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HomeMy WebLinkAbout040-1018-50-000 \ e ] 0 . � 7 = � m n $ ) 2 ) � $ § � / \ £ 2 ) \ 2 2 ca E k e Lo \ Lo f ® % « L B o z 7 % # / $ a ■ B z 2 )q « � � J 2 ƒ ƒ § 2 = e Cl) \ 7 } ) / k { \ z co k E 7 0 ~ © � � $ � 2 � + q $ ; 3 0 o a o I U) U) m \ \ ) E k k k ® ® ® £ � f 2 2 2 V : o -� k a B � m -j u _@ ) % §m m @ � \ § / o0 2f � $ n � / r- \ a i ] — :3 g E § § ) c o § @ { & B a B a k / s r I_ 0 k 5 0 a f 2 % - a a / G 2 $ 2 § a g g o z _ e ■ _ CL ■ e k CL E 2 2 i J ) a 2 10 k v . � PUMP CHAMBER e Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenth: �3 . Number of Lines:_ Area Built:-Z/2.5- Fill depth to top of pipe: � � ' Number of feet from nearest property line: Front, O Side, O Rear,Q Ft . 2�! Number of feet from well: Number of feet from building: $ '� (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: Plumber on job: License Number: 3/84:mj e Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER !x TOWNSHIP /1� SEC. T 2 N-R _LjW ADD RESSaeQ aty" ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ray 2 4 ( s- `6e,5 401 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used .d Elevation of vertical reference point: /( Q Proposed slope at site: SEPTIC TANK: Manufacturer: . _ Liquid Capacity: Acagg Number of rings used: (f Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet E' levation: Number of feet from nearest Road: Front 19 Side,O Rear, O ,7 adl feet Jam" i From nearest property line Front,O Side,O Rear, 7�-�' feet Number of feet from: well , building: (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 t. �M�ATDISOJW,WI 53707 7I LAW 4, SE�,S4,T28N-R19W 13 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: ur ae:lltnea) Town of Troy ❑Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tom Close 1114 2nd Street, Hudson, WI 54016 7 lb, �' 7 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: M /MPRSIN No.: County: Sanitary Permit Number: William Schumaker I6382 I St. Croix 95970 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: L?(pf /3 `��lJ. 54YES ONO DYES 1;dN0 BEDDING: VENT DA.: VENT MATL.: HIGH WA ER NUMBER OF ROAD: PROPERTY W�EMLL BUILDING: VENT TO FRESH ALARM' ��ll� FEET FROM l�j� LINE 1Vr AIR IINLLET. DYES �O �_ ❑YES IaNO NEAREST t ' 1 1, I� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO [DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES 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 MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENUT11 I NO.OF DISTR.PIPE SPACING: COVER INSIUE DIA SPITS L11 U10 BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS �p GRAVEL DEPTH FILL DEP DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: !NO� TR. NUMBE R OF PROPERTY WELL: BUILDING: V NT TO FRESH BELOW PIPES. ABOVE COVER ELEV.INLET.ELEV.END. FEET FROM LINE. N..,r AIR INLETp� q(p Q Ill R EST--► 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 0 N SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES I--]NO IOYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED 7�HED CENTER: EDGES. DYES ONO DYES ONO YES El 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 DISTHIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.: DIA. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY JCOVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES NO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE �- OYES ID NO OYES 1:1 NO NEAREST 192 � Sketch System on Retain in county file for audit. Reverse Side. SIGNAT TITLE. Zoning Administrator DILHRSBD6710(R.01/82) r � 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: Property owner's name and mailing address. Provide the legal description where the system is to be installed; I!. 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; 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. -----_..---------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 :01, included the creation of surcharges (fees) for a number of regulated practices which Wisco if s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaSure 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- lerer by the Department of Natural Resources. These funds are used for monitoring ground- t wat<;r, groundwater contamination investigations and establishment of standards. Groundwat(--r, it's worth protecting. L D D-6398!R.031(86) - SANITARY PERMIT APPLICATION COUNTY DILH1i In accord with ILHR 83.05,Wis.Adm.Code • `/1 v STATE SANITARY PERMIT# 9 9 d '—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 PROPERTY OWNER PROPERTY LOCATION J A v S .f,,i,<J'/a s°L'/a, S Tat N, R l/r E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK &AIke'd [15K TOWN OF4 i4 ❑ VILLAGE : 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in P. Check#2,3 or 4,if applicable) OSn 1. a. 464 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. -Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑See 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(Square Feet): PROPOSED(Square Feet): C� s�. 