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HomeMy WebLinkAbout030-1065-60-000 eJ do > 0 o I 0 N � N C i I R„ I Fr C Z co LL C O E Q V @ M a a� Of rn Z E O 0 z LO coo W (L m N F- Z O O Z C U w 0 Z O C O � E � N_ N 3 C O •ly � � .c � d U ® Z CO Z O N z N (D C E C N CL o : C (o (o ots v N y L v Q o o °o o c a .0 C N N CIJ 04 E ¢. 'Y Z 0 d) `oaaa CL L) n n N O O N M W O N J U 3 rn m } N In Z 00 CF) o O O O N O O Q O C) °y L m ;. C- a 9 En N X33 O O 7 O O C N pip N C �, 0 3 > o E N �n ao O 'm O a O C U 3 0 0 0 O M ~ O N C C U LL O o o C (0 Q N N O +Oo . ° m E E° r E c 0 V m ! :E ac a L a • c� a m .� m `Iv E ` c c A 0 a I O m v Parcel #: 030-1065-60-000 02i20i2007 04:03 PM PAGE 1 OF 1 Alt. Parcel#: 25.30.19.2386 030-TOWN OF SAINT JOSEPH Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-KILIAN, ANTHONY F&MAUREEN W ANTHONY F&MAUREEN W KILIAN 841 140TH AVE NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): "=Primary Type Dist# Description *841 140TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 38.000 Plat: N/A-NOT AVAILABLE SEC 25 T30N R1 9W NE NW EXC E 208 FT OF N Block/Condo Bldg: 416 FT Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 760/286 07/23/1997 742/180 07/23/1997 503/305 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 60,700 103,500 164,200 NO UNDEVELOPED G5 35.000 80,000 0 80,000 NO Totals for 2007: General Property 38.000 140,700 103,500 244,2000 Woodland 0.000 0 Totals for 2006: General Property 38.000 140,700 103,500 244,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 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 plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width Length: Number of Lines: Built: Fill depth to top of pipe: r� Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . , Number of feet from well: Number of feet from building: /Z& (Include distances on plot plan). SEEPAGE PIT Size: 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 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ®- 9-f Z Plumber on job: �1r1GsL �- -c License Number: _ Z2 3 3/84:mj rf 1 ' Form - S T C - 104 rt AS BUILT SANITARY SYSTEM REPORT sr OWNER TOWNSHIP� T� cj° SEC. T , N-RW ADDRESS// ST. CROIX COUNTY, WISCONSIN SUBDIVISION �T LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 71-9L9.�<41 F.C� ERYTHING WITHIN 100 FEET OF YSTEM .R /lot y�Salle, --6,g -= i � INDICA E NORTB ARROW BENCHMARK: Describe the vertical reference point used �1;/ �J— °' i Elevation of vertical reference point: 04LQ Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: /�(�c� �► T Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number bf feet from nearest Road: Front,O Side, Rear, O , feet From nearest property line : Front,0 Side,0 Rear,O feet Number of feet from: well , building: J(� (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 MADISbN'WI 6707 T30N-R19W ]CONVENTIONAL ❑ALTERNATIVE state Planl.D.Number: NEB,. NWT,s25, (If assigned) St. Joseph ❑Holding Tank ❑In-Ground Pressure ❑Mound Town Roa d NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Anthony Kilian Route 4, Box 121 , New Richmond, WI 54017 �n'7 BENCH MARKr((PP�e11(m\•anent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.EL CST RE .PT.ELE V.: Name of Plumber: MP�W No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix 95985 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROVIDED:LABEL ILOCKING R OVDED OVER DYES ❑NO ❑YES ONO BEDDING: VENT DIA.'. VENT MATL.: HLaN F D: PROPERTY WELL: BUILDING: AIR NLOTRESH A ET FROM LINE:❑YES ❑NO E EAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. �PUMPMODEL'. PUMP/SIPHON MANUFACTURER'. PROVIDED:TNI LABEL PROVIDEp OVER ❑YES ONO OYES ❑NO IDYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT LE_FRESH LINE. AIR INLET'. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) —]YES 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: BED/TRENCH WIDTH: LENGTH NO.OF DIST .P17SPACING: COV INSIDE DIA #PITS LIQUID TRENCHE& r MA E IAL: 'PIT DEPTH'. DIMENSIONS I 1 s GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: N .OI NUMBER OF PROPERTY WELL BUILDING: V N LE FRESH BELOW PIPE$:� AB E VER'. I ET E V N / PIPE LINE:^ T L AI I NLET: f ' \VL' => I i NEARESTO by ! oZOO 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 ONO PERMANENT MARKERS OBSEH NATION WE L LS OIL COVER TEXTURE ❑YES ONO El YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDE MULCHED CENTER: EDGES. DYES ❑NO 1 [):1 YES ❑NO DYES ❑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 IMANIFOLD MATERIAL. NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.'