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HomeMy WebLinkAbout026-1044-60-000 0 y 'o n q 2. (D m ro ` 1 (D O 0 a 'I 2 w 0 o co cT1 N ,~1 • ]~/1 cn a z a H 00 m 3° h w CL 3 ro ro m ? ° N ` 1 0 ~ O C) c CD I o m 0 o co A~ 3 0 f o to o O 0 d CD A ! (CD (n a C = ro n r m W S 3 0 coffin co\n voi (D CA) K) (D 0. z co 0 o o 00 oODi ? 3°. Q t~ 000 CD Oro Ry ~ OD H 0 cn ro Q v v a N ro 90 n n C ID - a m C) 0 ~ co N 3 °f U1 rt v Q w vai z N U' o C I D o ty N O a N d a ro cn I O W `L~1 ro In {CZr1 ro o N N O 7d w CD roa rr, ~ V a 3 Q oo 7y £ N z c6 z 0 O , ~O• v a' G) R o 0 K ' I p, Cl) ~ Ln W M m w v, ro ro o z o C ' z I ro I w m N a I ;v Q ~ a O - I ° 3 w c 0 o G C ~ N I a ~ I x I I ~ I a I R 0 II N O O I ~ A O_ ro o 0 N a 00 : I I Parcel 026-1044-60-000 02/05/2007 09:22 AM PAGE 1OF1 Alt. Parcel 15.30.18.218B 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): O = Current Owner, C = Current Co-Owner O - CARLSTED, DIANNE A DIANNE A CARLSTED 1731 96TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1564 HWY 65 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.110 Plat: N/A-NOT AVAILABLE SEC 15 T30N R1 8W 4.11A PT OF LAND IN SE Block/Condo Bldg: 1/4 OF NE BEG NE COR TH W 242'S 739' TH E ALG DRIVEWAY 242' TO E LN N 739' TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB 15-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1085/543 WD 07/23/1997 44L&6 WD 07/23/1997 725/536 07/23/1997 2006 SUMMARY Bill Fair Market Value: Assessed with: 176937 172,000 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.110 43,200 90,900 134,100 NO Totals for 2006: General Property 4.110 43,200 90,900 134,100 Woodland 0.000 0 0 Totals for 2005: General Property 4.110 43,200 90,900 134,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 144 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP i~ yp SEC. T0_N-R~W OWNER ADDRESS ST. CROIX COUNTY, WISCONSIN Ord SUBDIVISION LOT LOT SIZE PLAN VIEW ` Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L mush r~ f INDICATE NORTH AR OW e©~~~- 9710 BENCHMARK: Describe the vertical reference point used ' Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer:~~s~ ;~Lo4iquid Capacity: mom/ Number of rings used: Tank manhole cover elevation: ¢l 7S~ ank Inlet Elevation: Tank Outlet Elevation: o?AwK Number of feet from nearest Road: Front 10 Side 0 Rear, f feet From nearest property line Front 10 Side,, Rear, O ~ feet Number of feet from: well building: / S , (Inc ude this information of the above plot plan)( 2 reference dimensions to septic tank) QAF ARVFRQF QTnV 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). SOIL ABSORPTION SYSTEM Bed: Trench: Width:l 9 Lenith:_, Number of Lines: Area Built:za~ Fill depth to top of pipe: Number of feet from nearest property line: Front,/ O Side , Rear,O Ft . Number of feet from well: Q Number of feet from building: .ply (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: ~~3~ Plumber on job: License Number: /,S f 3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS P.O. BOk 7969 PRIVATE SEWAGE SYSTEMS SAFETY & BUILDINGS MADISON, WI 53707 DIVISION BUREAU OF PLUMBING L%ONVENTIONAL DALTERNATIVE ❑ Holdin State Plan I.O. Number: Holding Tank El In-Ground Pressure ❑ Mound Ilrassigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER T John Ammann Rt. 1, New Richmond, W1 NSPECTION DATE: BENCH MARK IPeimanent reference pomU DESCRIBE IF DIFFERENT FROM PLAN. 54017 ~A SE NE, Section 15 , T30N-R18W, Town of Richmond REF. PT. ELEV. CST REF PT. ELEM Name of Plumber: MP/MPRSW No.. Coumy. ary Pe-1 Cal Powers 1563 S sa°"79158 "°m e` t. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER: j L QUID gPgCITV TANK INLET ELEV.. J TANK OELEV WARNING LABEL LOCKING COVER BEDDINGIOV ED PROVIDED VENT DIA VENT MATT JHIGH WATE YES DNO DYES ALARM UMBER OF ROAD ROPERTV 0NO DYES I°" ` EET FROM WELL BUIT TO FRESH YES EAREST 1) 110i ;1 1 1 LINE r AIRI EZ DOSING CHAMBER: i,a'` MANUFACTURER. BEDDING. ~LIQUID CAPACITY PUMP MODEL PUMP, SIPHON MANUf ACTUHEH WARNING LABEL LOCKING COVER YES ❑NO PROVIDED: PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLSOPERgTIONgL DYES DNO DYES (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL FIND PUMP ON AND OFF) BUILDING I VENT TO FRESH DYES FEET FROM LINE AIR INLET: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing O__4 NEAREST- or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE " rIAMF rE l+ MATE RIAI AND MARKING the soil is dry enough to continue.) CONVENTIONAL SYSTEM: MAIN BED/TRENCH wIDT" LENGTH No OF UISrH PIj'E SPACI N[. COVER - DIMENSIONS THENCHFS / 7SHIAL INSIDE Dln ZPITs EPTH ( l/~_ \2 DLIQUID ~HAVEL DEPTIi FILL DEPTH DIS7 H. PIPE L, PIT DEPTH DISTR. PIPE MATERIAL : BELOW PIPES ABOV DISTH PIPE E COV R EL V INLf f E~V.END NO DI H PIPES NUMBER OF LINE PROPERTY WELL. J F 1( FEET FROM euILOING VENT TO FRESH / 2 i ' AIR INLET NEAREST " MOUND SYSTEM: "14 Z5 Mound site plowed perpendicular to slope LIPsl and furrows thrown rpen e: Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES DNO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PF HNIAN! NT MAHKF HS oBSEHVanDN WELLS DEPTH OVER TRENCFI BED DEPTH QVFH TRENCH HEU DYES DNO DYES CENTER EDGES DEPTH OF TOPSOIL SODDFD ❑NO SEEUFD 11-1-f-1-11C PRESSURIZED DISTRIBUTION SYSTEM: DYES. ❑NO DYES L~NO DYES ❑NO BED/TRENCH WIDTH LENGTH TRENC LATEHAL SPACING GRAVEL DEPTH BELOW PIPE DIMENSIONS TRENCHES: FILL DEPTH ABOVE COVER MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTF41BUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA ELEV PIPES DA - DISTRIBUTION INFORMATION HOLE slzE HOLE SPACING DRILLED CORRECT f-v COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED OYES ONO PLANS COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ❑NO /C NUMBER OF PROPERTY WELL BUILDING: DFEET FROM LINE YES DYES zO` NEAREST etch System on •erse Side. d county file for audit. S I G NATI,/fiiE+^°` ,.x , " A - TITLE SBD 6710 (R. 01/82) "t sw ' ~f~~ wlsconsln APPLICATION FOR SANITARY PERMIT Jln-A - y D I L H R (PCB 67) I COUNTY TmEnTOF UNIFORM SANITARY PERMIT # iiill InDUS InOUSTgM, LRBOR 6 HUTLin RELFiTIOnS -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 PROPERT OWNER MAILING ADDRESS j _ PROPERTY LOCATION CtT_V Il l err T le ' 1/4///!!F 1/4, S/ , N, R E (orj TOWN OF: . LOT NUMBER BLOCK NUMBER SUBDIVIS19,N NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED G Q_. 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System PI Tank Replacement ❑ Repair X Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 11 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): 1&_2 r Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation f t pri ate sewage system shown on the attached plans. Na of Plumber (Print . Sign re MP/MPRSW No.: Phone Number Plumb's Address: Name of Design r: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / ~Y~ aa,~ ❑ Owner Given Initial Approved Adverse Determination Reaso or D' ap va Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 1 ' 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 ~n!-:~Z,tL,r ,41 Location of Property , Section T.