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HomeMy WebLinkAbout020-1028-60-000 0 cn O 3-0 n d O C ~1 3 ~ K n C ~ _ e4. O m z co C) o N O m 0 O T W O I C O) N ~ O C t"D W N N N ~ m a Z° m m C- o !o o ►vh W C 7 W 7 (D CO N C n CD O O N y 0 j 0 :3 C, 101, Cn CD rt I O • y y O O rt m w 1. v~ < D a c • 9 0 (D CD (n ] bd by m y W n CL = o o - ~ rO ~ 3 Ir« m oo w yC1 r J ` N 00 0 (D co S, 0 r- cn co 00 - (D 0) 0) 0 H !tn z O O O E- o 3 tin u~ to ~ off- D y @ cr o v o r 0 N y A tai t-+ d a o o C7 Q A cfl 00 _ y r W 00 v 00 N i~ 'O a - CrJ Z 00 0. O 7 Z Z co Oz O rt O ~y v O D a= 1-h 0, :r I~ v m y l~l (D CD -0 cp x a Irt CD N v`1 c m m IF.~ a IOU W rt (D O I v A Q a o H H ~ W T m O) CD 3 a z o y Z 1.0 " C A W a O 3 T O C O OZ d ~O? y d I fi A ti N O O a O = by O O H y~ ti Parcel 020-1028-60-000 02/15/2006 11:41 AM PAGE 1 OF i Alt. Parcel 16.29.19.126D 020 - TOWN OF HUDSON Current X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner WILLIAM J & CHARLENE WILLMAN O - WILLMAN, WILLIAM J & CHARLENE 595 SPURLINE CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 595 SPURLINE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.970 Plat: N/A-NOT AVAILABLE SEC 16 T29N R19W SE NE LOT 4 CSM 4/958 Block/Condo Bldg: ALSO PT OF C & N RR R/O/W LYING ADJ TO LOT LOT 4 CSM 4/958 & OUTLOT 2 NORTHLINE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ST II RUNNING FROM THE SWLY LN LOT 4 NLY 16-29N-19W TO S LN MCCUTCHEON RD Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1063/159 WD 07/23/1997 1011/506 LC 07/23/1997 988/257 WD 07/23/1997 750/425 2005 SUMMARY Bill Fair Market Value: Assessed with: 91584 309,700 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.970 81,100 234,800 315,900 NO 05 Totals for 2005: General Property 5.970 81,100 234,800 315,900 Woodland 0.000 0 0 Totals for 2004: General Property 5.970 57,000 176,000 233,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 135 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Form- STC-104 • r AS BUILT SANITARY SYSTEM REPORT OWNERS TOWNSHIP Is60 SEC. Tcecj N-RJW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION h~N E ~fgi. LOT 1,4 LOT SIZE Dr PLAN VIEW rn N c+~ o who, Distances and dimensions to meet requirements of I•IHR 83 '1- SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~r 'A o a n© ~ o L4' S;i f e ~~Du sPi a J i ~u P~ ,6 e- 6VI-I ~ - 4-x-6-1 sw ~~.r.. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /~,c Elevation of vertical reference point: `--()Irl Proposed slope at site: SEPTIC TANK: Manufacturer: a" . Liquid Capacity: IWO Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: 5 <E~V' Tank Outlet Elevation: Number of feet from nearest Road: Front,(~Sideo Rear, O /S feet From nearest property, Front, 10Side,ORear,0 feet Number of feet from: welliW&W building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) az+ta n~~ic+n nn nTnn t _ PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size V Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: `I 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: ! Length: Number of Lines: Area Built: r0 rc) 3y Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, 0 Rear,0 Ft.