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HomeMy WebLinkAbout020-1084-60-000 \ o ) § \ / & % I M 7 ! §/ � ae% � k ® M / ;-Z, .0 0 ) r � � / ■ §5 � o � %a 222w� Z I ® M\/t C t5 .2 r> d ƒ§ 2 § < o ,-1 o .� Cl) E 0 , q § q I ; � B Z 2 § § C ■ _ ƒ § N k j (n k ) c 2 •• E t n .. § 2 LU S ,. )§ / L o = k � o $ \ E m # \ � \ \ 2 ƒ k ) / b § § IL o -� � � j \ k £ � � -co b ° ° 2 � E ) ; £ � � � ■ 2 � § � 9, ( / 2 I 2 6 cl \ , ■ a E a m = § § } \ \ o ] / k 2 � •• � � � a k . E & k I k a.v a a f . & t �j3 k v , . s 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: Width: z--� Len$th: �'2 Number of Lines: Area Built: iS Fill depth to top of pipe: l `` Number of feet from nearest property line: Front, O Side, Q Rear,0 P't . Number of feet from well: I/o T Dt-.;A 1 Number of feet from building: 1 1,,e4 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has efther 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: S Plumber on job: License Number: ?/�' �p 3/84:mj t Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � ��.,�-1J ;' .Q� TOWNSHIP yL��..-t.� SEC. TN-R W ADDRESS �/ � f'1��,. ot� �*� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT '�� r LOT SIZE �s, , PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ta 1�d t 1-7,2 e' -- INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference oint: P �L1�l, Proposed slope at site: SEPTIC TANK: Manufacturer: „_ Liquid Capacity: Ar6le Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Side 0 Rear, O I Z2 feet From nearest property line Front,O Side,O Rear, �?� r feet Number of feet from: well , building: 05- 7 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX�7969 BUREAU OF PLUMBING MADISON'WI 5371;7 SEk, SW%, S29—T20N—R19W IM CONVENTIONAL El ALTERNATIVE Pla Town of Hudson El Holding Tank El In-Ground Pressure ❑Mound Lot 4 Se4a--ms's=s NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTI N DATE Randy Schmidt Route 1, Hudson, WI 54016 '� , C 0 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No Coun[y Sanitary Permit Number: William Schumaker 6382 St. Croix 96026 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ( P O IDED. PROVIDED: �a I 1 2 Iry C- YES El NO OYES ANO BEDDING: VENT DIA.: VENT MAT L. 'HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH A M. FEET FROM LIN8 O AIR INLET ❑YES NO ❑YES NO NEAREST f DOSING CHAMBER: MANUFACTURER. BEDDING'. 11-IOUID CAPACITY PUMP MODEL JIUMPISIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES 1-1 NO ❑YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUM13ER,OP PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 'ES ❑NO NEAREST'` SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: _ WIDTH: L - NOOF DISTR.PIPE SPACING: COVER 'INSIDE DIA #PITSTRENCHES. M ERIIAL: PtIT DEPTH: DIMENSI C GRAVEL DEPTH FILL DEPTH DISTR.P PF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL BUI DIjV G: VENT TO FRESH BELOW PIPES: 1 ABOVE COVER. ELEV IN; ELEV.; �^ ^ c 1 PIPES FEET FROM AIR I I T: t NEAREST / N MOUND SYSTEM: Lr Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL. S . SEEDED MULCHED. CENTER. EDGES. El YES 1:1 NO DYES ONO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: E #? t tNH TRENCHES: _ENS`�ONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL'. ND.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. :+ ry ELEV.. ELEV.. DIA.. ELEV.' PIPES: DIA.: EI.EVl4'll'I01l1 ANi3 1►STR3ftI ITtON N. HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED h1Ft�RIUT ICII PLANS: ❑YES NO DYES ONO 11MMENT PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET'FROM LINE : DYES ❑NO EYES 1:1 NO INEAIREST__� Al Sketch System on etai�n 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; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed-, rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years;, 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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 EIY2 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; welts; 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 included the creation of surcharges (fees) for a number of regulated practices which Wisco ECt`S can effect groundwater. The surcharge took effect on Jul/ 1, 1984. All of the water that buried Teasure 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. 