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HomeMy WebLinkAbout020-1131-30-000 7 ~ 0 / 0 t m � A � I 2 � . ] � � 2 j � % } 7 2 7 § < _ � . � � � « \ E I / \ § � 0 z k ] ) U) / 7 7 0 ] co ® E � -� ƒ $ } q z ) k ) k � 2 . t 7 � D � % { § c % 3 k 2 2 ` e . \ k C « - 0 -� k � 2 2 2 2 z � IL U) ]k k CO CO° : [ kk \ 22 ■ co t § k_ $ = E o Q ? § ) 0a � g8 � a § 2 > o n a § % a E ° _ = ) z a g $ © , ` © a § § § } ) \ 0 2 / z / \ . � ■ � 2 \ § a — , _ _ , - a # \ E ) . § a § . o j a m � f' 50 Carr _ � tk o C u 9®,yo t; .21�. b q to Q tr 1` L.�In e t,00 c Se T,� L �! x3o' FW ZR `W �e 5 �,e r n it �c ��� oil e 3 DEPARTMENT OF INDUSTRY, JJ 1 INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION !tA'D P.O.BOX 79ll 53707 BUREAU OF PLUMBING l�l,!R',Will SW,'4,NW',4,S19,T29N-R19W UCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number : Town of Hudson ❑Holding Tank El In-Ground Pressure ❑Mound (if assigned) Lo Strawberry Point go ME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: G. Robinson � Route 5 Strawberry Drive, Hudson, WI 54 16 --/y-S BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT,ELEV.. Name of Plumber: MP/MPRSW No County Sanitary Permit Number Thomas A. Wang 3231 St. Croix 99059 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: ROPERTY ELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE. LAIR INLET. DYES ONO ❑YES ❑NO NEAREST P W ' DOSING CHAMBER: MANUFACTURER I BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO DYES 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) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.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 MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: y WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER JINSIDE CIA.- #PITS: JLIQUII BE @JT(iE1yCH TRENCHES MATERIAL: PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR.IPIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES ABOVE COVER ELEV.I NLET 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 ❑Nb SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS. OYES ❑NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES. DYES 0 N 1:1 YES El NO IQ YES ONO PRESSURIZED DISTRIBUTION SYSTEM: i WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER. TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: s�� std ELEV.. ELEV.. CIA.. ELEV.: PIPES. CIA.: E�»E51Y,4Tt0s*F A�1D HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED rTt, PLANS. ❑YES NO ❑YES —]NO COMMENTS: PERMANENT MARKERS: BSERVATION WELLS: 0 OF PROPERTY WELL: BUILDING: FE `FR #M 'LINE: OYES 1-1 NO ❑YES 1-1 NO NEATEST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R.01/82) Zoning Administrator 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; 1 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 installatidn; 5. Private sewage systems must be properly maintained The septic tank(s) should be pumped by a licensed pumper whenever necessary,'usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 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; 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'./z 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 GroundBr included the creation of surcharges (fees) for a number of regulated practices which Wisco in ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure 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 pumper. a .. 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 IR.03/861 SANITARY PERMIT APPLICATION CO � In accord with ILHR 83.05,Wis.Adm. Code CS �" ST SANITARY PERMIT# -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 NO PROP�< OWN PROPERTY LOCATION fv- s S`4j '/a %4, S Z T o'� , N, R f� E P O1iERTYOW h�AIwNGeA��ESS [� LOT BER BLOCKNUIJy$E� SUBDIVISION N�A�ME ,ZI f7 Q0.0)i STATE ' ZIP ODEfE PHONE NUMBER C Y •••- `J L KEp R LANDMARK VILLAGE: SB 11>1 TOWN II. TYPE OF BUILDING OR USE SERVED: /Qd - 1w, o A70— 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. 