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HomeMy WebLinkAbout020-1132-80-000 k g c w K 0 § . � \ � � § � A � � § � 2 � � 2 � 2 7 3 0 � . » � � ® z iE f . t 0 $ § \ M. © 0 . § 2 k 0 k \ ) k 7 7 2 0 - \ -WAR& } ) / S 2 k ca k \ " z R 0 o { .. \ . � \ CL 3 \ 2 ) k \ if Of .� 0 k k k . m j OD k ; , _£ a. # � / ) � � / 7 ) � CO \ § E / c a I \ \ \ ) 0 & k X75 CD 6 : E CO ■ z f \ e - § a. 2 0 ) c k \ 0. 0. 0. ) � k $ v � : U) PUMP CHAMBER Manufacturer: Liquid Capacity: P�p Model: Pump/Siphon Manufacturer: Elevation of �- inlet: Pump Size Bottom of tank elevation: ---__, Pump off switch elevation; Alarm Manufacturer: Gallons per cycle: Alarm Switch Number of feet from nearest Type: property line: Front, O Side, O Rear, ' Number of feet from well: 0 ' ----- Number of feet from building: (Include distances on plot plan), SOIL ABSORPTION SYSTEM Bed: yi Trench: Width: ' Length: 5� Number of Fill depth to top of pipe: Lines: Area Built: Number of feet from nearest property line: O O Number of feet from well: Front, Side, Rear, gt Number of feet from building: (Include distances on plot plan), SEEPAGE PIT Size: Number of pits: Liquid de Diameter: pth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box absorbtion sytems? O been used on any of the above soil (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 Number of feet from well: Side, O Rear, Ft. Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Dated: Inspector: Plumber on job; License Number: 3/84:mj Form - S T C - 104. AS BUILT SANITARY SYSTEM REPORT ��,.. V- SEC. T N -RW TOWNSHIP 4NER ST. CROIX COUNTY, WISCONSIN ADDRESS LOT SIZE LOT / SIJBDIVI SION PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 1 ' E-�C, �� rI !INDICATE NORTH ARROW I point used e vertical reference BENCHMARK: Describe th p e at site: / Proposed ,slop eference point: Elevation of vertical r n j — �. Liquid Capacity: SEPTIC TANK: Manufacturer: Tank manhole cover elevation: 1 � Number of rings use _._-- / � � Tank Outlet Elevation: feet Tank Inlet Elevation: Rear, Number of feet from nearest Road: Front, Side, Num --T feet line Front,O Side, Rear,O From nearest properrty r bufl.d;ing: ` dnsions to septic tank) lan)( 2 reference ,dips Number of feet from: well lot p SEE`REVERSE SIDE (Include this information of the above p DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 5370 BUREAU OF PLUMBING •NE14, 1VE14,S19 T29N—R19W [CONVENTIONAL ❑ALTERNATIVE fState Plan l.D.Number: Town of�Huds n of assigned) ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 31 Willow Ridge II NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Steve Pederson 606 Nth 4th Street, Apt. 8, Hudson, WI 5 016 g_S_ g -� �.36 BENCH MARK(Permanent ref rence point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELE V.. Name of Plumber: MP/MPRSW County Sanitary Permit Number: Calvin Powers, Jr. I1563 St. Croix 95989 SEPT TANK/HOLD NG TANK: MAN FAC RER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELE V.: WARNING LABEL LOCKING COVER �,r� PROVIDED: PROVIDED car ��� u�Jt�O(� OYES ❑NO ❑YES VIVO BEDDING: V NT DIA.: VENT MATL: HIGH WATER NUMBER AD: PROPERTY WELL: BUILDING: VENT TO FRESH �� ALARM. FEET FROM LINE. LAIR INLET: ❑YESNO —(�t1 ❑YES N�NO 111EAREST owO DOSING CHAMBER: MANUFACTURER: BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL ILOCKING COVER PROVIDED: PROVIDED: YES ❑NO DYES ❑NO OYES ❑NO GALLONS PER CYCL E: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) EYES ❑NO NEAREST SOIL ABSORPTIONS STEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH: NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA.: #PITS. ILIOUID TF F NCHES (V MATERIAL: IT. DEPTR. GRAVEL DEPTH TT L_ DEPTH DISTR.PIPE DIS7R.PIPE DISTR.PIPE MATERIAL: NO. TR UMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES AB VE COVER: ELE V.INLE7 ELE V.END. PIPES. ,LINE: AIR INLET: cat' } __ ay.3q q4 t 12 a��� a NSARIEs M a5 L,A acs+ MOUND SYSTEM: Mound siteplOWE d 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 ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO _ YES ❑NO DEPTH OVER 7RENCH/BED DEPTH OVER TRENCH/BED DEPTH O TTOPSOIL. SODDED SEEDED: MULCHED. CENTER. EDGES. El YES ❑NO ❑YES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: "WID H. