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PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
8�Wr����
SOIL ABSORPTION SYSTEM -IU0 '.uo
108Sb Iog.S6
Bed: Trench: 7 s ° d Bo}�orti
Width: Length: I u3 ero of Lines: 3 Area Built:.
Fill depth to top of pipe:
Number of feet from nearest property line: Front, Side, ( Rear,O Ft .
Number of feet from well: got V�
Number of feet from building: r
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job: Ync-��
License Number:
3/84:mj
mom
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER e TOWNSHIP u ,s�ti SEC. T N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISI N LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3 '
° ► �k71 �
3 ,
12ao M
INDICATE' NORTH ARROW
BENCHMA Describe the vertical reference point used
Elevation of vertical reference point: J00, Proposed slope at site:
a
SEPTIC TANK: Manufacturer: W P-1Z K S Liquid Capacity: IQ 60 �(4�
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: 100. T Tank Outlet Elevation: do, s-o
Number of feet from nearest Road: Front,Q Side,O Rear, O feet
From nearest property line Front,0 Side,O Rear,O �(01 feet
Number of feet from: well Cp S1 , building: a ( ,
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
1
DEPARTME0 OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS .DIVISION
P.Q.BOX 7P69 BUREAU OF PLUMBING
MADISON,WI 53707
SW,S.W,S17;T29 —R19W MCONVENTIONAL 1:1 ALTERNATIVE (fate Plan I.D.Number:
Town of Hudson ❑Holding Tank El In-Ground Pressure El Mound
LOt 4100, Will.ow Ridge East
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Gary Stepan 213 Locust Hudson WI 54016 6"%5_ 7
BENCH MARK(Permanent ref rence point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 92482
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
�O t '0 S�j O P IDED: PROVIDED:
e YES [-]No OYES N NO
BEDDING: IVE NT DIA. VENT ATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
C AIR INLET'.
/) ALARM: FEET FROM ` S LI �J Z /'••
DYES NO 4 ❑YES NO NEAREST l
DOSING CHAMBER:
MANUFACTURER T1 DOING: LIQUID CAPACITY. P PUMP/SIPH
UMP MODEL: ON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
YES ONO ❑YES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) OYES 1:1 NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO.OF DISTR.PIP SPACING'. COVE INSIDE DIA. #PITS LIQUID
BED/TRENCH TRENCHES r� M RIAL! PIT DEPTH.
DIMENSIONS ` �N S
GRAVEL DEPTH FI L DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATER( NO.DI NUMBER OF PROPERTY ELL: BUILDING: V NT TO FRES
BELOW PIPES: A U R'. EV.1s�,w`T.E�EV.END: /) ^ PIPES' FEET FROM L /n 0 � A�yl7
to / Ms/'MvII/ !/Vl, L / NEAREST (/ �I�/ J`
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.
❑YE ❑NO
OIL COVER TE%TUR PERMANENT MARKERS OBSERVATION WELLS
OYES ONO DYES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER: EDGES.
❑YES El NO OYES ONO [—]YES ONO
PRESSURIZED DIST IBUTION SYSTEM:
WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
M NIFOLD PUMP MANIFOLD DISTR.PIPE MNO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
E EV.-. ELEV.: DIA.'. ELEV.. PIPES DIAELEVATION AND
DISTRIBUTION H LE SIZE HOLE SPACING DRILLED CORRECTLY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
EYES ONO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'.
FEET FROM LINE:
—1-Fs ❑NO DYES 1:1 NO NEAREST
i
f 1
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f1 V0
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE
DILHR SBD 6710 1R.01/82)
Zoning Administrator
l ,
i
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 revision3 to this permit must-be approved by the permit issuing authority. A new permit may be nee�eo.
if there is a change in your building plans, system location, estimated wastewater fldw#umber of bbd
roorr)s, etc.), depth of system, or type of system;
4) Changes in.-ownership or plumber r6quires a Sanitary Permit Transfer/Renewal'Form (SBD 6399) to be
submitted to the co my prior to installatign;
5. Private sewage s�/s�ems must be proper*ly maintained. The septic tank(s) should be pumped by al licensed
pumper whenever necessary, usul3tty every•2 tc 3'years;
6. If you have questions concerning your private sewage system, cont ur local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815. t
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:
11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
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 Warne, 4iofication number, ad res,"nd 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 81/2 x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with compete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers;dve Is; 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
requi-red by.the county; E) soil test data on a 115 form.
