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HomeMy WebLinkAbout020-1106-50-000 \ ° } CD R s \ _ � m ° } / � ] o 2 ) � $ \ � ]® � � in ) 2 2 £ ® \ \ \ 7 � � » � ± ° z b \ z 2 ; z / ) © § $ IL m co # k B c \ z F @ ® I \ a } k § k \ 0 � \ 2 z 2 D = % E ) ~ (D 2 2 ƒ { 0 c o o s I - ° $ . k k / ) ) � # � \ a a 2 � IL E ' J � q � k k k ƒ _ ! � $ \ w 2 2 t ) c _ io :3 E ) � _ a § � 2 I m ca � - - / § • � k , k @ S aoo � [ 2 } § = c § K 2 > ) o § e { D ± % a k E - • 2 z f 2 ~ § - § } \§ j / /o z ) / 2 .. d � k % k , � E § \ ? J / a 2 � 0 3 v , + � kit � PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on pplot ylan). LoWeK ShoF . le e��p� X7.0') -cQ�•OU NeP�eR 49,00 -89.UU SOIL ABSORPTION SYSTEM f ou.f �r�� "0'(,.93 � {�_93 £Nd 88•g3 8 .43 Bed: TrencH4:78 BorzM + ) ;oo•: — ia.71 BeHoM Bid . � {f a; Width: Leng!fh: Number of Lines:,J rea Built.. U Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, pt .� Number of feet from well /Q' Number of feet from building: (0s i (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameaer: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either 'a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. + Number of feet from well: i Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: Plumber on job: License Number: 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP I �'.J i '> r,p � SEC. �. T "� N-R ? W OWNER I 1 ti 1. ? ; I a 1 ADDRESS C.�'.� ? ? q ,1 ST. CROIX COUNTY, WISCONSIN SUBDIVISION - ( .' LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r � i 1 1 i i 0 1 ` i r3 1- v6 a � Ill - (a9oi,q � S• � 33,= 17 _ s INDICATE NORTH ARROW I y ' BENCHMARK: Describe the vertical reference point used r�, e of Elevation of vertical reference point: Proposed slope at site: I In SEPTIC TANK: Manufacturer: { Liquid Capacity: (� Number of rings used: Tank manhole cover elevation: 9,.(00 9 4.0 0 u�Q� U Tank Inlet Elevation: of Tank Outlet Elevation: .out Icy -99,3 ' 5S LowR Number of feet from nearest Road: Front 10 Side�Rear, O feet 6�14� � a s: From nearest•VToper-ty line Front 10 Side,GRear,O feet Number of feet from: well ^, building: to `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 1969 BUREAU OF PLUMBING P30.BOX 7 MADISON,WI 53707 SEA, NE%,S35,T29N-R19W 000NVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: (If assigned) Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Kinney Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: , Steve Lallemont 1 85 Coulee Road, Apt, 1, Hudson, WI 54016 i iI ;cNZ� 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: Richard Hopkins 1059 St. Croix 92544 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA EL LOCKING COVER q PROVIDED: PROVIDED: I O S � YES ❑NO ❑YES QNO BEDDING: VENT DIA.: VENT MAT_ WATER NUMBER OF ROAD: LINE ERTY F'L�/h� BUILDING: AIR NLET RESH ALARM: FEET FROM S lJ V DYES NO DYES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. PROVIDED LABEL PROVIDED: OYES ONO DYES ONO ❑YES ❑NO GALLONS PER CYCLE: PUMP NTS7?FATIONAL: NUMBER OF PROPERTY WELL BUILDING V NI LE FRESH LINE AIR INLET(DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) E 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 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: JNO.OF DISTR.PIPE SPACING: COVER INSIDE DIA. 'PITS LIQUID BED/TRENCH 1 - be MATERIAL: PIT DEPT"' DIMENSIONS I 1 Z GRAVEL DEPTH FILL DEPTH IDISTR.,PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV NLET ELEV.END: PIPES. FEET FROM LINE: I I Alfj NT {tt 1� 8(�•�� NEAREST---► I v l/Y 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. ❑YES 1:1 NO jFFF_MA_NFYN T MARKERS OBSERVATION WELLS SOIL COVER TEXTURE ES ONO El YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SODDED. SEEDED MULCHED CENTER: EDGES. DYES El NO DYES ENO 1-1 YES ❑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.: CIA.: ELEV.: PIPES DIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. ❑ PLANS YES ONO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE:ERTV WELL: BUILDING: FEET FROM II OYES 1:1 NO ❑YES —IN NEAREST 0010 141PA-0 � �1 •S10 � r Sketch System on Q �Retai in county file for audit. Reverse Side. Q� SIGNATURE: TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) 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 approveq,py the permit issuing authority. A new permit may be needed if there is a change in your building plans, sy tem 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: 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment. 