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HomeMy WebLinkAbout008-1092-10-000 ,,,� .c o •v o I 0 3 0 0 a O 6FY ~ > 00 0. 0 a� N > U N N 7 O O O+ ~ JX c6 m N ^� fU6 C O. q O D O N ox- C.0 3 �+ N N o u 0 O y0 0 C O f6 U L o Z Z 'N �o 0 LL c� i o 00 U. C 0 O N J.N E Q E d N E w m U U � I N W C O z E m a+ N N a m d m M 1- (n O O Z :i o w c Z to E 'o Cl) N (D 0 d ) C N CD � N O .N d (A L_ _ z m Z O o d d O O z z z N N ++ O C C) N LO E ta _ A > a �l c ai W c N °' a o g N \vi m o o a $' 3 0 o a N r N N N �I N N m > ? o m 3 3 d m m 3 a = Z o O O O .� oaaa 0aaa 00 00�N ►i 0 c N ° aNi rn rn co J V U rn rn U } eo o } o N = O 2 5 o C) o a y I m c a CL 9 m 0 n_ .� N D1 N j N •� N Q } (n 'C Q } 04 m N 04 1� O O O m I�N/1 C E I�yl! C — J"o 0 CL ++ °o @ � E ° � � f4 o o N C C m m N N N N U 0o N -a v I a0 r NZ Z 00 N 7 V O 47 o y N @ U (OO O O O 17 U O M W Q. °r m Z m _ (n O7 O Z H F y fat a n a ca +�+ E c c :: c O ', 3 � o 0 C.) _1 A c� a2 Omc� Parcel #: 008-1092-10-000 02/21/2006 04:41 PAGE 1 OF F 1 1 Alt. Parcel#: 32.28.16.487A 008-TOWN OF EAU GALLE Current [X j 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 O-SCHLEGEL,WILLIAM J&LACINDA WILLIAM J &LACINDA SCHLEGEL 2272 PIERCE/ST CROIX RD BALDWIN WI 54002 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "2272 PIERCE/ST CROI RD SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 32 T28N R1 6W 20A E1/2 SW SE Block/Condo Bldg: EZ-UT-1503/411 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-28N-16W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 648/358 2005 SUMMARY Bill M Fair Market Value: Assessed with: 138976 Use Value Assessment Valuations: Last Changed: 08/0412005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 15,000 107,200 122,200 NO AGRICULTURAL G4 6.000 700 0 700 NO UNDEVELOPED G5 0.500 50 0 50 NO AGRICULTURAL FOREST G5M 2.500 1,500 0 1,500 NO ENTERED BEFORE'05 CLOSE W8 10.000 6,200 0 6,200 NO Totals for 2005: General Property 10.000 17,250 107,200 124,450 Woodland 10.000 6,200 6,200 Totals for 2004: General Property 10.000 18,850 104,300 123,150 Woodland 10.000 12,300 12,300 Lottery Credit: Claim,Count: 1 Certification Date: 04117/2001 Batch M 513 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 138.00 I i Special Assessments Special Charges Delinquent Charges Total 138.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT "ZER rsns�I , TOWNSHIP 0, G a/� � SEC._�?Z T 2�N, R W ,0. ADDRESS ST. CROIX COUNTY, WISCONSIN. �— 3DIVISION , LOT LOT SIZE PLAN VIEW -Distances S dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ((1 2 n�r arc C>r+�eciLy plcJe!l I of L — �f �� Swale � • ?TIC TANKS)/c9,!!�o MFGR. �� � s CONCRETE STEEL NO. of rings on cover]/orpe Depth r9 DRY WELL !�'610 INCHES NO. of width length area no. of lines 2 width /2' length area 7,?0 o' --/2.5" 7 �r �,/,;_ well depth to to of pipe 3d 3REGATE X RATE 2.51 ARE ? d A REQUIRED 9c C> AREA AS BUILT 9o.5- I' sciaimerr The inspection of this system by St. Croix County does not imply complete 'pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the Count will make ever effort to Y i _ y ermine cause of failure. _.ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER w Mr-PORT Or ITISPECTIO.;I--INDIJIDUAL SE14AGE DISPOSM, SYSTEM Sanitary Permit r State Septic IE TOt•1IISHIP Chu • t, Crovx County SEPTIC TAM,'. Size Lod gallons, `'umber of Compartments , Distance From: Well ft. 12% or greater slope ft. Building ' ! ft. Wetlands f: liighwater ft. DISPOSAL SYSTE',1 Nile Field or Seepage Pit(s) Distance From: Well. 7,-5 ft, 12% .or greater slope ft Building , „5 ft, Wetlands f„ FIELD Hiphwater ft. Total length of lines,/ ft. Number of lines Length of each line ft, Distance between lines -�- �.