11� // 2 S- /Y, ! Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank / Lf El Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shoyCn on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: J l f w VIII. SOIL TEST INFORMATION Certified Soil Tester ST) ame CST# 3 P CST's ADURESS Wreet,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) Approved ❑ Owner Given Initial rc`hha�r'`ge Fee Adverse Determination /�-� �+�-�.Vb •--5�~� L�'^� / ' X. COMMENTS/RF4SONS FOR DISAPPROVAL: n J SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber i • APPLICATION FOR SANITARY PhRMIT 8TC - 100 i Tide application form is to be completed in full and signed by the owner(s) of cite prupurty being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec IK,use"), then a second forte should be retained and completed when the property is su1J and submitted to this office with the appropriate deed recording., - - - - - - - - - - - - .. - - - -.- - - - - - - - - - - - - - - .- - - - - - - Owner of Property 1019 ekej Lucat Lou of Prop arty Cd� k .5�;j• Section ._, T � N ' R W r Township ;„(LUV Milling Address /(w Ss— S ��Ze-?V 4 sya 1•6 Subdivision Name Lot Number - • -,•---.�_ .._.....___ .. : Previous Owner of Property Tutal Size of Parcel �d bate Parcel was Created Are all corners and lot lines identifiable? � Yes No lb thLH property being developed for resale (spec house) ? �- you _ No Vulume 20 7 and Page Number ` as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract J. Other recordings filed with the Register of Deeds Office In aJJltion, a certified survey, would be CertifiediSurveyys deed description 411 cite reviewing process. If the Nay, the the Certified Survey Nap shall also be required. -. -. e - r -. r - -. - .- - -• r .- r -. - r - -. r r r .� r •.. -w -. r -r r r �i. r r r �. � � � .- � r PROPERTY OWNER CERTIFICATION J (wrr) evtti.6y .tjwt au etatemenu on thiA. JOAM Me true to the bebt 06 my (uuA) a des CA--bed in .thec a k►iuwCt�dge: t�w.t 1 (we) am (ane) the owneJt(a) a6 .the p�+. ply c n 6 u Duna ti,un 6 onm, by uiAttue o 6 a wama+,! deiad ! cakded •t,nthe I e(06 1 tsi e County Reg"tea o6 Deeds ae Document No. q a a and (uA I (we) sass Iw ee e.KU y own the,qu pos ed a,t,te bon the sewage po y n the ubtai.ned an eaaemen,t, to A" wi th the above de cA bed phop�t V, 6 o eopn6t4ueti.on o6 aai.d 6pt;em, and the same hoe been duZjy neeoAded in the Mice VA the County RegiA ten o6 Deeds, ab aaeumt t No# SIGNATURE. OF 9WNEK SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE S 1GNEU DATE SIGN1sU I . CfMTCI. tt li40 { f TW* Deed, wade lletwe. ...... lls--....... ST.C�dx M !.- 1.A... 11,�..htl�end.�d•>tdfa�.. .i�a.......... far ; r •*o•=. 1111UVid■d -clef--i�Ill et:.............. I d�1 day lot . am.. ..................... .. ................................................................................................................. I ii R Witnesseth,That the said Grantee for a Tabu"emd6nilm...... !iw�t.Ht.t►dt�d...(SRF��•-�)..............................•-..... asruan.. =` conveys to Grantee the following described real estate in ....ritew.. mix........... County, Stan of Whoswin: A Parcel of 5.0 acres Located in the west one-half of the Southeast Quarter of Section 4, T 28 N, R 19 No, Tfaz lnensl III:-- further described as follows: beginning at a point on the east line of said west ens-half of tale Southeast Quarter a distance of 1691.4 Beet north of the southeast colder of said west one-half of the Southeast.Quarter, thence, due west a distance of 1266.5 Beet, moms or lose, to the east right-of-W S'M1 �. line of STi 35, them north along said right-of-way a distance of 170.0 fleet, thence due east a distance of 1266.7 fleet, moms or Less, to the east line of said west one-half of the southeast quarter, thence south a distance of 170.0 fast to the point of beginning. This ..........iS.XX*---... homestead property. ~ (is) (is root) Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... Faswell . . . .... . . . . ............................... warrants than tale oo indeTeasible'R-Iee simple and free and clear of encumbrances eseept , recorded pmo+mective oovenants, easements, and restrictions of record, if any ' and will warrant and defendflame. Dated this day of January ... ..... ....._. ........., r .(SEAL) ............(SEAL) 4 L ... rry Eugene n .......... ........ .(SEAL) ia� LLI+ .(SEAL) • Ract al A. poa,�e11 .. . . . . . ..... C AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN EL ........................................................ ....................... St. Croix § .............. ............ .........County. authenticated this ........day of.........................., 19...... Personally cams before me this .....5........day of Janu3tY................... 19...ffi. the above named ................................................................................ �r • ................................................ . ............... nY.Eu .Aoallell.cud---.................. TITLE: MEMBER STATE BAR OF WISCONSIN RaCl.B... 11 .................................. (If not. ......... ....... ... ....... ....... .. . .. . ......... ..... ; authorized by 1746A9,.Wis. State:) to me known Ie•91I the person........5:...... ..who esxeutsd.the •,�+� foregoing ins%Fument#nib nowledgs the same. THIS INST WA� �ar /` .•••' -ar � .z C.A. J ....... ( . ......... - 5 �.{ .,.. ..;; Notate bh 16r ........... .. ..: 4'. ........GWU , (Signatures m 6p a n ate lenowledlted. Both Mr (' ssio� irmal�ilt;of trot, state. are not nett arar7li•. t� dalte: 2. ..... . %~l.. !9 , •Naato of pMon- eM++M+f�ltl erd�ltr. "Id be t)y.i or printed below thrir elenatunw. CO STATE BAR OF w1ANSI)WAIC �W FORA"ft 1—1043 t y STCl r r ' y - ti SEPTIC TANK MAINTENA CE ACkEEMEN'r St . Croix ounty :c i � i y UWNEk/BUYEk /am C165e, m KOUTE/MOX NUMBER A//"'Ij L 5 Fire Number ��ri/�+ir�+rrr.r.r�. CITY/STATE ztjzk_7 • GIP NkOPEkTY LOCATION : Section 't' N . R W, Town ofr" Itul - -, __�. St . Croix County . Subdivision , Lot number�_�. i Improper use, and maintenance of your septic system could result in I Its premature failure to handle wastes . Pruper mu Litt e:nunce: cun- slats ut pumping out the septic tank every tlireV yvars or suuu.•r , I It nuedeed . by a licensed septic tank puum ar . What you put into the system can affect the function ol- 41e.e s•eptfc funk us a tr.eat - ment stage: in the waste disposal system. St . Croix County residents !ay be eligible to receive a grant for o maximum of 60% of the cost of replacement of a falling system. which was in operation prii:: 1978 .-St . Croix County .ecceeptud this program in August' of 1980, with the rutl: ilrtement Cleat owners of all new systems agree to keep their systems properly maintained. -= --- The prupesrty- owner agrees to submit to St . Croix Cuunty Zoning a certification form, signed by the owner and by a muster pluuit,er . Journeyman plumber , restricted plumber or a licensed pumper verl - lying that (1) the on-pit* wastewater disposal system i.s in proper upe:rating condition and (2) after inspection and pumping ( it nec- ebsery) . 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. a A I/WE. the undersigned, have read the above reyuirementa and agree N to maintain the private sewage disposal system in accordance: with M the standards set forth• herein, as set by the Wisconsin Depart- V ment of Natural Resources. Certification form must be completed R. and returned to the St. Croix Coun;y Zoning Offtoo within 30 days of the three year expiration date. SIGNED ��R� DATE 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 addreus . -� II y���. � o ��ir � � �� o �'�'��,Y''f a \ -� � .�A \o,�• -N .� � � G' rye �� `�� Gf 42 �95, O �� s, ��, 'o. �: ?, f C)FPARTMENT-r`"'-` REPORT CAN SOIL BORINGS AND sAFCr�UILDIN N Itd('.)USTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63,0911)&Chapter 145.045) x LO I WTI ON, T N smip MUNICIPALITY: O N NO.: SUBQI ISI A 14 A COUNTY: ADDRESS: �R to lai+�1 '�e�L� 1114 7,x `JT uGsa 1 S4p!(a USE___ /�{ DATBS 0�11VATIH M1t MAGI& Residence � / ,� -I �UNew ❑Replace �rO A-1� 9c QrTb1 /0 /`)'% -SOIGI<- K_ A4L 74 Sol LS 'SI — '$A"Ittr RATING:SA Site suitable for system U-Site unsuitable for system C. MOUND: L 1 K: COMMENDED SYSTEMaoptional) SU xS DU S ❑U CJ S S U CQ�vE $ If Percolation Tests are NOT required DE/S►tIGN RATE: If any portion of the.tested*roe is in the under s.H63.t19(5►{b),indicate: Flaodpiain,indicate Flood lain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO WU ID T { G A A 1 R, X U AND DEPTH NUMBER % ELEVATION BS V TO BEDROCK IF OBSERVED EE AS RV. SACK.) B- i g. 9.43 - > zg"BL5L7s s ' K 5p 6 5 19"BLSG.Ts 27"Ut i Ms W&N&0FbKtt &"'s What B- Z .4 5 ir }4.1-7 2�., , „ M6 /_: '&SLTS I I`6L St L IS"EkN S I L 21-804 Mt" 34"RQ8QN M I-z"t-rderyms B- 4 7.83 7,Q7 r . ? 7.�3 za"SIB& sL RL 1a'dkr.( Si l 4rA&9kN S*GP.MS ZOv &LTS 2d' 9Ita 3tL 4tf'�419kv Ms -4(L B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER S AFTERS WELLING INTERVAL-MIN. R PER INCH S P_ ) 5'9 0 o I i' 20,0 P. 2 3 9� Y a 2C3,c1 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 qA , C4I1A I I ' W' i � � ii i v c►ll IM + 4 iT LA 1 I r i I P . . AMU } i I i ; 16 t� r , 7;S a ��.AQ�/ JtiV�-`r:7 IV A 41A 4 �Lp,i, I r D r r , k v _ i A signed,hereby certify that the soli testa reported o is pr by ry P,in accord with the procedures and methods specified in the Wisconsin Code,and that the data recorded and the location of tine tests are correct best of my knowledge and belief. --- YS-STS WERE MPLETED ON: ate), so c o 6 19 6 ERTIFICATI N NUMBER: PHONE NUMBER(optional): su-40 0 T SICIPJATURE: one copy to Local Authority,Property Owner and Soil Tester. -OVER - ,, op r 3 � { t� f i f i 1 � �y