~s Number of feet from well: No &e~ u b,-, Si ~e, Number of feet from building: (Include distances on plot plan). SEEPAGE PIT ~r 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ! ~~ZO Plumber on job: S License Number : 3/'84:mj EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR & HUMPjV RELATIONS PRIVATE SEWAGE SYSTEMS .O. BOX 7969 DIVISION ADISON, WI 53707 BUREAU OF PLUMBING ' ]ENCONVENTIONAL E-1 ALTERNATIVE State Planl.O. NumHe+ ❑ Holding Tank ❑ In-Ground Pressure D Mound 111 NAME OF PERMIT HOLDER. ADORESS OF PERMIT HOLDER. INSPECTION DATE Jerry Doss t. 4, Box 121, New Richmond, WI 54017 Q BENCH MARK (Permanent refnence pomtl DESCRIBE IF OIFFERENi FROM PLAN- REf. Pi. ELEV.: CST HE{ PI ELEV SE NE, Section 16, T29N-R19W, Town of Hudson,Lot#4,Northline Station I m. nl Plumtwr. MP/MPRSW No.. County. San,wy Pe,mn Numb-. John Sykora, III 3212 St. Croix 83836 EPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAP Cl TANK INLET ELEV. TANK OUTLET ELEV WARNING LAB L LOCKING COVER PROVIDED PROVIDED BEDDING VENTOIA. VENTMATL. HI(:FIWA EH~ I~J'ES NO OYES ONO ALARM NUMBER OF ROAD: PROPERTY WELL BUILDING VENT TFIIFS14 t4 O ET FEET FROM LINE IAI L YES ONO OYES ONO NEAREST OSING CHAMBER: - MANUFACTURER BFUUING LIOUIOCAPA(A7Y PUMP M11UEl PUMP. SIPHON MANUI AC TI THEN WAHNIN(: LABEL LOCKING COVER DYES ONO PROVIDED PROVIDED GALLONS PER CYCLE: PufdvANOCONTROLS OPERATIONAL OYES LINO OYES r~NO (DIFFERENCE BETWEEN NUMBER OF LI n'(If ly WE Lt Fit n1 UINI. VENT lSll FEET FROM LINf AIR INL F I F PUMP ON AND OFF) OYES ONO NEAREST OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IE NGn+ n1nn,1 n II Inn Hlnl n"u MARKwI, % r excavation. IIf soil can be rolled into a wire, construction shall cease until' FORCE he soil is dry enough to continue.) MAIN ONVENTIONAL SYSTEM: BED/TRENCH WIDTH LE N(iiH NO O 111!TH PIP[ SPACING COV 11 1.1 5/ / TOE NC S / MATERIAL' INtill11 11 sP11S 14111 DIMENSIONS 7V7 /Y~_ `JC„ PIT nf•l" (,FHAV L UFVrH rILL UFP nI IIIS nI PIPI DISTH PIPf. DISTR. F. MAT RIAL NO S TH NUMBER OF II LOW PIPES 48UV VfH ! I V {N~1 1 ELE ENU~ I PI PH(IPEHI V WCL1. HUIL(tIN(; VENT r(1f 1(f•.n FEET FROM LINE All(I LF r NEAREST-~~~ OUND 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- DYES ❑NO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TFxTUF+E PF HnIANf NI MAHhI H$ nIISI l(V,IIInN WI 11 S DFPTHOVFH TRf NC1I BF U Uf I`IOOV(N IHf NCHBEU 01PT/1 qF TOPSOIL Sr,1111f 1) OYES ONO DYES [_INp CE N1EH EDGES SF[Uf 11 M111 MI OYES ONO DYES ONO OYES C_JNO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LF NGT/+ NO.OF LATCI(ALSPACIN(: GHAVELU(PTHHF LUWVII'1 TRENCHES 1 Il L Uf PI11 ANUV( CUVI 1/ DIMENSIONS MANIFOI1) PUMP MANY _01O UISTN PIPE MANII OLU MATE HIAL Nf1 OIST11 1115111 PI I 111ti 11111fUlIUN 1'119 n1 P,11 Hlnl 8n1,MUU INI-, ELEVATION AND ELEV ELEV OIA ELEV. PIPES U1A DISTRIBUTION INFORMATION /+OL SSIIF HOLE SPACING. 13IIILtLO(.0fOHCIIV =ATEHIAL VFI+IICAI 1 If I CUHNl SPUN Uti IU AVPHUVI U PL ANS COMMENTS: DYES DNO OYES C)NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF Pl+oPEINERrv WELL BUILDING O L YES ONO FEET FROM OYES ONO NEAREST---y~ Sketch System on Reverse Side. Retain in county file for audit. 11,11111, E TITLE DILHR SBD 6710 (R. 01/82) wilsconsin APPLICATION FOR SANITARY PERMIT DILHR ~ COUNTY OEPRgT'EnT OF (PLB 67) - InOUSTRV,LRBOR6MUfngnRELRTlOnS UNIFORM SANITARY PERMIT # ti _ g38~6 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for ins ructions fo mpleting thi pplication. PLEASE PRINT PROPERTY OWNER 01 S MAILING ADDRESS ~,~C PR PERTY LOCATION CITY.: -9E 1 /4 N411 /4, S /(A , T N, R/ E (O W L G N LOT NUMBER BLOCK NUMBER SU DIVISION NAM SOH / L ST ROAD, KE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED _ 0 co 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ~ System-In-Fill ❑ Holding Tank ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity ' Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: C IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: t~ `f' T Ii/Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signa ore: MP MPRSW Phone Number: Plumber's Address: 2E Z 1 7es)~^~ ^ Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 0, _4,g ❑ Owner Given Initial Reason for sap val Approved Adverse Determination Alternate course(s) of Action Available: DILHR-S8D-63)8 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete.-and, accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether,this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type.,of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block fof conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc'.); location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. r i TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Prop ertySection T N-R Township Mailing Address * /<11 13e;z- j„~? Address of Site ,j Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? w Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number I` as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pa&e number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) centi6y that att statements on th.Ls 6onm ane true to the but o6 m fouk) knowledge; that I (we) am (ane) the owneA(s) o6 the pnopeAty denscA bed in t t his in6oAmati,on 6onm, by viAtue ob a waAAanty deed neconded in the Oss.ice o6 the County Reg.usteA og Deeds as Document No. %S7 3446 and that I (We) pnesen#,ey own the pnoposed site bon the sewage dispos system (on I (we) have obtained an easement, to nun with the above descA bed picopenty, gon the construction o6 said system, and the same has been duty neconded in the OK6ice o6 the County Reg.csteA o6 Deeds, as Document No. J St6RATM(E 0 OWNER SIGNATURE/OF CO ER (IF APPLICABLE) DATE SIGNED DATE SIGNED frd4 C;g Spielmsn !NOTARY PUBLIC My commission Explros June J, 1960 State of W-19consln ' N~2~ ~t~t f ~ ••°••'•~•"M.MPV{yR4f •wV•t+.R i~.i. j~ 1111 ' • VvTT • .rrtnrrss..,pa~^'~."YSt+*its•..K•^enaxr4a•+:e°.~^.•>Matsa:,ac-m~x•aew..•.- • t V ~i I Vol 'S.12-4 441 'P.0 rx l f all •~S ERR A i' j t ` : •'3•' • , ,M4V ; •f~'M >'s I .i + ! y r. yt'•' JS. ~t• :Q:YST. 1 t: fj fiv { N~'°r t R.•c.i aa~ ' r a s t `CS•"wat t.i: 1 If't '1. ,q,; ~ ~.~9; r 1 ~ ~ a l ~ ~.~.L« ~ I RtLs.9 ~tt8rs4rrBYt rti.{rsi: % }L e V 1 t W• . 1 ; } Cli ww~ i. n 3 00, C13, t ~ fi'b` • + j' : ~ , ~ ' Ir tt ~t• g F l~ 3 e to a .~1 i ~ • A• N , • ~ • .s ~ C'j r=y , , I L arn y 8016 ~$C 1 K tt•pe 4 , I It Woo ~'x a p•• f 1 C apa 1L•°L' t 1 on N i~ 1• t ~t ~ ~t N ~ t C'j Pro 61 io- ' r 4 t) 1 `f W'. ; •1 ' 1 •t D; A Uf p,Na •rl•~ra : " to va.-o"I 00.4 P.W, 00 "two lI ; t •I ~ . r, •att~t ii ]•'•rf }•'{"lOgf.act• ~ ao. 1.{a oL „ ` " t' , - - , - ras • R iD'rri fw1 1..4v10, , z H a STC - 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d a OWNER/BUYER ra ROUTE/BOX NUMBER Fire Number .CITY/STATE /PYwj-oo' G(l ; ZIP S' 5~1416 PROPERTY LOCATION: Sf_ k , ~✓G k, Section, T / N, R__Z_L_W, Town of ~ -r""re-f e~z , St. Croix County, Subdivision/kpokx~~,n,~ ~7~Q7P,oy -Lot 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, if needed, by a licensed septic tank pumper. What you pdt 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 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x 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 within 30 days of the three year expiration date. SIGNED 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 address. r- - r n p cn W A (p ~ ~ K O ~ ~,~~J C " A A 7C A A m v f~a3 ww~w I C ° c o co jR - ~ 3r 0m o~ ~~Dca N 0g ~ c m N a O D 0 A o p~ o., ~p cp CD *oo N;rc~pww~ SD 0 CD Er o3a 0 c0,w > > ? (a so w o o o w =r C- a S'ZQ c~ z QS 2 on o M A. - o. a W 7 H :3 CO co -0.9 , R 1+ c N O A o A -4 = p1 A w O • 0 =r ~ ID M01 °aO ~m ANN y~w~~N z a L1~ ID ~w N~~ C Z U) M o am o 3 co Na D .