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HomeMy WebLinkAbout030-1095-90-100 7 C ju :E 7 O A CD '0 v~ n 3 3 A) N O CD f O N Z ° UVi Z C) N W ~C ~Oy• (D C) ° in C_ W O ICI S CA Q A n N N= N O O co CD , Co ~ n N 01 ` V W T C CL CD S~CO O 3 O C7 0 3 N A 7 O Q N ID CO O r~ !1 CD 0 NN ~ A CD 0 t ~ Q W a o N;2 O c ' 'CO CO N [ 0 r CA a 0 n r CO) N cn cn CD C 0 000 fA In o_ D Otq 0 o = 3F CT O D o 73 ~ m o O (D ° N m N CD M y z z D CWD o O a 3 m ID m' N l~l (D N co G N' CD CD W (a a 3 7 z CD (6 O = p z m in a n C ij v z o p o o. z -i w co M m w N a z o' 3 y g 0 (0 z 80 ° r m° Er D o~ ~-o n a) CL n O En O. O O Z C Q . 7 S 3 O C= h N CD O N CD N j O O N N N = 7 N ~ 7 a ? n (n CD CL N O (D C2 O f CD VC x N "D CD Cn O O 3 7 Q a y' CD NW N S CD ~ w CD 0) O= CD 0 CD CD o a N d N CD L 7 N N ~N CD Sa a CD 0'0j av N C ~ N CD N N O (D O S COi~ y 0 w 3 p O a 69 ° O ti b C=) CD ti Parcel 030-1095-90-100 02/25/2005 10:22 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.348C 030 - TOWN OF SAINT JOSEPH Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner R & E, %CITICORP MTG INC METTLER * METTLER, R & E, %CITICORP MTG INC 449 ROLLING HILL LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 449 ROLLING HILLS LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.500 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NE SW LOT 1 OF CSM VOL Block/Condo Bldg: 6 PAGE 1514 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1014/64 07/23/1997 860/182 07/23/1997 724/580 2004 SUMMARY Bill Fair Market Value: Assessed with: 5606 241,800 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 81,600 156,300 237,900 NO Totals for 2004: General Property 3.500 81,600 156,300 237,900 Woodland 0.000 0 0 Totals for 2003: General Property 3.500 47,900 130,700 178,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 550 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER NeLyo," TOWNSHIP SEC. 3_ T 3v N-R W ADDRESS Al-21 ¢cx:XCtIor ST. CROIX COUNTY, WISCONSIN fir, w~c / SQ~c:Qi SUBDIVISION uoL a P LOT SIZE _3e-_ PLt VIEW Distances and dimensions to meet requirements of IZBR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~Qecd6ad~~i7ev Rc~ l it f' /5 Lo ®pa.J~r uesra. too J'Vorm 3 Qnd•~'" No w ~ r INDICATE NORTH ARROW .1 , BENCHMARK: Describe the vertical reference point used f ~LoTs>ak® GorIA Elevation of vertical reference point: (dProposed slope at site: SEPTIC TANK: Manufacturer: 4-4er_._~~rc_ Liquid Capacity: 00000 _ t Number of rings used: l Tank manhole cover elevation: /per jg Tank Inlet. Elevation: tOS-, q-~ r Tank Outlet Elevation: `C,s-'61 r Number of feet from nearest; Road.: Front ;O Side,0 Rear, O g' feet t From nearest- property. line Front,OSide,QRear, O lA x, feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RR.R RRURRRR CTnv PUMP CHAMBER° rv/14- 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: X Trench: Width: / g LendEh : -=X' Number of Lines: Area Built: 6.760 Fili depth to top of pipe: ya` Number of feet from nearest property line: Front, O Side Rear,0 Ft. 5 oQ Number of feet from well.: - 90 Number of feet from building: (Include distances on plot plan) SEEPAGE PIT rV/# 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 P/.q 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: h- 63A8 3/84:m3 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING R71CONVENTIONAL ❑ALTERNATIVE State Plan LD. Number ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound a~~9nedl NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE'. Jeffrey M. Nelson R. R. 2, Box 266A, Hudson, WI 9-F~ /0~p BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN'. REF. PT. ELEV.: ST-REF . PT. ELEV.'