-� ft. Width of the trerieh �ft. Total absorption area ri '' , s q , t ft De h 1 p of rock below tile /; in, Depth of rock over tile `,2 in., Cover _ -,over.rock /u Depth of tide below grade �� () in. Slope of . trench in per 100 ft. Depth to Bedrock - - ft. Depth to ground dater �-----'ft. PITS . ?lumber of pits �_. Outside diameter _ft. Depth below inlet ,.eft. Gravel around pit : yes no. Total absorption area sq. ft. . Square feet of seepage trench bottom area required Coquare feet of seepage nit arearrequired Inspected Iiy:� 1 f Jrt Title' L Approved -- �� J Date i` - 197,: Rejected Date 197 . EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH P.O.BOX 309 MADISON,WISCONSIN 53701 c REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:�W'/4,s��/a,Section TAI, RA(02&(or) W,Township or Municipality �f3 V Lot No. , Block No. — County .5f• �RDid Subdivision Name Q Owner's Name: Mailing Address: L f^) TYPE OF OCCUPANCY: Residence X No.of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW DITION REPLACEMENT � — � DATES OBSERVATIONS MADE: SOIL BORINGS g — mX Of— /77 PERCOLATION TESTS 9 SOIL MAP SHEET —� SOILTYPE !t1G-,yoyq 5, Lt 4-0,407' PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE CHARACTER OF SOIL NUM- INCISES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 NO 5!0 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B— Z V;o so!L— '�,f /9 N o 14 rrI y� " � P �y y 68 y IT r� r/ �� v rr 1l 46 B_ r 6 if if B_ PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. L It � G dr 5 s 1 0 ry 4 G� o r t N r J t C 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 location of test holes are correct to the best of my knowledge and belief. Name (print) G. I� Certification No. Address 23 14 4.,at l4!r t S .5,4002-- Name of installer if known e,R e, f + L d CST Signatur COPY A—LOCAL AUTHORITY State and County State Permit # 6 PLB67Permit Application County Permit # for Private Domestic Sewage Systems County s4. o >< *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: '/4 '/d, Section T N, R_ € (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township A u zA ((e C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family —X— Duplex No. of Bedrooms Re, e- No. of Persons_ D. TYPE OF APPLIANCES: Dishwasher YES )_NO Food Waste Grinder_YES__X-NO # of Bathrooms-OA/4t Automatic Washer C YES NO Other (specify) E. SEPTIC TANK CAPACITY /00© Total gallons No. of tanks 01-j *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement X Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New_ Addition Replacement X *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth ,f,Y Tile Depth� l No. of Lines �cJo r Seepage Pit: Inside diameter 0 Liquid Depth Tile Size_ Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME Ev off �o/- C.S.T. # 5�S -.S'S/S/ and other information obtained from GJN (owner/builder). ry Plumber's Signature MP/MPRSW# Phone #1.�5�� -.3;5 71? Plumber's Address w PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 1/0 OD ...... _ .� 31 c�rf I _ Do Not Write in Spaqg, Below FOR DEPARTMENT USE ONLY Date of Application - Fees Paid: State © .1coun Date Permit Issued/ (date) - - � Issuing Agent Nam Inspection Yesg Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON,WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76 � $ U ` § 0 C 2 cc m � R [ (b � § e � § cm ( c ] R% k ) �2� ƒ 2 §7� ■ \ }j/ E \ § k ƒ M n \ \ % R p % [ a © § \ k ! 2 7 \ k z � E 72 c a k Q ) k ) / z \ k . k ° $ o 2 \ k k § U 3 ; � K ■ & « ® / 2 a 2 2 : o � A ( � k .?5 k k � ƒ � § § f § 27 �= _ § � ® � /� � c $ ■ \ \ § # » m R m o } E 2 \ $ m o § ® CO � k / § @ \ \ k C)-ca 2 2 § r.- § � . ■ � m o 9 ® / 7 f D + ) § W \ % o z / k 2 \ � ■ � EL : • CL $ k k a § k 2 a 2 \ 0 3 J ! � . D.I.L.H.R. Leroy Jartsky O.W.S. Wisconsin Department of fndustry, PLB-1 INSPECTION REPORT 13 E. Spruce Street Labor & Human Relations Chippewa Falis, WI 54729 Safety & Buildings Division (715) 723-8786 Bureau of Plumbing Name of remises /n► Date an oun y Sa y rmi sE SE, �z 7-9SN, 2 Tvv P, F_� UA"F, -S , CRn\x um er & FirM Name Address OV.X81983 Journe man Plumber Address ION► owner 6 daress ✓w 32- o�-3 3 �- - w P�Y2 mm 33- 2' zs4k% t4dr. aB W VL _ SGAt-E t%`FO S OF S 50 s i En1T T c. 33 c 0q&% LSE a PIT z" BE44jw ts.L Z'.�.!?� SAT T • AA ZA LAO Discussed with igna ure ( )See Attached. DILHR-SBD-6192 (R.10/82) Signature of is . n e Waste p a is Inspector Local Inspector Plumber or Responsible Party Owner Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER W C L� 4i�t SCALt eLTOWNSHIP eqL C-,,v LL,f SEC. 3,;2 T ­�ZP N-R 16 W ADDRESS ✓��( c5 /(, ST. CROIX COUNTY, WISCONSIN SUBDIVISION �SIXLOT LOT SIZE cj PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O r =LL I ` 0 q ..20 ill i I i i I ( INDICATE NORTH ARROW , BENCHMARK: Describe the vertical reference point used �� Elevation of vertical reference :oint e P 5 Proposed slope at site: � �o SEPTIC TANK: Manufacturer: —. Liquid Capacity: /�7,!52 � Number of rings used: 2 W ;A Tank manhole cover elevation: 2�?,j:j�; 7 41 Tank Inlet Elevation: 2 Tank Outlet Elevation: 7e/ Number of feet from nearest Road: Front,Side,O Rear, O y feet From nearest property line Front,O Side,Rear,O feet Number of feet from: well 7J , building: `0 (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: w /-�S Liquid Capacity: Pump Model: W p� ff Pump/Siphon Manufacturer: 60c)tcl Pump Size Elevation of inlet: /I II/Sl Bottom of tank elevation: 7 7, 1 Pump off switch elevation: /7 Gallons per cycle: l 18 Alarm Manufacturer: S; �/ ri��_ � Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear,0 Number of feet from well: q3 Number of feet from building: aZ (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: _ x Trench: Length: ' Number of Lines: Area Built: 3-),.x Width: g Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, ®Rear,0 Pt . Number of feet from well: � Number of feet from building: (Include distances on plot plan). SEEPAGE PIT KI A- Size: Number of pits: Di ter: Liquid depth: o`of seep a pit elevation: Area Built: Has either a drop box O or diafribution box O been use any of the above soil absorbtion sytems? (Ch�"one). HOLDING TANK Al � Manufacturer: Capacity: Number of rings used: Elevation of bottom of .tank: Elevation of inlet: Number of feet from nearest property litre._, Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet- ' rom building: Numbeet from nearest road: Alarm Manufacturer: Inspector: Dated: O Plumber on job: License Number: At P 6"6 �9 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 53707 BUREAU OF PLUMBING SW',4, SEk, S32,T28N—R16W ❑CONVENTIONAL 3M ALTERNATIVE IState Plan 1.D.Number: �}�� (lf assigned) , Town of Baldwin ❑Holding Tank ❑ In-Ground Pressure `[�MOUnd Croix Road NAME OF PERMIT HOLDER- _JADDRESS OF PERMIT HOLDER: INSPECTION DATE: William Schlegel I Route 1, Baldwin, WI 54002 ` 1g' BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name o Plumber: MP/MPRSW No.: County Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 96017 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY:_ TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER U PROVIDED: PROVIDED: ❑YES ❑NO BEDDING: VENT DIA. VENT M TL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ,�j ALARM. FEET FRAM LINE: AIR INLET. DYES ONO Q�1 OYES ONO NEAREST DOSING CHAMBER: MANU FACTUR BEDDING: L�ID ACITY PUMP MODEL. PUMP/SIPHf1N MANUF ACT�REH WARNING LABEL LOCKING COVER � I ♦�� /' PROVIDED: PROVIDED: YES NO / V �J V vL�JLRJC YES NO YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF IPROPERTY WELL- 1BUILI)ING.JVENTTOFRESH (DIFFERENCE BETWEEN ) / _8 FEET FROM .� / AIRINLET PUMP ON AND OFF) YES ONO RIEARESf �� C/ \J ZL� SOIL ABSORPTION SYSTEM.Check the soil moisture at thia,epth of plowing FORCE LENGTH 7DIAME"TER MATERIAL A uD MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until �s}/the soil is dry enough to continue.) MAIN 2 CONVENTIONAL SYSTEM: y. WIDTH. FELEV H. NO.OF DISTR.PIPE SPACING. COVER µ .INSIDE DIA.. #PITS. LIQUID TRENCHES: MATERIAL' 1�I71 DEPTH: ! I3y4q'P�ILAN _"',ur GRAVEL DEPTH "" FILL DEPTH PF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NU MBI OF PROEEPERTY WELL BUILDING: V NT TO FRESH BELOW PIPES ABOVE COVER. LET ELEV.END: PIPES. FEET FROM LINJ: AIR INLET: _ NVA�IEJT:. 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- YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE / PERMANENT MARKERS JOBSERVATION WELLS \•f\�/�V`/ YES ❑NO YES ❑NO DEPTH OVER TRENCH/ DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. / � EDGES D (/ (/ 1:1 YES 57NO U YES 11 NO YES ONO PRESSURIZED DISTRIBUTION SYSTEM: ywy# ^.WIDTH" LENG H NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: PIT TRENCHES: . � 3 Z r ' • S MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: L1� 3R ELEV.: ELEV.: CIA_.� ELEV.: PIPES DIA.: HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL l/ VERTICAL LIFT CORRESPONDS TO APPROVED 11� Mr�F C / r4 ^I r PLANS: fJ YES 1:1 NO YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: 1s PROPERTY WELL: BUILDI G: FEE LINE: / O FEE�`'F'944 YES ❑NO VYES ❑NO IMEAPIf Sketch System on county file for audit. Reverse Side. A PCOqE TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator SANITARY PERMIT APPLICATION COUNTY 7fILHR In accord with ILHR 83.05,Wis.Adm. Code ' (f - •°°•^ ^�^�- STATE SANITARY PERMIT# 9Ie,0/ 7 -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. LI?w3g/,F -See reverse side for instructions for completing this application. PETITION (�' 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES YES JA NO PROPERTY OWNER PROPERTY LOCATION l,e,;,;Z/,Q/" S /) ( 50 114.5E '/4, S SO -VF , N, R l(j/ Q (or)W PROPERTY OW R'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME �; y� CITY,ST//AT ZIP CODE PHONE NU�MBBEJR/ CITY NEAREST ROAD,LAKE OR LANDMARK �C>f GIJ//f l.G// • `4'000_ 7P� a2l VILLAGE; .J�-// /-0//� e E ✓'G e- S (fr0,lr II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): /a III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. N 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.,®Alternative C. E] Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. Dd Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) t, 1. a. Seepage Bed b. ❑seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): , 7 3'7-'5-' S 7(, 99-5' Feet 0 Private ❑Joint ❑ Public VI. TANK CAPACITY ##of Prefab. Site Fiber- Exper. in allons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank 1600 000 We e-<-5, . ❑ Lift Pump Tank/Siphon Chamber o 1 — 9001 JX I ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: ?/e �l��so� e. �9 Z ��5 �6�-337 Plumber's Address(Street,City,State,Zip Code): Name of Designer: Zd /�a�%� VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 15 X9'71 `361 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing gent Signature(No Stamps) 50 Approved ❑ Owner Given Initial Sur arge Fee Adverse Determination C �X. CO MENTS/RE SONS FOR DISAPPROVAL: '50/0f, Re c>>ea.'-d b 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. Property owners name and mailing address. Provide the legal description where the system is to be installed: 1!. 