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) ,SANITARY PERMIT APPLICATION COUNTY 1:ED-1,LHFi In accord with ILHR 83.05,Wis.Adm.Code IST 6 o j X STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than STATEPLA 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 PROPERTY OWNER PROPERTY LOCATION An �z .rc rn, !z- %54,/%, S -a--' T .ate{, N, R 1 Q' E(or PROPERTY WNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME `s, % CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK " .��U.✓ r �O�to 1:1 VILLAGE : 1111-e 11. TYPE OF BUILDING OR USE SERVED: ,40,-A6, 0 A 0 �Q-- 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. ANew 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.&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.fid Seepage Bed b. ❑seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): ` G f �l-�1.7 aZ r Feet 2�rivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons 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 00 ,�s„cs� Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system sho w on the attached plans. Plumber's Name(Print): Plumber's Signature:(No amps) M /MPRSW No.: Business Phone Number: 1.a .., "- -. �e l l Plumber's Address(Street,City,State,Zip Code): Name of D r: .�. �1 Gifi- G✓ tr' f� Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS re ty, tate,Zip Code) Phone Number: d IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) El Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination 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 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 Location of Property - a/ h , Section , T 9 N-R If W Township __ /.�,^� �✓ Mailing Address 7"q 1r,�. 2,�✓ �,�� y°dlG' Address of Site Subdivision Name v- - e J Lot Number Previous Owner of Property . Total Size of Parcels mac_ �/ 3 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 _2_L441 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: 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 OWNER CERTIFICATION i (We) ceAti.6y that a.Q, -ftatemena on th.ie 6o&m cute true to the bust o6 my (ouh) knowledge; that 1 (we) am (ace) the ownerc(6) o6 the pnopenty ducAi.bed in thin in6onmation 6ohm, by viktue o6 a wavcanty deed neconded in the 066ice o6 the County Regaten o6 Veed6 a6 Document No. , and that I (We) pnebente.y own the pnopobed 6-ite bon the 6ewage di6pob System (on I (we) have obtained an eabement, to nun with the above d6cA bed pnopehty, bon the conatnucti,on o6 said 6y4tem, and the Game has been duty neconded .in the 066ice o6 the County Reg"ten o6 Veed6, a6 Voe meat No. ' r//�?,_ L`0 ° SIGNATURE /OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) � Z q F5 7 DATE SIGNED DATE SIGNED • itDOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1992 II TNIS SPACE RceeRVCD FOR RECORDINO DATA i WARRANTY DEED 40.'LUe J x, 711 PAGE ---------- REGISTERS OFFICE This Deed, made between ...AARRU L...R.....LEWIE................ ST.CROIX CO.,WI& I ........................... ................................................ Rec'd. for Record this 30th .............•. :--•- --....------.•...........-•-----•-.............................------....... .....nto , day of�—A.D. 1985 ••••- .., Grantor, and ......RAN.DX._.F+.....SC.HMID.T...A,ND.-MARTHA..,I.....SC.HMID1'r_...... t 12:25 P A Husb..and..And_..Wi-£e-............................................... ..... .....__...__._._ i --------------------- -- ---•----............. ...............------................------------- beiltr N Dwdg .............................................................-...--...---•-----••-•-------........, Grantee, � Witnesseth, That the said Grantor,for a valuable coltaideration..Of ONE D L — -- — ........... ..Q...LA1?..and..o the-r...va.].ua}�l.e..con.sideration..._.. -- conveys to Grantee the following described real estate in .... g.--......... RETURN To ��)) ------- County, State of Wisconsin: f+R•S—/v/riz►�l/r-'l1 /ec� i.,ec ICL= '5 yv/L I Taz Parcel No!................................... i SE 1/4 of the SW 1/4 of Section 29, T29N, R19W, Lot 4 of II Certified Survey Map in Volume 4, page 903 of ORD (is 1,231 itacre) . I� �I MANSFA FM I This .....;L&..11Qt,........ homestead property. � ((jq (is not) Together with all and singular the hereditamente and appurtenances thereunto belonging; And.......DARRELL-R.—LEMIS............. .................-----...................................................................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this .............29.th........ ... •-•-_.... day of ........... ........April.................................—, 1985.--.. ........... ... '.'+.' ysv- .............(SEAL) .....---............................•... ...••... .............(SEAL) DARRELL R. LEES ....................... • ...... ........................................................... .....................................................................(SEAL) ........................................................... ........(SEAL) .............. ........----........... ....... ..---..---......---°-..............._........................... i i I AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN �e/r as.` C---_-Counauthenticated this__._..._day of........................... 19...... e ally came before me this . .......day of Q.r�Z................ 19. the above named ................... ..................... ............................................ /�t�t3AL.. ...... �W TITLE: MEMBER STATE BAR OF WISCONSIN (If not......................... .....................$_ authorized by § 703.00,Wis.State.) /tr xr .. Or to me known to be the person ............ who executed the foregoing instrument ano acknowledge the same. i THIS INSTRUMENT WAS DRAFTED BY V /. _._..A1�RR ?•L._R.,.._LEWI$............................�afj4��C�t , I ? •.............................. .......................... Notary Public ............. . C.J;N.,.......County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is p anent.(If not, state expiration are not necessary.) C0 rr'M'SSIGn..XP:I s date: _..........;1�{Y-_....... ..,,.. ;.�,. o 19......... ) t -Names or Dena signing In any capacity should be typed or printed below their eisnaturea. WARRANTY DEED STATE BAR OF WISCONSIN When-in Leral Blank Co.Inc FORM No.1-1882 Mil—Aft,Wis. ST LINE Of THE .SE 1/4 OF THE SW 1/4 • v 0 -r- I-r- 1� 10 � m N • 'O w 0 4D N 1 rmn 1 � 1 !V � O 00. 0 20 . o' ao N 0611 ' S9" w .� _ l; _ _ _ � Q1 N + , th ° 1V59�- o 597EMk La ry 0 G 0• " O 'D 5 p 2 0 3 . 5.9 Z �� to STC - 105 r ' y H SEPT IC TANK MAINTENANCE AGREEMENT o St . Croix County %G d 9 i H 0W N ER/B U Y E k c I�ire Number s_,. K U I1'f t:/ B 0 X N U M B S It �� s�_�.�! �di%'� _.A✓ __ _ PROPERTY f.00ATT(1N :�'% t�• + $.e • + Sect ion a+ f-_.. l'�` .1 N + Town c,1' _1h,--,e-5, , t __.. _---. r ____ St . Croix County , Subdiv Lsion �',�C t!__-- �;• C" ___. Lot number Improper use and maintenance of your septic system could result in i.ts premature "Iailure to handle wastes . Proper maintenance con-- ststs ut pumping out the septic tank every tftree years or sooner , if needed , by a 11cens d s_eLtic tank puuile_r . What you put into Lite system can affect the furictlort of Cite septic tank as. a treat- ment stake it► cite waste disposal system . St. . Croix County residents ma-,y_ he eLigible to receive a. grime for it maximum of 60% of the cost. of replaceutent of a failing system, which was In operation prior to July 1 , 1-978 . St . Croix County accepted this program in August, of 1980 , with the requirement that owners of all new stems 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 . p I /WE , the undersigned , have read Lite above requirements and agree � to maintain Lite private sewage disposal- system in accordance with x H Lite standards scat forth , herein , as set by Lite Wisconsin Depart- 'o meat of Natural. Resources . Certification form must be comple'ted and returned Cu the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE ` �zL St . C •oix county Zoning 'Off ice P .O . liox 9E, 11ammotad , WI 54015 715-7r16-2234 or 715-425-8363 e Sign , date and return to above address . � T :ter•r- t� trl N�/I er WOW I Ii lop are 1�� 0� v♦ N yes M�a />•,'nFI + O F. r v,,„a, ` i V1 l yt in a l � ns t • ��yreo6y Y W a,v.,r�wl� 3lvy���� i VV IA H>"I PNI bl- � � %'Evl%3 I v uN 3 Ti SIN r aa°���r � f�s. �'�,���.s,:fix^''' ...a�•°� :�+ [�,/�Q'�' /�� fit► �'"# /� RTMENT OF RE-PORT ON S O�NGS' A $ if* '&HUIL!