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HomeMy WebLinkAbout030-2080-95-000 O O 3 0 h ~ ° d N O DO � V N 1 a C4 i h I / mI 0 C 0 � O `_7 W Z CL CD Z o CL I N F- U) c O_ O 2 it C z U � c c - N Z :!t O O 0) H rn N Z C � � � N M N � N •�V � L O c ° m Q z z NZ 2 N w -O 00 d _ d m O LO to O d N OO o O a r_- N �^ O O N N N E Wu k _ O t�l o o o a a a 5o a ~ Z o •►V o v �1 z o U) 'm N J V rn rn Z CD ° ° CL m c d 'O cn Q m a) M y d Q Z c!1 Q O N V7 3 m H c E O r.+ O O C y D N 00 0 IL CD r \ O (D L E w O N CL r CD V W O N d 12 U)H N M ' N Lo w QO7 _0 C N • N U O N U) Q O O Z c Z cL (n .� 4i E � d A d #t s 1 L a CL r A ciao U) 00 f PUMP CHAMBER * r 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: `> Len the 7 Number of Lines: Area Built: �GS� Fill depth to top of pipe: _ Number of feet from nearest property line: Front, O Side, Rear,0 Pt . ?� Number of feet from well: /6 ' Number of feet from building: I (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 0 or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK �f 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• r% Z �lJ Plumber on job: License Number: 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER D� r.�;� TOWNSHIP .� ,���¢� SEC. T N-O<f) W ADDRESS / ST. CROIX COUNTY, WISCONSIN SUBDIVISION AA LOT LOT SIZE PLAN VIEWA Distances and dimensions to meet requirements of IZHR 83 ^r SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM AD6 nd Ib 1 � � v II 4, i I Y i INDICATE NORTH ARROW r'= BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /ee Proposed slope at site: SEPTIC TANK: Manufacturer: ((L � Liquid Capacity: /ems Number of rings used: --0- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Q Rear, O /6o f feet From nearest property line Front 10 Side 10 Rear,0 feet Number of feet from: well �J� , building: OP (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ,DEPARTN NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. ISO ,VVI BUREAU OF PLUMBING MADISON,loll 53707 SEk, NEk, S25,T30N-R20W �1X CONVENTIONAL ❑ALTER TIVE State Plan l.D.Number (If assigned) Town of St. Joseph ❑Holding Tank ❑ In-Ground Pressure and Lot 10 Woodland Hills NAME OF PERMIT HOLDER: A ESS OF PERMIT HOLDER INSPECTION DATE Donald Anderson Route 1, St. Joseph, WI 54082 7-ilk lli-t-7 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: Rr-F.PT.ELEV.: CST REF.PT. LE V.: Name of Plumber: MP/MPRSW No County Sanitary Permit Number: Roger Timm 3224 St. Croix 96055 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: IT ANK IN ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ENO EYES ❑NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBS '.F ;R A PROPERTY WELL BUILDING, JVENT TO FRESH ALARM. FEET OM LINE. AIR INLET: ❑YES ONO EYES ❑NU NEAR DOSING CHAMBER: MANUFACTURER. BEDD:1N G. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ES NO �y ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING:I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑NO NEAREST depth SOIL ABSORPTION SYSTEM.Check the soil moisture at the d pth of plowing FORCE LENGTH: DIAMETER IMATIRIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO.OF DISTR.PIPE SPACING. COVER JINSIDE DIA. #PITS. ILIOUID BEQ/TRENCH ` TRENCHES MATERIAL: PIT', DEPTH: "DIMENMNS a GRAVEL DEPTH FILL DEPTH DISTR. IPE D III STR PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END. PIPES. FEET FROM LINE: AIR INLET: _ FI"A` IES MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEX TURE-. PERMANENT MARKERS. OBSERVATION WELLS. DYES 1:1 NO EYES 1:1 NO DEPTH OVER TRENCH;BED DEPTH OVER TRENCHBEU DEPTH OF TOPSOIL. SODDED SEEDED MULCHED: CENTER. EDGES. EYES ❑NO 1 ❑YES 1:1 NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: ENr}'I WIDTH. LENGTH. TRENCHES: LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: JNO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. 1 + ELEV.. ELEV.. DIA.. ELEV.: PIPES: DIA.: HOLE SIZE HOLE SPACING- DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ❑NO ❑YES NO COMMENTS: PERM ANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET'FROM LINE: ❑YES NO ❑YES END NEAREST Sketch System on `� ,1 U Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: f\ DILHR SBD 6710(R.01/82) "1 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; il. 