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HomeMy WebLinkAbout026-1014-10-000 t o co) Q l d 0 d r~ 7 ' 3 A. ID Q lD 'D A7 CD ` l O p~'j N m O O -A J= ;o 0 0 f0 " N • (D N O O 00_ a n (A W O C O w O 7 OD C c7 rrr H o n o L O A~ G 1 O CD CD 0 O cn '0 3 Co ~J (D U) 0 C)_ N' F O W 4 m (0 m Dn Q a O N fl Er k p x c O . o o J P, ~z 3 co CD CD CD "WIN, z m w H N rn rn: co) 0 c ;1 cr ~ = v 4-1 O. 0 -2 :3 a III O ! Z _I F C C Y CD v m a~ w < I N ' CD O U.) 0. CD r%) O a co a, z o W Dai o O C) o O Z M 0 =r y • 0 7d (n m lei rb G rh I- (D CD C 00 c '0 N rt ~d VQ; n w (o a (D CD rr CD cn H- CL 0 z (D -1 (n G a' o ° v c a C a m a a z C)' I II ~ w i' W ~ o CL 3 a ZZ 00 (n H Z Cl) O ~000:3 =rn 3 N O N O c N S m C N (n N L C N - 7 'G 7 fp (D to O O O O. 3 0 N F (D C C O (P CCD S nO p~ 7 7 x j N I c°n_o rn~ I ~ a a en o ~ a ! m °0=3 7 O _ N (D C~ A N N CL O C O O 7 A 0 A ~ b (D m ° 0 0 C) a Parcel 026-1014-10-000 05/24/2005 04:23 PM PAGE 1 OF 1 Alt. Parcel 4.30.18.49D 026 - TOWN OF RICHMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * JOHN D & MARY A SMASAL ANDERSON ANDERSON, JOHN D & MARY A SMASAL 1710 112TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1710 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.540 Plat: N/A-NOT AVAILABLE SEC 4 T30N R1 8W LOT 1 CSM V 4/1028 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 984/249 WD 07/23/1997 984/248 QC 07/23/1997 735/52 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.540 42,800 131,900 174,700 NO Totals for 2005: General Property 2.540 42,800 131,900 174,700 Woodland 0.000 0 0 Totals for 2004: General Property 2.540 42,800 131,900 174,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 f E= oEG 1980 ss &Gwa 84 3% ca* .3685 CERTIFIED SURVEY MAP I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of,.,the< Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Dennis Schultz, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the SW!4 of the SW14 of Section 4, T30N, R18W, Town of Richmond, St.Croix County, Wisconsin, to-wit: Commencing at the W1 corner of Section 4; thence S89°58'5611E along 'the E-W Quarter Section line 1320.381; thence Sl'07'4011E along the center line of a Town Road 1789.571 to the point of beginning; Thence continuing Sl°0714011E along said centerline 330.001• thence N89°58'5611W 330.00'; thence N1°07'4011W 330.00'; thence S89°58'56 "E 330.001 to the point of beginning. Contains 2.50 Acres subject to Town Road right-of-way over the easterly portion thereof. Dated this ~~~day of OC-M-Z&k _,1980. Arthur L. Wege er S-963 Kozel, Wegerer and Assoc. Inc. River Falls, Wisconsin W 1/4 COR. SEC.4 T30N, R 18W. S89°58 56"E CEO RI I" IRON PIPE 11 1320.38 +`++~i+nrrrrrrrr~' _ APPROVED • 1 ARTHUR •eG 2 9 1980 _ C WEGER _ w I 5-963 ST. CROIX ELLSWO H • LARGE ROCK AT ~ • • COMPREHENSIVE PANICS I'LA:, r4G N ~ I • • : CORNER, I. P. SE O r° • WIS. : AND ZONING COMM(Wi t 2' EAST. S8905856"E 330.00' - "i"';~ s U R Iem°s 2 9 6. 99' 31.01 P. K. % rrfit 19 I is 009 Op 1 9` Z 133' 33' o 1 n o U ° 0 M M I O i M 21, LOT I W 2.50ACRES of Z 2.25 ACRES TO I o R.O.W LINE I - I N W E I as ~e I SCALE S 1 100' oc~ 9 296.99' 133.01' 0~ 50~ 100' 200' N89°58 56 W 330.00 P.K. I l 0= SET I"BY24"IRON PIPE WEIGHING Q. 1.13 LBS• PER LINEAL FOOT. I E-; CC: IRON PIPE FOUND. 1 80-78 Volume 4 Page 1028 THIS INSTRUMENT DRAFTED BY \-X) L Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER ijTOWNSHIP SEC. T ."'y N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN C~ CSvpt 100 oY SUBDIVISION LOT f LOT SIZE 1N1 ,~j 3 (pL PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I 7~f 4 f I r, (~~RICE '0 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: MQ Q Proposed slope at site: SEPTIC TANK: Manufacturer Liquid Capacity: moerz, z~ X Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: q g`;~ Number of feet from nearest Road: Front,© Side 0 Rear, O feet From nearest property line Front,O Side,O Rear,(?) feet Number of feet from: well , building: (Include this information of t e above plot plan)( 2 referenceTdimensionsTto septic tank) 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, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len&th: Number of Lines:_ Area Built Fill depth to top of pipe: -2 4 Number of feet from nearest property line: Front, O Side, O Rear,© It Number of feet from well: I//,,. ~r Number of feet from building: 74" (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: Lp ^ j5 2 Plumber on Job: ZAI A:;~ 'jZ License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR % HUMAN RELATIONS DIVISION P.O. BOXXK969 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 RP(CONVENTIONAL ❑ALTERNATIVE State Plan LD.Number a ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If ssigneC) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSP CTI DATE. ` John Utgard Rt. 2, New Richmond, WI 54017 - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SW SW, Section 4, T30N-R18W, Town of Richmond, Lot#l, Schultz Sub. Name of Plumber: MP/MPRSW Nu.. Coumv_ Sanitary Permit Number: Cal Powers, Jr. 1563 St. Croix 79143 SEPTIC TANK/HOLDING TANK: MANUFACpie!2 : LIQUID CAPAC Y' TANK INLET ELEV.. TANK CUTLET ELEV.. WARNING LABEL LOCKING COVER / PROVIDED PROVIDED 40 f> r I p 0 (/(lj_FL/J~ YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD . [ROPER TY WELLBUILDINGIf ALARM FEET FROM INE JVEITTOFRESH AIR LET: YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING- LIQUID CAPACITY PUMP MODEL JPUMP,SIPHON MANUF ACTIIREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL JBUILDING (VENT TOE T (DIFFERENCE BETWEEN FEET FROM NE AIR wLr PUMP ON AND OFF) ❑YES ❑NO NEAREST I" SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - I 1111AMI TEII 111ATI RIAL 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: , BED/TRENCH WIDTH' LENGTH IN1101 DISTR PIPC SPACIN(I COVER INSIDE DIA =PITS LIQUID 2 1 /P r4 l a f PIT DEPTH: DIMENSIONS RA`d CL DE I'T 11 FILL D 7 D'S'" PIPE DISTH PIPE DISTR. PIPE MATERIAL N TH NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOV~VER EE V.INLF i ELEV. END PI FEET FROM LINE AIR INLET. 67 4o__f{++? NEAREST -i►1 Q .0 j 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL SODDED SEE UFD MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIOTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES CIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV 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 ' county file for audit. Reverse Side. S ll~ TITLE , DILHR SBD 6710 (R. 01/82) V~ wlsconsln APPLICATION FOR SANITARY PERMIT D 1 L H R (PLB 67) COUNTY ~ DEpRRTmEnT OF UNIFORM SANITARY PERMIT # MMN~ InDUSTRV,LRBOR6 MUTRn RELRTIOnS 9 y4-3 -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 instructions for completing this application. PLEASE PRINT PROPE TY OWNER MAI ING ADDRE S PROPERTY LOCATION VIL6AG&E: 1/ 1/4, S , T .?Q, N, R 0 (or TOWN OF: ,Ig LOT NUMBER IBLOCK UMBER JSUBDIVISION NAME NEAREST ROA , LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): A" 7 THIS PERMIT IS FOR A: I New System ❑ Tank Replacement ❑ Repair L Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of Plumber (Pr" Signa e: MP/MPRSW No.: Phone Number- PI umber' Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved t~4 ~(77 ❑ Owner Given Initial /p~ d` t7 Approved Adverse Determination Reaso for D' ppr a Alternate course(s) of Action Available: DILHR-SBD-6398 (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 for 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. 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 r, or Location of Property Section , T.~D N-RW Township T7~~ Mailing Address Address of Site JZ Subdivision Name Lot Number / Previous Owner of property Total Size of Parcel +r 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 11!~29_._ and Page Number L9-3 , as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page 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) ceAti.by that at t statements on this bonm ake true to the best ob my (oun) k.nowZedge; that I (we) am (ake) the owner (.s) o6 the pnopeh ty dens cA bed in this inbonmation botm, by viktue ob a wwtcanty deed neconded in the Obbice ob the County Reg"ten ob Deed6a3 Document No. and that I (We) pnesentzy own the pnopo-sed site bon the sewage dispoz system (on I (we) have obtained an easement, to nun with the above de~scA bed pnopehty, bon the construction ob said ,system, and the same has been duty neconded in the Obbice ob the County Registen ob