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 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.X 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. 1K Seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit ,K301 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes pJer inch): REQUIRED(Square Feet): PROPOSED(Square Feet): pp�� C/ 6 1,5 to do 111e- VL> Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 0 o b " lu S I (if p ❑ ❑ El 1 ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ I ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumb is Name(Print): PI s Signature:(No tamps) MP/MPRSW No.: Business Phone Number: Plumber's Addre (Street,City' ate,Zip Code): ` Na esigner: fQ O 9 a L/ Ka 7 vet X51 S day VIII. SOIL TEST INFORMATION CertifI oil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip C d Phone Number: pO IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S"�ary Permit Fee Groundwater rate Issuin gent Signature(No Stamps) 'Approved ❑ Owner Given Initial ( �11� � rch'�argre Fee Adverse Determination VY Ql W .6 X. C MENTS/REASONS FOR DISAPPROVAL: to-, � ���� L' ��-�n G�2�J SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 1 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 cn �"' V'�0 (J S 6�I Location of Property _ it N W k, Section _, T N - R W Township Mailing Address --=s•�1 V Subdivision Name -� ,fyo be' LOU �- Lot Number L ` Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? � Yes No Is this property being developed for resale (spec house) ? Yes No volume and Page Number l q 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) ceAti6y that a t statements on this 6onm ane tAue to the best o6 my (oun) k,noweedge; that I (we) am (cute) the owners) o6 the pnopexty deachi.bed in .this in6oAmation 6onm, by vi tue o6 a wannanty deed neconded .in the 066.ice o6 the County RegiAteA o 6 Deeds as Document No. 9'4!�6 ; and that I (we) pnesentty own the proposed site bon the sewage disposat system (on I (we) have obtained an easement, to nun with the above dew.ibed pnopexty, bon the const ucti.on o6 said system, and the same has been duty neconded in the 066.ice o6 .they Co Regis.ten o6 Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SA 6D/ i I ! �e �' ry �� ��"'�`+: f� •, '�`����� �'�+,,��� zx� r �.� <3��u�� Yom'°i� "'�, i i se r.r t✓.d ,. s� `! DOCUMENT NO. STATE SAR OF WISCONSIN FORM 1—.193g TM1e a�"ea ass°'vse�°e"a`ea°I"a e"v" WARRANTY DEED ' t� ,, .r., V0:• t19.(.y PAGE 94 RtiGi$THiS aFflCE i ST.otOix CO.,WIS. 7 . u This Deed,made between .....Nicholg$»P•r Vap 'Brgftt Wd.for Record this26th I!' .and.-NA....Jane..VAt1.-bXUA ...A i4.. i�8if%e �>�ii6 sapt A.D.19-34 . > x I Yan..9r111►t...husktand.. l sti£a raptor at 8:30 A ,M. !� a -"-...Gerald" "'RoB3iis6ri'fixia IQ Icy C 12t5I)iHs$n and........................S:......... ... ......... .. i}u>�}�and and wife as.,•joint tenants _ranee O'Connell r of o.�s ..-.-.. bo Del ,.. ������nnegg TTh�a� .�attie� raannttor���ttaorr�`�� aatt!loonn tr •. Y of One j1heSS 'Ot21ez*A anG°ValvaW fln'blooi reratlOn ..................................................................--...............................iX aaTOah re g<e conveys to Grantee the following described real estate in..,St Cro -, � Y County.State of Wisconsin: e : Lot 4, Strawberry Point in the Town of Tax Parcel No:........................ ...... .4 Hudson j TRANSF� ; FLE is not x ! This............................homestead property. , " (is) (is not) P K'+x Together wN fs s Vh anp Vm rennto helooging• It And......................................................................................................................................................... f•. ' warrants that the title is good,indefeeaible in tee simple and free and clear of encumbrances except ! easements and covenants of record. and will warrant and defend the same. • 21st September �! �.I Dated this............... ...............day of---...............................................................,19.84 i'. I ..(SEAL) .. J�� ..(SEAL) .. Nicholas P. Van Bnhnt ... ( AL) ..................................... . .(SEAL) d�(... .... G/.A.V..�,�+..f.:c=s..l.�...-.......... - M. ape Van Brunt �. i AIITHENTICATION ACKNOWLEDGMENT s Nicholas P Van Brunt STATE OF WISCONSIN Sisnatnn(s) ------------- $ and M. Jane Van Brunt ...........«-°--........_....... _.....:« St Croix .....County. 84 «.«...«...« ...... authenticated thL��ay of«^.' .......�...........19...... Persondly came before me gab......2A.St..day of .`t. SePtaaber-- .........18.. �.�.�tphe above named ................................... ............... .............« .:. ........ ..i.�.-1 an. 4NM«------»-------«.. r e................».................« »..... ...» .... .4..LZa•�fp�.A1-. a�I t «.... •.. `11 Yr i TITLE:MEMBER STATE BAR OF WISCONSIN ! ( Lu 6�risad b7;70e 08 WIS. tate.) to me known to bs the Bin A « .-.'who e:omted the f i end 4 the same. THIS INSTRUMSNT WAS DRAFTED BY } Charles B.Harri.s II)a>Cic 1 RICHMS, WML & HAS • ..... e. ... «S ....................... ril ».My)YF.j1ir..,�4QA.6 ............................ 4Y ........... (Signatures may be sutbeotieatd or adtnowledgad,Both are not necessary) 1 »�-. ......» 0��IY=••'-•) a<+",. .Neaw N eefres eMahE in get essaNp pleats M eYSed of arhNM.takw IMbelaeaWw. Na.w.11�. r w 4 , r \ f t 4 r�Nft,J iro ay 4 us ai t53q�3 , m r t d 4 �•E .+FA .' .. ,`. .,z�� Ca' r+.kw #.• �c?.x•,s. xN :. &.. r>.H.,• a Sa�".�.w .y ,soe�t�'.st�.. M .,}'1.. ,r 11�f•et•TC tmeraea�.M W eww ee«e�. PTA"Or eeaeaeeaq �''«` ;•f•. ,�� ry.Qryw.Yao.8.t De.te,llh BrtW.. ►o.wt Nw eFTa `.: TheFbwFederalSaviagsandLoondacoiadonefLaCrotee,aCmporationdu(Yor�anfaedmutaa+WtBl�"�1andM La Stab Wis-ruk,do m hereby m'NYy. looatedatLaCrorse Cros+a d the/awe the Unibd3bteatfAmerioa, .Cordntyd _ d d dwt the Mortgage erauted by Nicholas Y."omBssn►t and Margaret J. TanBremt, husband and wife and each in their awn separate right. ' to Tri County Savings and Loan Aaodation now known as First Federal Saving and Loon Association d La COMM "4"q dated die 28ttf day d July A.D..19 76 .and recorded in the urjtos d the Rsgbbr of Deeds or St Crotx Courtly,SST of wbMwin,an On 28th � tiro' A.D., 76 .at 12t1S e'efoolF pdf M'VotaBw 540 aflt�oordt.::P. d July a at P 480 .Doeummt No. �334498 ' .kluUyp�� . Or , r'4�� ..r �. In Witness Wherootr the laid Fim Federal Swings and Loan Amciodoee of LB Croce has aumd that to 6e .? prwatte dined M John V. Sias AsBist and John J. Marino dbhssistan ,. ib i �raidaK ' at LaVCcrosa,Wisrnnatn.and is corpataM leak to be haswuo Mfssd,';thtt 21st day of September ,A.D..19 84 { 21 GISTERS OFFICE Ftnt,F goyim and Loan Aaodation of Lo Croce ST.CROIX CO.,WIS. Reed.for P.edotd Ness 96h*- 5 r_ --�_« r --------• 9 d-yof Sept.A-D.19_84 - -- Assisi ce ►�++.r'" » James 0 Coen Correa Ll: f; k � 1 I t � ..Q..Q Dputy -. LJ!eer�l__-�sBfH"tint John J. Marino 'X State of Wisconsin l Pereonsify carne before me this 21st doy of September ,AD,19 84 ti {3 John J. Marino, assistant Staebry d eat above name Corparodon.to me known m be ;� person wko exeeeted due forogMv insdnsmene,and to melwoane to be sedh+Assistant Secrem+y d+ Q�4 and oeknaoledged deaf(lu,sic)ereeuted the forrgring inatremasi au each d."i«r as the dad d maid Corporation by .cses�u! Y 4 ` - Marlene M. P St. Croix Notary Puuk,Exame County iii. � —3, ¢ ; My dommbsion e:plra--4'10°- State of Wisconsin St.Croix Cam• Pawnally came bq%m me this 21st " d4y of September .AD.,19 84 .j John W. Sias Assistant Vice President tithe abaos rmme Corporation.to me known do be dam � i person who caepeted dhe foregoing hest*en4.aad to me known to'be sadh8aa1ce t President of said Corporodae, a d ^r and acAa+owiedgd time[/t4 sW eaa cood Me XmobW isWunM et or each ofliav am,tlu deed of said C-poonaon,by.W -authorib• Marlene M. Peterson s: ,.akF 4,. a .