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g... MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's 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%2 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. r i -----------------------------------------------------------------------------------------------------------------------------------------------=----------- 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 negotiatioruand public debate. The groundwater bill Ground At f> .. inciuded the creation of surcharges (tees) for a number of regulated practices which Wisco iWA can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaSt#f3 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. a -he monies coller;ted through these surcharges are credited to the groundwater fund adminis- tere(I by the Department of Natural Resources. These funcs are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, s «ortl": protecting. G-6396 R.03 B6) SANITARY PERMIT APPLICATION COUNTY 51L HR In accord with ILHR 83.05,Wis.Adm.Code STATE , ANITARY PE MIT# 9as.el —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 El YES ® NO PR PE TY OWNER PROPERTY LOCATION S 5f '/4, S TQ'9 N, R 9 E (DOW PROPERTY OWNER'S M,%ILING AD FkSS I LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CIT ,ST TE tt�� " ZIP CODE PHONE NUMBER -CITY . r NEA kiljot�4 VT LAKE R LANDMARK I�t� ` , `fL ❑ VILLAGE: � J 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 1 OR El Public(Specify): Cf; t' t 4 A! III. 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 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. A 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): Q /� I J (4( IJ t3 ° V Feet Private ❑Joint F-1 Public VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank NQ6 F-1 ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber 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: 1 L RA lam/ 105 9 Plumber's Add ess(Street,City, late,Zip ode): Name of Designer: P Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST t ?15 R C. Ri�'� Ise ) �q CST's ADDRESS(Street,City,State,Zip Code) Phone Number: j so ant s N IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved I Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial I6.�C6 Syrcha Fee 6'/9 8 n y� Adverse Determination 11� + � /y°G/0- X. CO ENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT S T C - 100. This application form is to be completed in full and signed by the owner(s) of the property 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 �7`r���l, © GR</�11*-�,^ThG� !'�J�i�� �. G!�!/ �sz,Oh Location of Property s�` ' � ' , Section 3� , T / N-R /9 W Township Hailing Address 95- ee,6,, Ce �Ct` / Zy Address of Site �1� / ,de r 12D Subdivision Name Lot Number Previous Owner of Property 1�eiel 7L 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 X No Volume 7 -7 ' and Page Number S- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: k 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) eQJW6y that att Statements on this 6oAm ahe tAue to the best o6 my (ou/0 knowledge; that I (we) am (ahe) the ownen(b) o6 the pnopenty descAi.bed in this "n o c 6 Anati on 6oAn, b y v�.tue o a warvc y 6 ant .c deed heeaxd d ' e n the 066.tee o6 the County Register o6 Deeds as Document No. Z e(57'16- ; and that I (We) pnesentC y own -the no oiled p p site bon the sewage di..spo.a .sys em (on 1 (we) have obtained an easement, to nun with the above descAibed pnopeAty, bot the eonsttAucti.on o said system,Z ¢�n and the same y e has been duty heconded in the 066ice o6 the County Reg•c.ateA 06 'Deeds, as Document No. V2 SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 7 D E SIGNED DAT SIG ED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 . THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED PW 77PAtE Q5 REGISTERS OFFICE This Deed, made between ......Robert W. Linehan and ST.,CRO1X CO., WIS, ---- Janice__-.