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 8Y2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground iter included the creation of surcharges (fees) for a number of regulated practices which Wisco ln*'s e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasu l 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 . 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 T DILHR In accord with ILHR 83.05,Wis.Adm.Code • C STAT ANITARY 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 ��jj 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES Ill NO PROPERTY OWNER / PROPERTY LOCATION ahwz"P d E '/ aJ %, S �-55 T v, N, R QO k(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ✓//'' / , CITY,STATE ZIP,C/ODE PHONE NUMBER C TY 1 �' NEAREST ROAD,LAKE OR LANDMARK /t � o Z- ! S ��/� VILLAGE: �T, V C. II. TYPE F BUILDING OR USE SERVED: pat4CI• /1.C1• ©&0- - S'O Number of Bedrooms if 1 or 2 Family -� OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check;!#2,3 or 4,if applicable) 1. a. ❑ New b. Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. X Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b.XSeepage 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): PROPOSED(Square Feet): p 10 76ci 7_6c 7.3.ld Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of 's Name Prefab. Con- Steel Fiber- plastic Exper. Manufacturer INFORMATION New xisting Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank Y 16yo Ah iul-- 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' Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No- Business Phone Number: 3 zz5< 7/5 )72Z 3Z/5/ Plumber's fdd res (Street,City,Statp,Zip Code): Name of Designer: e Vlll. SOIL TEST INFORMATION Certified So,I Tester(CST)Nam CST# G CST's ADDRESS(Str et,City,State,Zip Code Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) 5C Approved ❑ Owner Given Initial /v i\ f)C) SyLcharge Fee Adverse Determination / CJLJ V91C�' 1 �-/74 �J X. COMMENTS/REASONS � � FOR DISAPPROVAL:�n� ---%•���h ( ,`� SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber w 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 'Z)On� y,D f'• _ L ipa 2WL� Location of Property 'SE, � _ , Section S , T 3Z) N-R 7-0 W Township SZ` Mailing Address 4 Address of Site Subdivision Name __ . Lot Number ) d Previous Owner of Property J;�7 Total Size of Parcel �?_ 3 4 p Date Parcel was Created _ 13., I cf 7 7 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes _� No Volume and Page Number :3S�5 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 T (tie) celtti.6y that at,t 3tatementA on thus aloe thue to the bent o6 my (ouh) hnowtedge; .that i (we) am (ahe) -the owneh(,sfoAm 06 the phopehty deAchi.bed in this .in6o"ation 6ohm, by viAtue o6 a waAAant deed L Bonded in the 066.ice o6 the Count Reg usteh o6 Veed�sah Voeument No. ; and that 1 (We) pnebentty dun the phopoaed site to bon the �5ewage di�spoe dyes em (on 1 (we) have obtained an Eabemcmt, to nun with the above debc& bed pnopeAty, bon the eon,6tAucti.on o6 said aye tern, and the came hae been duty neeonded in the 066.iee 06 the County Reg•i,a.teA o6 Vttdb, «b Voctanen t No. .. I i) o SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED - ppCllMLMf NO � /TA" t r 56� '355 THIS ,�.CI }) , 343370 Il f REGISTERS ©FFFCC {' ti-la J. Johnston and Dianne H. ST. CROIX CO By hb a --- Read. for Rewrd ji day Of t __lSonald A:An croon—an3 ' at 10:30 A• Covent convey d air s t° —_ r -- — .. — ° any� rncTerson, hus�ian an wide as < _ -- - -- _ in enan s%_ _— ------- -- — - - -`"iL1 -.