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HomeMy WebLinkAbout040-1053-85-000 \ / 2 & o 0 k :5E . bL to \/ A { C ƒ A§ . % c2 {k§ =E , o= � ! \E (D z \ ) kk LL 0 C, � E [ co « $ f E } = & z / § 2 Cl) § $ a ■ E � ) z 2 \ . ■ 2 5 } � \ Cl) / D ® f � c � -� CL ƒ g \ � § Q z .. ) CD � § 2 ƒ E % � ` \ q 3 k 2 / ° z \ i } k k A 0 a a 2 ) t0 & k ! 2 j U) co co co co LL k � � z _ � � / \ § § } E � < z f 2 ; ) k_ % � § 2 LO I 2 , 2 , / ' o c _= E © & [ » ^ 40. § / / : ) = k k 2 k % § § / \ } 0 j � ) ` 2 0 2 2 ] ) / J m k ce E / k � \ $ J a A U) U Parcel #: 040-1053-85-000 06/23/2006 03:20 PM PAGE 1 OF 1 Alt.Parcel#: 13.28.19.199E 040-TOWN OF TROY Current X1 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 ERIC J &SUSAN M BJERSTEDT O-BJERSTEDT, ERIC J&SUSAN M 361 CTY RD U RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *361 CTY RD U SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.403 Plat: N/A-NOT AVAILABLE SEC 13 T28N R19W SE NW 3.403ACRES LOT 1 Block/Condo Bldg: CSM 7/1970 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 11/09/2005 811659 2925/349 EZ-U 09/06/2005 805613 2882/444 QC 05/12/2005 794749 2801/382 EZ-U 07/23/1997 812/262 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.403 63,200 167,000 230,200 NO Totals for 2006: General Property 3.403 63,200 167,000 230,200 Woodland 0.000 0 0 Totals for 2005: General Property 3.403 63,200 167,000 230,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 St a Plan SE�,NW4jS13,T28N-R19w CONVENTIONAL ❑ALTERNATIVE IIfassigned)O Number Town o{j Tko y ❑Holding Tank ❑In-Ground Pressure ❑Mound County Road U NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: O EAiC B 'Wjed Rowe 5, R.iveA 1=a ez, w1 54022 q-7- ye a BENCH MARK IPermanem reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.'. CST REF.PT.ELEV.. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number. Roger Timm 3224 St. Cno.ix 112688 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: T ELEV.. WARNING LABEL LOCKING COVER P IDED: PROVIDED.ITANKOUTLE YES 1:1 NO DYES NO RO BEDDING. V .. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPER WELL: BUILDING. VENT TO FRESH LALARM FEET FROM LINE JAIR INLET DYES. NO ` ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ❑NO OYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF P HOPE RTV IWELL BUILDING VENT TE FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 0 N NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I LENGTH DIAMETER MATERIAL AND MARKING or excavation. Of soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH' LENGTH. NO.OF DISTR.PIPE SPACING COVER JiNSIDE CIA 3PIis LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PI DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH 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. DYES ❑NO SOIL COVER TEXTURE 1PIRMANINT MARKERS OHSEHVATIONWELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES EYES ❑NO DYES ❑NO ❑YES EINO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATE HIAL&MARKING ELEV.. ELEV.. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES El NO ❑YES 1-1 NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: ❑YES ❑NO OYES 1:1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Adm-nLb, '' rte-I i� SANITARY PERMIT APPLICATION COUN Y T ®ILHR In accord with ILHR 83.05,Wis.Adm.Code °°�...,.......,�� STATE SANITARY PERMIT if —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 C�NO i� PROPERTY OWNER PROPERTY LOCATION % tU 1Z%, S 1 3 T-2,e, N, R /(F (o kW PROPERTY OWNER'S ILING ADDRESS LOT NUMBER BLOCK UMBER SUBDIVISION NAME CITDY,STATEn ZIP CODE PHONE NUMB R CITY r NEAREST ROAD,LAK OR LANDMARK 1.5 bJX 1/J 22 #. VILLAGE : l I/p L 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. Ln New b. 1:1 Replacement c. El 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. P Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. 2 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(Square Feet): -- I l�I -7­5o 5 v � - 2- /o'7,o Feet &Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed El Septic Tank or Holding Tank uZ�C� e E-1 ❑❑ 1:1 ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber 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 'gnature:(No St am s) MP/MPR, a.. Business Phone Number: _ 3zz fS 77z $ Z�<C Plumber'i Address(Street,City,State Zip Code): Name of Desi i j uJ�;s �vz VIII. SOIL TEST INFORMATION Certified/Soil Tester(CST)Name CST#d L nG& 6 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: `f✓ 5 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved �� Sanit ry Permit Fee Groundwater ate Is? Agent Signature(No Stamps) `Approved ❑ Owner Given Initial S rcha�rgce Fee 't��(w„ Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: C'�Gti�-. ��(11�1� 1 f r!