Loading...
HomeMy WebLinkAbout040-1005-20-000 _0 p h p U9, N ° t III' I h I', �v I N I i I V i I -C a I � I � I z° I c � m u. c 0 C a 0 co d � I O � � I °' E z w °o z a a m m IN- U) o c U o cto o v z U o N - m z d C o O z c E o w r) CD a � I O v +►v a r t ° 0 O o a w co z F- z N Z I � L '0 l d 0O > ` N C a7 L r C m N a) a) O N 7 C a 1 U 3 3 3 a 5 w 0 p` O O O z +N Da a a a o �1 0 ►i g n n (D CO rn aNi o O N N�O(6 m N m CL O IV H o m a } @ C O O N L .N !'. m O E O N cb O N M L O a) a d N 0 C C Cn p C C m N C 0 CN [ p (4 C ,O z co i�l N O .N (D aOY � p C O rn C) O` p E .0 O co F- U rn 0 Z N 2 F- U)U) CL 2 CV £ iL C w o A U al. O N U i a Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Cffj` j'(/-f0 TOWNSHIP . / SEC. 3 T '2"�*PN-R �9 W �f • � ,f�°w pp� l�iP ADDRESS ST. CROIX COUNTY, WISCONSIN 0 wNS f,/vD.se�✓ Gv/S. S�f c R o I u SUBDIVISION VOwAol S LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r l INDICATE NORTH ARROW -ro P 6F '0,u4Le7(-e W/NPow v// BENCHMARK: Describe the vertical reference point used lWft' Elevation of vertical reference point: /v01 Proposed slope at site: .J r P o _5,',rr1u G-- T7uK C/N en r ?Pe) W it'S e"D.cX{7ce— /00 d - SEPTIC TANK: Manufacturer: Wtl& S TONG. Liquid Capacity: Poo 1F.R , Number of rings used:,uE,.o- / Tank manhole cover elevation: 10bw : y'7, 2O OGQ 7 S , ocp �D Tank Inlet Elevation:AAE !q! �9yTank Outlet Elevation: ,Vtw . 9Y7G Number of feet from nearest Road: Front, Rear, ,,,,, (D D O feet WEST j>O�i� ZO U From nearest property line Front,OSide,)(Rear,O feet y 040 = Yy ; Number of feet from: well 7 S , building: y� I . Z (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE o Form - STC - 104 • �D� TE�FJ/� AS BUILT SANITARY SYSTEM REPORT OWNER Cn �'yJ� N TOWNSHIP . / SEC. 3 T 29PN-R �9 W ty ADDRESS ST. CROIX COUNTY, WISCONSIN ry�Ose�✓ Gv/S. S4 'ewI u SUBDIVISION V o w.t> LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I j II ;r it I I INDICATE NORTH ARROW -Top 6F ed vae-le &IwPo w v// BENCHMARK: Describe the vertical reference point used lWft' Elevation of vertical reference point: lyO'C7 ' Proposed slope at site: �� Po 6/'V en-rell'FOr P1_ NFw T1f,Je SEPTIC TANK: Manufacturer: W& t041G. Liquid Capacity: 00,0 oao ° / OtQ r ?J'. D� Number of rings used:,uFw- / Tank manhole cover elevation: AeW t g], �Q oco S O ' 01-0 -�✓ /0 Tank Inlet Elevat ion:N*LJ!Q7. 9y Tank Outlet Elevation: ,vow Number of feet from nearest Road: Front,O Side,O Rear, O 0 J a O feet WEST" d p�;� ZO U From nearest- property line Front,O Side, X Rear,O feet Number of feet from: well '73 ; building: 'P z (Include this information of the above plot plan)( 2 reference dimensions to septic tank) --_---_ __- -___ SF.F RFVF,RSF STDE � j 1 y f r I r NS g so IFF t4v�pi pV A o� ho. O c N O � tK N ' � � -z � L b n o v H ----- d � v y �► CNI Ilk- Irk c � a ' � n o I � I .:. I , DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P,O.BOX 7,969 BUREAU OF PLUMBING MADISON,WI 53707 SE%, NE-,, S3,T,18N-R19W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: Town of Troy If asslyned) y ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 36 St. C nix Downs NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A E: Bob & Teresa Christianson Route 1, Deerwood Drive, Hudson, WI 54016 `7 aq -97 l •3 0 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber. MP/MPRSW No.. Cou my Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 96061 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER �/ PROVIDED: PROVIDED: r-?' l YES ONO EYES LFNO BEDDING: 71JNO VENT DIA.: VEN M NUMBER QF ROAD:/ PROPERTY WELL: BUILDING: VENT TO FRESH RM: FEET FROM ` _ _ LIN C AIR INLET: ❑YES ❑ S ❑NO NEAREST I v/Uv J DOSING CHAMBER: _ MANUFACTURER. IBEDDIP4G: I..IOUID CAPACITY PUMP MODFI_. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES LINO OYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING ENT TO FRESH (DIFFERENCE BETWEEN FEET F L I FROM IV LINE AIR INLET: PUMP ON AND OFF) YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER JMATIRIAI 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. LENGTH NO.OF DISTR.PIPE SPACING. COVER JINSIDE CIA. Pt PITS. LIQUID OED/TRENCH �f v TRENf;fiES 6' f / MAT IAL: PIT DEPTH: DIMENSIONS / L GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES. , ABOVE COVER EcVc,INLET ELE VcyENO �l PIPES : LIN AIRLE_T� G 3 G c/ ! 727 �1-- NEARESOM 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- meets the criteria for medium sand. TIONS MEASURED. OYES ENO SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS DYES ONO OYES El NO DEPTH OVER TRENCHiBED DEPTH OVER TRENC HBED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER EDGES. DYES LINO F-1 YES 1:1 NO OYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: QED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENS.01115 'l MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.. PIPES. DIA.: ELEVATION AND STRIBUTION INFORMATION 'HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 1:1 YES ❑NO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING: /' FEET FRAM LINE: ' /mil' ❑YES ❑NO I El YES ❑NO INEAREST- Sketch Q System on ,6 eta' -i�clty file for audit. Reverse Side. f / / /1 IIG TORE: 40 X TITLE: DILHR SBD 6710(R.01/82) V Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION t 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, contayour 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. Prcperty owners 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, ande 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; 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 GROUNQJYg4A R SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed int©`law.This legislation is more commonly known as the groundwater protectibn'law,This change in statutes was the result of over y ears of'steady negotiation and` ubiic debate. Thd groundwater bill Ground inter — included the creation of surcharges (fees) for a number of regulated practices which Wisco Intl can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re8stire', is used in your building is returned to the groundwater through your soil absorption 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 C DILHR In accord with ILHR 83.05,Wis.Adm. Code s � STATE N TARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I. UMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YE NO PR ERTY OWNER / PROPERTY LOCATIO, N :k C_R-6s .1jF % S 3 T LD , N, R E (or W PROP RTY OWNEP SMAILIjV���EyS$ p��. L U BER BLOCK NUMBER SUBDIVISION�ME�O� '/� CITY,STAjIE�d� �' ZIP r�O/� PHONE NUMBER VILLAGE: ��d "/ NEAREST ��a v +AAR II. TYPE OF