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HomeMy WebLinkAbout020-1169-20-000 St. Croix County Planning and Zonin Monday, April 04, 2005 at 4:21:41 PM Detail Sanitary Information Page 1 of I Computer 020-1169-20-000 SubfPlat: Ranchwood Section: 7 Parcel 07.29.19.1049 Lot: 22 TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: 1/4114: SW 114 NW 1/4 Owner. Dunaski, Jerome 327 Highview Road Hudson, WI 54016 State Permit: 83811 Issued: 07/2411986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 10/0911986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Tom Nelson Yes Money Owed Schumaker, William 1000 gal Wieser tank to 18' x 63' bed $0.00 Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/24/2005 M Parcel 020-1169-20-000 04/04/2005 04:13 PM Alt. Parcel 07.29.19.1049 PAGE 1 OF 1 Current X 020 -TOWN OF HUDSON Creation Date Historical Date Map # ST. CROIX COUNTY, WISCONSIN P Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JEROME D & DARLENE E DUNASKI " DUNASKI, JEROME D & DARLENE E 327 HIGHVIEW RD HUDSON WI 54016 Districts: SC = School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2611 SCH D OF HUDSON ' 327 HIGHVIEW RD SP 1700 WITC Legal Description: Acres: 2.070 Plat: 2362-RANCHWOOD SEC 7 T29N RI 9W SW NW LOT 22 PLAT OF RANCHWOOD Block/Condo Bldg: LOT 22 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: TDa/te23/el199Histo rcry: Doc # Vol/Page 7 Type 728/566 2004 SUMMARY Bill M Fair Market Value: Assessed with: 49089 321,200 Valuations: Last Changed: 10/29/2001 Description Class RESIDENTIAL Acres Land Improve Total State Reason G1 2.070 48,200 200,300 248,500 NO Totals for 2004: General Property 2.070 48,200 200,300 Woodland 0.000 0 248,500 0 Totals for 2003: General Property 2.070 48,200 200,300 248,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 102 Specials: User Special Code 018-RECYCLING Category Amount SPECIAL ASSESSMENT 27.00 Total Special Assess 27 s Special Charg0ess Delinquent Charges 00 600 } Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER l~U.4114-S Al TOWNSHIP ~r,±✓ SEC. 7_ T ~ 9 N-R~W ADDRESS " ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /Y r i4 INDICATE NORTH ARROW BENCHMARK; Describe the vertical reference point use S'Q~4 ~'s i Elevation of vertical reference used point: Proposed slope at site: SEPTIC TANK; Manufacturer: 41 ~e, Liquid Capacity: Number of rings used: ~j Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,© Side Rear, O feet From nearest property line Front,0 Side ,O Rear, O feet Number of feet from: well (Include this information of the above plot plan)( / p )(2 reference dimensions to septic tank) SFF RFV~`vca .r,.,. PUMP CHAMBER Liquid Capacity: Manufacturer: pump Size Pump/Siphon Manufacturer: pip Model: Bottom of tank elevation: Elevation of inlet: Gallons per cycle: Pump off switch elevation: Alarm Switch Type: Alarm Manufacturer: 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: ~ - ~ Area Len$th: Number of Lines• Width Built : Fill depth to top of pipe: Front, ® Side, Rear,O Ft•~~ Number of feet from nearest property line: Number of feet from well: 3 a Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Diameter: Size: Number of pits: Bottom of seepage pit elevation: Liquid depth: Area Built: or distribution box O been used on any of the above soil Has either a drop box O absorbtion sytems? (Check one). HOLDING TANK Capacity: Manufacturer: s used' Elevation of bottom of tank: Number of ring Elevation of inlet: Rear, Ft. Front, O Side, O O Number of feet from nearest property line: Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: / Plumber on job: Dated License Number: i 3/84:mj SAFETY & BUILDINGS DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ' DIVISION LABOR & 4UMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.Q.Bi 7969 MAD FSON, W 153707 ❑ Slate Plan I.D. Numher Ill