---------—------------------------------------------- --------------------------F --------------------=--------------------=-----------'--�------,-7---
F 6 } "
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
qommonly 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 in's a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reastlre
is used in your building is returned tc., the groundwater through your soil absorption o ,
system or the disposal site used by your holding tank purnpei.
0
The monies collected through these surcharges are credited to thz� groundwater fund adm+nis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishrneit cf standards. Groundwatc-1
it's worth protectina.
SANITARY PERMIT APPLICATION COUNTY,
�'L R In accord with ILHR 83.05,Wis.Adm.Code
'w*^•�°° STAT ANITARY PERMIT
—Attach com let plans to the count co EP� 8a
p p ( y copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches ill size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES LQI NO
PROPEXY OWNER PROPERTY LOCATION
R S '/a 5 Q %, S T , N, R E (or W
PROPERTY OWN MAILIN ADD SS LO NUMBER BL CK UMBER SU D ISION E
Jr B Lo s ' d o d CASt
Cl T ,S ATE ZIP CODE PHON BER CITY NE S R LANDMARK
0 C.• Q ❑ VILLAGE:
II. TYPE OF BUIL ING OR USE SERVED: - 3620 — 11:7,1— 00)
Number of Bedro ms if 1 or 2 Family OR ❑ Public(Specify): C akj
111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. L^ Ne% 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 SYS EM: (Check only one in##1 and only one in##2)
1. a. %Con entional 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. Useer age Bed b. ❑seepage Trench c. ❑See a e Pit
2. PERCOLATIO 4 RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED Square Feet): PROPOSED(S uare Feet): �"
4 ' • .�• 0 0 Feet �Private ❑Joint ❑ Public
CAPA Y
VI. TANK ##of Prefab. Site Fiber- Exper.
in gallons Total Manufacturer's Name Con- Steel Plastic
INFORMATIO New xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank Q I LJRR Ks ❑
Lift Pump Tank/Si ho Chamber ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber' Name(Prin): Plu er's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
rl� d d 10 9 Ts 3X-51an
Plu a 's A ress(S reet,C y, tote, p C e): a of esigner:
W 1� 6fjj N
VIII. SOIL TEST IP FORMATION
Certifi Soil Tester( ST)Name CST##
10 km som
CST's ADDRESS(Stye City,Stat Zip Code) ' Phone Number:
V13 I (-G mu-A5 ,4N IX. COUNTY/DEP RTMENT USE ONLY
�{ ❑ '.approved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
rAApproved ❑ caner Given Initial / rchharrgge Fee �y
dverse Determination ` J
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
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 bei I ng developed. Any inadequacies will only result in delays of the permit
issuance. Sh uld 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 646�
Location of Prop.erty G`J
_j V-) ? , Section _ _—, T .N-R
Township U yJ
!failing Address
tJJi"
Address of Site �/r�in�;�2 PA
Subdivision Name (A)JLt,d6v
Lot Number
Previous Own r of Property _676 ,\j T�l�
Total Size of Parcel gyp;!
Date Parcel was Created 5 S�
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes __� No
Volume and Page Number _ as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and pa-&-e 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I ((fie) CeAti6y that a t statements on this 6044 cute true to the but 06 my (oun)
knowtedge; that I (we) am (ate) the ownen(b) o6 the pnopmty de�scAi.bed in this
.in 6onma t ion 6otm, by vi tue 06 a wa Aanty deed neeo&ded in the 0 fi 6.iee o6 the
County Regis eA 06 Veed-5 as Document No. ; and that I (We) ptesentfy
own the phop ed 4 to bon the .sewage di�spoza d� em (on I (we) have obtained an
easement, to tun with the above de cA bed pnopenty, bon the eanstnuction o6 said
.system, and the tame hab been duty n.eeonded in the 066.ice o6 the Count Reg isteh. 06
Veede, as Document No. ) ,
r
SIGNATURE OIL DWNER SIG TURF OF CO-0 E ( APPLICABLE)
13'
DATE SIGNED DATE SIGNED
DOC MFNT NO. _ STATES BAR OF WISCONSIN FORM 1—x9 @3 TNIS SNAG[ Rts[RYWO FOR RtCOhDINO DATA
WAkRANTY DEED
i 189J.95 (�
This Deed, made between B & H Development. Inc. ' �_ApIX .
..................P....... .. L7,?.� V1�1'�
Rrrd 611 3rd
............ ............................................................................................... chly or '-NOV. ,A.1,), s'8
...................................................... .. ....................... Grantor,
and..Gary -J._.Stepan••and Cynthia L. Stepan: '
hl�s and and,wife: Aiurvivorship_.marital._property-
••--•-•-•-••-•---•--••••. ...... ----------'----------
...............•----•--.............. . .. Grantee
Wi nesseth, That the said Grantor, for a valuable consideration......
