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HomeMy WebLinkAbout020-1048-80-00 0~nO' l0)0 d ~1 0. g M e I M a) m ID 3 = O N a 0 o Doi (j) o ° 000 w c o n°i • U) d CD 3 3 m w a n CD° Hy N ray O vi 7a c Z C_ N A 0 'O M (D CD (D CD 00 rat 7J N a w v `O "e n m H. £ N V o 3 u7i o°° O \ Fj_ H I- trj cn o D o F- 7y to ! ° °o O ~ 0O0 In e~ yHy ON..i m 'J Z d an n 0 D !D a \ Z W O rimed m cn W a a c a v O N (D a F i CD l\~ H I ~ 0D 2 !tii V) H co m a 0 r- ca d Z 0 0 v o < i z 0 'a 3 N U) N rn D r G rn tv \ r ~n y m ID i o D O rt eD = cc OD O N 3 C V vs n a w N n a z CO z O W H H rt D c o C o o d O CD (n E CD C (v Cl) 3 H U) d z 7 D1 1 -I A Z H ~ ..v N 7 ~ A z Z -I N W T m N) ° CD z I o' 9 a ~ z 3 z C.) I I CL o - I m e o a CD N I fi II a. I I a st y N b N I CZ) O a q O_ CD QO A ~ I o a Parcel 020-1048-80-000 08/29/2006 08:50 AM • PAGE 1 OF 1 Alt. Parcel 20.29.19.189A 020 - TOWN OF HUDSON Current XJ 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 BRIAN T & KATHLEEN A GARDNER O - GARDNER, BRIAN T & KATHLEEN A 946 RIDGE PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 946 RIDGE PASS SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.290 Plat: N/A-NOT AVAILABLE SEC 20 T29N R19W PT OF NE NW LOT 71 OF Block/Condo Bldg: C.S.M 6/1508 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 770/408 07/23/1997 757/358 07/23/1997 693/46 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.290 60,000 196,500 256,500 NO Totals for 2006: General Property 1.290 60,000 196,500 256,500 Woodland 0.000 0 0 Totals for 2005: General Property 1.290 60,000 196,500 256,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 105 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' Fo rm. - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ 1119 L j GAR( e TOWNSHIP SEC. T aN-R~W ADDRESS t~Q CROIX COUNTY, WISCONSIN SUBDIVISION I Ulf ( OT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11RR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 &--ROOM / l" d Hom C O R 18x3 7~1 a Pips cti ' PMK K s INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~1, Pips Elevation of vertical reference point: I00, -Proposed slope at site: 5 _ 6 SEPTIC TANK: Manufacturer: Wep k5 Liquid Capacity: 1000 , Number of rings used: Tank manhole cover elevation: 103,0c, r ~ Tank Inlet Elevation: Tank Outlet Elevation: CL Number of feet from nearest Road: Front,O Side,' Rear, O feet -From nearest-property line Front,O Side,O Rear ~ feet Number of feet from: well building:tj fiCf 4 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER 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, 0 Ft. Number of feet from well: Number-of feet from building: (Include distances on plot plan). Htp4ti N7.0 I " 17M SOIL ABSORPTION SYSTEM CN ) 9 4.O 1 - Bed: Trench: $ vftm ~k Width: 10 Length: 3 G Number of Lines: _ Area Built: oyy Fill depth to top of pipe: IsA,r Number of feet from nearest property line: Front, 0Side, Q Rear,0 Ft. Number of feet from well: MOT rk) Number of feet from building: 3 (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, 0Ft. 