�'`� 3 v�•��,K.i rte.$ V 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 private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 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 Ground Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco irt's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaiure' is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. w . The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signdd by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, ("spec ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - er of Property Location of Property k rUL) 1%, Section / 3 , T N-R W Township Mailing Addressc lei vets l s (� . 'Address of Site Y ( Subdivision Nsae 7 6 Yn / 5 Lot Humber / Previous Owner of Proper y i3 ;el .5/. Total Size Size of Parcel —'°'�- Date Parcel was Created _ �' -31 -,$ Are all corners and lot lines identifiable? X i Yes No Is this property being developed for resale (spec house) ? Yes __ No Volume C�I Z_ and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS S 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 I'I helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION i POP) c9,t,Lc6y that aff 6tatementJS on this 0AM ahe true to the but o6 my (otL&) hncwtedge; that I (we) am (ahe) the owneA(.61 06 the pnopehty deAcAi.bed in thin .in6onmation 6oAm, by viAtue o6 a waAAan.ty deed Aeeonded in the 066ice o6 the Cotin.tyy RegiAteh o6 Deeds ah Document No. ,YC v ; and that i (We) pneaentty c.un tl�e pFtoposed site 6ok .the sewage poh eyb em (ore I (we) have obtained an easement, to nun we th the above deAcAi.bed pnopen.ty, 6o& the eonatnuction o6 said system, and the same has been duty keeakded to the 066.tee o6 the County Reg.ie.teh o6 Veede, ae Poe mont No. ) SIGNATURB OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ' / . DATE SI D DATE SIGNED " DOCUMENT NQ. STATP PAR OF WIS60NOIN FQ l—_ Mina PAT. ,Vm WARFiANTII -R9W 437 REGISTER'$ OFFICE This Deed, made between ...Richard_H. Bjers-- ---- X and_ Norma-_J.__Bj erstect, husband and wie and_ Co., W1 r t04'4 fQr Record each. .�.n._thgaex..s? iil...r� h , . ..... ............. ..... ................... /� ..... . ........ -------------------------..----- --- .-.-, Grantor, ' MAY 3 1 ,,„d .-.--Eric J., B�erstedtx a single person- -- ..... .. ........ t 1;45 P M ...................I......... ............. ............... ------ -- --- _.-- ••---•......................................•---••--•••---•- ..............---......, Grar. a, , Witnesseth, That the said Grantor, for a valuable ecosideration. '-f xle dollaran . th __ _ _. cideratiot - -=- ._=- conveys to Grantee the following described real estate in ...._. aaTU.4ry Ta g , t.:. .Crox_.... County, State pf Wisconsin: :t Tax P4rcpi NA .RR �.!l.,-.................. Lot One (1) of Certified Survey Map reco ,ied } YQ ”' !� ( xtab tied Survey Maps at Page 1970 as Document #437332 . LJ3 y \ j" �� fI This ... S not....... ... homestead property. (is not) !i i Together with all and singular the hereditaments and appurtenances thereunto beioair,g; And....Richard H. Bjer twit and Norma J. B�erstedt warrants that the title is good, indefeasible in fee simple and free and clear of encumbraw ea eXcept ed: FltB restrictions and reservations, if any, of record. urrd will warrant and defend the same. Dated this .. _ '•.... ..ZT _ day of ....._ 1 Y.---- . 18.. .$ r . ----- ............................... .(SEAL) a� 1/i SEAS.) ----- ---•-------•-- ---•-----••-.....---...__ _ R' chard ers e _........ (SEAL) �. 1. OC I4 . .......(64AL) "Nc rma 'J. .....jer'stedt AUTHENTICATION ACNU[T + u ?Gk, �iTT Signature(s) AOF RISCOtSFyL ' ss. authenticated this A&SY of-------at........ 19.R_2 Personally ;,sibs+ b@fo;l We Qthhip . .. ".day of -- ------••......_•................... ....... ..•-•-........... named l! TITLE: MEM3ER STATE BAR OF WSSCONSIN ° .. .f... -....... .... (if nut, ........................... QQ l; authorized by QQ Wie. Staff.) to me known t !