BUILDING OR USE SERVED: � 4— CI / Number of Bedrooms if 1 or 2 Family OR �Publlc pecify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New bNReplacement 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 ,�OyF SYSTEM: (Check only one in#1 and only one in#2) 1. a. p Conventional b. El Alternative c. El Experimental 2. a./❑al System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) �' �eN� r' x 70 1. a. ❑ seepage Bed bi�+6ee a e 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(Squar eet): PROPOSED(Square Feet): j� �� �0 Q / Feet Private ❑Joint El Public VI. TANK CAPACITY 0 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 Se tic Tank or Holdin Tank vd i on Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage sys m shown on the attached plans. Plumber's Name(Print): Plumber's Signat e:(No Stamps) MPfMPRSW No.: Business Phone Number: CGrT 33 ,0 3P6 Plumb is Address(Street,City,State,Zip Cod Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name PIOMESITI! CST# RT.3 O'NEIL RD.,HUDSON,W&54016 CST's ADDRESS(Street,City,State,Zip Code) wIS.AST€R PLUMBER LIC.N0.3307 M.P.0 Phone Number: P Q MINN.INSTALLER&DESIGNER LIC.W.00663 7!s ,3 _p/ V/ b IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanit ry Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee fl- Adverse Determination 16>0 ' 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 {. SEPTIC PLU10W CO. 3 u NEIL RD.,HUDSON.WIS.54011 ' ROBERT ULBRICHT APPLICATION FOR SANITARY PERMIT ;f f'Pi.UMBER LIC.N0.3307 M.P.R& !a,;En DESIGNER LIC.NO 00669 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. r — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — rF r Owner of Property f ocation of Property J PIC ' , Section , T N-R W F Toanship .., rrrw■r.rr�rrw—�..■ ■ � Mailing Address, {poi X 1�6 trJw-S �.1©�J Gc)i S v, 4 L.`Address of .Site r--- $utfdiVision Na>ae 4 } ,r� 3 }.N t- l7mber,'.r..+.ri+.��� ,... r. 3 .as w'Propety ' ■"' x , bate',Parcel mAN`.:Created ` Are all corners and lot lines identifiable? � Yes No K Is „this property being developed for resale (spec house) ? Yes \ No and Page Number as recorded with the Register of Deeds. xr y 1; i 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 helpfui 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. r r i — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — PROPERTY OWNER CERTIFICATION i We) eeAtijy that att atatementa on thi.6 6onm are true to the beat o6 my (our) knowledge; that I (we) am (cue) the owner(s) o6 the pnopW y dea n i.bed in th A .i n6onmati on 6ohm, by viAtue, o6 a waman t �,d�eed recorded in the 066ice o6 the . County Regi step o6 Veeda as Document No.�2 1 ; and that I (We) pnea entty own the pnopoaed site 6oh the sewage dapo-6 by,6 em (on I (we) have obtained an eaeement, to nun with the above deaehibed property, bon the conbtnucti.on o6 .said -4ptem, and the tame has been duty %corded in the 046ice o6 the County Reg.caten o6 f k �`beeda, aA Poement No. ) . :IIIIMT rRE 01 OWNER SIGNATURE 0-OWNER (IF LE) r 1 4'�A'LE SIGNED �i � DATE ED . d � .r.:J y � � °�i`3S ,✓ .4 4 K �.-.�ktw. ..«w{. .a.�rlfi r� .,e,. at�`s-� sa .71,r.+x.�r+ �•+Y��•f~�i� .jrX ...:►+11II1e.FM+ .Mi �`yf.> .{..is.• !�I{r .yl. ♦ � " ,a TWO ............ Wew.. ! rapt. •�. iW ..Y��jl 4 Y .