. NE SW, Section 32, T30N-R1 , Town of St. Joseph Name of Plumber. MP/MPRSW No.. Cnu my Sanitary Permit Number Michael Wilson 6388 St. Croix 75002 SEPTIC TANK/HOLDING TANK: MANUFACTURER v LIQUID CAPACITY: TANK 7~0 T ELEV_ TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ~ PROVIDED: PROVIDED: BeoDING 7/ tr1 0 El YES ❑ NO ❑YES ❑ NO VENT DIA.: ENT MATT JHIGH WATER NUMBER OF RO D'. PROPERTY WELL'. BUILU11 G: VENT TO FRESH ALARM FEET FROM LINE //a ~ /,q IAIR INLE VYES [::]NO ❑YES ❑NO N_E_A_REST D&ING CHAMBER: j/ MANUFACTURER BEDDING: ~ LIQUID :APACITV P IMP MOU -L PUMP; SIPHON MANUF A(;T l1HER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPEHTY WELL BUILDING (DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET: PUMP ON AND OFF) ❑YES ❑NO _ NEAREST--> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing u 'IT UTAME TEH MATE HIAL 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 NO. OF =111SIPIP,I N(COVER INSIUE UTA API TS LIQUID BED/TRENCH TRENCH DIMENSIONS ~'1 " PlT DEPTH C 17". LL DLPTH FILL DEPTH DISTR PIPE UISTH PIPE DISTR. PIPE MATERIAL NO )ISTH BELOW PIPES ABOV OVER E INLf1 ELEV END NUMBER OF PROPERTY WELL. BUILDING: VENT TO FR SH 11 FEET FROM LI" alR # LL NEAREST--_► MOUND SYSTEM: f v 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 PFHM ANf NT MARKERS OHSEH VATIQN WELLS DEPTH OVER rRENCH eeD DEPTH ovFH TRENCH BEU uePTH of TOPSOIL )F u ❑ YES ❑ :NO ❑ YES F-1 NO CENTER EDGES IS11 UFU MULCHED ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING (iHAVEL DEPTH BE LQW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV. DIA. ELEV. PIPES CIA - DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DHILLEDCOHHEC TLY COVER MATE RIAL VERTICAL LIFT CORRESPGN DS TO APPROVED PLANS [:]YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. =NU MBE R OF PROPERTY WELL: BUILDING: EET FROM LINE ❑YES ❑NO ❑YES ❑NEAREST Sketch System on Retain in county file for audit. Reverse Side. SI NATU E' TITLE: DILHR SBD 6710 (R. 01/82) r .i~ wleconeln APPLICATION FOR SANITARY PERMIT D I LHR PLB 67 J Q COUNTY oEVRRTrnEnTOF ( ) UNIFORM SANITARY PERMIT # nmnt~ InOUSTRV,LRBOR&HUMFInRELRTIOnS -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 PROPERTY OWNER MAILING ADDRESS PROPERTY LOCAT N CITY: )V A9 1/4 W 1/4, S , T -in. N, R E (or) VILL E: ow S T. T 4 LOT NUMBER BLOCK NUMBER ISUBDIV18ION NAME NEARESTdM22UP LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: f~_k 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. ,54--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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber _ Holding Tank capacity Manufacturer: L~1 v~ N L 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): 643- 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): Signature: /MPRSW No.: Phone Number: Plumber's Address: Name of Designer: r L. S-VOO/ bt COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: El Date: Disapproved El cull/ CO~2,~ ~as i9, a'g Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-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. f APPLICATION FOR SANITARY PERMIT S T C - 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 LTE FF RE T M r SN SA D Location of Property N ' S 3 14, Section 3 Z , T ~ N- R W Township 1 r Mailing Address R c~ BO AC 2 (P fP /4 Nu~Sz~ 0 ~s -'4 © r ~v Subdivision