assigned) CONVENTIONAL ALTERNATIVE . ❑ Holding Tank D In-Ground Pressure E Mound INSPECTION DATE NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. JeAome Dunoki 215 Heten Sxheet N., Hud6on, W1 CST NEF PT ELEV . BENCH MARK (Permanem reference you+d.OESCRIBE IF DIFFERENT FROM PLAN: REF T. ELEV.: SW NW, Section 7, T29N-R19W, Town o~ Hud6on, Lot#22, Ranchwood Sanitary Permit Number MP/MPRSW No.. - CounTv' Name nl Plumber. St. Croix 83811 1. GI,c„r✓Q,%am S chfonafzen 6382 SEPTIC TANK/HOLDING TANK: LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET EELEE PWRARNINE LABEL pROOVIDED OVER MANUFACTURER. - / L'-~ /0 U n ' /0 7. !O YES ENO EYES NO TOFRESH ROAD. PROPERTY WELL BUILDING VE INLET NIGH WATER NUMBER OF LINE IR BEDDING . VENT DIA. VENT MAT.. ALARM FEET FROM /71 C DYES NO NEAREST EYES NO DOSING CH BER: PUMP SIPHON MANUF ACTIIREH WARNING LABEL LOCKING COVER LIOU ID CAPACITY PUMP MODEL PROVIDED PROVIDED MANl1F ACTUREH aE DUING DYES ENO EYES ONO EYES ENO PUMP AND CONTROLSOPERATION AL. NUMBER OF PR(PF fITY WELL HUILDING 41RINLf7RES11 GALLONS PER CYCLE: LINE FEET FROM (DIFFERENCE BETWEEN EYES ENO NEAREST, PUMP ON AND OFF) LEN(,TH DInn711114 MATIHMAI ANOMAHKINt SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) INSIDE ILIA_ av1 S - OF CONVENTIONAL SYSTEM: 1 uoun) WID~ LENGTH NO. OF 1715TR PIPE SPACING COVE SIDI DI, BED/TRENCH ~ TRENCHES / I DIMENSIONS ^ IIY~ PROPERTY WELL HUILOING VENT T(7f IHS11 GRAVEL DEPTH FILL DEPT/1 I1151H PIV DISTH PIPE DISTR. PIPE MATERIAL NO DI H NUMBER OF LINE / AIR INLE T PIPE S~ BE LOW PIPES ABOVE OVER f I f V INI I ELEV END 2- ~ Z~ / FEET FROM ~p'✓< LF JL'~ L WZ /0 /oS 3 / J NEAREST = . 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. OIL HMANINI MAHKI HS UHSF/TVA I ION WI I IS DYES ENO Tp, COVER rtxn)HE EYES ENO DYES ENO SEE OF 1) MULCHI 1) S()UDf UEVTH (7F TOPSOIL ~I EYES ENO DEPTH OVER TRENCH BED DEPT H OVf IT TRENCH BED I) CENTER EDGES EYES ~NO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: f IL L OFPTFI AHOVt COVI IT WIDTH - LENGTH NO. OF LATERAL SPACING 5 AV_ DEPTH HF LOW PIPF BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANY OLO MA EHIAL N~) DISiH DIA(It P1151 UI1IIIµ1111UN PII'( h7 AJI HIn11L A1AItK ING PIPES ELEV. ELEV. DIA ELEV. ELEVATION AND DISTRIBUTION =IHIAL VFII(1(:M III T CIIHHF SV(1NU5 IU APPIII)Vf U HOLE SIZE HOLE SPACING UIHLLED COR"FC1 IY INFORMATION PLANS EYES ENO EYES ENO PROPERTY WELL BUILDING PERMANENT MARKERS: OBSERVATION WE LLS-. NUMBER OF LINE COMMENTS: FEET FROM DYES NO EYES ENO NEAREST_ `t~ ;D 633 S y 1 C* tRxetcaa in count Mile for audit. I Sketch System on Reverse Side. TITLE SIGNATURE DILHR SBD 6710 (R. 01/82) NT SANITARY PERMIT APPLICATION ESTAT ~ DILHR In accord with ILHR 83.05, Wis. Adm. Code E SANITARY PERMIT # o~.._ j/ -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 FOR VARIANCE ❑ YES NO 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY LOCATION E (or PROPERTY OWNER td% 4/%, s T a,Q , N, R e LOT NUMBER BLOCK NUMBER SUBDIVISION NAME PR PERTY OWNER'S MAILING ADDRESS a Z NEAREST ROAD, LAKE OR LANDMARK CITY, STATE ZIP CODE PHONE NUMBER CITY VILLAGE : s ~ ao'10~- ~ll04' as-~ II. TYPE OF BUILDING OR USE SERVED: P72 M Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) El Replacement of d. ❑ Reconnection of e. El Repair of an 1 a. New b. ❑ Replacement c Septic Tank Only an Existing System Existing System System System Date Issued 2. El A Sanitary Permit was previously issued. Permit # 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) ❑ Experimental 1. a. ti~ Conventional b. ❑ Alternative c• 2. a. ❑ System- b. ❑ Holding c. E1 Pit Privy d. ❑ Vault Privy e. E1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑ See pa e Trench c. ❑ See a e Pit Feet): PROPOSED (Square Feet): 5 SYSTEM ELEVATION 6. WATER SUPPLY: 2. PERCOLATIONR hTE T3. ABSORPTION AREA (Minutes per r) REQUIRED (Squa ley, y® Feet ®Private ❑ Joint ❑ Public I 67K 57 s CAPACITY Site Ex er. VI. TANK in allons Total # of Manufacturer's Name Prefab. Con- Steel glass Plastic App INFORMATION New xisting Gallons Tanks Concrete structed Tanks Tanks l Septic Tank or Holdin Tank Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system show n yy attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) 2 l a t 6 Name of Designer: 1p, ber's Address (Street, City, State, Zip Code). y VIII. SOIL TEST INFORMATION csT#~ Certified Soil Tester (CST) Name ~ Phone Number: C T's ADDRESS treet, City, State, Zip Code) ` t l/Q Q S w ;rApproved OUNTYIDEPARTMEN I USE ONLY Issuing Agent Signature (No Stamps) ❑ Disapproved Sanitary Permit Fee Groundwater ate S r harge Fee ❑ Owner Given Initial %~1 6 Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber SBD-6398 (formerly Plb-67) (R. 03/86) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION , TO THE APPLICANT: ti 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 t6-3 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: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; ll. 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 approp MP, etc.), address and phone number. Plumber must sign application form. Fill in des gner'nameeif'x (e.g. 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'/z 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 rriains/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 included the creation of surcharges (fees) for a number of regulated practices which Groundwater Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried fsin'g is used in your building is returned to the, groundwater through your soil absorption Uf1eCireasure~ system or the disposal site used by your holding tank pumper. o~ 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 water, groundwater contamination investigations and establishment of standards Groundwate it's worth protecting. SBD-6398 (8.03/36) APPLICATION FOR SANITARY PERMIT STC - 100 i 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/contractgr,("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 Jerome D. Dinask' and Darlene E. Dunask Lucation of Property SW k NW , Section _-.7T 2Q_ N - R 12 W Tuwnship Hudson Matting Address. 21 Helen Street. North Hudson, Wisconsin 54016 Subdivision Name Mngb=2d 22 Lot Number Previous Owner of Property ilry Ann Windol f Total Size of Parcel Acre 321u§ Date Parcel was Created December 20.1985 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No volume 728 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 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 01 Lhe reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eVuti6y that aU atatemente on .this. 6oAm ane t4ue to the beat o6 my (ouA) knuwte-dge; Vat 1 (we) am (ane) the owner (a) o6 the pnopen ty deAutibed in ,thi 6 .411 nmation 6onm, by viAtue o6 a wamanty deed neeonded in the 066.iee o6 t:he Cuun t y Regi6 teA o6 Deeds ae Document No. 407954 ; and that I (we) p.q"e.itUy own .the, p,%opoaed bite bon the sewage poaa -aya,tem (on I (we) have obtained an eadem to nun with the above dewibed pn.opeA.ty, bon the -On6tAuctti.on o6 6y.6tem, and the bame hab been duty neeonded in the 066,Zee u .the Co e ' -t o6 Deeds ab Document No. 4079.54. I 57 TORE ER SIGNP_T RE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED N v r I S T C ..10 r > SEPTIC TANK MAINTENANCE ACRELMENT St. Croix oun~Y z E 9 OWNER/BUYER Je ome D. Dunaski~~and Darlene E. Dunaski ~ ' ROUTE/BOX NUMBER 215 Helen St. North Fire Number • CITY/STATE Hudson, Wisconsin LIP 54016 _4N, R19~W, PROPERTY LOCATION: MW w i4• ,~4, :Section'T'7 T 2 Town of Hudson St. Croix Cuunty,- Subdivision Ranchwood Lot number 22 Improper use-and maintenance of your septic system could result in I its premature failure to handle wastes. Pruper maintenance coi►- sistb of pumping out the