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HomeMy WebLinkAbout040-1209-70-000 Iry Q O C c ti RL o ti C O I y N > r c ns oii c �o � � I A 3 I z (D v Z c U. c E o �o Q � I Cl) O Z in o E U O mv w a m N I- Z c O O 2 U 0 0 z 2t �, a o U) Z c E v 0) M i CCD N y y m O O O •� d cn L O N O 0) Q U N Z M Z o N _N � Z LO 0 C141 y 4) — m x m a ea c p LL M " d N C O d .r > w w E U 8000 z � Y � O O O N `- an. a � U a � g n n o Z y J U U rn rn M N Cl) 4) m y c a N 7 Lo to C) y E C14 to OO OO O O y d m O O d O O N N O d, Cl) 42 N H O c M y U Z ~ d N >. w COO E c r o o N H co o Z H ci vs ;, •m € a I CL • cl a m t PUMP CHAMBER �A Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Ma ufac er: Pump Size . Elevation of inlet: ttom f tank elevation: Pump off switch elevation: G lons per cycle: Alarm Manufacturer: Z 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: ,2 Trenchs; S Width: J Length: D�. Number of Lines: Z Area Built: /DOD Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, ht . ,2 Number of feet from well: 5d�/�.%I, /� wCL� ' a A'71( Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: I Diameter: Liquid depth: Bottom s pag p t elevation: Area Built: Has either a drop box O or .distr utio bo O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: // Capacity: Number of rings used: lev -tio f bottom of tank: Elevation of inlet: Number of feet from neares pr p ty le Front, O Side, O Rear, 0Ft. Number of fe fro w Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:— Dated: cf' 13 -F? Plumber on job: � �• lY License Number: 1-) ddb z / 3/84:mj 1 Form - S T C - 104 1'4 AS BUILT SANITARY SYSTEM REPORT OWNER �u01i�/ L(/i�/�0n TOWNSHIP O SEC. TN-R/0 W ADDRESS 103Z _ i-c`I C'��TT ST. CROIX COUNTY, WISCONSIN ?el -5 ezZ SUBDIVISION s' •C'roi X da_�ff_ls LOT 7 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of T1HR 83 7 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I t;�f7r ,Exi•s fin 9 d 16_ ..��,�w (jC)rALl�i NOuS f/ i 3S /000Ga� o Se p yo. I S X 90'- rC ChCS 6'� Vents So I ` { eo ad / INDICATE NORTH ARROW I / I BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 106)-0 ' Proposed slope at site: SEPTIC TANK: Manufacturer: z yee,XS Liquid Capacity: /000 Number of . rings used: /u�p Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: 9� �Z Number of feet from nearest Road: Front,O Side,O Rear, J'.30/ feet From nearest-property lire Front,OSide%� ' Rear,O //0 feet &-e/1,oef/:) a/ f�I.k %.i��B J Number of feet from: well /��%�. , building: 35' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L SEE REVERSE SIDE 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADIS014 W 1 53707 CONVENTIONAL 1:1 ALTERNATIVE State Plan 1.D.Number NE n o f 'S25,T28N-R20W ❑Holding Tank ❑ In-Ground Pressure ❑Mound (If a-gned) Town of Troy Lot 7 St. Croix Highlands NAME OF PERMIT HOLDER. ADDR ESS OF PERMIT HOLDER: INSPECTION CFATk Judith Wilson & Jean Flemin 1032 Birch Cliff Drive, River Falls,.WI 54022 „ k3_" 2; 3c) BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No County: Sam r tary Permit Number Dale E. Hudson 6629 S t. Croixnl 96063 1 i SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TA K INLET ELEV.: TANK OUTLET ELEV.. (WARNING LABEL LOCKING COVER I � ` Q Q PROVIDED: PROVIDED. �> 6 t U I YES ❑NO DYES NO BEDDING. VENT DIA.. VENT MAT L.. 'HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: TO FRESH ALARM FEET FROM t u LINE I �� IVENT AIR INLET DYES NO L( ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MOD[(,. PUMPISIPHON MANUFACTURER 'NARNINGLABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO EYES ONO [!]YES ONO GALLONS PER CYCLE: PU MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING.(VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ENO NEAREST' SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing ENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,constructions all cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WI DTH. LENGTH NO.OF DISTR.PIPE SP VER INSIDE DIA. #PITS. LIQUID SEOITRENCH TR ENC ES 1 MAT IAL PIT DEPTH flIME.NSICINS -f GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DIS NUMBER OF PR OP E R WELL. BUILDING. VENT TO FRESH BELOW PIPE �( ABOV�COVER. ELEV.INLET ELEV END q PIPE FEET FROM LINE I �© �� AIR INLET/ 9 NEAREST------s 7Sr MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELE A- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE. PERMANENT MARKERS OBSERVATION WELLS. ❑YES ❑NO : YES ❑NO DEPTH OVER TRENC H;BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EOG ES. ❑YES ONO DYES ONO EYES 0 N PRESSURIZED DISTRIBUTION SYSTEM: +.WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER. `ef3EI/TII�tCI 'I TRENCHES: t I11MEISI IQNIS :.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.: DIA.. ELEV.: PIPES. DIA.: ELEi1At�#ion,'ANP 11STA11- ION 's HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED NM�4ON PLANS- EYES ❑NO YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: uNE: FE161 FROM: S (� o ❑YES 0 N DYES LINO INEA REST -i Sketch System on In file for audit. Reverse Side. SIGN T LE: Zoning Administrator DILHR SBD 6710 IR.01/82) � _-- INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be 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: I public is checked, .ndicate type of use (i.e. 10 unit apartmen', 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- 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 G rou ndu.iter —' included the creation of surcharges (fees) for a number of regulated practices which Wisco tl1`a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buriedreasure is used in your building is returned to the groundwater through your soil absorption � o systern or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adrn,'nis- ° tered by the Department of Natural Resources. These funds are used for monitoring ground- f wate!, groundwater contamination in.estigations and establishme-t of standards Groundwatr:r, J ;I's wort`, protecting. SANITARY PERMIT APPLICATION COUNTY TDILHRI In accord with ILHR 83.05,Wis.Adm.Code 7 �+^o.X STATE SANITARY PERMIT## / &10 —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 r PROPERTY LOCATION Nt '/4 S�/4, S Z,j T Z N, R 0 M(or W PROPERTY OWNER'S MAILINQ ADDRESS LOT NUMBER rLOCKPUMBER H SUBDIVISION NAME CITY,STATE ) ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK i v ✓ U�/S G[//S, Z VILLAGE : ✓,O II. TYPE OF BUILDING OR USE SERVED: 0370— /570 —x-" Number of Bedrooms if 1 or 2 Family OR EJ Public(Specify): /114 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.,�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. 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(Square Feet): PROPOSED(Square Feet): 7IR00 90� 3,-710 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xistin Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank (_ S ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: 1926 - Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## ,Qo6erf el/d,-Acfi7� Z`-&4 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: f u�orl Gf/i: .5'ir0�� 7/�' 3fl- /?.� IX. COUNTY#DEPARTMENT USE ONLY ❑ Disapproved I Sa tary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial f�\ �-\ S charge Fee �y Adverse Determination /W 'w ��-UC� !^' /9 / X. COMMENTS/REASONS FOR DISAPPROVAL: a. 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 inadequaoies 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 _ -J L-C U1 Location of Property Section -Z5 , T e)c' N - R 2. 