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. TRENCHES: MA IFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. �y ELE ELEV.: DIA.. ELEV. PIPES. DIA.: � fC3 HOL E SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED F� PLANS: ❑YES ENO ❑YES ❑NO OQTS PERMANENT MARKERS: OBSERVATION WELLS: EA0 BUILDIN G- LINE: DYES ONO DYES — NO NEE'� ' (j � U Sketch System on Reverse Side. Retain in county file for audit. UR TITLE: DILHR SBD 6710(R.0 /82) ✓�$rry��p (, Zoning Administrator tOep►. INFORMATION & INSTRUCTIONS FOR-COMPLETING A SANITARY PERMIT APPLICATION _ f 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 ydur building-plans, system location, estimated wastewater flow (num-ber of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumbef fequires 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; 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 dwel.ling; 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 816 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) cro",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 r •._. included the creation of surcharges (fees) for a number of regulated practices which Wisco fn;;t a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur . is used in your building is returned to the groundwater through your soil absorption ;- u system or the disposal site used by your holding tank pumpet. 0 The monies collected through these surcharges are credited to the groundwaterlund 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) SANITARY PERMIT APPLICATION COUNTY /�� l 77DIL R In accord with ILHR 83.05,Wis.Adm.Code • v d/ __. STATE.SANITARY PERMIT# • C� /c Op'/Q, —Attach corhplete 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 nj NO PROPERTY OWNER PROPERTY LOCATION 11-Ali '/a, S J9 N, R E (or PROPERTY OWNE 'S AI G AD RESS LOT NUMBER BLOCK I�IGMBER SU IVI NA CIT ,STA E ZIP CODE PHONE NUMBER 77 CITY :W,sr NEAREST ROAD,L E OR LANDMARK [__1 VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedroc ms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. X New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A SanitE ry Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The Sys em 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. XConv ntional b. ❑Alternative c. ❑ Experimental 2. a. ❑Syste - b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTIONI oYSTEM INFORMATION: (Check one) 1. a.X Seep tge Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATIO RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per nch): REQUIRED(Square Feet): PROPOSED(Square Feet): 07 A Private ❑Joint ❑ Public Feet 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 I Tanks strutted Septic Tank or Holding Tank I ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBIL ITY STATEMENT I,the undersigned, ssume responsibility for installation of the private sewage system shown on the attached plans. Plum er' Name(P Plu er's Sign 7e. o Stamps) MP/MPRSW No.: Business Phone Number: Nu m s Ajes City,St Zip Code): Name of Des' ner: VII . SOIL MATION Certif' So' ame CST## C s DRy,St ,Zip Code) Phone Number: M ENT USE ONLY � ( El sapproved S itary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) 1 Approved ❑ C wrier Given Initial ] 166,06% rcharg Fe e verse Determination ✓ ��/ X. CO M/ENTS/R ON,5 FOR DISAPPR VAL: {�^ J" �C� ` T,1. �6wrS SBD-6398(formerly Plb 7)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber i 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 i 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 Location of Pr petty ' � , Section W Township Nailing Address Address of Site Subdivision Name : Lot Number / Previous Owner of Property Total Size of Parcel Date Parcel wa3 Created ,Are all corneri and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number,-.2?