}; ... r s�r.s �tMs. rta.A Tf OWN 4 LLi t n�� it is r�YYV 1 r ' ra 1•w «.w.. ,r..rwrf��.I.N..s.Mrr C r ..` �_. F.A'. "3 v r - •r'i ._ :. ass ] ' ��I��� ja , ki 9... :. ... N .4Myrr.JJ{:r,A YS Far T'I�L. � r x�� � •� �-i t ii,,. - fill Olt A ift wax a k;: r w s a� 13 yf ,J a 0 1 ,y Ad � •' �i�x i5' t f i x' ati, r10 AA arty , E r a , �'� .i Syr •� � �,_.,�` n rY 7 r� gar �., � �,�5 ,Y� 7«... FY ��. �•„ a s HOMESITE SEPTIC PLUMAG CO. RT, 3 O'NEIL RD.:HUDSON, MS.54016 ROBERT ULBRICHT NIS.MASTER PLUMBER LIC.NO. 3307 M.P.R4 1INN INSTALLER&DESIGNER LIC.NO 006613 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County tv ht OWNER/BUYER A / ��/`CC-S/� r//6f/1�,/�'/lJro�1 y / ROUTE/BOX NUMBER /Qi` � � Fire Number--�__^�,�, CITY/STATE "�/is ZIP ? f' f C� PROPERTY LOCATION:'s , N� '�, Section ✓ T N, R- w• Town of / �� , St . Croix 0{ 44%..y, Subdivision �1" `"�CJ�X Lot- number . oa Improper use and maintenance of your septic system could result in � I its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner, i if needed, by a licensed septic tank pumper. What you ptit 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 ri 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. J � I 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. l Certification form will be sent approximately 30 days prior to three year expiration. c Z I/WE, the undersigned, have read the above requirements and agree y to maintain the private sewage disposal system in accordance with M the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Off:Lpe within 30 days of the three year expiration date. SIG ED DATE - - � I 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 . ; I µ�PARTMENTOF ' REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION INDUSTRY; P.O. BOX 7969 LABOR AND A PERCOLATION TESTS (115) HUMAN•R1:L.ATIONS MADISON,WI 53707 (1-163.090)&Chapter 145.045) SEC OWNSHIP/Mt1!q a Pf4tH;rY: OT NO.:BLK.NO.: SUBDIVISION NAME: �/, t� /TAP NIV E( ► ?�°o)/ 5T. Cleo rx moww S 5'T.� /IC -B08 , -mResl_&efS{iw5-o4 I - • I J'�EE,e�c.?JOD 'DR.�)uDSo.a cv�S- Syra/� USE DATES OBSERVATIONS MADE FORM COMMEI R TIO ❑New gR S: TS: apiece .0 .2 esidsnce E " 7 l 4 � $CS' 7f Z rRE I f S K fa C, EAc� `'MATING:So She sukable for lysteM Um Site unsuitable for system a. N : MOUND: IN I -FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) ��� S ❑U S DU BS ❑U TIS ®U ❑S ®U r.PEw s 9, z w O$ V ' t i•f v Tio.J " 11 Percolation Tests are NOT required DESIGN RATE: Foodplain,any portion of the tested area is in the tMIldltr.f.Fi63.091511b1,indkate: indicate Floodplain elevation: PROFILE DESCRIPTIONS iBORING A R UNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH .;. NUMBER DEPTH IN, ELEVATION OBSERVED EST.H I G TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.). i r r J. .2.0. 20 se 1 .G7 ' Ll. a a Xf .33 ?v &.0 5. 0 (ffP.) s/1' 1.32 'Mo1'}rfv yy. Sit 1•6G w�e4 RAdL S . L Z.Q I'd.V r .(07' 0 6.3 f'! of 3 DIP. ivof,lL�e p S ,2 l0.0 / �,O Z . f �. s►l 3. 0 Noifcfv dir,,< C 44 war � �/ s% , wit a-F 00- o S '; .3 /• 3, $ � I e D Brf. S ' $N. S� t40441.ED 1 134�+ S. I ; . to 93.y� of a. QA. S. S S,'f!L 1.33 Ir 164t x S. S 7,fA/ . ,7 P • d r c9 �K, ate.s, 210�A a , .o F 40 or E,ZGS PERCOLATION TESTS r►, I�kJM1AeER v. Y WATER UI DROP WA LEVEL-INCHES RATE MINUTES N NCHES AfERSWLN N TERVA MIN. PER INCH 11� �.