•.......... ...••--•-•-- Sal---...•e -- --...----..—. ---
conveps to rantee the following described real estate in RETURN TO
County, State of Wisconsin:
Lot 100, Plat of Willow Ridge East in the Town of Hudson. Tax Parcel No: ..........................
.........
TF i I
i
i
i
SF
FEE ,
I�
II
1
This ........... homestead Property. i
(-Is) (is not) i
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And.... gxantQx.,-.�._&•.iI,.D�velopment.,-•Inc.•
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except .... .
easements covenants and restrictions of record, if any, II
and will warrant and defend the same. '
I� 1
Dated this ... . October I
............ ........ dny of .......... ........ ........ .......................................
19.86.. . I1
B & DEVELOPMENT, INC. 1
(SEAL)BY= .` � 4i •--••----...(SEAL) '
.. ............
* Donald B]ornsta
................. .................. .
...............•.
.................... ................................................(SEAL)
I4 -''- . ------ .(SEAL)
William Harwell
..---•---••--•-• ......-••---
I� I
AUTHENTICATION ACKNOWLEDGMENT
II 1
Signature(a) ...IIana]d..B _._.__.._ N '
OF WISCONSIN
..
William Harwell
... ................ . j
I 1 / ...County.
i! authenticated !.. day o bet 8fz Personnll came before.me this
•---- .� 4 ............... 1c.sdRy of. I
19 the' above:'named
..........................................•-------------------------....---•--•.
TITL ME R STATE BAR OF WISCONSIN
... -•-•-•••----•---••-------------•-----••-••--------••-•-•-........._.............
I
I (If not, ..................•---•-----•-•---•---------• !
authoriz(d by § 706.06, Wis. Stats.) --...........................•----•--•--- ...--------•-----•-- .. _.. -------
' to me known to he the person ............ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
HEYWOOD, C RI_, MURRAY & SHERBURNE
by Samuel Cari '--•---------------------
*. .. ............ ...... ........ •....................._...._........... ..
P O,•--Box--2 9T--Hudson,_W_T......54D1b..••--..•••• .
(Signatures may be authenticated or acknowledged. Both Notary Public ...............anen...............stateoexpi Wis.
i are not necessa y.) g ���' Commission is permanent. (If rot, state expiration
date: ......................................................... 19.........) '
*Names of persona lIgning in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE OAR OF WISCONSIN
FORM No. I—1982 Milwauke LW is Blank Co. Inc.
Milwaukee. win. J
J
L
N
y
S T C - 105 r" '
- r
a-
S 1:1''1'IC 'TANK MAIN'PENANCE ACIth:l:htEN'1'
St . Croix County
PA
RO '1'E/BOX NUMBrR Fire Number
CI Y/SPATE Z111
1
t
PRC PERTY LO CAT ION LA) 4 , U '-4 , Section—L-7 1' a9j ti , IZ_�►
Town of 0,J k � !, St . Croix County ,
Subdivision (,,/1L,6 I�Ia6� Lot number,
Iiiq roper use and maintenance of your suptit: system,- could result in °
it!n premature failure to handle wastes c, Pruper maintenance con-
SiE is of pumping out the septic tank every ;three years ur• sooner
, t
if needed , by a licensed septic tank Lml,er . What you -hut into'
the system can affect the function of the sVI)tic tank as a troat
mert stage in the waste disposal system .
St . Croix . Cuunty residents mcL be eligible to receive a grant fur. ' y
a i axtuium of 60% of the "cost ' .0f replacement of a Jailing system" '
which was in operation ; prio,r,, to July l , - L978 _: St . Cruix 'CountjL_.�, .
ac epte'd this 'prugram. in August of .1980 , . with the requirement.-that 4
owners of all new sysccins agree' to keel) their systems properly
ma ' ntained.
The property owner : agrees to submit to St . Croix County ZoninL, a
certification form, signed by the owner and by a master plumher,,
journeyman lumber, restricted dumber- or a licensed �uui ie
Y P . 1 r v�.ri-
t
fying that (l) the on-site wastewater disposal 'Systern is` in proper.
operating condition and (2) after inspection and pumping ( if nec-
essary) , the Septic 'tank is less than 1/3 f-ull. of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration .
0
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- 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 .
SICNED , ou�
I (�;;,I
DATE
St . Croix County Zoning Office
P.. O . Uox 96
Ham lord , WI 54015
715-7S:6-2239 or 715-425-8363
Sign ,' date and return to above address .
