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HomeMy WebLinkAbout030-2035-40-110 0 cn 0 m 0) 0 d col £ o `0 0 I 3 o o F) z i p w• o W o O t1i CA n Z m N W N 4- CP (D b ri N a 3 O N O` S ~O R O h (D U) 1i Cn 7 -I v Ry rt N Q+ H U7 c O 7 j O (n O Fl. n 3 0 y N O tv rt (D N > to G a w H C N In 41 m W a' O rt x CL (ZD W 4-- ((D Z 3 al a S o rrt a o j m Z coo co p n r (n rn rn N w c F-3 , z O O O A < w z t-4 OIQ f N N fn co D 0~ (D O D N O C7 41 a~ O N cD ~ ~D N O) jn ~ ` ~ I N 3 d a~ W CL ON WO p z m z O Z Z = D a ~r W o Ij fJ O • i h N C- O N CD N n O cn ~y N N N cn m m (yam rt n b rt c <D N L-1 i~ o. w m ° 3 n (°n v a C z f° a z UI (D `t) b p a A z v ff O C/)CC ~ N 1 W ~ < w0 cD CD II C Z 3 3 z I w CD ~ I a N a o 0 3 w c o pz m 0 CD m m n. ~ I I o• t 0 I ~ I Vv I o 0 I a A o b ~ w CD A <A O N O S~ O ,'a ' 02/22/2006 11:26 AM YPar(;el 030-2035-40-110 PAGE 1 OF 1 Alt. Parcel 24.30.20.467E 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X j 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 - DEROSIER, JOHN & MARGARET JOHN & MARGARET DEROSIER 1472 23RD ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1472 23RD ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 24 T30N R20W 3.OOAC SW NW LOT 3 OF Block/Condo Bldg: CSM 6/1613 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 24-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 734/87 2005 SUMMARY Bill Fair Market Value: Assessed with: 84408 255,500 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 72,900 159,500 232,400 NO Totals for 2005: General Property 3.000 72,900 159,500 232,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.000 72,900 159,500 232,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 137 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -ST C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER J"L&24SLe& TOWNSHIP SEC. TN-R° W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of MI;R;83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ ! /PGJ,F~i£ 7'Ydtd~ ~a3 7'.3 , INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,gyp ®t -qt--s Elevation of vertical reference point: -Ial Proposed slope at site: SEPTIC TANK: Manufacturer:)Wa L/r Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: Tank Inlet _Elevation:~ , Tank Outlet Elevation: 27,39 Number of feet from nearest Road.: Front,O Side Rear, 0 / feet From 'nearest property line : ° Front,OSide,0Rear, O p~ feet Number of feet from: well Xbj&Uri- , building: / (Include this information of the a ove plot plan)( 2 reference dimensions to septic ta. 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). SOIL ABSORPTION SYSTEM Bed: k Trench: Width: Len the i Number of Lines: - Area Built•_C,~/ Fill depth to top of pipe: ~Number of feet from nearest property line: Front, O Side, Rear,O Ft.ZO Number of feet from well: Number of feet from building: 3p (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, O Ft. 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: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR IiAE•OR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan LD.Numb., ~~J ~,~~-,u• (lf assigned) 'J,~__ ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER- INSPECTIOATE: John De hosier 404 Frances St., Somerset, WI 54025 1114 BENCH MARK We,-anent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.