. ELEV.'. DIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY. COVER MATERIAL. PLANS DYES ONO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WE LLS. NUMBER OF LINE:ERTV WELL: BUILDING: FEET FROM DYES ONO ❑YES ❑NO NEAREST fgL� � �. s-- Sketch System on 1{ etain in county file for audit. Reverse Side. `y4 s R TITLE. I ` Zoning Administrator DILHR SBD 6710(R.01/82) s ,INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PER_ MIT 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 (numberof-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•hcensed - - -» pumper whenever necessary,-usually every 2 tb 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; 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; 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% 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, -1-983;-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 ABA- included the creation of surcharges (fees) for a number of regulated practices which Wisco ibtS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water Zhat buried reBStifB' ' e is used in your building is returned to the groundwater through your soil absorption 0 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(R.03/86) I DIL R SANITARY PERMIT APPLICATION oo" In accord with ILHR 83.05,Wis.Adm.Code IT STAT jARY PERM # -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 FIT Y OWNER AF PROPERTY LOCATION t '/a % '/4, S T , N, R E (or P OP R Y OW R'S ILING ADDRESS LOT NU ER BLOCK MBER SUBDIVISI NAME CI STA ZIP C DE PHONE NUMBER O VILLAGE: .4St NEAREST ROAD KE OR LANDMARK II. TYPE OF BUILDING OR USE SERVED: Puz"_Azo . /17A(9— LD71Zv- 111111. ''`�© a Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. El New b.R 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. L1 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(S are Feet): PROPOSED(S pare Feet): 'l Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in c3a llons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks I Tanks Se tic Tank or Holding Tank D Lift Pump Tank/Siphon Chamber ❑ ❑ —ER El 1 ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation f th rivate sewage system shown on the attached plans. PlumJ ber's Name(Print): Plumber's Signa re:(N Sta MP/MPRSW No.: Business Phone Number: AV Plum is Address treet,City fate,Zip Code): Name of Designer: J y V11 f. SOIL TEST INFORMATION Certi' d S ' Tester(C T)Name CST# CST's DRESS treet, it State,Zip Code) Phone Number, IX. COUNTY/DEPARTMENT USE ONLY F1 Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) f 16C), dL S charge C) ��� �1 Approved El owner Given Initial �(p t J ! / Adverse Determination r ` X. COMMENTS/FMASONS FOR DISAPPROVAL: (� . rat 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 ,d ;�1%. �,1 14, Section , TAN-R1� W Township "x'17_ Mailing Addresses Address of Site Subdivision Home /Zf_ . Lot Number 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 2Z,-9 _ and Page Number 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 1 (We) eenti6y that a.CC .6tatement6 on this 6otm cute ttue to the best o6 my (oun) hnow.tedge; that 1 (we) am (ate) the owner(a) o6 the pnopen ty dens eh i.bed in this .in6otmation 6onm, by vi tue o6 a waAAanty deed seconded in the 066.iee 06 the County Reg.ebten o6 Deeds as Document No. ; and that I (We) pAu entey own the ptopoaed z to bon the sewage dispo,� .dya em (on 1 (we) have obtained an easement, to nun with the above d6 cn i.bed pnopeh ty, bon the condtnuc ti.on o6 chid eydtem, and the bame has been duty recorded in the 066.ice o6 the County Reg.isten o6 Deeds, ae Document No. ) . SIGMA & OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED �. I I p v M r: <,� �;� �: �_ �__._ 1 w Al do aid panow ba 4mWW IIIAW POSON 00 10 OPG'by Tifton A bw &I silot Inch D, to Mid to be bwnnw me"Ibb -A ammom am= in rug==or state DWI of amalmomm 77"1 no* MAIM -MA-A& Benesh JL D..It A. RLu Aset.Vice Proal Dow A. Km_tsonL_mv_- ORION w be dw pmm who wwwAd dw to m 4d OM CapretWIN ajW wWwwkdjpd itlat tkY w-p m is It as M�d a am C"m"by ke wodmkY. VA on A-A LL. &AA Still 'Rank mak Como Still"t" tip - z W H ST C - 105 r a _ SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d H OWNER/BUYER i `i ROUTE/BOX NUMBER Fire Number i CITY/STATE / ZIP -7 PROPERTY LOCATION: ', �, Section T -'30 N , R 19° W Town of ,�blf ,� �. �J�/ St . Croix Coun Y . Subdivision V1,4 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. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- Fv ment of Natural Resources . Certification form must be completed f and returned to the St . Croix County Zoning Office within 30 days { of the three year expiration date . It III I SIGNED i DATE — St . Croix County Zoning Office i 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- SRD - 6395 To be a complete and accurate soil test,your, report must include: 1. Complete legal description; 3. The use section most clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS, 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locaVn€g your test locations. Drawing to scale is preferred, A separate sheet may be used if desired; Make, sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; R_ Campleie all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 103 If[lit, information (such as flood plain,elevation) does not apply, place N.A. in the appropriate box; 11. Sian the forr7r and piac.e your current address and your certification oUmber; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS � Soil Separates and Textures Other Symbols � I st — Stone (r)vur 10") BR Bedrock cob Cobble (3- 10") SS Sand'stiali gr __ {gravel (under 3") LS - Limestone S &anrf HGW -- Higir Grr>crrsdwate€ E's ._ coarse Sarni Peak, Pi tco[abori RaN r7�r�;t - _ Liit,�>sand VV -- We ! ..._ Lo-wly rarrci - Glelter Tit<€r sl -- rrndy Loam ; E_# s Thar , — Lj=am Rn it E -=`t Loarrr B1 ll€ wk - Si 11 Gray { u! — t r-y Loans y - `e 4w," ,s € [y 4-lay Loam li -... p,eci cl - W,? Cray Loan+ nI-ot °- %Io.iles Cl CC _ sx I' �, CrsY'¢-r al cm' lextures o r facE'tbaror. i or" hqu t. vv a`,t"c €;' posal I''.M _._. B ( J,i 1";ia,'k tf R .- 1tr r t .a rfar F rsi�t I 1 TO THE CtrNELi, l rs cord tf.=s; report is rl?e first carp i r,se Curirtcr a san=tiory fie vtnit. They coun(�,� or the Di partrn ant may request cr ircai;on of th2 s so l te's't in the i ld rji;or ri> ")t,rmit '3ssmwlce A {;t')inple w Set W plans for the of ivate and a ipelmi3. )plicati')n must iie GC,lellittoi"I to lh'! ."trypiop,isle local aUtl,orily in order to ,r?t =i , L, <„ ,E sza) 1 .rry 0� i:'eait nius! bc,<r,i.i) le,l „,7_i g'3��..T:t= pit w t,,�,3 ilr, ;tc:="t 4)f r`t C'1 ` C?t1StS"ElCtdf);l. mss DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON,WI 53707 (H63.0911)&Chapter 145.045) ' LOCATION: SECTION: TOWNSHIP/MLH*etPA-MTY: LOT .:BLK. O.: SUBDI SION NAME: �� �� s- IT3,oN 1Rjqj(o C OPINITY: N MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCI DESCRIPTION: PROFILE DES RIPTIONS: ER LAT ON TESTS: Residence � ❑New Replace I , L,,�.., � RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE -IN-FILLHOLDING TANK:RECD ENDED STEM: ptional) WS ❑U .®S DU CIS DU OS U OS 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: J Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHW. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B-,S- .� B- B- y B- All -3 B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER fEB AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PER PER INCH P- P- P- P P- I� 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. I SYSTEM ELEVATION i 2 3 I tt({ f• I I tN € i e c i , l i , € i y (( [ I_.. 1. ...... .. ... .......m_..__.m.�.�_..m.m....(................ 1,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(pri ): TESTS WERE COMPLETED ON: J � _ AD CERTIFI ATI MBER: PHONE NUMBER(optional): CST N T R RiBUTION: Original and one(,opy to Local Authority,Propel ty Owner dod Soil Teter. W.02/82` ? ,: F /-Z vo �5'ays,E PAGE OF r CrvSS S �c � lrJn o � /a i3et) S� S �r��� ' r ,�� •��� fresh Air Iniels And Obdervalion Pipe 1/ C:) --Approved Vent Cap inlinum 017 MFI o G12'Above 20-42"Above Pipe _4"Cost Iron To final Grade Vent Pipe Marsh Hey Or Synthetic Covering win 2"Aggregate Over Pipe Oletrtbmtlon i —Tee Pipe -� 9 0 0 0 6"Aggregate o Beneath Pipe Perlaater Pipe 8slcy _ o Campine Terminating At Bottom 01 liysleim PruPo)cD t'Ina) (19rh��t � .. ��tJwT tort \`� uI2� SOIL FILL DISTRIBUTIO'.1 PIPE APPROVED $4ktPETIC COVER "�MATE�tU�t OR 9" OF STRAW 2"OFh6bRE6A1E -�� ,y OR MARSH NAY TV ` (;'OF12 -ZI/2 AGGREGATE tLEV. OF, ZFEIT, .•.�l i DIS-rRIf3UTI0M PIPE TO BE AT LEA57 WCHES BELOW ORIGIAIAL GRADE AIJU AT LEAST20 INCHES BUT AIO MORE THAI) 42. IAICHES BELOW FIAIAL GRADE MAXIMUM ®EPTH of EXWATidw Rom OKI&WJaL 6RAoF- WILL BE INCHES MINIMUM AEP" OF MAVATION fKO/A.*161aAL (aRAV€ WILL BE 21! INCHES SIGiJED: -Z) LICEWSE WUMBER: OAT E .