�#At#, s rNOUSTRY, C?1 ISi ON U AND W7 HUMA N RELATIONS PERCOLATION TESTS (115M 0 043.09(1)i Chapto 145.045) EMKTIO s CIPALI'f Y: r J �' ;�q z9 N Rte { �,go 4 - �3 CU14TY: : J�,"p f _ OATU pf145 NO. rOMMERCTAL-DESCRIPTION: PRO ILIE 0911110"IM"M 1 Ree►derecew Id1 U1,V ------ New ©Raplaee UN£ --- Sol" K 46 66 ScafLZ - 8xbx . fwi(L"x*1,1' RA�610.S-Sits suitable for s(y'sWim, U-Site unritt'able for symann rNs � L.J�1 � iJY o s ZO S K. OMAAENQ ANA 'oPt ? ........ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested areais In the under s.1-163.09(5)(b).indicate: T Floodplain,indicate Floodplain alevation: bUL ..F. PROFILE DESCRIPTIONS' SORING AL -_� A ACTER OF SOIL WITH THIC SRI C WN-15 DEPTH NUMBER LPTIi'IM, ELEVATION TO BED K IF OBSERVEQ E V,,' - /P'A .sc , 3"Ux$tr,�SL �4"G!►Gs + 2`rU�M 5 B- 6_.4 �tJa�Ciz RN© > a,.qZ 37"CSI, B- ? f ' , } C47 iZILSOrs al-l-&r MS3iQn FS 41716eq -MSi6ie B- 7.5� �C; 7(: .'ti.. 7M ° 9`8cst r -Z`BR+qC'S*4t S At .04 M'Sv6OL 767 ? 7. 67 ��° c.�< r3�'��a�.� is � � '�►1t S fit ��.► ECy N Q- PERCOLATION TESTS DEPT—H- A HOL S TI ±6-tBEIIA&tP9L AFTERS WELLING ( T VAL-MIN. IfMCH /00.,'U 3 ,z ?x PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable mil areas. Indicate scale or distanaes.Dowbe who am the horl zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all btorfrtgs wW the dirsetiion and percent of land slope. SYSTEM ELEVATION WK KCAX i 6' L r P r p ♦ i' $ 1 E � OAI 6-4� 30"^ 1,the undersig ad,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and metlwds'specified in the Wisconsin Administrative ,ode,and that the data recorded and the location of the tests we correct to the best of my knowledge and belief. AME print : TesTs WERE coMPLEf ED ON. Ak\(,> 6 Zak slJ� >t�� � ���12 ��ra�G� lNC. )uMr- �4 /98 7 ERTIFICATION NUMBER: PIJONE NUMBER(optional): 3o4 9 DISTRIBUTION'Original and ofte rripy to Local Authority,Property Owner and Soil Tester, DILLHR-88D-6395 M.021821 - OVER wr .. tiro//y �. 1+•✓vi�� btiO 007 i rs r/ sr r/ tw Im SIP 1pf.1 IP o vi Y nn • t• �p /s�onty y .r � p W F- Z 1. { , TA rq I� z .��i �p��aa� b "�� WSJ•. 01 LS rl . Z`I 9 � 1 S'�1dlz 3 - a(IN's Ti S4 dd DEPARTMENT OF REPORT ON BORINGS AND �BUtLti�' INDUSTRY, ,. ... LAIIiOR AND PERC AT IV TESTS (115) ilA w HUMAN RELATIONS (H63.09(t)&ChWtor 145.046► LOCATT SECTION-5[ /s-�/ z9 /TZ9 N Rio (� H Dgo I ALITY: .�-• " 4 Avc 70 C LINTY: Vii . OJT ✓yi E DATES OM �t t iResidence �Nk 21Mew FiRepiace UN Solt< "f- RATING:S-She wltable for system U-She ualask"for svetattt J ❑� U �•❑Y K• ECOMMEND S �U If�J to r1 ct, Y If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested arcs is in'the under s.H63.09(51(b).iindicate��C �---- t,rt�5 Floodpgin,indicate FloodplaM Nsvation: Lkr-vs PROFILE DESCRIPTIONS* BORING TUTAL � A L ' AN H NUMBER HIS, EL T BED K IF SSERVE yON 8'' L5LT5 1'7" eASS,C-7T33 > 7.3 3 q''Bc•BaivcS GR 4©�c--i&4ls( c-w13 B- G 6, /DO.OZ 40NE 4.4'L 37"CS�Ge B- Not r > 6.67 /Z%LSc.'rS /'51-r9 ,4MSrkbBi4 FS:,4'x'i C-h?S aI+E B.d '7-so ea2,24 a6 ? *7 SO 9''b-st-M zg`BRNcstoe Sg&rIS ,�'A,iSv6%t 8- 5 _ /3;1 '.. !V&r�i L S /D IC "'be 7.67 roz. t4O >7. 67 t,, SI B- PERCOLATION TESTS TEST NUMKR DEPTH AFTER SWELLIN I T RVAL-MIN. PERIOD I Ex W 4 P. I -Z.10 ioc�•!O 3 Z �, ; P. z Z- a 3 7z y� l ivz. 3 2 > , P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil arias. Indicate pole or distanitat.Describe whet are the hors xontel end vertical elevation reference points and show their location on the plot plan. Show the surface elevation at aft borings anti true direction and percent of land slope. SYSTEM ELEYATM Q8.00' NCtPb1'� BM- l��N PiP;rt i - Z & - ' tl WcAft gtE.XLPosr ! P-1 A' P T f4 1 =241 6-4 1,the undersiy ved,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 iocation of the tests are correct to the best of my knowledge and belief, A print T WERE COMPLETED ON: l4Ae,rL) �a f g .i.( �" ,2 Yl C INC.. -JNl: 19 /487 D CERTIFICATION NUMBER: P ONE NUMBER(optional): X 37 S *. ,�,a r,� "l � ua � 1 S �al6 3�$4 % 4ow C Si NA LIRE: 9 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SSD-6395(R.021$2) _.OVER L_ V26 4—s i e 1 y eel ..... oe _ n