- CST REF. PT. ELEV.: SW NW, Section 24, T30N-R20W, Town of St. Joseph,Lot#3 Name of Plumber: MP/MPRSW No.: 1"'umy: Sanitary Permit Number: Cal Powers, Jr. 1563 St. Croix 75043 SEPTIC TANK/HOLDING TANK: MANUFACTURER- LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKINNRE I r►n P OV DED: PROVIDYES ❑NO ❑Y=~: VENT DIA.WATR NUMBER OF ROADPROPERTY WELL: ALARM BUILDING: FEET FROM LINJ~ NO ❑YES NO NEAREST ~J t d 0 k~O 1 8 DOSING C AMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODE L. PUMP/S IPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: M PROPERTY WELL. BUILDING: VENTTO FRESH (DIFFERENCE BETWEEN EE M LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO E RE -0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L (,IH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORC the soil is dry enough to continue.) MAI CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SP ING. COVER BED/TRENCH - INSIDE oIA TRENCHES. MAT AL: #PITS. LIQUID DIMENSIONS PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. No. DISTR. NUMBER OF BELOW PIPES / ge(y0~ ~pygSt E V INLET . EL,V. PIPES y~ PROPERTY PERTY WELL: BUILDING: VENT TO FRESH T pF(/,i]I FEET FROM ~j AIR IrvLET: 2- ~ 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- ❑ YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE: =RS OBSERVATION WELLSDEPTH OV ER TR ENCH/RED JDE P OVER TRENCH/BED DEPTH OF TOPSOILSODDEDSEEDED ❑NO ❑YES MULCHED. ❑NO CENTER E D . . ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. 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: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO -]YES ❑NO NEAREST cif C. 5- v c Sketch System on Retain in count file for audit. Reverse Side. y SIGNATURE: TITLE DILHRSBD67101R.01/821 mo~ . WISC°nsln APPLICATION FOR SANITARY PERMIT ~a t71 LHR Sri ~~"dlu COUNTY (PLB 67) oEPRRTmEnTOF UNIFORM SANITARY PERMIT # - InOU5TR4,LR80R6MUTRn RELRTIOnS S.6 Al -3 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNE MAI NG DDRESS PROPERTY LO AT 'N ~ ` ~ ~ ~ C , ' VISE: 1 14 k 1 /4, , N. (0 r) TOWN OF: LOT NUMBER BLOCK UMBER SUBDIVISI N NAME NEAREST ROAD, AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 1Z 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. LZ Seepage Bed ❑ Seepage Trench Cl 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity X 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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): 21 Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of th p vate swage system shown on the attached plans.1 Na f umber P Signat re: MP/MPRSW No.: Phone Number: umb 's Address: / - Us- Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved d p~/ ❑ Owner Given Initial / O f7 y~! Approved Adverse Determination Reason for Disapproval: 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 s 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 - /m,4, Location of 14, SectionTN-W Township Mailing Address JQ~ ff'my)c S~noof I-- oC-~.5 Address of Site l.t~1 h Subdivision Name Lot Number Previous Owner of property ~1~~L 11.L7J1,~~~ Total Size of `Parcel 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 and Page Number CO, Z-7 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 Rester 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) ceAzi jy that aU statement on this 6oAm atce tAue to the best ob my (ouA) knowledge; that I (we) am (ane) the owne& (,s) o6 the p topW y des ch i.bed in this in6oAmation harm, by v.vrtue o6 a