~~N-R _ W Township Mailing Address Address of Site 6S Subdivision Name Lot Number Previous Owner of Property "U Total Size of parcel Date Parcel was Created Are all corners and lot lines identifiable? x 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 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) cehti.by that aft .statements on this bonm cute true to the but ob my (out) h.nowZedge; that I (we) am ( cute) the owneA (s) o j the pnopett y dens ct bed in thi.6 inbotmation bonm, by vch tue ob a wannantyvdeed neconded in the Obbice ob the County Reg.c stet ob Deeda ab Document No. ~049 , and that I (We) pnesentty own the proposed site bon the sewage dispoz zyzs em (oh I (we) have obtained an eabement, to nun with the above desetubed pnopetty, bon the construction ob .6aid dybtem, and the same has been duty neconded in the Obb.i.ce ob the County Register ob Dee6 , ad Document No. ) . SIGNATURE OF OWNER GNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H v~ H a STC - 105 r r a y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a r~ OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE .TJZ~o ~t: ZIP PROPERTY LOCATION:_ 14, Section T,3 Town of 26C,,,/j~ St. Croix County, Subdivision 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. y 0 E 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- d 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. r' otwO_4v. SIGNED DATE ll ~ - cY - 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. i • o LA x m x ~ o N O (D ~D x' O n f (pN~ 0 a fQ o o~ o C o w c z ; 'D Do Cl) Y° -0 3~co°o~ . ~ c n• a co go O i CL 0 W-j 00D w 2 fD fD N a N p Err =r Co o 3 a O ° tp CD ~4 om? ~Ow0C° w a > > w c° ' 3 ° 2 c a o c ° N 3 Z~ F 0 ° w N O° a m M M CD w A c1D C n N Q C1 N N o D Q CD Lam' ~_wo°° 37 wow 'Rag mof p i CD v pi C m p vO h vp. ~ -~N ~ ~5D Z a 91) z aCL0 CD (D 3gCDm a D a ° a°~cC :.w=.~oao m (D N w N w a a c aco c = m o u' N o w C ~T1 CD o OL =r ° O CO (D N fD .N« N p~ ° v w = a co 0 (D co c co CD N w 1 CD 1 o co n o t cn a 0 o' It1 w CD - O O N O CD aaaa.~ C O ? N N N o O c c° (D can o ID o ~co N o N O a O o co a C -4 N; 3 c a w ~ m -BCD - d ex 0 w 3 aCD ° o ' °a O< 3 1 ~ fD • v \ i O z • 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR ARNDELATIONS PERCOLATION TESTS 115 DIVISION ) BOX 7969 HUMAN• (ILHR 83.0911) & Chapter 145) MADISON, WI 53707 7 TION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.:BLK. NO: SUBDIVISION NAME: : '/4 ME'/4 /6 /T3o N/W.For W E o T__ AJA /14 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ST, G~d~ R TIOAIAL o 5 - S Y&W 'A ic~ w.J r D/7 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER UAL DESCRIPTION: PLATION TESTS: ~esidence ~ A ❑ New ~eplace / WI)Aj ~rop~~ a~plPX RATING: S= Site suitable for system U= to unsuitable for system NVENTIONAL: MOUND: IN-G~ND-PRESSURE:SYSTEM-IN-FILLULD TAK: RECOMMENDED S EM:(optional) S DU ❑ S NU SS U S UU YS 0-2 -4- F y x III If Percolation Tests are NOT re wired DESIGN RA E: If any por ion of the teste area the- under s. ILHR 83.09(5) (b), indicate: 3 jjtrnhC~ Floodplain, indicate Floodplain elevation: 4TEXTbRE,A AJ E PROFIL DESCRIPT N _ No e i Cu .Irv#d/, w rrr1 *dn D PT T ROUNOW ER-INS C ARACT`ER OF IL WI H THICKNCBORI TOTA DEPTH r NUMBER DEPTH ELEVATION OBSERVED EST, HIGHEST TO BED CK IF BSE VED (SEE ABBRV. ON BAC 1 B- 7o 97•y lV0,4)E > 7 .2.a`BAY,$w/j'-"8 dii-tyS70'ft~„~an$' B 0 k~ A G~r .z..d 1owQr vddu C co or Stdrnrn ~t Al oxie > 7 ,I-t). s -s , z • y' srr. a.1 AAK; 5 44C :2 _0 04 B- ~k 'C3 ll r S~ G.,r 70 ' l3n ~,f Ba s r-'a t, 5 k'/ dcdlr B-3 .O~ FS-f3~ o Lc ~7' 0-.6 /xP v~r y - ry r- B SI/' An W/.bk do ~TTy S bam 5ir B. Y &3 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUII-IBER INCHES AFTERSWELLING INTERVAL-MIN. PERloot PERIOD2 PERIOD RAPERIINCHES P ~r- -4 LI P2 45 P_ P_ P_ PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal 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. 