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'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. ------------------------------------------------------------------------------------------------------------------------------------------------------------ I 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. Th s change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground ylater — included the creatior; of surcharges (fees) for a number of regulated practices which Wisco ins a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasura.,. is used iri your building is returned t,- the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 ne. ponies collected through these surcharges are credited to the groundwater fund admmis tered by the Department of Natural Resources. These funds are used for monitoring ground- T water, groundwater contamination investigations and establishment of standards. Groundwater, i''s worth protect ng. c�7339� R.C3 36? INDUS TMENTOF REPORT' ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION HUM LABOR-WD.LATIONS PERCOLATION TESTS 115) P.O. BOX 7969 (H63.09(1)&Chapter 145.045) MADISON,WI 53707 .5`W S�'/ 3 /T N R t(o W TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: .?� / / N ,60,.. Q Ile. COUNTY: WNE U ER NAM MAI I NU ADDRESS: USE: CIAL BE DATES OBSERVATIONS MADE Residence T 0 PROFILE❑New Replace �,�-• �� S• STS1 =- RATIN43:S-Sits suitable for system U-Site unsuitable for system O cc N'AII: MOUN��`D=E1 -GROU�Q`D• :S ST(� -N-FILLHOLDIING TANK:RECOMMENDED SYSTEM: optional) OV ®V ®J EIJ Y—11 ®� �J �� If Percolation Tests are NOT required DESIGN RATE: [Floodplain,any portion of the tested area is in the undei s,H63.09(5)Ib),lndicate: �� indicate Floodplain elevation: PROFILE DESCRIPTIONS !B-'ORING TOTAL P R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH UMBER DEPTH Ci ELEVATION B ERV D E IGHES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) g-: B- 9M7 lVolld f PERCOLATION TESTS I TEST NUMBER �E#g4W FTERSWELOLING INTERVAL-MIN. DROP IN WATER L VEL•INCHES P I RATE MINUTES I D PER INCH jet 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 ow er on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. Se c. .3Z GcJ,/llom ,`'chle jel NO 30�u�w i✓>� G�J�', 5-106 Z. A"ercelstCCON lid s SF X 800 sol., �8N RA, Pur*p 7L -1 Zoe /000 /o' �,/v�. /00,0 . 31 417' /,�ousC '(D'—>���_® ell 76' 13,M. p 3z. - 9f, `l3, y0, 50 1"3' c� - 17enofes �3ov'e; /,lo/eS No 25' B/ GD` 1BZ PO O - i7ehofe5 Sore, �o%S I I 37, Pao po 1 y /Vour)ol B'M,® -Denole5 13enCA :/?go r�` �a DOHOM 0 3 ss' 93 ZY6 of 179 at Soej Ldesf -� house . yzo' /rlou✓� C/ I ICI ` 3 8,703818 PLUMBING I 3d113 L Page Of3 c , } Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G Topsoil —11 ---,�-- F 3 E 'I D u li Slope rtaz e Of 2"- 2 12 Force Main Plowed gre £te From Pump Layer u D ,O Ft. } �E ection Of A Mound System Using E /�/� Ft. tv � A Bed For The Absorption Area F °75' Ft. � L C G AO Ft. A Ft. H /�.5� Ft. Signed: B `17 Ft. License Number: K Za Ft. \Date: L - 7 Ft. J 7,7G' Ft. 8703818 Alternate Position of T 9,3 Ft. Force Main W ,2 5 Ft. L Observation Pipe J I g K AL---------------------- -------_--------=----. � r �•-----T------------------------------------- Force Main W o Distribution --- Bed Of -'2 2 2 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Pa9e i of 3 l OEP,4,RT�,�'�'r Ofi Perforated Pipe Detail L ' Q 'CJ t,. I < A I„) D o CLAT/QN5 End View w'. )Perforated / `. End'Cop PVC Pipe • 0�4,Q� Holes Located On Bottom, Are Equally Spaced X $ P t^k PVC Forcer Main X From Pump 8703818 P PVC Manifold Pipe Alternate Position Of Distribution �— Force Main From Pump Pipe ' Lost-Hple Should Be Mezt To End Cap ^ I End Cop Distribution Pipe Layout P a oC �* R 5,33 S 3! y0 „ Y = yLl Signed; _ /,,�� � �%�-- Hole Diameter Inch a Inch es Lateral ( ) License Number; �/�p ���� Manifold Z Inches Date: -5-- 1;7 Force Main 2 Inches kd�� 7--\ 1.. PAGE 3 OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS --VENT CAP 'I"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING _ �t 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12 MIU. I AIR INTAKE GRADE I `i"MIN. � CONDUIT -- ________ 18"MIN. \��� ---------- \ INLET 1146PROVIDE I ---- hA AIR� HT SEAL APPROVED JOINT A �x�{ I � �1##v,11! �• I I APPROVED JGIIJ' W/C.Z. PIPE W/C.z. PIPE EXTENDING 3' RLL�`�1�� I III EXTENDING 3' ONTO SOLID Silt_ o- �" �h N1i ALARM B ONTO SOLID SOI ON v � I DL �r�`riv I I ��L PUMP_� �--J OF"� (n� � Q D 81 CONCRETE BLOCK RISER EXIT PERMITTED GNLy IF TANK MAMUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND y DOSE TANKS MANUFACTURER: 4 � - xS NUMBER OF DOSES:_ P E K DAy TANK :,IZE : Po O GALL A 0I.J S DOSE VOLUME: ���'Z GALLON] ALARM MANIUFACTURE /J R: . �//a+f'YY% A l / CAPACITIES: A= ES OR ,=Ef25Ve,,,GAL`OKJ5 MODEL NUMBER: __ �✓�'ZoOU' B= z INCNES OR �p►GALLOWS SWITCH TYPE: - f -"/ C(/ \I C= INCHES OR _L�1 GAL S PUMP MANJLJFACTURER: INCHES OR 2D 7 CALLOUS MODEL NUMBER: ��O 5 7 NOTE. PUMP AND ALARM ARE TO BE SWITCH TYPE: UY- INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE _ GPM VERTICAL DIFFtRENICE BETWEEN PUMP OFF AND DISTRIBUTIOU PIPE.. FEET + MlhJlMAUM NETWORK SUPPLY PRESSURE , . • 2.5 FEET + -L- _ FEET OF FORCE MAIN X -21 FY0 FrFRICT101,J FACTOR., -5"5y FEET TOTAL DJNAMIC. HEAD = �� FEET IIJTERtOAL DiMEP1510NS OF TANK: LENGTH 7/ / ;WIDTH ;LIQUID DEPTH SIGNED: ��,�,� LICENSE IJUMBER:_C� �27 ' DATE: J 6 / Bulletin CL2.1A • For Homes July 8, 1983 _ • Farms Sol& GOULDS • Trailer courts Model 3885 • Motels (Supersedes Model 3870) • Schools • Hospitals Submersible • Industry EfflOe^t°°m° Effluent Pumps • Eff luent Systems Pump Specifications anywhere effluent Solids Handling Capability to 3/4". or drainage must be Discharge Size disposed of quickly, 2"NPT. quietly and efficiently. Semi-Open Impeller 3 vane design,threaded on shaft.Three phase units use impeller locknut to prevent accidental back-off.Pump out vanes on backside of impeller for protection of mechanical seal. Casing Volute type for maximum efficiency. Heavy-Duty SOWS Handling Stainless Steel Fasteners Series 300 stainless steel for corrosion Dependable Capability t03/4 resistance. Mechanical Seal Ceramic vs.Carbon sealing faces,stainless steel• spring and Buna N elastomers. Maximum Temperature 1/3, 1h H.P. 60 Hz j 160'F. 870381. 8 ( Single Phase 115, 230 Volt. Capable of Running Dry without damage to components. Motor Specifications 1/2, 3�4, 1, 1 142 H.P. 60 Hz I Motor Fully Submerged Single Phase 230 Volt. Three in high grade turbine oil for permanent lubrica- tion of bearings-and mechanical seal and Phase 208-230,460 VOIt._ ! efficient heat dissipation.Motor sealed from environment by rugged cast iron enclosure. x Bearings ' Heavy-duty all ball bearing construction. Stainless Steel Shaft Series 300 stainless steel for corrosion resistance.Threaded shaft. Single Phase Units All single phase units have built-in thermal overload protection with automatic reset. 80 Three Phase Units Overload protection in starter unit.208-230 or F, 70 460 volts.Threaded shaft 60 Hz operation. W Power Cord C60 Water and oil resistant.Epoxy seal on motor end a acts as a secondary moisture barrier in case of 2 50 damage to outer jacketing.Corrosion resistant V gland nut. a 40 Single Phase Units } 1/3.1/2 H.P.models equipped with 15'of 16/3 0 30 SJTO with 3-prong grounding plug.3/4, 1, Iva H.P. a models equipped with 15'of 14/3 STO power O 2 cord. 10 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. 0 0 10. 20 30 40 50 60 70 80 90 100 110 120 GALLONS PER MINUTE GOULDS PUMPS, INC. SENECA FALLS NEW Y0pK 13148 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 l,(// � 10 1.7 -5- Location of Property 14 14, Section ��� , T Q N - R �.5� W Township c1t 6--a A Mailing Address Subdivision Name Lot Number Previous Owner of Property 34"-n i Pewic-5-01I Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (epee house) ? Yes VV No Volume and Page Number j as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1.