0 W Township _ e Mailing Address -r Subdivision Name 6 % Lot Number ' Previous Owner of Property De E,"r>e5-Y 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 7110S• and Page Number 4�-5- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 1 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing .process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION r (We) cVLti.6y that a t statements on this 60Am aAe true to .the beat o6 my (ouA) knowledge; that I (we) am (aAe) the owneA(s) o6 the pnopenty deacAi,bed in thi,& tn60Amati,on 6oAm, by viAtue o6 a wa4&anty deed Aeconded in the 066ice o6 the- ..County RegiAteA o6 Deeds as Document No. ; and that 1 (we) pAesentey own the P.Aoposed 6 to 6oA the sewage poa system (oA 1 (we) have obtained an easement, to Aun with the above descAi.bed pAopen.ty, bon the constAuation o6 eaid system, and the same has been duty AeeoAded in the 066.iee o6 the County Reg ' en. o6 Deeds, as Document No. ) , S NATURE OF OWNER G ATURE OF CO-OWN (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA 1 STATE BAR OF WISCONSIN FORM 2-1982 I V i . in 7 A�-r I� kEGISTERS OF F CE Del H. Einess and Maylu E:'•ifbss, husband & wife; S7. CROIX CO., WAS,, Paul T. g�"d� for Record Ntis 21st ........... wife.. William_.S-_..Nlx r __-&...l�,a_rya.n...Mye.rs.,---husband.... &..-wigR;...Cli fI.ard..b L,...1?Qt erson..R..Phylli.s..P.eteraon, aplio of A.D 1987 husband- &,_w'.f a;.. L.- nce..A-...Norde.rh-us...&..Kar.en............. ¢ :15 No._. "El . {{,, n & wife AS lGl+ cot ?sr"El "C�............................................................. .............. Judi-th...W _lZ.Qri.r...ai ngle...a.nd...,Tean...Flem.ing_,_..singl.e, az...tenantn..In...comman...-"•---. ...--•----""--"--"-----"--.... 1"ble.W De.a. ------ I •--........... -- ----- -- - -- ------ .................................................................................................................. RETURN TO ................................................ ----------........................................................................................................ the following described real estate in St. CrO1X -•._County, j State of Wisconsin: Tax Parcel No: ............................... Lot 7, St. Croix Highlands in the Town of Troy, according to the plat thereof on file and of record in the office of the Register of Deeds, St. Croix County, Wisconsin. ( This ...is riot homestead property. (is) (is not) Exception to warranties: Dated this ... `':... ._........ day of ................. . ........., C/I!/ � (SEAL) ...(SEAL) ................. ��il rte_? -..y• .. (SEAL) )C-- -•— .... . ....... . . . ...... EAL) rC 7 AUTHENTICATION ACKNOWLEDGMENT II Signature(s) ............................................................ STATE OF ' I SS. ----------------------------•---------------------...-•---••-•-•-.._..........__ t.� s�-. .• . County. authenticated this --------day of-..------------------------- 19 ----- erson311y came before me this ---..-day of 19_17_ the above named ............ ... - ._.-..._...... Del. :.: . ri� s_._.1`ia�t�u_Einess�-P-aul---T----•- *................... - --..... - --. --- -- F]�rsm Me�?�ks�xtlMyex_s.2�l�f£oxdlA_..P tersol TITLE: MEMBER R STATE BAR OF WISCONSIN M (If not. ............................................................ hyllis Peterson, Lance A. Norderhus, P St ----------------------•----- --------- authorized by § 706.06, Wis. Stats.) Kareri'"�TO�agg"��••fi"u"•g'"'""'""""' to me known to�1e the person S_.._._..._ who executed the foregoing instrument and acknowledge the same. j THIS INSTRUMENT WAS DRAFTED BY ' ge1..H-..Eine s ... ....... ............... ................................ 5100 Edina Industrial Blvd. ...' ......... Ediina;--Mid_-.5tJ4S-•-------------------•-----•----•- Notary Public .._..�.a,�*� .... County,IM. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) date: < /n�GA� .... .