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: n y4 Z I 3/84:mj b ce.e,,'S j, x'11 fi~ 1 p4 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ,LABOtA HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION e.O. BOX 7969 BUREAU OF PLUMBING -MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank El In-Ground Pressure 1:1 Mound [If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Brian Gardner Rt. 5, Willow Ridge III, Hudson, WI 54)16 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SW SW, Section 17, T29N-R19W, Town of Hudson, Lot #71, Willow Rdg. III Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Richard Hopkins I1059 St. Croix 88434 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET E VV.. WARNING LABEL LOCKING COVER n~ p/Zj7 ~J)PROVIDED: PROVIDED: (/N/ Y It -6/ !i YES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: ROPERTY WELL: BUILDING: VENT TO FRESH C JALARM FEET FROM 1~Z LINE/ LAIR INLE ❑YES NO / ❑YES NO N P EAREST DOSING CHAMBER: MANUFACTURER: 71NO L IQUID CAPACITYPUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDEDPROVIDED: ES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR I"T' PUMP ON AND OFF) ❑YES ❑NO 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 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH: INOEOF DISTR. PI P~;ACING COVER NSIDE DIASPITS LIQUID BED/TRENCH TRNC S PIT D EPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR71PEJOISTR. PIPE DISTR. PIPE MATERIAL: O TR. NUMBER OF PROPERTY WELL: BUILDINGVENBELOW PIPES: ABOCOVEREV. IfJLET LD- PI FEET FROM LINE~~ / AIR IftILET. NEAREST-► 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED CENTER. EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: IND. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.: DIA. ELEV.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNT a 1]• DILHt~ In accord with ILHR 83.05, Wis. Adm. Code S STATE SANITARY PERMIT # -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 G89AWtF, 5L) %Stj S Q N, R 19 E (or)® PROPERTY OWNER'S MAILING ADD ASS LOT NUMBER BLOCK NUMBER SU`ED+VIS N NA F `f 6 1 k '71 ITT Wt 0 1 AC~ CIT T TE ' ZIP COD PHONE NUMBER ❑ CITY NE TOAD, LA LANDMARK sttjI.S r TOWN OF* £t/0 ❑ VILLAGE : s O S II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ORE] Public (Specify): C( 6 1 V III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. yN New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. R 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. a See a e Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: ( n s per inch): REQUIRED f (Square Feet): PROPOSED (Square Feet): L 3 15 (OV? Feet Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in gallons Total of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank lou- Kt' Q ❑ ❑ El 1 1:1 Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plu er's Name (Print): Plumber's Signature: (No Stamps) -MR/MPRSW No.: Business Phone Number: Plumber's Street, City, t e, Code). Name of signer. ~ S 24-4 VIII. SOIL TEST INFORMATION Certif' S Test (CSJ)~Va_ mq J CST ##~~o - Z C/OY'rrT GJl ~r G. CST's ADDRESS (street, City, State,, ip a Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) p~A roved Owner Given Initial Su charge Fee I,d PP ❑ /400 lJ f~ Adverse Determination ~ d_ / 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 M 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: If public is checked, in 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'/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 f result of over 2 years of steady negotiation and public debate. The groundwater bill Grot]nd,)~ter included the creation of surcharges (fees) for a number of regulated practices which wiscorlsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure , 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, ~ The monies collected through these surcharges are credited `o