�Warranty-Deed 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eetti.6y that att a.tatementa on .thia 60nm ate tAue to the beat o6 my (out) knowledge; that I (we) am (cute) the ownen.(s) o6 the pnopeAty de c i.bed in thin in6o4mation 6oAm, by vi tue o6 a wahta.nty deec,teeonded in the 066ice o6 the County Reg,iAten o6 Deeds as Document No. 3rj,-( and that I (we) ;14eaentfu own .the ,►_v:opoaed 3%�e 6en th teenage pos Lyatem (o;, I (we.) fLase obtained an easement, to hun with the above deanibed pnopen.ty, bon the con-6tAuction o6 said sya.tem, and the same has been duty necon.ded in the 066.bee 06 the County Reg.ia.teA 06 Deeds, ab Document No. ) , a- 1, 4 SIGNATURE OF OWNER SIGNATURE OF CO-07ER (IF P ICABLE) T NED DATE SIGNED �.i A NAME -1--ccM IN 0 ................................................................. ................ ................................ ......................................................... .................................................... i nd NWI b .......St.....1rXQU................00mV. Tax Kv Xa� g -t Half 'of the West Half of the Southeast as quarter of Section thirty two (32) , Town eight (28) North, Range Sixteen (16) West. V Tn F, Thb ...... is lihmapdon to venom": Dated this ........./Y . ................ ................. day of .... June 82 ... .. . ..... ..... . .................... .......... .........................- ........... ..............(SEAL) .................................................................. - MyrnW J. Pe ....................... ......................... .....................................................................(SIrAL) ................... .............................. A .......................................................... ....... ....... ... ....................... .......................... AUTURNTICATION ACKNOWL111DOUNUT SiMm"m andwadoeted day of STATE OF WISCONSIN .................................... .............................. ... .......... Personally eseve befon on,this..................oft�et . .. . . ....... .....I..........419...... the above Y4"� -numax-A.—Kc.0armack.................. TITLZ: *ZN2ZA STATZ UR OF WISCONSIN - ------ - ................. ................ (if ......... . . . . . ..................... ...................... out= 78US,Wis. Stats.) ........... ... ............................. . . ................................. ....................... T"18$"*TRUMKNT WAII DRAFTED BY tu we krown to be the pams ............ Who M. A. McCormack �oregoing instrumsent anal acknowlefte the Ban& Thomas ..S4t-v SUite- -1-0-3 ------- Baldwin, ................. .. ......................................... ..... .. ...... . .... ....... .. .... .............. p be authenticated or a&nowledred. Both Not&ry Public ........... ..... .... ................ V My Commission is permanent. f If ncC state ex;;;14. date: ........ .... .. shwift is en3, eqwfty @"W be tvp�l pri"W blw dwir sigvaWm. H L U) H a ST C '- 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT H 0 St . Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER �5 , /, Fire Number CITY/STATE 1'�Q�C.��v.:7. Gyi: ZIP 5'70DZ PROPERTY LOCATION : 14, !4, Section 3'Z T z N , R -W, Town of 'c—Oa ;-wle' St . Croix County , Subdivision �>y Lot number /VX 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 the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents m_ y 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. H 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 the standards set forth, herein , as set by the Wisconsin Depart- b 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 . O wner r; J � Sec. 32 eLo 4 x r' SWAY SE Soo sal, ,E"x,'sT,'✓�9 �JV R/� w RUM Iaut /600 Ga1, $e,pt� G /00,0 £x f �®® 3 z. - 9f,7,# > IB _ 97,. og 50� `l3� y0� �' t= - 7enofes Bore;; tlo/es I25 Bl ��' P# O ' L7ehofeS !Sore; //o/e5 37. Pi o pzo I /Ylovr�c� -J7enofes eencA foot 7` t� I 3enG 0Hom � 3 93 2616 o slot%n9 a�' Saufl� �iJesf Corner- o�{' house . y,20' I I s Z X 47 3 81703818 PLUMBING tionativ ConJi *ov i MIA Jt /F• � pA�iTI F[`il OF II �rdWh By � !Y caGZ/atr 112P az9 csr 3113 d, ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 28, 1987 Division of Safety and Buildings Bureau of Plumbing P . 