�n�, ^n^AAM.kn� *Names of persons signing in any capacity should,be typed or printed below their signs ' � MUNTT < MY COMMISSION EXPURES 8-25.92 WARRANTY DEED STATE BAR OF WISCOIVJIW/V��VVVVVGGV�aI aXtSiri L aA�711ank Co. Inc. FORM 270. 2— 1982 Milwaukee. Wis. z En H 9 ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d OWNER/BUYER JL¢b17 4 W,L, eyo V- ROUTE/BOX NUMBER IV �G{� C //?`7F !/� Fire Number CITY/STATE ] ��� ��-1 -1 ,!5 w ZIP PROPERTY LOCATION : A/�F'lt, t5W 14. Section �G6 , T N , RAW, Town of Fier , St . Croix County , Subdivision S r /yam kot 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 , I 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 z 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- 'b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'Zoning Office wit in 30 days of the three year expiration date . SIGNED DATE ?7 if 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 . mmmo yn/K111t(o COt1NTY OW f17r1fS0A P �s oo P USE DATES OBSERVATIONS MADE ( Residence, 'r` 0 �lyaw ❑Replace �pip�� 3� T7 y/yp LE DESCRIPTIONS: RATING:S-Site suitable for system U-Site unsuitable for system 5�S P///or Si/. 21) ONV M UND: N - L OLD NG TANK:RECOMMENDED SYSTEM:(optional) So - E S DU S DU ❑S- J EIS CCU Coe 04,07., .✓oL sEE-uo7� . t o DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the under s.H83.09(5)lbl,indicate: e` f s Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION ATER-INCHE A R I H KN S ,COL TEXTURE.AND DEPTH NUMBER DEPTH IN, BS TO BEDROCK IF BSERVED�I"SEE ABBRV.ON BACK.) foop 11 Isle. I a� 9� r vB_/L * - D � /,/o' �S/� S�' /.p3' 8�r. si d , .3. 1.1 51 B-/ d•�7 , • ' 1.P1 $o. sr qy o :vc9/� ?,#AO' s l S . 2- p Q ,s ',&14 ti/ D dw. ti/, /G ,8.u. , 3,3y 74.P g-/,7/ S/ �d•3 r d •S , J&RV cs ' . If' A4AA110 -PAr r4AJ Sd 47 • • "S • , • ' �B•/G 19,0' 97tr �o- 'fO ,� d � r PERCOLATION TES S /,O; vtwy Cf DEPTH- WATER IN HOLE TEST 71• RATE MINUTES PER INCH NUMBER INCHES' AFTERSWELLING INTERVAL-MIN. P- P- ►LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances.Describe whet are the hors• tontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings end the direction and percent of land slope. �� • ,l� • SYSTEM ELEVATION •� l _ - VE f r a cony ot ial epti 8 m . N Ll VE J -- ----- — S• — - d t o S 7-,'0 ' _ -- v ,c r' ♦ _ 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): TESTS WERE COMPLETED ON: NOMESITE SEPTIC PLUfylON C(L 7". / l Q0 7 A ' CERTIFICATION NUMBER: PHONE;U•M. �(optional): ROBERT R08ERT ULBRICNT p L MAS MASTER PIUMDR UC.NO,3307 M. A /a JINN.INSiALLER b DESIGNER LIC.NO.OD663 c 'DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. 4 01 LHR-SBD.6395(R.02/82) —OVER— . f t ~..,� REYUHT Vlv bu1L .0VA.LJLvkr0 0c Project I.D. _--_ God • � LEGEND --- Nom .•—_._ "��,t� SITE SEPTIC FLUMW N6 COL AL I WAIVE AD.,HUD",WIS SM1� i • Ba ckh oe fits NIr1 MASTER PLUMDER uuC NQ 3w ALPRt X Pere Locations MINN.1NSTAUER A DESIGNER m NO ma � = Existing Well C.S.T. 2482 RT ,�PpeOK. s.W. lo+ coe R, fog Rants CPC' 19 = Vertical Reference Point ; Sir 3/y Pr c- _ to d G P EIE u. •p � , Elevation of Vertical Reference Point / 00. 0 , -' s Lot Line SCALE: 30 o �p EOF �D ' lon T ® No. /pt IQ' �F-PAcej"4EN� 9 R o ou { fEN Si +CAU&- qv� � 13 Pose . i. I 40' $z sys-re M — No J'o00 5. so O'K, o,K . a3 By 60' (a0� No jee>' i � r i '� Go 1 � f000 3/o j 70# �o • � L Po C ♦O M � �� �� � 0 \ 3 � � M 0 � N � r � - � • •J°e oe qj INZ Sz \ AJo�os �% ♦ O e ra If Oe r \ a 1 ` ` PQ Li r � v • v p Zs T M 3 V n1 0 •,.��.o° INZ/ Q � \ padeeOe b0 Q .0 ♦kn cl / � ,�� � \ ORja a♦oe • (� m v t \ P a v d W � �•` t� V I I " 1 e Q Y tit � 0 o �+ r `b`1 \ `�•oee�e 4f* bs 0 � oObo � � e 0 w�� v a • a e \•< e v 1 I I �IS!a•450,• \ %, lbA p 1 go I t o 4- x4- Ns tu Vi G Q L I;z i