--Linehan,--husband--and-_wife_-as__-oint-_tenants------ Reed, for Record this 1st - -- --------------------------------- --- ----------------------------------------------------------- j ------------------------------------------------------------------------------------------------- Grantor, CY. of WZ . A.D. 198 and-----.5_tephen--P.---Lallemont,.-and--P amela__S,__Lai lemont,___________ i' 10:00 A ._-husband_.and__wife_,.-as_-maxxtal--su�y �o�shp__property_,_ � � -------------------- - -------- -- --- ------------------------- ----- i. H �MBr Dlw9 - ------------------------------------ - ---- ---- ----- --------- Grantee, Witnesseth, That the said Grantor, for a valuable consideration------ j conveys to Grantee the following described real estate in -----St._ Croix RETURN TO County, State of Wisconsin: i Tag Parcel No: ----------------------------------- Southeast one-quarter of the Northeast one-quarter of Section 35, Township 29 North, I Range 19 West (SE4 - NE4, Sec. 35, T29N, R19W) "UNSFU i except the North 396 feet thereof. ; This deed is given in satisfaction of that certain land contract recorded June 29, 1984 at 3:40 p.m. in Volume 691 of Records, pages 460-461, as document no. 394511, in the office of the Register of Deeds for St. Croix County, Wisconsin. i This ---is—not ________----- homestead property. i (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; f AndGrantor ------- --------- ---------------------------- ------- ------------------------ ---------------------------------------------------- -- -- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, and rights-of-way of record, i i i and will warrant and defend the same. I Dated this -------- t. 1 Aril 87 day of p - ------�--, 1 (SEAL) --------•--------------------------•--------------------- --------..(SEAL) --- - - 1; * ------------- ---------------------------------------------------- * Robert_W._.Linphnn...... •-•------•---•-------- ----------------------------------------------(SEAL) �L -----------(SEAL) * Janice M. Linehan -•--•-------•----------- --------•------------------------------- -•---------•-----------•-------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) ... Uhert_W,,,_UA4ahan_and_______________ STATE OF WISCONSIN Janice M. Linehan ss• ---------------------------------------- --------------------------------------- ----------------------------County. authenticate this I.. .-d of------Auil__________ 19_$_7__ Personally came before me this ________________day of ------------------ 19-------- the above named -- - --------------------------- , -------------------------------------------------------------------------------- `------ '�t yen__B.__Goff------- - - -- - --------------------------- -------------------------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not, --------- authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Steven B. Goff, Attorney at Law -------------------------------------------------------------------------------- 710 Nortfi Mani Street; Box Tb7----------"'---- s hls,__Wiscons in54022 ___ -____- Notary Public I __.___.____----------------------------- - County, Wis.(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) - date- ------------------------------------ -------------------- 19--------- *Names of persons signing in any capacity should be typed or printed below their signatures. l.� KC,MiIIsrCortpany M STATE BAR OF WISCONSIN L , r+..w..r.....,.. ® - FORM No. 1-1982 Stock No. 13001 CA STC - 105 r • r w r SEPTIC 'TANK MAINTENANCE AGREI?MEN'1' St . Croix County o e7 OWNER/BUYEfi '� ROUTE/BOX NUMBER !lt f '6 0,Y ��O Fire Number CITY/STATE �lGr j�Oh , l ZI1) 0 PROPERTY LOCATION: '-E , Section 3.