Name Lot Number Previous Owner of Property G e &,q Ld ZC>i1A,)j-o,.j Total Size of Parcel 3.5 D Date Parcel was Created Are all corners and lot lines identifiable? v' Yes No Is this property being developed for resale (spec house) ? Yes t/' No Volume and Page Number -596 - as recorded w_th 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, a certified 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 1 (We) ceAti6y that aU statements on this bonm ane thue to the best of my (ouh) knowledge; that I (we) am (aAe) the owneh.(s ) og the pnopwy desc Libed in this in6onmation 6onm, by viAtue o6 a wa ftanty deed neconded in the 066ice ob the County RegisteA o6 Deeds as Document No. ? and that I (we) L106, z. pne6enfity own the proposed site bon the sewage dL6poaa~system (on I (we) have obtained an easement, to nun with the above dedcAibed pnopexty, bon the conbtnucti.on o6 said system, and the same has been duty neconded in the 06j,i,ce o6 the County Regizten o6 Deeds, as Document No. S U OF OWNER SIG ATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED Ul y y STC - 105 r' r ` y SEP'T'IC TANK MAINTENANCE AGREEMENT St. Croix County d OWNER/BUYER Qe Ff RrC M N~1 ~uJ _ ROUTE/BOX NUMBER_U__'oA_~j~_.9(e(A Fire Number CITY/STATE ffuo~5:.Jf_► ZIP ~~DI(p PROPERTY LOCATION: ME SUJ ~4, Section .L, `l' 3Q N, R__!I__W, Town of 'b p e Qh St. Croix County, SubdivisionC,S,M, %&L#<) PC S1~1, 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 purer. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system., Sr. Croix.County residents m Y 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 newsystems 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 I/WE, the undersigned, have read the above requirements and agree n to maintain the private sewage disposal system in accordance with 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 -~I ~ 8S St. Croix 0ounty Zoning Office P.O. 3ux 9f1 Hammojid, W1' 54015 715-736-2231 or 715-425-8363 Sign, date and return to above address. V c Z N w ° w E ° c:2 c~ co o . L ire 0- i~twr 0~ c~ y O N~ N O O C C C V) O) o C 0-0 V to O 0) 0 L: U) C ~ ~ V m E N t cd cn w C O .y i N 3 _C p C u) ~ ~2 O v) C7 3 p .N. ~ U W O C cv c co 0 X 3 0 oa 0 3 ov v~Wcv`>>m cEm O (D ~ Q _°fw= o o, v, 0,2 0 ,Z O :o a~ cts cm.0 O V ~ N L N .C O c W ~•EM~IDa ~0m (D E (D '0 (D (n Q Q E ~ CD 0 (,Z ~ 0:2 0 O E U y Q v'3 .U3O Mcc° c`~1 U) Z yOC?&- oai 0 a m` ~~~cxZa vi0 v o Iw:r 0 co 0 cu CL -C z e} co Q o y 0 p 0) v) O O C7 Q a a N co (Dir C C( C O 0 y M c C cc m N 03ca>,~ =cocv ~ C: ~ Z . 3 0 C C t O O E a)O c0 O CY) ~ c t O i all M v) 10 ~ N - O c0 CO cu 3t --0 3: L: 0 U) co - cm C O O O C a. O L' a Q >+Y V1 ~E C 0 C VZ; p .0 C W .c t a E .0 L- COQ>jCD c 0)4)(D3 `o r-~3_ m m° e oC cm = y J D o 4 C r J ~ p ~ O CL fl O 77~y n~ • ~ ~ vp ~ ~$q11 4 G J h i 046 r j u a+ ~ o ` U t,y J a all 1~ \ cf y r r 4Ce . w C a z r s ~ a ~ V 3 S ~ i W q~ 4i ~ -U o p O c7 3 s ° r I~ V Q cs i ~t~N~ c IN DUST OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUST~iY, DIVISION LABOR ANA PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP ~Lr, LOT NO.: BLK. NO.: SUBDIVISION NAME:(! s. /.r/arua ~2 /T3aN/R/ ~co . -kE Tvs ! 