«o n A' w o ?(aMo. oN=a.cm Vf V M N~ o° co emu; n \1° -'•a9 Es*= Qty x 00 o y,o o=,cy~ D ID co c ••c~ ~ m a co a m m ~ CS a, 0 ~ CL a ao Q~ =(A 0 C) (Ac a o~'AN0 Vs g noa oco~ cm-~c°c~D o a =su =o (yQ m e = c m= o o v cm 3 0 3 °D oi' w a o a cu o 3 Co o Z 0 • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND, PERCOLATION TESTS 115 P.O. BOX 7969 }IUMAN`RELATIONS (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: SECTION: OWNS IP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: /(6 /V7N/R/78(0& COUNTY: OWNER'S 4MA*&4*3"NA1ft: MAILING ADDRESS: JTa Ilk- -T, J C♦ tJ c7 Of L►tJ[Sr s>Ia Will. S~ WI S `f USE q yCrt ,6 e. err-Y QotS eZY6-6 DATES OBSERVATION MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PERCOLATION TESTS: _1 I Residence ~j New ❑Replace p. 70/ A /'11107' RATING: S= Site suitable for system U= Site unsuitable for system .4r f -CS-106- CON~TIO❑NAL: Mj ®ND-l URE: SYSTEM-ILHO ❑LDING TANK: R ~OMENDED YSTEM:(optional) U S U S S (Z J U C /w wa If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: AIA ( Floodplain, indicate Floodplain elevation: PR FI E DESCRIPTIONS BORING TOTAL. ELEVATION DEPTH T GROUNDWATER JA~CiiE& CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 0(-bA4e_ 1-0 Nil 0& 0 0 B-3 9,0r 7. 4,1ekt.. 7 YO' B/ -s'/ As t S, 7 9,t rs 9,0' r B_ PERCOLATION TESTS TEST DEPTH{ WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 0161 IiiS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P-/ A1$ 2 1 L3 P- o 4-3 P- 3 3..f' P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the \\i~je As--d a soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their locatio the plo Ian. Shy the surface elevation at all borings and the direction and percent of land slope. / SYSTEM ELEVATION ,ems ta` i 1 i y~E d- E , ~e t A~a 4&,~Fv t~__47x q :q~ _F ; 3 ~ t ~ i 1 4-4, t t ~ 3 v y c-rts l <B~~ i - - ~ ~ TCS' t - f ~ I E ~ E _ G41 4_1- 0I a 3 I, 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: L RE6: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST TURF: r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r- "MPL,E1 ING ' 'n 15 - SBD - 6395 --yep { e 46, f 3 _ 4 ~ b Aj • f J r _ v t N~ (ID tv N P ~ t 15-3 t7 (P ZY . Tr7 J ' 0 l State of Wisconsin ` Department of Industry, Labor and Human Relations c SAFETY & BUILDINGS DIVISION 8 - nlz f.. - z _ a 4 = i s , s f 6 1A /mar s s i t F IL HR-SBD-6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor ° and Human Relations SAFETY & BUILDINGS DIVISION t / t r1o ) FAfEC ±7 - ev "t y y /i 4 rr} 1"T 1- P S-..:Y 4 ~g S r., r z r . 6.3 t,. • `x fi r ry,'` $ } r S 3 c" t F ~i C I`7 L $Y(:' 4 4 k Y ~ C y~ (t F_=fi 1~~ t l _ y ~l .fi`re.~t ~ r k tt4-rP F p9",r~ l .''Ifilf e+~ i r::? k .i?,p t qtr t F. t, t t a 7 r L rt. -1 iy .Y.( - a.c b4 ~9L M 1, iiirs 1 c, zin C ,c~ i ~ m( t Gtft t"fi vr CZ tcnt:r) t Ct %6' ~xc r t !tt? (c s fyr w C of Ei y U c a tx. 4 1_ DILHR-SBO-6423 (N. 04/81) r f State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION t a Ct' r d. F e r it.'~€ ' y, q ~ r 2 "yy' F w i , f ~r' "4,t _ xu~' f~i3i• ~.-~d.°. ~ ~,_if a r$ .C 7k%i? t€`. `I~~ It i YtC'..aC d d s DILHR-SBD-6423 (N. 04/81)