�. , 1 21 M R / W Town of Od! , St . Croix County , Subdivision Lot number Improper use and maintenance of your septic systeue could result in its premature failure to handle wastes . Proper maintenance cun= silts of pumping, out the septic _tank Bury 'three years or sooner , if needed , by a licensed ` septic tank LmLer . What you put into the system can affect the function Of the svj)tic tank as a treat- ment stage in the waste disposal system . St ., Croix . County residents ii be eligible to receivu a grant' fur, f a maxiueum of 60% of the cost of replac* ement ' of a failing system, which was in operation prior. to July 1 , L978 . St . -Croix ,County - g . accepted this''prub`ram .`in Aul;ust of '1980, with the requiremernt owners of all new s•ystem5 agree to keep their systems properly maintained .- — -- The property oweier 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 1)uni1)er Veri fying that (1) the on-site wastewater dispu'sal Systeue is ' in proper operating condition and (2) after inspection and pumpinb, (if, nec- essary) , the septic 'tank is less than 1/3 full of sludge and `-scum. Certification f.urm will be sent approximately 30 days prior to three year expiration . O I/WE , the undersigned , have read the above requirements and agree U) p b p Y cn to maintain the private sewage disposal s stem in accordance_ with x ' the standards set forth , herein , as set by the Wisconsin Depart- v ment- of Natural Resources . Certificatiun form must be completed , and returned 'to the St Croix County Zoning Office within 30 'days of the three year expiration date . A c STCNEll DATE /2 St . Ctloix C_.)unty Zoning Office R.O . f-ox 98 Hammond , WI 54015 715-7S;6-2239 or 715-425-8363 Sign ,' date and return to above address . IDEPARTMENT DUS Y , of REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,, •OIVISIf1N LABOR AND PERCOLATION TESTS (115)l P.O. BOX 7969 HUMAN RELATIONS ` / MAQISON,W1 53707 (H63.090)& Chapter 145.045) 05 C A T I V: S R TION: TOWNS IP/S V ILOT NO.:BLK.NO.: SUBDI VISION NA r 4 �/ .3Ls"/T,2�j N/RI's�(o COU TY: OWN R'S BUYER'S NAME: MN LIN ADDRESS: / /1," USE DATES OBSERVATIONS MADE NO.BEDRWT COMMERCIAL DESCRIPTION: R EST§: Residence i / Nlew ❑Replace X.; � Em o Ss�c/ RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND PRESSURE:r[]S STEM-IN-FILL OLDING TAN1:11`1 ECOMMENDED SYSTEM:(opti nal $ ❑U ®$ DU $ DU OU ❑$ U d.v / 2 If Percolation Tests are NOT required DESIGN RAT • If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PR9 ILE DESCRIPTIONS BOR_ING TOTAL P H TO GR UNDWATE CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH4. ELEVATION gSERVED S I H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) Pot V.O" B-3 7 B-S 0" - 13.o �s' ,� ? ,8.4 sf it B- PERCOLATION TESTS TEST DEPTHI WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER i 4444E-i, AFTER SWELLING INTERVAL-MIN. PER INCH P. 'ot ,3 6 6 6 c 3 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. SYSTEM ELEVATION I l -- _-__ $ln, �_I .?•-.� _ Ifs- I . �o tN — - - 3 1 - i. rf x (4.144 -i -7� 1 Ov �7 - - .` ! r i u�s1,�� 7a �,�.�.�y vim- .� � ' I,the undersigned,hereby certify that the soil tests repo ed on this form were made by m in accord with the procedures and macho ►specified in t e Wisc Administrative Code,and that the data recorded and the location of the tests are correct to the a f �� b st o my knowledge and belief. NAME (print-- TESTS WERE CONMwi— ED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(Optional).. CST DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Testes. DILHR-SBD-6395 (R.02/82) -OVER - L R ' 67 p r 0 4.y f jr s L. I L oT A N F) �.� I O r,.J S �� I I\I IV T _.�..._ _._ -..... - ._.._.._ .._..._._ PROELT 13LUMf J `;N AM E n �� __.._.-- -- N...A M E Rik- 00 10 DATE 1 L 0 1— M A P ce ri _ r�-� - a1f A- '15 Ve1 , d-4W+-. k Ref, Po"I,st At fAlz G a y s-�• Ut Colt"zg w4 0 to S Bri PQ 0' , 10, UPS) r _300 too �- :,� 0 Yao, ep �e�u�Rpmeu �- h' 140 Ae P t A �1 A�folteiz G v�) P' t0�. _.11N� P, P+ SESHA:' R_ INLETS—AND OBSERVATI()N P:L-.PB CROSS SECTION xs,t C AppQroved Vent Cap Minimum 12" Above ��, ►�a 12AC��t F l ;; Final Gra Q y ; w 4 " Cast Iron Above Pipe Vent Pipe To Final GradE�� ' Marsh Hay Or Synthetic Coverli t t Min. 2" Aggregal.f, Over Pipe Distribution -U - Tee Pipe —� ! - +, 88,4 Aggregate Perforated Pipe Below Y Or; ,� Beneath Pipe 4 Coupling Terminating At :I \/ ___. . Bottom of System