-f-- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deel which includes a Document number, vol_ ume 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ee ti.6y that a.te statements on thi.6 604m ake tAue to the best o6 my (oun) know.tedge; that I (we) am (ah.e) the ownen(b) o6 the pnopehty de�sehi.bed in Chid .in694matlon 6ohm, by viAtue o6 a waA.anty 4eed neeo&ded in the O66.tee o6 the County RegiAtet o6 Deeds as Document No. ; and that 1 (We) pnesen.tey own the en pnopos d sc.te bon the sewage dispos sys em (on I (we) have obtained an easement, to w.c th .the above de c& bed pnopehty, bon the eona,tAuction o6 said system, and the same had been duty %eco&ded in the 066.iee o6 the County Reg-ia#en o6 Veede, ab Vownent No. ) . SIGNATURE Old 0 MER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED f , WNW 4.wy�•y..:...»», »• «- ..»» , .. r ................. «., .... ..» ........»....» ............ s+raM M TM Fm Bub t Rifte 2nd Addition to the Zbwr► o' Ham • r 14* 31e Th • r �t /l � and &"Urtensum L�aOpLp � wltil ar EiaN� .. Multorls ........................... .... f - N ................. r . »ry�tl'1Ctio[ffi and r MS- and sere and , o! s-of-waY of record ffid• a �epLp r ........................... dar of September , l�tth- ,1 ..................._ ,.. ..» ...... . . . ........... ............ •(SEAL) ...............................-•---• ... -...._.._....... . .. AQ?!!!?IO♦?IO�I ACKNOWLRD01 ANT STATE OF WISCONSIN tea( .—Ka math- ............... VIL Aotth A. Jot�cieon x_ �. ......................_..._. _.._..-., 1l.Q�l_ ..................................... -._.....��iy ems bef C°°a4•� »............:.dq� x �' a Mr 1.�..•dq ot.._Se�ite�mbet• ., Io----.... do aMw iii , QCs n.e� -��s�-----------------------------ICSI ............................................................ --------••••-----•-• .................•••-........._..� ( -------------------------------------------------------------- ---------------------------- ----- -. .. F. ........................•-•••---•-- ....._.. by; TOLOt.Wis.Stats.) to me known to be the Person ---------•-• w� ; foregoing instrameat and adtnowiedSr the sass. ENT WAS DRAFTED By Kri ixia 061_and Lundeen -- ... .. t .... . ......... ....... Notary Pubiic .. --------------------------- '�WiL ) 1e atithw►tkatad aeknowb W. Both my Commission is permanen .(i not, 1�!Mt •) date: ..- .. .... ..................•... .... .. I!. � aA of R d 1p momm dart is ry moset4 shat"be typed or printed below their siaastures. • e wtscomux wt ew.m L01924•+ ETA" An o iFM+a Cu_tii� � r H z H Y STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a OWNER/BUYER ..5zz-4'_r -AQ ROUT /BOX NUMBE �i✓?l ��! _ f _ Fire Number .CITY STATE - ��[ ZIP.- 7 PROPERTY LOCATION : , _, Section & Tj� N , R _W, T Town of St . Croix County , Subdivision AIL Lot number_. 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 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/W , the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- 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 /l DATE •� �7 St . Croix County Zoning Office P.0 Box 98., Hammond, WI 54015 715--796-2239 or 715-425-8363 Sign, date and return to above address . INSTRUCTIONS FOR COMPLETING FORM 115 - S D - 6395 r 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 commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement systern; 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; $. 