waaanty deed neco&ded in the 046 ice ob the County Reg.usteA o4 Deeds" Document No. ~ ; and that I (We) pusentey own the proposed site joA the sewage di s pas (oA I (we) have obtained an ecvsement, to tun with the above dens cx bed pAopeAty, 6oA the cowstAuc ion o6 said system, and the same has been duty AecoAded in the 046ice o4 the County RegisteA ob Deeds, as Document No. t 14 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED CER TIFIED SIR VE Y MA P 0 s0 /00 /=o A94V ,100 00 500 600 SCALE : I/NCN a zoo feFr CO .Vrr 410AWMAW #401~ .vn rromrsr CO.aanr See. 211, r30N- "AW f f • • N89'/5'00"/V yI~B. G8 % % ~ rao - a - /vs.oo h ~ t•!6 O 3 Sol. LOT $ / 11 Acores .60o w ti- d• 0 00' s~3 of Accrls pE ~.0 yµe'i•= fig"` /Mrs 00 ; ; 61 4 y --L" r4'A AL ell 3 n.• a too yt;~y~~oo ''~~L NE h h O ACRES , , ► -2~ o 6.31 oroy, 8g00~0, 19 &0- 0. o• a SIVA, tq&o sE% tWool to y O yN ~ jpi S 4 Vlcl .o,0r=4`•93 Lot 4 as shown hereon will be . Z'/irr M.oa Se+c. 2V T30N-/P20/Y ' 1fy A's f Rh+ •rN~ added to C.S.M.. Volume 4, Page sr &SZAN TOwNlN// / 1105 by Quit Claim Deed. et~~ / T Op p, •~o ms's NOTES w v X41 S N `.~z o Denotes 1 inch by 24 inch iron pipe monument, weight at least 1.13 lbs. per lineal foot, set marked with a plastic cap inscribed FREEMAN RLS 1733- • Denotes 1 inch iron pipe monument found. Rec.= Denotes values from Certified Survey Map recorded i Ce&Nrr .hcw:ammr r+Y/NO Volume 3, Page 799, St. Croix Co., Wisconsin. *jI wr ifa rnnr eoxArr S" zoo nfov- R20w Bearings are based on the west line of Certified Survey Map recorded in Volume 3, Page 799 having a recorded Bearing of N 0 *451 usmaaag or Lg4omzs :Lq pe4jvap sSM 4uamna4suz sills (S4osauaTw 4aa4SMTTt4S) uzsuooszM 6uo4TnOH L 04UGH PaVATH T9UgDT W -aW :aaptnlpgnS Pus aOUMo Woo-&L (20) ~j~ans o 94aOX anuaAV OMTa aXeZ 6trtK NtsWOOS 'b3SS32la • OUI 4 saofaAang pusZ OMTH OXVI E£Lt-S a a~SQ ~~GI,-S `usmaaag Lg4omzs JiRMIL sg zz o~ tiigNo~s~t~ •SeTTaq pine Suipua4ssapun 4a9paTMouX Tsuozssajoad Sm jo 4seq aq4 off. aouSUTpao UOTSTnzpgng L4unoo xzoSo •49 eq4 pus sousuzpao uoisTnzpgng udasor 049 So UMOI aq4 PUS 894n4948 uzsuooszM aq4 jo tK*q9 e ae4dsuo 3o suotstAOad sq4 g4TK paTIdmoo LTTn3 ansu 14Vg4 pus ! PaLansns puvT eq4 jo saiavpunoq aoTae4xa eq4 jo uozp-e4ueseadaa 4oaaioo pus ans4 S sz 4-9-Ed dons q.1elq4 `.L4sadoad pagzsosap eAogs oq4 paddsm pus paLatiaus ansq 14Stl4 LjT4aeo Lgeaaq op 6aOL8AanS pusZ uzsuooszM p9sa4st99g °usma9aa •r Lg4OMTs 'I •paooea jo s4uamasue aag4o pus 664 a9sa uo 4 amnTOA uz papsooei deW Latins PgTJT4,zao piss uo uMogs 94uamessa auk. 44TM aag49904 puu 04 409Cgns sz pus •ssaT ao asom 'sasos 9G•fi~ suzs4uoo Taoaed stuy •uzsuooszM IL4unoo xzoaD 04S `sPeea 3o a84sz9ag aq4 Jo aozjjo aq4 uz 66L aSed uo C amnTOA uz papsooei dsy4 koAanS paTjT4a9o eq4 3o ~ 4oq jo TTV xolsalxos~a H z f ~ H a ST C- 105 r' r a • H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z t7 a OWNER/BUYER y ROUTE/BOX NUMBERc Fire Number .CITY/STATE ~ ZIP~~~~ PROPERTY LOCATION:_ Section, T_,!::~ N,a W, Town of St. Croix County, Subdivision Lot number_ 3 • I 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 0 E I/WE, the undersigned, have read the above requirements and agree cn 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. S I G N E D (NJa 4""& lam ! 