*W .4 the �f�;e�oin(� its MpTHIS INSTRUMENT WAS DRAFTED 13Y � D . Peter Seguin Attorney at Law � R' .' �3 River Fal . s, Wisconsin 54022 �tR ` ..... ..................................................... Notary Pw lic .... .Pler.: �R .g. County,-Wis. (Signatures may be authenticated or acknowledged. Both piration .tre not necessary.) -Names of persona signing in any capacity Oould M typed or printed below t1;4Fk ai(inatures. Vlt1U ky fAR 7 i AL aTAT H.C.Miller Compary� aA& F �i6COAf8IA( Lt� r H N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d _ a OWNER/BUYER v c. lJ �z H pp x v 6 ca ROUTE/BOX NUMBER Fire Number CITY/STATE AAS ZIP��!",lGZ Z, PROPERTY LOCATION : SL ;z, /y(� 14, Section T Zb N , R /J W, Town of Tfdt1 St . Croix County , Subdivision (S /-1 C/ 7 ,oa 1y7d , Lot number_. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you put into i the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , 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 . 0 E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth , herein, as set by the Wisconsin Depart- •o ment 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 . DI'PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. DIVISION Y LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911)&Chapter 145.045) LOCATION: SECTION: TOWNSHI MUN e PALI I Y OT NO.:BLK.NO.: SUBDIVISION NAME: s� '/aMJ/a 13 /Tas N/R/9 E(or W � ti� /VW COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St ceoxy T z -57 7zl lezv�crl F)W_6 uo r SyOyz USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: ER A ION TESTS: Residence ®New ❑Replace slGp2jL Z1 1c?$g plelL 2,Z /9 RATING:S=Site suitable for system U=Site unsuitable for system z4 — �t Q'r P yip S /97 CJ1 SA, o 1 X C4. r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM: ®s au ©s ❑u 1 s ❑u ❑s ou DS EA co,V Vf� a,N0+` L A Cz If Percolation Tests are NOT required DESIGN RATE: lFloodplain,If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C� SS indicate Floodplain elevation: /q PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 6-IZ dK Br' 5W I j )2-,3(. n SI 36-96 /t An 'tined S w� 0-12 dk sly , iz-Zy r s� 2y-30 S,»aw LS AXE esS, B- 2 l(so /0,50 > 30-100 1E PN MPA. 5 f 0-15 dK Ian sil, 1, S/, 3(d-R e /t on med.S w B- 96 103,33' 103,-53 �_S 147; '14 Q-18 dk fie. Sil , 18-31 Bn 5l; 31-96 /t n /tie S w/ 0-19 �K Rn Sil 19-34 r 51 36 -Ifib 1t » `vied S B- / 1007 J0�' 17 Fs B- SsR ,4U_ OF PE?cs PERCOLATION TESTS TEST INCHES AFTER SWELLING .DEPTH, WATER IN HOLE ME ROP IN WATER LEVEL-INCHES RATPER INCH ES NUMBER NTERVAL-MIN. PERIOD 1 PERIOD 2 P R P- 2 b 0 7 P_ a1.60 I 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. 407 0 �f SUN r2F_�>Ctf= l off,o' SYSTEM ELEVATION s pZZT N JZT !-PwE — tN r � F I € , � 1 � - YY,_. I p } , ' jT _ l t " i p � 2 »... ; 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(print): TESTS WERE COMPLETED ON: 'ed C E'KNO avS 4PerL Z" , )988 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 5' pv,.wfi �u coy✓ G+/1' Q/b 36 30 386-3y76 CST S E. - L..�+✓ DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DI LHR-SBD-6395 (R.02/82) —OVER— 1 INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 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 residence or cormercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED 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. Drawing 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 Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg Building Is - Loamy Sand > - Greater Than 'sl _- Sandy Loam < Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI Black si - Silt Gy Gray *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam me! - Mottles Sandy Clay wl - with -� sic - ilty Clay fff _.__ few, fine,faint c C y a cc - common,coarse 1), Pe t trim - Many, medium m - Muck d - distinct p'- prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP --- Vertical Reference Point s r: 0 T O THE OWNER: ha soil test report is the first steP in securing a sanitary permit. The county or the Department rnay request u';ification of this soil test in the field prior to permit issuance. A complete set of Flans Tor the private u<rt e systern and a riermit application must he submitted to the appropricite local authority it) order to s% err"ritt. Ti+e sci';itary pe,rinit must be o1)tai,ied and posted prior to the start of any cc)ristr:ir'Cton» I MPRS 3224 WI MPCA 696 MN JOB ZoL Timm SHEET NO. OF CALCULATED BV- DATE 7- 7 Excavating Co. CHECKED BY DATE_rr�P��� �ZZ R 1, BOX 192, Wilson, WI 54027 SCALE 715-386.5443 ROGER TIMM 715-772-3214 .. .�_ I s _j r / — -�.- < yZ, a n � a 7`2 rR=E.2X11 fM..&Qbt Alp.01471. MFRS 3224 WI , • MPCA 696 MN JOB Er ,I`r * Timm SHEET NO. Z" OF 2 — CALCULATED BY— " DATE Excavating Co. CHECKED BY DATE_ �� R I, Box 192, Wilson, WI 54027 SCALE 715-386.5443 ROGER TIMM 715-772-3214 i Iayv- ....., .... .. . _ ~L . . . .. 117 L L lDy.�4 o • c e i cj n G rAmicr mil 7IM,Gmtm,Ma,01471.