1. Atx PG si COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: -5b Civ i ~t l so # S~,Lr t v USE DATES SE RVATI DNS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER LATION TESTS: Izesidence i/ New ❑Replace ey- qx w C D• O ,i RATING: S= Site suitable for system U= Site unsuitable for system oeia a CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 5dS ❑U 9S ❑U , SEA ❑S ~U ❑S ~U Cbu~ ox~ / /d''~ If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /w P FI DESCRIPTIONS BORING TOTAL/ DEPTH TO GROUNDWATER-'4l^-:e CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS ELEVATION OBSERVED EST. H GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 7 /c , Y' T s S' 81/ Ida l , /S .f ; / ~d fir- C A" 64- B- 4 e, ~0`.~. ~ ~ 4",,.1~- 7 ~ • ~ / , n ~ . ~j. ( p!n (fir C S B-3 9.0' /03 e_ 1;// an /08 NA 61. /s 5!S 6-11 Coo- e5 B- If [11-5" laffIf A 14 g- 6 6+- Al orQ- `J off. n -5. S- B- PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1NQPWES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 P RI D 3 PER INCH P- y/' o 2 -'::=3 -P- S.3' o X P--3 4. ' Q 3 P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the ions o ita s as. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location pl*laG~thel5[i ace elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION f 3 Nlf' 9 r w_ E n a I ~ f [ ~ ` ~ 3 1 /ae'w►•r /i.ilf'~• ~ ' ,F~ ~ ,:3"'..`~ IJ ~""J a~_..._--1 3 i ~ { 7 E ~ ~ ~ l f i kie, o- E ?1' I f _ _ O) J16.~.~ (e- w r` -fie A [a 7 F e Am -c 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.. A4 .e. ! t - o Be ,v~i►-Le- o „~L f3 Z -OZ O Hi~~f o.~,, of-k" / A R~Qu•~ ~i. s,! WL< NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): It so Cc%~i. 6 15-99 1 CS TUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - R:fi 1 ° - - 6395 a. } T X39 't' 4 AI _L -VWC WW , K N°EPAR'TMENT OF NDUSTRY, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION ABOR AND -,MAN RELATIONS 1 1 PERCOLATION TESTS (115) P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 53707 S TON: WNSHIP~~~^nrion~ LOT NO.:BLK. NO.: SUBDIVISION NAMEiC K CA ZV u /T3dW/RI ~(o TO r ZA s :OUNTY: OWNER'S BUYER'S AME: L ADR SS: CI-v Q s s s , S~a~6 'SE CO DATES SERVATIONS MADE esldence O ' .UNew ❑Replace STS: C .7- :ATING: Ss Site suitable for system U- Site unsuitable for system TMr ONVCERNUCIRI UND: IN.(Th6Ui r - FILL HOLDING TANKT E COMMENNDED SYSTEM:(optional) r s au ~s ❑u OS 12q, n s Ru 167, r I Percolation Tests are NOT required DESIGN RATE: ender s.H63.09(5)(b), indicate: It any portion of the tested area is in the Floodplain, indicate Floodplain elevation: P FI DESCRIPTIONS DUMBER IORING DEPTFIJbF T 4j+ ELEVATION PTH T GROUNDWATER.LAICM& CHARACTER OBSERVED OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH 3- 7 E GHE TO BEDROCK IF OBSERVED (SEE KARRRV N ON BACK.) On cl- /S j 1,6 6'_ 3-1- IP 3-3 9,0" /C3.I' - - 46 e.5 /0 ve, if . ,S' d?rs S; S car Cs 3- PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TEST TIME DROP IN WATER L VEL-INCHES vUNBER 40WA4E9 AFTER SWELLING INTERVAL-MIN. RATE MINUTES P- y. IF Q P RI D 1 P RI D TRIOD3 -7. PER INCH P s 3 to < P. 14 . L O G P. ~ 3 P P_ ]EEE .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• ,ntat 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 f land slope. YSTEM ELEVATION /O Ali f /f i._ 'i ( + I i I 7 ' R 75" 'CO Ate, Z~v t rat ~ ~ ~ M i ~.l~~~ Tb'•. y I O lip 7i?s t Y061.3) the undersigned, hereby certify that the soil tests reported on this form were made by! e 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_ /tlo JA?- ( Cwf- v ~e Mime. vwti[ Q Z- -~Z Ni.o.. ,~yy et-~4.•as / d />>'t ut:it•~v~7sr,~fr`, DAME (print TESTS WERE COMPLETED ON: ADDRESS: ell? r CERTIFICATION NUMBER: PHONE NU MBER(optional): CS TUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L nit HR.CRn~~oa to n-oat