the groundwater 'fond 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, Ws worth protecting. <3D-639& (R.03/86j APPLICATION FOR SANITARY PERMIT SrC_ loo the owner(s) of the application form is to be com leted in full and signed by P ermit This app result in delays of the p being developed. Any inadequacies will only property - this development be intended for .resale by owner/contractctr,("Spec issuance and completed when the property is house"), then a second form should:be retained ubmitted to - this office with the appropriate deed recording. - _ _ sold and s--- _ v ~nJ Owner of Property r - R W Mailing Address 7 -p Subdivision Name ~~1ilr 1 i Lot Number/ Previous Owner of Property qG Total Size. Of Parcel f'- Date Parcel was Created Are all. corners and lot lines identif able? Yes No Is this property being developed for resale "Cspec house) ? Yes No Volume 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, acertified 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. I (Ole) ce a6y that aP.e 6tatement6 on .thin Bohm aAe thue. to the but o6 my (ouh) knowledge; ghat `I (we) am (one,) the`owrleh(a) o6 the pnope&ty deacAibed in thi6 in6onriati.on p6o.lm, by ,lL tue ouI ,7 L4at) aprt`y doerl jLor?.Qfidod .in the 06.i.ae. o6 t`he County Regia teA o6 Deeda as Document No. / and that I (we) pneaentty oun the ptopoaed .6 to boa the 6ewage poa aya.tem (oa ,I (cue) have obtainedan eaaement, to nun 'with the above duc&i,bed pn.openty, ` bon the con6t4ueti.or, o6 aa. d syb.tem, and t:he name has been duPy neeonded in the 066ice o6 the Counzy.Regizten o6 Deeda, as Document No: SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE 'SIGNED DATE SIGNED STC - 105 y r Y SI'PTIC TANK- MAINTLNANCL `ACREEMLNT H H St. Croix County o o ..OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE c.Q~t _'G IP PROPERTY LOCATION:~, ,Z ' _ a~ /VCr 1-z> S'ec:tiun_.17'hZ~~/ it, RW Town of (4C1,S , St. Croix County, SubdivisionA/iU 6) el Lot number~7z Improper use and maintenance ofLyour 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 pum,er. `What you put into the system can affect the function of the Sul)Lic tank as a treat - ment'stage in the waste disposal system. St. Croix County residents Lila eligible'to receive a grant for a maximum 'of 60% of the cost of.` replaceIII ent -of; p failing system, which wits; an operation prior to °July 1, 197.8 »St. Croix County ac.cept6a .`this prubram `in Augus:„ o,f_198'0 ownera ':of all new s stuins•'a ~.'wi11i';the, rc qulrc:mnt that breve keel) theirl systems properly maintained, :r The property owner agrees to sttrbmit to SL Croix County Zonin.g a certification form, signed by,,ahe.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 pui:?pinb (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. 0 I./WE,-the undersigned, have read the above requirements and agree to maintain the-private sewage disposal system in accordance with x 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 Office within 30.days of the three year expiration date. SICNED DATE Q_ St. Croix C.,unty Zoning Office P.-O. f•ox 98 llammord, WI 54015 715--7S'6-223 or 715-425-8363 Sign, date and return to above address. 