-• 541 P b PLAN: Show locations of Wcolation tests, soil borings and the dimensions of suitable soil areas. Indicate`scale or distances. Describe what are the hori- N, lwal 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 bf land slope. NI blti• 7.P p - , ,• o f d- - - -- Ar TN X S s --- , / a G _ I 47/ - V6 igned,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 Atimihi ive Code,and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. 11 TESTS WERE COMPLETED ON- rfINNESItE SEPTIC PlLMrIY�(i(o. 3 — / j,a 1N.3 0 NEIL RD.,HL"" ULBROT CE TIFIC T N NUMBER: PHONE NUM ER(optional): ' +� &AMS16R PLUMPER LIC.N0.3307 MAKI '2 �L_ —�/� S 1111"If Not"a mam M,1W.0M CS IGNATURE: srs�y - 6UTION:Original and one copy to Local Authority,Property Owner and Soil Tester. 1 Aiit)-6395(R.02/82) —OVER— i' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS '. INDUSTRY, DIVISION 1 LABOR AND PERCOLATION TESTS (115) P.°. BOX 7969 . HUMAN RELATIONS \ / MADISON,WI 53707.' 3707. (H63.09(1)&Chapter 145.045) J LOA ION: SECTION: TOWNSHIP/ OT NO.:BLK S E ' NO. 0 DIVISIO N NAM c.Nl x'/4 '/4 3 1W N/R/ T (orW Tomo Y k � COUNTY: OWNER'S/BUYER'S M ADDRESS:51-CAx- 37Rfs��NsO/J 94.1 �4;C op USE DATES OBSERVATIONS MADE ' NQ.BE : COMMERCIAL DES R TION: R S:jPIERC0j.ATION TESTS: �tesidence ❑New Replace —�� Z�-. RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: STEM-IN-FI LL OLDING TANK:RECOMMENDED SYSTEM:(oplio all ❑S ❑U ❑S DU EIS RU ISE)SEA10SEA1sue- Pfd If Percolation Tests are NOT required DESIGN PRATE If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUP D ATER-INCHES CHARACTER OF SOIL WITH THICKNESS,t;OLOR,TEXTURE,AND QgFTH NUMBER DEPTH IN, ELEVATION OBSERVED TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B_ �,4�ps 3 '` -c.�0 B- B- B- " PERCOLATION TESTS EST DEPTH. WATER IN HOLE TEST TIME DROP WATER RATE MINUTE NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH P- P- 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 7-- 7_1 i � l I I 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(print): HOMESITE SEPTIC PLUMW W CO. TESTS R COMPLETEO�„QQL� RT.3 O'NEIL RD.,HUDSON,VAS.54016 ADDRESS: CERTIFICA QNNUMBER: PHONE NUMBER(optional): WISAWSTER PLUMBER LIC.NO.3117 0111 CST SIGNATU E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02182) —OVER— �' wa.IsAS 10 ,wollo8 Id. BurloulwJal Bulidno0 0 L ed!d 4loaua8 k Molaq adld PalDJolJad o aIO6aJ66 sllr?✓3d'L d " � , Q� �'� _ s roil-✓n3/� 0 0 0 0 0 wild : �s aal uolinglJlslp t wild JOAO aID6a-J66d 11? ulW u .6ulJ8no0 ollayluAS JO ADH ysJOW epDJE) IDUIJ Ay adld .IuaA adld anogd UOJI Is D O 1,t, n kri1>dw W aPDJJ tDU!d w 3 anogd „z1 wnwlulW � O '-"b l�. dD O a A P ano.dd 1 adld UollDnJasg0 Pud slalul Jay ysaJd N y ` > � O iy ty d rA A Qh s k. �. / of / \obi/ ,� ON A SR ly '1 I -- REFORT ON SOIL BORINGS 8( ON TESTS 115 Pr o j e c t I.D. 13D tZ Ti RC S A- C 5'T- fA N SO A3 • . _ , � HOMESITE SEPNC rlUM11M600� LEGEND AL iO'NEIL AD.,HUDSON,IMS SW ROBERT IYMbCHT o Ba c kh o e n i t s NA&MASTER PLUMBER UC.NO.3317 M.PU MILAN.4WALLEA i DESIGNER UC.NO.OW X ,S. Perc Locations C.S.T. 2482 Q = Existing Well _ = Vertical Reference Point 6f 4144 AZAAGO� E?evation of Vertical Reference Point WiN'VOW S��/ ��€y� t ���• i Lot Line n I �I o til. �; ux �. Im p a tin w q RN V J ' C41 �1 L %S CA �T IM I � I I `u W � f v r I