DENART ANT OF `` . �_U,8
I�:ul.lsrRY, . MA0180Nr W163707
LABOR AND
PE.';' TEST'S (lit
HUMAN RELATIONS ,0911)St Chapter 148.M51
• t
OWN 1 U ICIPALITY _ •_
Sw '/w"/
O NTY: S /1C�AJUN W 1 S4O�G
STCROate i.►:$JoRw-STA4 CONS% SO
_ DATES OBSERVATIONS MADE
1LsE y� �¢
MMERVJXL OF.
`9'New., ❑Repbce G�C.TO$�R 2� l ruC 40
tesidence (Jln1K
s�►�S soots Aar sa. . 'So)t_s gx$ R�r{ Rer
RATING:IN Site suit N fa room U-Site unwhibli for ayatam ;p OMMENDED SYSTEM optloneU
'under a.H139.Q91Bllb1,
RATE:. Ft losnoy d ppla�lrntl,oIn n of atthe e tested eiores ln e Iv!n the
IQ lwetion'I(Percolation Tests an NOT required
ndke": CLAIR N s t
N
PROFILE DESCRIPTIONS
D DEPTH
CHARACTER Ur bu'L- T"I L� � E EVATION T BEDR C IF 098E VE EE ABBRV.ON BACK.) `
• 8"Ac�� yy $4N L wMGR 14"IRASL46it
4:�T O } 9.4Z B
y 'L.Y ¢N' 166 � -8Rnr5r Alt.i
. -z
Z ,33� 7.3� $•33 li" fib" a 73''& MS+bit c 6 I' /"o•�� Stitt
.B �
/O.O$ ., SrL 4 8C"& HS-fG 5 cob Sr batLs
9 6c.-TS 32'd
B 4 9.67 d/.71 tC > 1.67 �}I<S 31" SrC tfVR 76��dt MS tCaR �r
B- S
q.-75 95.67- 9.75 a" f_TS 37"dervSrL 0'&N MS flee coL
Is-
PERCOLATION TESTS
QFC.FT.
D P7
WATER I HO T S7 7 R PER INCH
NUMBER 1 AFTER LLIN INT VAL•MIN. 7 If.'4''
P. I `.71 N E 101,71-__ /d < 2
P. .SC o C 3 _ >z 2.
P. 3 Nd 7• __
P•
AT f- �-
P goll FLOT PLAN: Show I elevation reference points land,show their location on the plotsplan suitable how the surface elevationaalt all borings and the idirection and pertcent
rontei end vertical N Po
of land slope.
AcrON-4�TC 5 y'$--�r t-M CLE-V 9' 7-1
SYSTEM ELEVATION
3 L
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RED! 5 !3 prs. a�+a v J.— 4.
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were made by me In accord with the procedures and methods specified in the Wisconsi
1,the undersigned, enby artily that the soil fasts sported on this form
Administrative Cod ,and that the data recorded and the location of the tests era correct to the best of my knowledge and belief.
T T CAE CO PLETED ON:
pr nt CJcT�$EIL 23 19 C 6.
N�Q CY JnHNZo� CER I IC�ATION NUMBER: PHONE NUMBERIoptionnl
40-7 cicon.l[� S-r �v dso ti �I G 6.40
'C l'SIG TORE:
DISTRIBUTION: rigirtal and one Copy to Lost Authority,Pruporty Owner and Soil Tester,
DILHR.SPD-6395 1R.(7107) DvFr-1 •••
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FRESH AIR III L TS AND OBSERVATION P11)E
CP.OoS cI;CTION '
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Approved vent Cap
, Minimum 12" Above
9y.0 0 �"i IVA
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Final G r a e_�–.-`--
4 " Cast Iron
Above Pipe Vent Pipe
To final Gradc*---
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Marsh Hay Or Synthetic Cover:i.ng
Min. •2" Aggreg,;1[ e —
Over Pipe
> istribut I Tee
Pipe
Aggregate Perforated Pipe Below
Beneath Pipe 4 Coupling Terminating At
fv4i J.?Ed Bottom of System
R1 bG Lsr PAss
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PE DES-rAL
1 / �'rRerJ RP!
NEAP, TELEP14W' & PEDESTAL _
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L,r�6 TO 5 ySTL�M.
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:ent
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WILLOW R,NGE CAST
Sca�� r
LoY 99
Lot 101
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WILLow
UNPLATTED LANDS
71 159,881, 154,,E1 '
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76 77 �� 78 79 n 0 . 8O W
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,L `� EASEMENT. AND WALKWAY
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