septic tack every three years or suuuet-, I if needed by a licensed septic tank pun r What you Puc inCu the siybtem can affect the function of- t9h-e, s-eptic tank as a treat- ment stage in the waa,te 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 pt+,,+::+•M yt• CrQix County accepted this program in August of 1980, with the requirement that owners of all nne_w_ 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 maater;'plumber. journeyman plumber. restricted plumber or a licensed pul0per veri- fying that (1) the on-pits wastewater disposal system its 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 H three year expiration. o Ic z , I/WE, the undersigned,, have read the above requirements and agree w, to maintain the!psivate sewage disposal system in accordance with M j the standards stet forih, hsFeiaas set by the Wisconsin DepartT E 1 mgnt of N$tur&X Reso4r,cap. Ce,r41fica n form must be Completed';, €s : j and returned to, the St CC;axx .Cq.unty Ga ing Qf f i re w4thin 3,0 days of the thfiee yearx~,r►tl~►~n ;da,e• i 21 ' k. (SIGN ~ f 26 2] DATE 7 t~ a. I j St. Croix; County Zgn411g of rice i j P.O. Box !98 ; Hammond, WI 5401; f {,i 715-796-2239 or 715-425-6363 Sign, date and !returnto above 4ddress. { N US T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION ha PERCOLATION TESTS (115) MADISOP.O. BOX 769 N WI 37 HUMAN RELATIONS 07 (1,163.09(1) & Chapter 145.0451 E LOCATION: OWN HI UNICIPALITY: .19 NO.: SUSDI N NAME: SW 1/44J/ 7 %Tz,)N/R m#(or zz Q n COUNTY: OWNER'S/BUYER'S NAME: MA. C- e C, I DATU OWRVATIONS MADE 17 AL DESCRI"I RCOLATION T / E PROFILE OE3CRIPT Residenca 77: New ❑Replea MAY 14) / S86 MAY /'S /S@p JT RATING: So Site suitable for system eft wtwA%W for system CZ - SM4.j -r ~Q m,& O 1~ ECOMMENDEO SYSTEM: (optionel) [20 S 0 U S m T 150 1 S El * U ❑ S ❑ S CON VdrNf1&4x L. ~R-A If Percolation Tests are NOT required D E.SIGN RATE: If any portion of the tested area Is in the A under s.H83.0&5) (b), indicate: CLASS iFloodplain, Indicate Floodplain elevation: i i~t/c- PROFILE DESCRIPTIONS BORING: k ELEVATION CHARACTER 50 1814S ENIVIS E S T. HOW SOIL WITH TRICKNESS CO . AN DEPTH TO BEDROCK IF OBSERVED EE ABBRV. ON BACKJ B- 1 7 5~5 /04.$O NG 5.7.5$ 0-0 -Z< tLLTS 0.'LS -/.O kt,4 S .S to-Z.7K ~4 tN MS;f6Q 2.7 S- &A NS .58-7.5K 4 S 4- e B- Z 6,17- io5.S3 Ncnii ?6.92 0..~,,tk $LS,t7'S O.zk- l.'7S dR~l 'S,L S i•'T5-2.SK a Rid Z S$ -4.X 4crter4%,f61t 4 .75-692 Lr&Aj S lVo 0-x.5`6 9 S,LTS /•s~-3.33 Bt,S,L I-ItA,4Z U-1,4 B.3 6, z /og.a O r( L A w /4- RAY 9Z S A t4 B. g 30 /09.44 No e ~8 3a o-o-7S I~LS.LTS. 0.75-3-I7 kRNS►L ff5 3.1-7- a. 3o QA&tW S +GP -*r IL66 o-/.o $LS,C,Ts /.0-3.3 RN 1L 3. 3 e- S $.6U /09.97 7Y~N` f3 6o 8•d© B- pp PERCOLATION TESTS TINT WATE IN OLE TEST TIME DROP IN WATER LEVEMNCHES NUMBER IAiCMfiB AFTER SWELLIN INTERVAL-MIN., PER PER INCH - ? s /0 %46 T 32. o P. O or.( / 3 $ S" / P- 4,10 o / -2 . P P- PLOT PLAN: Show locations of percolation tests, loll borings and the dimen:ions of suitable soil areas. Indicate scale or distances. Describe what are the hori :ontal 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 /n4-4o' = 5~ 3 ~ f ~v • 1 1 I - s ( ) i s S . : A vm%yj AT i yS 615 • . ( f _ 1, _ . .c -L ,PI Cv T► 31 r 10wo 00 cc REC01 JUG '4s I i Z4ING! _ 1 I. OfFICEi I 57 Z- 1, the i certify that the soil tests reported on this form were made by me in accord with the pures and methods specified in the Wisconsin Administr nd that the data recorded and the location of the tats are correct to the best of my knowledge and belief. NAME print : l TESTS W R COMPLETED ON: 140YCI JoNNS4~ MAY l'S /9'%6 ADORESK CERTIFICATION NUMBER: PHONE NUMBER (optional) 4o Sccows% 4":-r ll rAsOti Wt '4016 34fs4 : M-4af',y CST SI U RE: DISTRIBUTION: Original and one copy to Local Authority. Property Ownw and Soil Tester. DILHR-SOD-6395 (R. 02/82) - OVER - c Q re a7 ~'rh V 1,7 aye y