1 lj,~ ^ 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. v F s ~ s m N aog~~ v w S cnw~S c 30 l i cD lD lD 7C' O n n cD ° ~ o y~ O C O w w w ? C O C cp 7r `G F :3 0 :3 p IC A CO: S cD a lD (D h N Tai O N Aa ° N w ~ ~ m to w a o 0 o c'D (?D C n a r O CD . C W W I S > > O ° 30 0 C L j ? C< Q E5 a O C, CD w v, O =-r r ] co O p a c1D M :U CD w 4 cD C n c<D O C cn cc Q ° Con o . C n- w n= d ~ a 4)" 0) a m o f 0 (''ACC,,, CD CE o r. Q Z ID , N fD (p w Z (A I >En ~ ~ cD w w~D) G Z Z ° lD~-~ n S - cD - CL CD 0 3 0 co rn a cn D D 0 CD Q d= S 9~ =7 c w s a a C 0* m Ch 'U v 3CD u,mww~ C m ~01 CD c S o a r c~D ° S w \1p °rom 0 CD ti C.~ a co u~ 3 a w = ~ 0 0 0 =cco D w 3 m e n ti N aog ccnc c °c~ w w CD S. m a w o' m a m OL cx Cn :3 S.- CD o N O (A c m' n C a° 3 o (D O- C~ 0 0 lot a o w CD m CD 3 000 vwn= am CD Fn ° a o < 3 cp CD 4 o z 0 NDLIS )EPARTMENT Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY DIVISION ` -LIBOR AND PERCOLATION TESTS (115) P.O. BOX 7969 iUMAN RELATIONS , MADISON, WI 53707 (H63.0911) & Chapter 5. 4 i k) !.O"'A ION: SECTION: TOWNSHIP/ttrttl. CFP> t-t Y: :SUBDIVISION NAME: I .24/ /T 3oN/RzX (or) W -0' TY- OWNE S NAM MAILING ADDRESS'. 1SE DATES OBSERVATIONS MADE NO. BEDRMS.: COMM R A S R TION: PROFILE NS: PERCOLATION STS: Residence ~vew ❑Replace 9-/3 -85 7 °/3 -SS iATING: S- Site suitable for system Us Site unsuitable for system %OI'JVENT NAL: M UND: aU JIN-GfKXJNDPRESSUR 0U E:,S STEM-ILHO~LDING-TANK: RECOMMENP~D SYSTEM: (optional) f Percolation Tests are NOT required DESIGN DA;i_ If any portion of the tested area is in the ender s.H63.0915)(b), indicate: Floodplain, indicate Floodplain elevation: 84 o , PROFILE DESCRIPTIONS 124::5 F_ 3 3 Cq,I D2 30RING TOTAL- DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH gLWBER 0 ELEVATION OBSERVED HES TO BEDROCK IF OBSERVED'(SEE ABBRV. ON BACK.) I 55 y `7 s -75 79 B- r/ A) 6 P6- IC, B-3 ruo/J Gf ~8 ~ gt.l ~n-oS~1. jLl_ B-S 0/1-0 B- PERCOLATION TESTS IOUs/ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES aUMBER 1Pi6}ffS AFTERSWELLING INTERVAL-MIN. PERT RI PER INCH P_ 3 V AbAllr 15 Y-/ I? P z .3 6~ CO- P_ P. P- OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• ntal 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 . land slope. ye ;YSTEM ELEVATION 13 ' . 3 1 J i t. Z' TN 3 :VIC C.P 6 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 im-nistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 'w.E (pri TESTS WERE COMPLETED ON: - DDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 229 ~s-z -lord CST SIGN U IST RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. !LHR-SBD-6395 (R.02/82) - OVER - F 1 f f ~~Icv1J 7T q jy' fi2 r* 52,0 i " PAGE OF CroSS Secjtoo Oi- A Zen S t y 5 ens ~ ®~~dS s, Fresh Air IMsls And Observation Pips ©~~~PSLc'~ J Approvsd Vent Cap Minimum 12" Above ~yo Final Grade i 20 - 42" Above Pips _ 4" Cast Iron To Final Grads Vent Pips Marsh Hay Or synthetic Covering Mln. 2" Aggregaj,j Over Plps Distribution Pips 0 0 0 0 Too Aggregate Perfordtsd Pips Below Cooping Terminating At Bottom Of System I PDpPoSel~ ~inal grAci{ / SOIL FILL DISTKIBUTIOAI PIPE APPROVED S4WNETIC COVER 2"oFA6GREGATE-~~ !`MATERII~t OR 9" OF STRAW OR AAKSN HA'J tai OF 1z -21/z AGGREGATE ELEV. OFyalaFEET, DIS-rRIf31JTI0M PIPE TU BE AT LEASTd-,2~ INCHES BELOW ORIGIMAL GRADE AMU AT LEASTW IAICHES BUT MO MORE THAI) 42 RICHES BELOW FINAL GRADE /"WIMUM DEPTH OF EXe-AVATIOP FROM 0KI&WAL 6KAoE WILL BE INCHES PY141MUM ®E " OF EXCAVATION FROM 01Kt41MAL (aRAp€ WILL BE -Z~- INCHES ~ i r i LIC E1J SE IJUMBE R: 1 ~3 _ f DATE: