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Parcel #: 038-1119-50-000 12/14/2006 11:44 AM
PAGE 1 OF 1
Alt. Parcel#: 29.31.18.493B 038-TOWN OF STAR PRAIRIE
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
RICHARD K OLSON O-OLSON, RICHARD K
1899 RALEIGH RD
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.360 Plat: N/A-NOT AVAILABLE
SEC 29 T31 N R1 8W PARCEL IN SW SW BEGIN Block/Condo Bldg:
SW COR,TH N 90'E 175 FT, S 90 FT,W
175 FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
29-31N-18W
Notes: Parcel History:
Date Doc# C725/42 g Type
07/23/1997 8
07/23/1997 07/23/1997 /
72 WD
2006 SUMMARY Bill M Fair Market Value: Assessed with:
175705 74,800
Valuations: Last Changed: 10/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.360 9,000 57,100 66,100 NO
Totals for 2006:
General Property 0.360 9,000 57,100 66,100
Woodland 0.000 0 0
Totals for 2005:
General Property 0.360 9,000 57,100 66,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 120
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER J'T
O e lor&t& TOWNSHIP S��tY ftri'r Q SEC. oZ� T 3I N-R f
ADDRESS ST. CROIX COUNTY, WISCONSIN
I�g-K' 4 tdr ,`
SUBDIVISION �^ LOT LOT SIZE '--
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Gc.roLlI
� 1 1
.2 6.j 3
I i
INDICATE NORTH ARROW
LL
V_
BENCHMARK: Describe the vertical reference point used 60Jjo-•�
Elevation of vertical reference point: /6 0 Proposed slope at site:
SEPTIC TANK: Manufacturer: h,Q Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: j XO5Tank Outlet Elevation: 9.5 ^v;7 ' S
9�6 7
Number of feet from nearest Road: Front,O Side o Rear, O feet
From nearest property line ' Front,0Side10Rear,0 a?a feet
r
Number of feet from: well 60 building: :;;?o O ,
(Include this information of the above plot plan)( 2 reference Dimensions to septic tank)
PUMP CHAMBER
Manufacturer liquid Capacity:
Pump Model: . Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation: «r
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: � �
AP LengY[h: Number of Lines: 02 Area Built:
Fill depth to top of pipe: a2$'
Number of feet from nearest property line: Front, O Side, O Rear, Pt OR-Z f
Number of feet from well: 6,S O
Number of feet from building: 3-3 X o? -f
(Include diet n es gn plot plan).
SEEPAGE PIT
,
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
t
oe Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
L
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
` LABOL3&HUMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
State Plan I.D.Number:
SW4-,SW4-,S 2 9,T31 N-R 18G1 (It assigned)
CONVENTIONAL ❑ ALTERATIVE
Town ob StatL PAv,&L .e ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
R O HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Joe Pul Route 4 Box 176, New Richmond, (UI 54017
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
B non Bii Ld Jn. 3318 St. cu ix 119373
SEPTIC TANK/HOLDING TANK:
MANUFAC UR R: LI UID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
J� PROVIDED: PROVIDED:
DYES ❑NO ❑YES AE NO
BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
I r ALARM: FEET FROM .�,e.� LI ;y AIR INLET:
❑YES O "� ❑YES ❑NO NEAREST--- �v
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
VIDE PROVIDED:
❑YES ❑NO PR YE ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPE TY W L BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑YES ❑NO NEAREST110'
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMET A RIAL AND MARKING:
or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: ( MATERIAL: PIT DEPTH:
la� 8(,v ..�.. •�•�
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOV COVER: ELEV.INLET: EV.END: +�" ^�,, PIP : FEET FROM LIN AIR INLET:
p '* NEAREST p'wZ �� �V 14—
MOUND SYSTE :
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO I ❑YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: iAREST MBER OF PROPERTY WELL: BUILDING:
COMMENTS: ET FROM LINE:
❑YES ❑NO ❑YES NO ----i►
0
w� J
Sketch System on Retain in county file for audit.
Reverse Side. SIGNAT RE: TITLE:
SBD-6710(R.06/88) Zoning AdministatotL
eta*
DILHR SANITARY PERMIT APPLICATION COUNTY Cro
In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT#!
/
9L?"/
—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 R1 NO
PROPERTY OWI�i PROPERTY LOCATION
'/o, S �s 2 TN, R E(o
PROPERTY OWNER'S MAILING ADDRE OT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER 71 CITY ARE T RDA , KE OR LANDM K
f�� 7� VILLAGE:J/GCS°
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family C:12 OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. ❑ New b.;NrReplacement 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. LkConventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. N Seepage Bed b. ❑See a e Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSPM LEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): r ��((
D ,20 Feet IalFrivate ❑Joint ❑ Public
VI. TANK
CAPACITY 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 OLIO I El
Lift Pump Tank/Siphon Chamber 1:1
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's nature:(No Stamps) MP/MPRSW No.: Business PhoneNumber:
a /— 1'062
Plu e ' Address(Street,City,St e,Zip Cod Name of Designer:
c
er1 a
VIII. SOIL TEST 1 OR ATION
Certified Soil T er(CST)Name ` CST##
a ?
CST's ADD ES Street,City,State,Zip Code) Phone Number:
IX. COUNTY/ EPART E USE-ONLY
❑ Disapproved S itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial
S rcharge Fee
2a c7 �
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 6399Y to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained:The septic tank(s)should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. 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 41. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; Water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill GroundtiB�.-
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 r, 8sltl`3
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.
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- f...._„'
water, groundwater contamination investigations and establishment of standards. Groundwater,
...... ...................
it's worth protecting.
SBD-6398(R.03/86)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/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 joswk A PfZ.OL,
Location of property Stv 1/4 56c) 1/4, Section _, T_ZZ_N-R 4? W
Township st/tvL p/2All?
Mailing address / �CIn
..S-y b/
Address of site E+ `f
4
Subdivision name
Lot number Q /
Previous owner of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? /Yes No
Is this property being developed for resale (spec house)? '�Yes No
Volume 7 ZS and Page Number ya ol 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. 6�0 6 7 3. ; 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. ) .
2 //-S-S
S
S&Jnatdre of Owner Signature of Co-Owner (If Applicable)
Date of Signature Date of Signature
r
and Caren i
Wo as joint twilantst
awe M+d a�rretwa w-311111 MA_.__Fi6UX 8
itle taNOMrMtdsseri0ed real sab In OMNMy,S rrni x� �*
saw atVVN MNN
Tax PwW No: K.
? miing at a point which is the Southwest corner of Southwest Quarter of-
westAuarter (SW* of SWD, Section 1•wenty-nine (29), Township Thirty-one
} North, Range Eighteen (18) West; thence North, 90 feet; thence East, 175 feeU
them South, 90 feet; thence West, 175 feet to Point of Beginning.
This is homeeteed property.
ExaptioatO�Warratttfee: -�.°>
a
- 9 85
Date e 1st a October
d this day
(SEAL)
Richar M. Baillameon
(SEAL)
• Caran L. BaillargeWn M
AUTHENTICATION ACKNOWLEDGMENT
Siyneturebl — --- -.--- STATE OF WISCONSIN
St. Croix county.
A auWAnticaeed this day of_ _ 19 Personally came before me this 1St day
October ,19 85 the share ttanN*
Richard M._ Baillaraeon and Caran L.
�z Baillar eon
TITLE:MEMBER STATE BAR OF WISCONSIN
(If not. be the person S who axaaulld .t
authorized by§70e.06.Wis.Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Acorn Realty t
245 Main St. - — — _ Dennis Fleischauer F ^
Somerset, Wi. 54025 Not"Public St. Croix cowi4y.wie. '
(Slpnatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, sate 154 �FAK
are not necessary.)
data: 10/5 .18 '
va
*0004dif Moil 1
-Ina" nityWWwOdbetyOMlorprWftd SNM WISW IaNWrM.— ---
w,wllalTtr Rem*0.2–low tMetw iprmM.P.O.fls�l ! �'�" �f�►1
oe�o . SIAM 9ASI OF WIBCD MM
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER 1 � T 6o X 12(o FIRE NO.
CITY/STATE ZIP
PROPERTY LOCATION: .5 4 1/4 1/4, Section 2 , T,S.?/ N, R le_W,
Town of s4/a/c pfelovzl-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
C/
DATE o C_a
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
' DEPARTMENT OF SAFETY& BUILDINGS
DEPARTMENT
T ME REPORT ON SOIL BORINGS AND DIVISION
LABOR AND PERCOLATION TESTS (115) MADI P.O. BOX SON,WI 533707 707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: NSHIP UNICIP,AA.LITY: I NO.: SUBDIVISION NAME:
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
1,Grt;x o roll le kv
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPO ❑New R IPROFI R S: A ION TESTS:
Residence r2
RATING:S=Site suitable for system U=Site unsuitable for system l�
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
SDU ®S ❑U ®S DU DSCU DSZI! a ��•
E
DESIGN RAT :
If Percolation Tests are NOT required DES If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: /1
PROFILE DESCRIPTIONS 6�
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
o-/6 / �! %6 - l n , ^
B- o-
a
B- d
B-3 g y1 �• S
B- 7,oP o !^ 4.,4' erY IJell o2
B-
B-
t PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER ffd6ilGt. AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIO 2 PERIOD PER INCH
P- J.-25- c Z_
a L
P-
3
P- r R 6
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
Of-
13 9
s—t -- Gi.irt�fic
Ile
..
�r�ve
!��s E/d. o 1 !eC
a13 3p TN
o s
tl �
I,the undersigned, hereby certify that the soil tests reported on thi 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:
ro , r. S--/ —A�
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
DO 7 /5; 6$76/,6
CST SIGNAT RE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395(R. 10/83) —OVER —
PLOT PLAN
PROJECT Ze, ADDRESS izd Ce��
1/+ � 1/4/S� /T� N/R` W TOWN ��7�u` �ra rn. e- COUNTY Lro
g s
MPRS Byron Bird Jr 3318 DATE M ,4 ,"_V— �`
BEDROOM CLASS PERC_�CONVENTIONAL IN-GROUND PRESSURE
CONVENTIONAL LIFT_MOUND_HOLING TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE ,�/�yy HOLDING TANK SIZE
ABSORPTION AREA ! J'�G' PERC RATE C'_ BED SIZE --12X �,5r-
IIL
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark dfla a•�- ; �,/, : SF_ a r,?-e p..E�s
* H.R.P. �t� -� -5 zK�
0 Borehole Q Well Scale = Feet
O Perc Hole System Elevation ��•
Uent
12"
Grnde
194 l/
TYPAR COVERING
2" -
12" 3' 4 6' O 3' N1
1 6" Sewer Rock
12'
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PB-3 141
�r 6 ab trin
1 1 I s'
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