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 riot apply, place N.A.in the appropriate box; 1 1. Sign the form and place yocrr 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 cola Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone -`s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate reed s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than Isl - Sandy Loam < - Less Than "I - Loam Bn - Brown *sil - Silt Loarn BI - Black si - Silt Gy - Gray `ci - Clay Loam Y -- Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc Sandy Clay wl - with sic - Silty Clay fff few, fine,faint c ..__ Clay cc - common, coarse of - Peat mm Many, rnedium m - Muck d - distinct p - Prominent HWL - High vvate;r level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark � VRP - Vertical Reference Point TO THE OWNER: This soil test retaort is the first step in securirrcr a sanitary permit. The county pr the Dcpartrnent may request verification cif this soil test it) the field prior to permit issuance, A complete set of plans for the private sevvage jystcm and e hermit application must be submitted to the appiopriaie> local authotit:y in order to Frutain a tserrni`. the sarrotary permit must be obtained and posted ter€or to th,�.start of sry cranstructiorr. J A U TIGIENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDU S INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN f�ELATI.ON ,. , (H63.090)&Chapter 145.045) LOCATION: SE T10N: e Tp N HIP/M ITY: OT NO.:BIL 0.: SU DIV SION N E: Al �� �� / N/If (or& W S �, COUNTY: OWNER'! BUYER' AME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE BEDRMS.: COMMERCI L DESCRIPTION: PROFILEDESCRIPTIONS: ER OLATION TESTS: Residence New ❑Replace — RATING:S=Site suitabl a for system U=Site unsuitable for system CONVENTIONAL: MO ND: IN-GROUND PRESSURE:SYSTE -IN-FILL OLDING TAN K:RECOMMENDED SYS M:(optional) s ❑u s ❑u �s ❑u ❑s ❑s LOU If Percolation Tests are NOT re uire DESIG RATE: 4 I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS �K LIU BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHIM, EL VATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSE VED(SEE AB RV.ON BACK.) IRIS 3e&. B-,: y B- > r'c�f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -INeftES I A TER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIQ.D 3 PER INCH P- D P_ Akllc J/9 P- 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. .S SYSTEM ELEVATION FA i bee / ( t j tN sm __._,- _ .,_,__---. .._...,_.,,. A._._....... ... ....m...m.t_. ..... ...._. ...... a - - _;.._ _. . F j € i � iii ri � � 3 E {y j[�- t' F 1 I _ ,.. .... l [ € 3 77 [ a I ` 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. NA (pri t1: TESTS WERE COMPLETED ON: A SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST i!N ATU RE: art DISTRIBUTION: Origina and one copy to Local Authority,Property Owner and Soil Tester. ! DILHR-SBD-6395 (R.02 2) —OVER — 4a:w �s= af'/,W f L, �1 "4. PAGE OF I . i It C j� l CrC) V 1 S S J PLC ' 1 -1 /"1 o �� �� �y51 ('0-1 ,Otj, 7 Fresh Alr Inlol• And Observation Pips J�—Approvod Vaal Cap riAv.-.w V y Minimum 12"Above Final Grade 20-42'Above Pipe _4"Coal Iron To Final Groda Vent Pipe Naran Fay Or Synthetic Covering it Yin. 2'Aggregole Over Pipe OisPIpaIt n —Tee Plpa .� 0 0 6 Aegis late o ParloratbJ Pipe Bsl.y Benaalb Pipe Coupling Terminating As Bottom 01 System wr tJw� \V �\ \amn SOIL FILL DISTRIBUT101•.1 PIPE APPROVED S4WPETIC COVER ° ~"MATERII�� OR 9" OF STRAW Z"cF A4 RE6ATE -��� �yO R f1ARSH HA'J rr 2 ccrr OF 12 -21/Z AGGREGATE DIS Rlp5'JTIOA) PIPE TO BE AT LEAST It,.ICHES BELOW ORIGIAJAL GRADE AQL AT LEAST20 WCHES BUT K10 MORE THALJ 42 IMCIIES BELOW FINAL GRADE twrium Daprvi OF EXCAVAT100 FROM OKI&VVAL 6000. WILL BE 16-5� IMCHES 11UK MUM OFPTV OF CACAvATioN fKOM o�'�I�IaAL C�RaD€ WILL BE — INCHES SIG EO: i LICEAJSE AJUMBER: 1 DA E' 110