3YSTENI ELEVATION _ g JT Af l~ d)' ad 1~ E co r e-ll- Rea -,exieftsloh af_ .S~ _Gorrter o Aouse-' a->fl~' a f e ~Locallyd wr)1241 bwe w a ker- -_X ` r r - soi If ae' r/- 5 - 8ucke;j ~t t/~ef 1 _ Vr r I&~ facp,,►er, _ _ Sake mariners, Ile %A 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 (pfinw) TESTS WERE C MPLET DON: AD F.LSS, CERTIFIC ION NN MBE HONE NUMBER optional): r o _ CST NA,T\U E: s DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. jjt~)ILHR-SBO-6395 (R. 10/83) - OVER - i Se~j and S1reQ; p Tie )r 1857- AJ4TIOAJ,41- OAIU K Proper cimov k!~ S yob i I Io $ - ale : 50 ~Pe f, y`Z 07 I _ t CIO V,a ~ L cvr BANK asnQ I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY,&BUILDINGS INDUSTRY, DIVISION • LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISOV, 153707 \ Ore f►naj Re orl j e~jd LHR 83.09(1) & Chapter 145) T` IG- T_ rajIMA&S 'e LOCATION SECTION: *A16 O NSHI MUNICIPALITY: LOTNO.:BLK.NO.: SUBD S,O NAME: E '/4 Aj 4 1-5-' /T 3oN/R/8.E(or ~ I A4 Aj A N 14 A ~I COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: r S Rnc i hop la Z 01 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: POFIL - DE 2PT ONS: R i;6 T O TESTS: Residence ❑New eplace 30 ~f 0 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: (~/~'I JI(~:SYSTEM II N-FILL HOLDI(`NGTANK: RECOMMENDED SYSTEM: (optional) IL~JJ ❑U ❑J 4bJ~+ J ❑ ❑ [NU ❑J A C.Oh o % ~ P r ►n-s % X G P e If Percolation Tests a OT required DESIG RATE: [Floodplain, any portion of t tested area is in t e under s. ILHR 83.09(5)Ibindicate: Alt indicate Floodplain elevation: ONF PROFILE DESCRIPTIONS BORING TOTAL. DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, "(EXTUHE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1%11 An B ' 7.0 9 7. 51 A10AJE > 7 /.S'-, .3~BnYSw~~r~enr~i~- l6lnoi~s~=•3.7.f'$ /3h B_ tir tr orr~.a w+ /o IVer VW V b ow W2S moist fat B .O~ > ' d..8ry,ixed vdicvy,On~4n31-/~•8-/24.41~ S A.2 B- 4 4.~ "V.`!3N GSA ~.2 -es,S"•e~JK Qn ~rS=7, ...eo N~%XeclVbKftt'l3.►~-l3r►✓y/,.G •'/./'DK/3"~ B yO~ O 7 D %1 B Si On SW fik !3n It s b and o, .2.8 Ski; n PERCOLATION T STS I[-.s-f DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUIIRER INCHES AFTERSWELLING INTERVAL-MIN. PERIOU,_ _PERIO 2 PER - I 3 PER INCH , 7 y } - P1. 3 - f._. A 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 hori- Pontal 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 (A land slope. SYSTEM ELEVATION 7 x -13M joP o f, L l oc-k 62.3- rep b o ve rovr 4. Z~ AIE. c_o r fle e' o WQ/k esv rvan+ eXff✓nS14h of 5,E ~Gorl;er o L,ovse , C_2 ~,,1~. e~ w,7~ ! navy 6 /v e X~ A rs a w ed e A va,6o tree to n A e tab o;,.. 5 TS - - - a ~rrdo P-1 4d~ a c to 04 P-i 1 Pe~~. T N P-3 8 0-3 or - - v► Sulfa 6 %a Xrea (Or s°ybe~s t t i ----i Go3tvtl /orio~t I e'd/acfrr,ewi)rd 411 4 i 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): n TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATIO UM ER: PHONE NUMBER(optiona.1l: CST ATUR i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - r I i. I r ~ Ep` r a c l ~ i i l f y f ~ PAGE OF r CroS Szc~lOr, Or t~ ~Jel~ Syste~~ Fresh Air Iniols And UYsorvallon PIPS ^7 C:~II.- Approved Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cost Iron To Final Grade Vent Pipe Marsh May Or Synlh6fic Covering Mirk 2" Aggregate Over Pipe Distribution - Tee Pipe o 0 0 0 6" Agar spate o Perforated Pips Below Beneath Pipe _ o Coupling 7erminalina At Bottom Of System P(~p~ole~~t+'Inc~l `9rh~1{ L 11. J w T ton SOIL FILL DISTRIBUTIOs.1 PIPE . APPROVED S4~1IT}IETIC COVER "'"-MATEIiII~I OR 9" OF STRAW 2°OFA6GREGA?E e OR f~ARSN HAS e (o 0 F%2-ZI/2 AGGREGATE tL E V. OF FEET_.. DISTRiBUTIOM PIPE TU BE AT LEAST IIJCHES BELOW ORIGIIJAL GRADE AtJU AT LEAST?-0 INCHES BUT AIO MORE THAI) LIZ IMCHES BELOW FINAL GRADE PWIMUM DEPTH OF EXCAVAT160 FKOM OWINAL 6RAD€ WILL BE INCHES MUMMUM OFF" OF EACOATION FK0^ ca~l4laAL FjRAD€ WILL. BE INCHES SIGKJED : J r LIGE►USE AJUMBER: DATE