1 AR, - LOT" ! s L, O f r'IUMIAN KtLH 1 1UNJ , ' ,r. 63.09(1) & .4.K..yr■-v? MADISON`Wi 63707 Chapter 145.045) L AT C,. E T- ON: TOWNSHIP/fv117fVtCfMLITY: OT NO.:BLK. /T29 NO.: SUBDIVISION NAME. 4 / l7 N/R Iq f (or voso,u ? CO. NTY: OWNS 'S BUYERS NAME: MAILIN AD R SS: 70 G ✓LI/ ~c4/X ~3u/ LpE~f'S ~'YK SOS' s dro, 13JoR N smv ' x ..t1SE..: , s 170 SD-tJ 4J/ S . ,d` 3 NO. BEDRNtS-: COMMER AL DESCRIPTION: DATES OBSERVATIONS MADE Residence ? IIc(PR 1 D _ 75277Z S: ~ New ❑ Replace RATING: S. Sito suitable for system Ua Site unsuitable for system S v/g -,A/oR/Z ox-s. y x ONVENTIONAL. MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (o tronal) os ou as o os au [:]S ©u ❑s u o.~~~-.~T,o~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is t under s,H63.09(5)(b); indicate: in the Floodplain, indicate Floodplain eleva tion: rf l` t✓T``~,, PROFILE DESCRIPTIONS BORING TOTAL' PTH T r'R UNDWATER-IN CHARACTER NUMBER NUMBER DEPTH ELEVATION ' fT OF SOIL WITH THICKNESSNESS, COLOR, TE T RE, A' D DEPTH Q BSERVED S ,_t ffEST TO BEDRQCK IF OBSERVED (SEE ABBRV. ON BACK.) ~)1; B- 7.0 goo, ya,.:_ . , , 9 0 - ~.o go. ; s , 9-2-- 70 /01:45 9tv ? 133 Qom. 1 •~3 ' ,u. p3 ' o,p v yo (g, 0 B-3 0 A3. .,j 2rd 1..._.... r . - J s J: a >!r . O w t, /9_'e, is rt± f ~ e 16132 33 N v cs :,~~R ,TG 3: t~ B- PERCOLATION TESTS 0%4 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES Nl~tJ18ER IN- fT AFTERSWELLING INTERVAL-MIN. RATE MINUTES k P < P~R~D 1r_ _P~RI D PER INCH .,tr s~-T /v i S S7 wi g P_ ` Z -rte Q~ Cv -9 P_ Anl2, /,j P RR. OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horl r ntal and vr:rtical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and land slope, percent Bo 77 a--, o F IS-zC ~'~c>9vi4T/o,J Q ~Xr?cTG (~Q ~d~.r 'u YSTEM ELEVATION vex is f-r- 1 , , f I. JJJ { , j : I V A 1 # _r • i i T is test site APP ®r Conven#io ral' Q~,<.p f ( septic system f I`( f w 1 ,I 1 he undersigned, hereby certify that the soil tests reported on this form were. made by me in accord with the procedures and methods epecifled in the Wisconsin ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, ~ME (Print).: ; LETED ON s S r~ A ~t~~ r~~ 'S~ 1 ~ TESTING co TESTS WERE COMP DRESS. p ~ S= FV AT fiAT 10 MI NNESOTA L.)CLNSE NO. 00663 TIFICATN NUMBER: PHONE NUMBER optional) • T• 3a C3'NEIL RD.a HUDSON, 54016 . CST SIGNATURE: ..t r :8: -MIX >TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -HR-SBD 6395 (13..02/82) ;r OVER s.rt •;rr~n. r - I } L R EPORT ON ~ S a l G-LSO K IN ~ ...I'sati~ttrm`r• LaT pLAM PROTECT C~ 5 ~ c n D. Z6 T -71 /3 r - - AArE G - ~u~/low " HOMESITE TESTING CO. .1 T.3,; VNEIL ROAD BOB UI,BHIG':.i irf'UUSON, WIS.:.._. 54016 CST SS5'- 0 eZ PROPOSED HOUSE MUST LIE ZS Fr of _ MD~ff FiPOM ALL TEST PPoPosE a WELL M vsr we, So c~ t10~PE F~PO.ti AL[ TEST ~j,PE~s,. • , = 4Ac.~iyfo,E' ~'iTs 0 = E,T'isr/~t1 ~ ~c1 ELL , /OG,¢rlmlf = flAuP ~Qv9EiPED o,Q S~OdEL IjG~ES 14 r ` yoe;z . Bm ~F,?ric~L ~EfERt^IC,~ Poi~T oP , V d , # Lo T' 4 14E" SU~UE oiP S i t duw~C LEGEND/EV~roN o~ t/~t'r. ~Pr°~" 7/ L of 7Z JRo A) P/P_C- '161YO Y. 10 0 - - yo 90 t P~ _ _ • _a PS 5 o E 3 7s Q- _ 3 s This test site Al PRgVED I for a conventional septic sys m. .S ti s~o T ,'P B.L 67 PLOT D CROSS SECTION _ _..~.w__ a PROJECT PLUM E NAME NAME LOCATION 4&.m- . L I C E N S- E !D" DA E PLOT MAP ' Fo kND a"TCON _rjfQ 1N 110" # as y i x sa ' Y xP Igx~l~ Bed - a 10" I r Pa R" 9n/ 1 32 f X } r,- _T~~ I , FRESH AIR INLETS AND OBSERVAtiON PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above Final Gra _ F'PAI Ifhdk Ya rn~~ 11 4" Cast Iron Above Pipe Y Vent Pipe To Final Grad Marsh Hay Or Synthetic Covering Mina 2" Aggre e Over Pipe Distribution Tee Pipe t4 Aggregate Perforated Pipe Below Beneath Pipe Coupling Terminating At Bottom of System