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HomeMy WebLinkAbout020-1185-90-000 -0 o rY o � o � h a I � I b o I N h" tl .p �L CD a LO 'C N d X d � 3 � Y O Z m C LL c m O m O 00 Q N II a y z y z a 0)N H U) O O O Z d Z c Z N F E O N O rn 4) • °) o wv v) = or O o 4) Q w z m z o N Q � I V m E O N G •� M C N O �r c o IL (` H N y O� O a � O n u5 0 0 0 o I Z •IV a a a N CL ►�. ' O N a N J U N m rn } N *mil � o �` _ O o to w O E N N O O r co C mI d 0 m �7 W N _ Q } In m CD co �i _ N O O J_ y C 6 EC O O O O C O N O 0 m - O O O O O C d 0 o m 0 ' p N N N I cu q C14 V W O LO oi ~ C N N �+ N M N Z Z C n co (O ( ' O 0 _ =x)i N N 7 p O cn O O U • O N 2 O Z N F- H 2 U) O CC on L:m CL m 4) c • at m o m 3 o 1 A U a '', O �n U Of r. 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 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: prl,J4,�rpno. Width: j�� Length: 5'Z' Number of Lines: Area Built: Fill depth to top of pipe: 4/a Number of feet from nearest property line: Front, O Side, O Rear,Q Ft .7S Number of feet from well: l©4 r Number of feet from building: SS (Include distances on plot plan). SEEPAGE PIT Size: (�(/�l 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 abode soil absorbtion sytems? (Check one). _eM 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: - Inspector: Dated: Plumber on job: �1. License Numbed, I `£ 3/84:mj f Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /t�(`( �: TOWNSHIP S©Y4 SEC C,7 T N-R j�? 4 ADDRESS 61 ST. CROIX COUNTY, WISCONSIN SUBDIVISION�Ca +^i i StG LOT LOT SIZE, ���`✓ S PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t m r I � �ss Zv"xZv' 20 n r ---- I S �3p f -51, `3Z,jam /00- a y T N INDICATE NORTH ARR� i� BENCHMARK: Describe the vertical reference point used,,j /.-AO Q � Elevation of vertical reference point: f y. '7' Proposed slope at site: �-2-3t6 wa "-'t' SEPTIC TANK: Manufacturer: Wa.jSQ.r Liquid Capacity: J2(00 GQ,\. Number of rings used: Ta4 manhole cover elevation: Tank Inlet Elevation: ''Tan Outlet Elevation: Number of feet from nearest Road: Front,0 Side, Rear, O { ZOO feet From nearest property line Front,0 Side 10 Rear,O feet Number of feet from: well . p7 ( building: 2-S" 4- 0-r( /�ro„„S vl1 Cdf n o/ OP Mflk Sa-- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE P DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707X SW%,SE�,S21,T29N-R19W t=1CONVENTIONAL 1:1 ALTERNATIVE (Ifa35gnedlO.Number. Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 13 Prairie Vista NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Route 1, Dox 282, Hudson, WI 54016 BENCH MARK(Permanent reference pmntl DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 102833 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELE V.'. TANK OUTLET jYE S EN 0 0 YES.. WARNING LABEL LOCKING COVER P V ED'. PROVIDED f�, 99, �i ANO BEDDING. VE T DIA VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH ALARM FEET FROM ,i� LINE A AIR INLET DYES NO ❑YES NO NEAREST V QS/ DOSING CH BER: MANUFACTURER BEDDING. LIQUID CAPACITY PUM MODEL. JPUMPISIIHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO 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: NO.OF DISTR.PIPE SPACING COVE INSIDE DIA -PITS LD BED/TRENCH TRENCHES M E IAL' PIT DEPTH DIMENSIONS GRAVEL DEPTH - FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE M IAL: DISTR. NUMBER OF PROPERTY WELL BUILDING VENT 70E HESH BELOW PIPES r/ AB COVER. ELEV INLET ELEV.END.� PIPES FEET FROM LINE AIR C-.L / 22 �2 NEAREST 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. DYES ❑NO OIL COVER ITEXTURE PERMANENT MARKERS :::]OHSEHV ATION WELLS - YES ❑NO EYES ❑NO DEPTH OVER TRENCHiBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED IMULCHED CENTER EDGES. DYES ❑NO ❑YES ❑NO DYE S ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MARKING ELEV.. ELEV.. DIA.. ELEV.. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVE MATER( L VERTICAL LIFT CORRESPONDS TO APPROVED PLANS El YES ❑NO El YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE O Z ❑YES NO YES ONO NEAREST 1;7 4 Scat, n Sketch System on � ainyin county file f r audit. l Reverse Side. SIG E _.....y ITLE. 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; 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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; Ill. 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 81/2 x 11 inches must be submitted to the county. The plans must include the ) P lot P A following: Ian, drawn to scale or with complete dimensions location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater—i 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 a is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) i i SANITARY PERMIT APPLICATION COU 7 D.ILHFR In accord with ILHR 83.05,Wis.Adm.Code - J ■^.o.., .ate.,..�,,,,. STATE 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 12 NO PROPERTY OWNER PROPERTY LOCATION 54/'/45�'/a, S Z/ T , N, R E (O6119) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME /3 fa' ',C, i' a CITY,STATE /-` ZIP CODE PHONE NUMBER CITY ��� NEAREST ROAD,LAKE OR LANDMARK K/� l �S G'.Z%PT VILLAGE: a-S-0 4 /..e./ C,N 6-01 L II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 5!� OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. � New b.El Replacement c. ❑ Replacement of d.El 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. 9 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. 91 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): PROP Square Feet): JWW ESP( �07 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ga ons Total #of Prefab. on- Steel Fiber- Plastic Exper. Manufacturer's Name Con- lass App. INFORMATION New xisting Gallons Tanks Co 9 PP Tanks Tanks structed Septic Tank or Holding Tank / �C ir✓ 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. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: �K r Plumb 's Address(Street,City,State,Zip Code): Name of Designer: 9-)e"K /VQCA) 2f'.4 Doti / 0/, ,- /o / 7 *roA�¢�� VIII. SOIL TEST INFORMATION Certified Soil Tester(CST//)Name CST# If s (fkr`'S� CST's ADDRESS(Street,City,State,Zip Code) Phone Number: �� �v WT- �O �� `7k� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S 'tary Permit Fee Groundwater Date Issui g Agent Signature(No Stamps) I Approved fytW� charge Fee 11-04 ��h/v pp ❑ Owner Given Initial v Adverse Determination X. CO ENTS/REASONS FOR DISAPPROVA : ^- rwtd bey `�jv'�-„a'' C' Ij SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 Propertyis?� l�Gr Location of ProAperty S k,) 1% S.,E 1%, Section -1 �_ , T �� N-R Township4 Mailing Address �,� 1`x „Bp Address of Site Subdivision Nameq Lot Number Previous Owner of Property � - a �✓ 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 46 _ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: I A Warranty Deed Which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be 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 OIVNER CERTIFICATION I VVe) cutti.6y that aft statements on .thin for ahe tthue to the beAt o6 my (ouA) hnowtedge; that i (we) am (ahe) .the ownen(�s the pnopenty desehibe.d in .th,ia .i"Wmati,on 6o)un, by v.ih.tue 06 a wamanty deed neeonded in the 06Ke)ce o6 the Co11 iy Reg.ustoA 06 Deeds ass Uoeument No. ��a � t and that i pne,sen,tty at?" tl�e p4opoaed d•i to bon the sewage di�spos s ys em (oh I (we) have obtained an ea.aement, to nun with the above deAcAibed pnopehty, bon the eon6tAucti.on o6 said a ystem, and the came hcu been duty neeo)tded to the 066tee o6 the County Regi,&teA o6 Ueeda, as Uoement No. 14(ga�lg/ ) . SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED _ z cn y ST C - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z d a OWNER/BUYER,C,�� ROUTE/BOX NUMB ER Z/e' I �61� 2-�Z Fire Number CITY/STATE ZIP �Yy/lo PROPERTY LOCATION : Su/ _S-1E- 4, Section/ T N , R Town o soyr St . Croix County, SubdivisionO&I r � ���`���t Lot number-L. 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 . 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 . SIGNE g:21e L/ Q^VaMA_�_ DATE r� 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 . { INSTRUCTIONS FOR COMPLETING; FORM 115- SBD - 6395 To be a cbroplete_and accurate soil test,your report must include: �. 1. Complete legal description; 2. The use section must Ilea-4y indicate whether this is.a fVsidence or commercial project, 1 MAXIMUM number of bedrooms or commercial use planned; 4• Is this a new or-replacement system; 5. Complete the suitability:rating boxes. A SITE IS SUITABLE FOR A�HOLt ING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON�OIL CONDITIONS; 6. PLEASE use the abbrvviatAis shown here for wrilk j profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sel3arate sheet twy be used,0rdesireJ, 8. Flake sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9, Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification numfaer; 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 C ERTIFIED SOIL TESTERS t "Y 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 Pere Percolation Rate reed s - Medium Sand W — well fs - Fine Sand Bldg Building is Loamy Sand > — Greater Than sl - Sandy Loam < — Less Than 'I — Loam Bn - Brown sil Silt Loam BI - Black si -- Silt Gy Gray *cl — Clay Loam Y — Yellow scl Sandy Clay Loam R — Red !., sicl Silty Clay Learn mot — Mottle-s _ sc _ sarsdy Clay vv/ with sic - Silty Clay fff few', fine,faint ..- �.• — Clay: d cc Common, coarse. � Pt -; Pe I mm Marcy, medium nn Muck °` of — distinct p — prominent HULL — High water level, Six gene.ral sail textures surface water for liquid waste disposal BM — Bench Mark VRP -- Vertical Reference Point : t TO THE OWNER: This snii test report is the first step in securing a sanitary permit, The county or the Department may request vcri;ication of this soil test in the field prior to ;aerrnit issuan ce. A complete set of plans for the private sewage syste.ni and a permit gpphca'Lirzn must be submitted to Vie appropriate local authority in order to obi,iin a,perrnit, The sanitary permit Wrest be ohlained and posted prior to the start,of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, r DIVISION HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)&Chapter 145.045) LOCATION: SECTION: OWNSHIP/ OT NO.:BLK.NO.: S DIVISION NAME: N/RJ l(or s�.� /3 �— .r,` � s /sue COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: j � ` c 57, Spa USE DATES OBSERVATICfNS MADE NO.BEDRMS.: COMMERCIAL D SCRIPTION: EOFILE DESCRIPTIONS:1PERCOLATION TESTS: Residence New F-1 Replace Sit/ me O //�� c, /'• RATING:S=Site suitable for system U=Site unsuitable for system (r S //T 4 J CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(option 1) ES ❑U ®S ❑U ®S ❑U ❑$ QU ❑S ®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: LFloodplain,indicate Floodplain elevation: PR FILE DESCRIPTIONS BORING TOTAL+ ELEVATION DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) E —I /d/.7, �� 7 i�/ • // . N S/ 3, Jc—0^ C J B- B S/ n S B-3 g,o , jdcs.s"OF A4.,e 7 g, 1 V r /3/ AS/ 3.7 ten cs / A 7 AAS-14 W,4 AM out B_ PERCOLATION TESTS TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES Ai NUMBER � GM�6 AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P_ S'3' 0 2 ( G. 3 P- 14.31 a c. P-3 a 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 percent of land slope. SYSTEM ELEVATIO tN j l E yor O i a JP 3 ` ` h � l lJe�-f•�Gf-� ��� �eQ.�c�.-tee-t�.�.4Fj; I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): _,I ' TESTS WERE COMPLETED ON: ADDRESS: NUMBER: PHONE NUBERIop tional): CST S URE: I-V DISTRIBUTION: Original and one copy to Local Authority, wner and I 'ter. DILHR-SBD-6395 (R.02/82) LA J LIJ 1 t . 0 � a1 N h ,* P d y. i t l cr � P � s � • • P P LAP I T I I � I w o � ° ry P I x � W ui i 'i1 f � v,U s N \4) o J S 1. f s -