Deeds, az Document No. C ~ L,,&,~ SI ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED • H z cn H a ST C- 105 r" r a ' H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER txl ROUTE/BOX NUMB ,ER Fire Number T CITY/STATE A L- ZIP n1f? PROPERTY LOCATION: ;4, <-4jk, Section, T&QN, R~ W, Town of St. Croix County, Subdivision N%1y2~ 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 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 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. - c N - r m N v ~ w w~~ o m~ o 0 o m o m 0=r = N O CO CT O C° w p 7C `G 3 mccocoo ° p O ? CD '0 cL CD CD p CD N D c C CD r N a p p -s W* O p- C Q~a N a~ 0 ,r w° O w w 0, *CD o a P0 W -0 - - =r ID r '00, r c,3a 0 00 CD CD 0 0CD- cow~ ? > -o 3po o c: w c~CD CD w w cn o m o .gyp aL 3 -CD -0~OO v cv D 3'~Dm w < CD ~ CD Q A CD Cn -Ci p D C CD L I U) C CQ w O N (ODD p' O 4r w CCD co w° w C N m Cl) =--I l< m w cD N Z w C-, ~ * ow w Jr CD C- C N D 0 3 ~ U) (a a .D.~ D CD C ma o ~p M o w ? _ a CD C~ = Q. O w Cl) 'O CL co¢CD C R1 CD 0 5T (1) 0) 0) 5- CD 0 CD s CD =t L7 O Cn p wO CA 0 c o w m 1 OM no f (n c C aW o m ww aaaCD N M C1 p CD 0 3 a~ vi' =r CD ~ m c ~(n o G) ~c DCD o c p v) o CD O r- ao- 0(M c-. v'm m hr~C1 joQ ,m?w~o °a.=3 -~3oQo3 V w ,ate C1 CD O - t co n O < 3 z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN hELATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LLLOOOCATI'~ SECT 0%T-?©N/R/S (or TOWN IP/Mt7RIteff`A4= LOT NO.:5 UT, SUBDIVISION NAME: COUNTY: OWNE 'S BUYER'S NAME: MAILI G ADDRE . 1. b2z: "~ov' z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER IA DESCRIPTION: PRO LE DESCRIPTIONS: PER QLATION TESTS: ®Residence YNew ❑Replace o / RATING: S= Site suitable for system U= Site unsuitable for system MM ENZE ALMU IN-GROUND PRESSURE: SYSTEM- -FILL OLDING NK: RECO MENDED SYSTEM: (optional) S U D U ZS DU DS 21111 EIS U If P er sercolat.H63ion.09(5) Tests a (b), are NOT indicate: Frequired DESIGN RATE: I If an j y portion of the tested area is in the undloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- > % - B- 1-7 B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER FAI6.44EFr AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PER IRO 3 PER INCH ' P- 2'(7 AlaA(Z A0 S3 P- S" P- S-sa'g P-_ P- 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 hcj i- zontal and vertical elevation reference point and show their location on the plot plan. Show the surface elevation at all borings and the direction and percq t y of land slope. SYSTEM ELEVATION ` . i ®3 e~s 3 I - • # r7 ? /I Mw- i- I d mC i ` l a. c Lad , /27 I, the undersigned, hereby certify that th sit tests ported on this form were made by m accord ~~W € m with the procedures and methods specified in the Wis n(i Administrative Code, and that the data recor ed and the location of the tests are correct to the best of my knowledge and belief. NAME int): TESTS ER MPLETED ON: AD S: CERTIFICATION NUMBER: ]PHONE NUMBER (optional): CST GNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCT 3 FOR Cl- LET IN FORM 116 - S - 6396 7 r l - r- ar m., ..)Ort MUSt include: 1. a residence or commercial project; 3, se planned; 4 l aar• rnn v nnscs rr_ ALL } 7. _ A 1 )X; r !L' .,TH THE - r a g -EST F e L it P" _ m UK Vt/ L - Paint To TWP OWNER: st step i sb Y un r I e joNu 1411-a4lfo .Sl~jrie AIA - >°Li'O/4~og.s/ J!~ I I 66' S 1.3s 7" eo I i I PAGE OF CroSS Sec ion O~ A beo S ster" Fresh Air Inlala And Observation Pipe S/ C2)--Approved Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grad• Vent Pipe Marsh Hay Or Synthetic Covering In. 2" Aggregate Over Pipe Oletribullon ipe 0 0 0 0 o - Tee P;;., i 6" Aggregate Beneath Pipe 0 Perforated Pipe Below o Coupling Terminating At Bottom Of System i Pr~PosenTlnal erect ~~cJnT ton - SOIL FILL DISTKIBUTIOF.1 PIPE APPROVED StfWNETIC COVER c4' ° "-?1ATERI^I- OR 9" OF STRAW OF1►6GREGAI OR MARSH HAy 4:0FJ2-21/2 AGGREGATE ELEV. OF YZ~ FEE7-► i DISTRIBUTION PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE ANU AT LEASTZO INCHES BUT 1.10 MORE THAI) 42 INCHES BELOW FINAL GRADE MAXIMUM ®EQTH OF EXCAVAT160 FRoM ORI&V AL 6RA0R WILL BE INCHES PUNIMIUM Bf. rh OF EAWAD(Dw FROM. OIKf(1NAL CIRAPE WILL BE ~ INCHES i SIGUED: k i LICENSE NUMBER: J`~~3 f r DATE: ~l9