__— ILOir1 Wet. Grantee _ ---- s . atTtlRM TO for•valuable consideration----__�. — --_ -- ----- ---- d the follow ins described real estate to $t. CroiX— _-- C'unty,State ofWtsconstn. y Lot 10 of Woodland Hills Subdivision locate' Tax Key • in the Northeast Quarter of Section 25, Tttt. -�_b'°"'•�'d�'�'rtr� T-)wnship 30 North, Range 20 West, Town of St. Joseph, St. Croix County, Wisconsin. M NSFER Exception to warranties: < Hue'..on Wisconsin this day a Exacuted at—__- —� -- — \ \t SIGNED AND SEALED IN PRESENCE OF —�+ I�'►'��+' W yne J. Johnston IDianne H. Johnston _ -41119,,w 1 s� a ; Signatures of -- authenticated into _--_— 40Y of_— p — Title: Messbr State Br of Wisconsin or Otkw paw Authorised under Sec. 706.06 vis. STATE OF WISCONSIN St. Croix " CouatY. Personally cants before M, this_— day of September ,t!k I the above nowwd Wayne J. Johnston and Dianne H. Johnston, his wife to 100 known to be the person_S who executed the forogoiag instruM t asd aehsswl the usNr ' } g�N w NCO••• � � `t ^ Y P0. a t This isetnamewt wee drafted by i • V + _ Samuel R. Cari, Attorney z t •• J _ % - Notary Public St. ,OOIx' O My gorpis"as 04WAGQ(U TIM sae of witMSSe11 is optional. Mosses of Persons st4tYtg M any capacity should be typed at prfitNAd war their aYatatwes. *"MANTV VSSD-6TA2% OAR OF tt 0161101, VMU NO 2 — 1911 t. Cn ` H z cn H 9 ST C - 105 r ' 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d /n� a OWNER/BUYER o p►��� tt, 7�LP�GwJ H ROUTE/BOX NUMBER �-�- ! �j�)C76 Fire Number CITY/STATE �`r �OS�,�1-� I ZIP 5'y0 $Z PROPERTY LOCATION d G 14, IVF_ _14, Section Z5 , T 30 N , R old W, Town of �� 1p��C t� St . Croix County , Subdivision WooD1.Aro® 4,LLS , Lot number ld 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 I` the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents m_ y 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. yo C I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- v 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 . SIGNED DATE /3 rz 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 . • M Y Yr rd f� DI « 7 •O QisW t a/ yy t�v3 r • r •e 00 B!/ •Fr \� IV it 7 70 ni' e,61 \ .; Oo�► .waa 1I'tr ''uj of t �oF . Q } � ..�ifaY•rrt .11t lfr � \ Oni ���,� Off Y/ .'° .a �, :NUN • par./n;a 0 /' .). � • ._,._ . Ile a".,.7 O i 'P /eimJ R! Q x p� v }tea �,• I t 7 OL CAP op Ogg jo fk V 07/ • os/ omi 96'6aM A � 0 4 r r ds a DEPARTMENT OF . REPORT ON SOIL RINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, ., p.0. BOX 7969 LABGR AND PERCOLATION TESTS (115) MADI$QN,W153707 HUMAN RE4.ATIONS H63,09(1)&Chapter 145.045) -LO- N:N MUNICIPALITY: T NO.: LK.NO.;JSUSDIVION NO 5r 1/L1/ T3oN/R.Za4(or) �' Jos�.Pt� /U F 1 Weoe CSOUT N TYPS Ix W NAME: j� ADDRESS: C cT \L,SePlj a { USE DATES OBSERVATIONS MADE I WResdence ❑New �Replaca p-7 I LS Ats� �l CS D� NAB+i A RATING:S-Site suitable for system U-Site unsuitable for system — ❑�. MI�.�� IN S �Y ZS ❑�L OIDINGTA K:RECOMMENDED tSYSTEM:(optional) 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: CC�Ss Floodplain,indicate Floodplain elevation: 'V A - CV-1 PROFILE DESCRIPTIONS BORING OTA ATE •INCHE RAC TER OF IL WITH THICKNESS,COLOR,TEXTURE;AND DEPTH NUMBER EPTH ELEVATION OB EflV TO BEDROCK IF OBSERVED SEE ABBRV,ON BACK.) t, f u B- 1 .-.4Z q� i3_ _ rga�1� �}.4-L I5 ,LS(-TS 7"��vsl Q St�aI le a m S B- B- z 9. 1-7 ''QcsL 'C, L Z "kQq FS zs" it �'►t B 3 l� 17,�� �9. /-7 /���jLSLIS S.,�AY SL � 1i '�IJQNSiS� ZS�y � DQN 1b• CK VT PERCOLATION TESTS TEST ��EEPP��H WATER IN HOLE TEST TIME RATE MINUTES NUMBER IBS AFTER WELLING INTERVAL-MIN. PERIOD 3 PER INCH P_ I ¢V9� ONIL '00 3 >2 > c P. z Sr/I .z 1 3 11> Z c P- r 47.z� / 4 T4 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 horf 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. C-04 1RItNK. SYSTEM ELEVATION b 13 A At YtEw��eAI L z>� ao p-3 Ig C7t'rErffJ''SI ON oR�L7t�'r 11 ACC S Cpt tF'C P,-1 � 5�o PE A I P-7- <� i BENS Il N✓t w�K t S I�/oRTµ&,QS i < 2°It, 60kNtk OV CCh►Ety-r f'Ak IN V-etNT Supt is pT GAQw?,L AN fJOUSC LLtv+�-r,at,J /06.06 'C. NTtk(-INIL ! kv, . 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. QQV t�/ TESTS`WERE COgMPL TED ON: _� V 0 N n/ Sr;/ __.FS.1`?�1�. Ll I`JI Y/NU / C_ J UL y ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 34v4 396- Ono CST S ATURE: DISTRIBUTION:9rupnat and one copy to Local Authority,Prom arty Owner and Soil Tester, DII.HR S130 63cP) iii 02/80 -..OVER -- Timm JOB d SHEET NO. OF Z . Excavating Co. CALCULATED BY DATE 7 —97 R I, Box 192, Wilson, WI 54027 f�7PRS 3 z� CHECKED BY D*ice i SCALE C4 lob- C-0y4ei p/ Lz4vielf --4� le"I'd f, enches GbncYl _ _ Le c�D o P� , " 5 o to ............... tuu l�Nrrr:.Inc.Clot.,W11 01471, ` �oB Timm 2 SHEET NO. OF _ • Excavating Co. CALCULATED BY ' ' DATE 7 1 R 1, BOX 192, Wilson. WI SQ27 CHECKED BY SCALE g-7;4 1 � - J 3,017 p 7 ;_,F+i a;:,;1Va.Gwtn kau 0147E