 WIGWAM SHORES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 805/583 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 59,600 286,100 345,700 NO Totals for 2006: General Property 0.000 59,600 286,100 345,700 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 59,600 286,100 345,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 129 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges es Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �lG l? r TOWNSHIP jf r I/ktL rl a SEC. T N-P,/ ADDRESS Co .�jyj 9, ST. CROIX COUNTY, WISCONSIN SUBDIVISION Gc LOT LOT SIZE / PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3� �J u5 0 ,o � 3a� INDICATE NORTH ARROW 044 1`e "'W. BENCHMARK: Describe the vertical reference point used 70"-Oe Elevation of vertical reference point: /62& , Proposed slope at site: SEPTIC TANK: Manufacturer: e-eS Liquid Capacity: DO / Number of rings used: 410­,(_ Tank manhole cover elevation: yg Tank Inlet Elevation: `� Tank Outlet Elevation: i Number of feet from nearest Road: Front'w Side 0 Rear, 61� feet From nearest property line Front,O Side,©Rear,O5 r feet Number of feet from: well , building: �,,? • S (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) I� SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: q 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: �� � Length:_ Number of Lines: _ Area Built:4/e i/ Fill depth to top of pipe: cf Number of feet from nearest property line: Front, O Side, O Rear,0 Ft ./0 Number of feet from well: T i e > ' Q/ /O e,-;e- Number of feet from building: (Include distances on pilot 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, 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 .3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING P.O.BOX 7969 MADISON,WI 53707 ,�,yy L'�ti State Pla . ONVENTIONAL ❑ALTERNATIVE n I.D.Number NEB,SF%,S 17,T31N-R 1861 ❑Holding Tank ❑In-Ground Pressure ❑Mound (If assigned) Town o6 Stan. PtLa(l(ie Lot 7 wti wam Shotces Zy NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA Atan Bee2en. 609 SpAi.ng StAeet, Someuet, w1 54025 � BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MPlMPRSW No.: County: Sanitary Permit Number: Byron &Ad Jn. i3318 St. Ctcoix 112726 SEPTIC TANK/HOLDING TANK: MANUFACTURER. J11JUID CAPACITY'. TANK INLET ELEV.. TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED WILOC� 1000 , Ia0 !� a�J( +WES ONO DYES ®NO BEDDING. VENT DIA.. VENT MATL.: HIGH WR NUMBER ROAD: PROPERTY WELL BUILDING. VENT TO FRESH ALARM FEET FRO /I LINEE AIR INLET DYES ®NO 4 C4.- DYES ONO INEARESTR—� `T� DOSING CHAMBER: MANUFACTURER BEDDING. ILIOUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED'. ❑YES ❑NO ❑YES ❑NO I DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WE BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check thesoil moistureat the depth of plowing IL ENGTH T MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE "METER the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: ---[- WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA st PITS LIOUIU BED/TRENCH // � TRENCHES MATERIAL: PIT DEPnf DIMENSIONS 8 �0 �--+ tp +- GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO. R NUMBER OF PROPERTY WELL BUILDING VENT TO FFIE SH BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END: PIP FEET FROM LINE. AIR INLET X0,1 f S a Q*� Cl l NEAREST 10 * ,_1 l 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. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES ONO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. 1:1 YES NO ❑YES NO DYES 0 N 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&MARKIN6 ELEV.'. ELEV.. DIA.. ELE V.. PIPES D A, ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVE D PLANS ❑YES ❑NO 1 1:1 YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBEROF PROPERTY ]WELL: BUILDING. FEET FROM LINE. ❑YES ❑NO El YES ❑NO NEAREST o LOA) '1. U Sketch System on /l Retain in county file for audit. Reverse Side. 1 S ITITLEZoning la� C1 g kAWn,[Str..aton DILHR SBD 6710(R.01/82) �,DILHR SANITARY PERMIT APPLICATION COUNTY GHQ i In accord with ILHR 83.05,Wis.Adm.Code ° STATE SANITARY PERMIT# —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 X NO PROPERTY OW PROPERTY LOCATION /1 % %, S 17 T ,N, R E ( r PROPERTY WNER'S JA LING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 0 /)2 e/' 5-C CITY,S ATE V ZIP CODE PHONE NUMBER CIT EA A OR LANDMARK VILLAGE: J4 lbQ 714 Sf 11. TYPE OF BUILDING OR USE SERVED: - ` 03 <X 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. IV 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. El Alternative C. E] 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. Aseepage 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): �- Feet JKprivate ❑Joint El Public VI. TANK CAPACITY Site in g allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank S Lift Pump Tank/Siphon Chamber ❑ El ❑ VU. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ignature:(No Stam s) MP/MPRSW No.: Business Phone Number: qAlr c l Gg c Plumber' ess(Street,M v State,Zip Code Name Designer: X18 c r Gv S oo/ o VIII. SOIL TEST INFORMATION Certified Soil T ter(CST)Name CST# r ,0,(, r• 7 CST's ADD E (Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved X121,ary Permit Fee Groundwater ate Iss 'ng Agent Signature No S ps) IN Approved ❑ Owner Given Initial S /h�ar�ge,Femme 1 �J `�Q�Adverse Determination 6 Z�- / �v� U I X. COMMENTS/RE SONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber j 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 H 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 mainta+ned.The septic tanks)should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years;' 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat- restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g, MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following; A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatmenf'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 GroundtB ' included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- .:: 1 water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT S T C - 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. ------------------------------------------------------------------------------- � i Owner of property Location of property 1/4 X1/9, Section Ir{ , T 3/ N-R_a_W Township �tTA2 i�r1oC1: Mailing address Z Z `30c std D m 4=tt-r. (..TT 2-5 Address of site i'a-r ') 1 Subdivision name t� 1,112LI" Lot number /..,- '7 11 �. Previous owner of property )400£ Total size of parcel Date parcel was created 22 mimcki y5 Are all corners and lot lines identifiable? x _Yes No Is this property being developed for resale (spec house)? Yes _N0 Volume E and Page Number 113 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. 4 $-a-N 9 7• ; 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 o the m y Register of Deeds, as Document No. I-3M y ?7 ) . Signature of Owner Signature of Co-Owner (If Applicable) Zr-- Date of Signature Date of Signature s 1400a Inc o .. .. .. .. .. .... ........ .. ....... w►'r A 3.,� i.iR::R. Viler, as ;ioiut tsman . _, _::....... .. .. .. ........... .... .......-. .... _q ,.... ....-...._. .................. .... .. ... ........ 4 '. - ........ ..,.... :I - ` ......................... ..................,.. .............................. ._...... .� rastea, s � . n Tbat dw Said Grantor, for a valuable eousiderstioa... - e a IS Grantee dw feilewias described real estate is .4t._GXV.JA......_....... asTUew To kk � fib. State of Wiiessush: ; 2 Pi o?t_.7e. 81ook D. Migtraai Shores. Star Prairie Tbwnship. _. according to the plat thereof on file at Register of Deeds ArMo for St. Crolx County. Located in ilk., sec. 17. Toz Panel No: . R . Tw 31x, .1. 18W. Together with a non exclusive easement f + 6~ that part of the private road shown as Bmvr :)rive -,. on.the- plat of Wigwam Shores, more fully described as followat ;k�� ; beginning at the North South 'Town road, lying masterly of said t= thence Oesterl along said Brave Drive to a 9"thorly extension of the hest line of said Lot 7, thepoint of ermination of said easement. Fr kof ? k �I a� A Tbb':ai uoL homestead property. V (is) (u not) 7 �3 a= Tosstiter with aR dad Singular the hereditaments and uppurtenances thereunto belonging, 33 Aad................................... .................... _. 1 y *arm*& that the title is goody iadefwwible in fee simple and free and clear of encumbrance except • •....••, x aM'wig Marseat and defend the same. Dati this .. ...... .,._...... ...... ... .. day of .March ........, 1, . .. ... . .... .... ..... .... . ... . . (SEAL) ode Inc. <� ohn A. L er ; ...... ud e P ........ .................... ... .......... ........ (SEAL) .. ..... _ .(SEAL) ........... . s AUTRIiNTIQATION ACSIfOWL>iDGI[ISIIT ^• ilgeatars(y ............................................................ STATE OF WISCONSIN s+ ..... ........ .........................•-•--...._......._.. _.__... t%VaadWr....................County. . at lfatiagtad this ........day of........................ .. 1Y..... Personally came before ate this .. ........ft r+; .................................. .............................................. ......................... 19.10. ... the above... aaaiM �s i ,. �TahR.1Ax..�tlgAx. ....................................... e ..........................................-... .._.I........_........._....... F}_ TI'E:KRUDER STATE BAR OF WISCONSIN # .................................................... r (If risk... :_.__.. ... f aotborised by ;708.06.Win. Stets.) to me k n to be the perso . ....... who ezecutsd for"Mi tte men nd Ti"S INSTRUMENT WAS DRAFTED by e .. ... ........ - a 272.1 Division St. �pcbacQt ..!Z..o ....N....St... ,... _ �1�9 ....................... Notary Public F�amecy.. ....... ftxd (SignataAw taa7 be at aentkited or si&nowled MY 'Commission is et ` ged. Both permanent.{if , R state are net iteeessitry.) date: ... .a... B rr"BRA A. MM,! hieene et MENIM is say esM1VA&wl4 be typed or pHat d b.bw I `s 1IAI1NA11T!,OelU StAlM or aecowaeM MY rgmT?s•ir n r .r•s e+ r� w wa.e t W STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER �)AQ ROUTE/BOX NUMBER a!�9 FIRE NO. CITY/STATE_ An TY ZIP 2S PROPERTY LOCATION: 9�11/4 m E 1/4, Section J_, T_aj _N, RA_W, Town of afa27?2gO;E , St. Croix County, Subdivision ta;c,�.tc�m 9ho"L&s , Lot No. Q 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 2.5 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 INDUSTRY, I ur 1 KtNUK 1 UN SOIL WKINUb ANU J~rte" a swtw DIVISION LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON W1 53 07 (ILHR 83.0911)&Chapter 145) LOCATION: SECT-ION: r gmt UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION/ NAME: 5,6 '/ /T N/R 4E(or r i i �k r COUNTY: W E 'S BU ER'S AME: AILING ADDRESS: Gr= , e-r •O O USE DATES OBSERVATIONS MADE BEDRMS.: COMMERCIAL S R TION: rr-��I I PROFILE DESCRIPTIONS:"MOLATION TESW Residence - I,aNew ❑Replace RATING:S=Site suitable for system U-Site unsuitable for system a (J �ST�u• M��.Q� IN G�S �U E: SSTEM-IN-FILL OLLDING TANK:RECOMMENDED SYSTEM:(optional) SS U S ('PUT, � U If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the reared area is in the /r under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: Zo PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUP WATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HM-WE-S TO BEDROC IF OBSERVED(SEE ABBRV.ON BACK.) D c .7 D .36 - O gZ7 s �+ B- 2 0 n G -2 155.,13 o-i..zsSn �/�� AA S' r B- ��-�t- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER L66MRS AFTER SWELLING INTERVAL-MIN. PERIOD I PWIQQ 2 PERIOD3 PER INCH P � G P. I� 3. -�Vol P- G P_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Desiribe 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 paraMlt of land slope. SYSTEM ELEVATION �y,7 eta° sfo ��- I � }_ i r i i - • � � I i �__ � _s Fry o f 'LV A4 Jjxf iP �I i 3 �f - I - - - c J � t ¢ Cr -- r � � Rio _ Rn►,r , o�3 ��__ _ . j . � __ � a__ ;__ .-�-.- I.--- � � --'— - 1 1 I 6T 5T, I % - i � I i /vo 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 0 Dit , I DRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional : moo CD3 J is" 7l! CST SI ATUR . a DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R. 10/83) -OVER - PLOT PLAN ' PROJECT D�//Gl /�e•�%/' ADDRESS 1/4.5� 1/4/S/T/T- N/R L�W TOWNSJa� /'a«i OUN Y MPRS Byron Bird Jr. 3318 DATE — BEDROOM CLASS PERC__ CONVENTIONA <, IN-GROUN ESSURE IO CONVENTNAL LIFT_MOUND_HOL ING TANK SEPTIC TANK SIZE Z LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE / ABSORPTION AREA ,r/ PERC RATE BED SIZE Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. �Y�„� u-o / ro �G, r d�c %C !/��• -0 e- C3 Borehole G Well Scale = Feet 0 Perc Hole ate" I System Elevation TYPAR COVERING '' 2" 12" 3' 4 6' 0 3' 3' Q 3' 6" Sewer Rock 12' 18' I i X17` rp o ,o 147 / I o u e I 7 '21 dh 57' (� 1