� f•� NOM/y ,Bt. a- 9 Document drafted b Met'Fttderai Swietps ' A ', and Loan AssocWtIon of La Crosse, kfyoonuunlaioee _ • st ��NN�t. Ck NWY aMY MwetusstsM pepeeeewnbMbm emoeeNdeAeBhwe/bMe1PNSM�srbMMm �L . '.•, pseNa,wMMNM sot nNMfd ..u. k :.r ON AL r+ z a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County x c7 a OWNER/BUYER (° Vla (� Q 11<l S�R ROUTS/BOX NUMBER Fire Number .CITY/STATE— l(CO SaGI GE1r � Df ZIP PROPERTY LOCATION: 5Cel 3t, Section, T�N, R�W, Town of tl( 4-0,q , St . Croix County, Subdiv191o0-�VaF:vberp 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/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- a ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offkre 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 . PARF R Y-i M E N f I N1 D L)S , 0 SOIL BORINGS AND A11,1D MAN RELA) 110NIS PEERCOLATION TESTS (115) P.O. BOX f-JU V601 M63-09A.'1) & Chapter 145.045) MADISON,Vill '-;,i/01 ��v rTfT,-`j-P A iT-Fy--- r L J '/4 .(l o �41 T- c' E (C)') 'T ------ T � i IA.)7* C-0 U-r1j--FY I - - G - ---, I W;J17IN AurXiLss: r t I S E 2 ES OBSERVATIONS MADE [IR07 C, E] PROF F'­ffL-9UffFi-TI­C�-1N- FlRepl-ice Nl N -A RATING: S= Site suitable for system U=Site unsuitable for system D: ECOMMENDED SYTEM:(option,, S [] .j]l- -------- U S DU I --U'-\j-Ij L- IZI S D I,r Perccl;4t-,1 NOT r lire ly )"t'o in inc ficale PROFILE DESCRIPTIONS tBORING TOTAL ELEVATION JDEPTH TO GROU DWATERJNC - CHARACTER-- ` -6—F sbiL vjir0—TmcrFiE§ S,CDLOR, TEX FURE,AND DE NUMBER DEvTH r, QjE-ERVLQ— EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABEPV.Olt BACK.) 7, ; 2 08' 50'R-Q B4 L5 Wle-)P) 06u 1-UI j Me-0 5%A R-;0,67`DL 9•j 116 f-;0..W 13 j A4 6D S—/<5 P-; C,7T'D 6,1 2-5 0,70' &Aj-F5 B,N 7. 7. 8-5, .5, T's -Ps -ilCiii R. /,7S7/ j LS Y 8..r 4:$; 3'-j 4o MOT-7, W,--crux.. 3-S. 6,.,j B- :5-1.50"5'j C5 4- 5 5 t 5. 4-10 ai- L) 1,50 'ZP e>o,-J LS- 3./c, Bj t,.0ta:t> S 62. ' T ZR- '. 0,¢c ' :�, -1 e,r-j Z;I/ - B-L-;;-I !S , 0'cd 8L I-; Z.0)- ' 5,j 4-5; 1,37' 2.,o 84 e,-S M,tk L oL 8,"--(S" W e�- 0.6--.' 6 -'r S j�tT -J PERCOLATION TESTS-NUI\AB�t�cop-r- 5POIJIZI-t WI-1-74 TEST DEPTH WATER IN HOLE TEST TIME - A U,j P, r-J-r tkoil-E NUMBER AFTER SWELLING INTERVAL-PAIN. DROP IN WATER LEVEL-INCHES RATE &lFJuTE'T-- jjLt-'� -__LEFIIOQj_ r.---------- PERIOD 2 PER I%CH P- Cw\j P- P- Ng, 7 - � 4 P L I"LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soi! Indicate scale or ciistance&.Dascribe what are the ho-i- -zr)ntal and vertical elevation reference points and show their location on the plot plan. Show the iurfacl?elevation at all borings-ard.tl-�e direction and percent of land slope. 13 H "V- I SYSTEM ELEVATION -1 it, rlpipa am M. T 4- Co Ali I-o-r LWF- MMA-Z- aAANLK.-V'�-. joo.00 El 0 0 cx --I 10 Plpr- O#Nj. V0 L.O! ;T L- 'r 3 7- !'0 rm rc,14 14 13 40R�I I UDS 0 N Tlp C/o, V Y SITE J, e C F? 0, �—E C., L- '.R U D 510 A P-4 0 0 -A e KI c-14 MAP-1�- 4 .2- 1>1 PF- - F-LEV. C)I.BG 0 -N- 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and thods specified i the W�;cimsi.1 Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge arid belief. %7*' 4, L'YJ COIL A iNf-(pr—.n t—). TEST J W&RE COMPLETED O. AC- ADDRESS: CERTIFICATION NUMBER:JPHONE N BTER(optional): 0 f -jCnIGNATUR 71 57 3 a(* 41-0 8 0 E- L &T Original and one copy to Local Authority,Property Owner and Soil Tester. 5 (R.02/82) OVER- 1-03 9