0. Box 7969 Madison, WI 53707 Dear Sir : An on site investigation for the William Schlegal property located in the SW 1/4 of the SE 1/4 of Section 32, T28N-R16W, Town of Eau Galle, revealed suitable soils at a depth of 2 . 5 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office . Sincerely, Thomas C. Nelson Zoning Administrator rc WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SW 1/4, SE 1/4, Sec. 32 T 28 N, R 16 ExPW4 W Town Y3rx Eau Galle Street Address Route 1 , Baldwin, WI 54002 Lot No. N/A Block N/A Subdivision N/A Landowner's Name: The application for this site is for: ❑ new construction use. x❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num e-rs issued to you.) L one of the applications needing a quota number. The quota number assigned to this application is - - ❑for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑for an application on file prior to February 1, 1980. ❑for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Q a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the bp-st df my knowledge. Name Thomas C. Nelson Signature _ County Official Title St. Croix County Zoning Administrator Date 5/28/87 DILHR-SBD-6158 (R 12/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAN° PERCOLATION TESTS (115 P.°. BOX 7969 HUMAN RELATIONS \ � MADISON,WI 53707 (1-163.090)& Chapter 145.045) LOCATION:SE SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: :S'cv Y "/4 3 /T.??N/R/ I(. W oglle A COUNTY: OW�NER)'S BU ER S NAME: MAILIN ADDRESS: SYL Cro;x USE DATES OBSERVATIONS MADE BEDR : CO M L ES R PTION: PROFILE S: A N TESTS: Residence ❑New WReplace I /��5'•_ ��' / RATING:S-Site suitable for system Ur Site unsuitable for system O I NAL: MOUND: IN-GROUND-PRESS_ UR. :[SYSTEM-IN-Fl LLHOLDING TANK:RECOMMENDED SYSTEM: optional) ❑$ ®U ®S ❑U ❑S'C"U ❑S ®U ❑S L�U tihu�� If Percolation Tests are NOT required DESIGN RATE:Q�/® (If any portion of the tested area is in the under s.H63.09(5)(b),indicate: N Floodplain,indicate Floodplain elevation: /JJ' PROFILE DESCRIPTIONS BORING TOTAL P T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH Ili. ELEVATION BSERVED EST.HIGHE—ST— TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-' ''D' 9M7 Aloti 2•.5 -,25 ' 3, 5 B- y1,0' 9F, .0 2 •,2�` f/ "� �� ,. B-'j guff 131 B-• B- B- t PERCOLATION TESTS EST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 14J61}66 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE I D P PER INCH P- 30 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 1perceni of land slope. SYSTEM ELEVATION. , I , r r i } _. f _ 1 tN i r 1 � j I . , r Ir r 111 1 i 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. r ^-� NAME(print): TESTS WERE COMPLETED ON: 'AD E S: / 0e, A CERTIFICATION NUMBER: PHONE NUMBER(optional): i CST SI TUuRF: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. nYr i�ih nYin rerw v. rr.rr� Owner; Se c. 32 om SChleje/ - i T No. 30 l dW i✓�� Gv�', 5-16)6 Z, S. e /�C��e�StC�o1X �d SWAY SE goo ca 1, �Ex�'sT;nq 19 PUrmp T n K Zo, O /000 Gol. Sept e Cxlsf"n? 3 I 9,?,Y7" 133 ` 97,009" T ' 13, y0, 50 �# De 13' go/es 25 g/ (p' �Z P* O - Dc,76feS 23ore- f✓o/eS No. I I o j� 3,,, P I o M P Zo AA I r�Ben F (7'--__ 25 I A �, �enC� �Q� re. iS 6O/ /�y 0M 0 1 M s8' 93 zqo s�'ol�n9 of S�uf/� Wesy- 0- ' house . yzo' Mou✓) C/ 4 7 ' � C5 3 II f�rdWl� By GolZ9 CSr 34113