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HomeMy WebLinkAbout182-1026-40-112 _ Er * 3E m 0 CD 00 c M 3 3 Cn IF 03t O N N O O W S O `C O• O 3 CD CD O Ol N 10 C fD Z L N W FT O N A 3 CD CD (D O N d o 7C y O O OD O ^ O O N n 4, N W O O 3 R, 2 A~ y y m v O _O COD, r~ ir- m CD N a C CD c =i 3 C) O W N CD co C) C (D H a Co J N ro O CO CD N .rrJ In co rn co m D! CA ~ c rr o Z 000 vP)~\ 00 o ~ • a pnj N I'S fq fA co) 3 N CD Z d Q• C Q O N CD E W , ~ + m (a 90 42 M M C 3 CD O I a v°, o N C~ o D? o O N o. rt 03 F- :3 00 CD. F - Z7 Cl) C (D ol ro I m rL C31, v CD a a a H C/) z CD z co) c v p a A 7 C% h W Cn Cl) m N 'rt n I co M rt rrt m CD Z fD o" $ 3 z ~ b 3 ~00 n 03 N CD a ri N W N. D a i I c z a CD m I I I ~ I I A O N O I a o A D b q O 0 b O O L ti Parcel 182-1026-40-112 05/10/2006 07:59 AM PAGE 1 OF 1 Alt. Parcel M 311812-24-04-00-00-000 182 - VILLAGE OF STAR PRAIRIE Current I 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 - BENSEN, ROBERT A & ELIZABETH A ROBERT A & ELIZABETH A BENSEN 601 HILL AVE STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 601 HILL AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 9.000 Plat: N/A-NOT AVAILABLE SEC 12 T31N R1 8W SE NW COM W1/4 COR SEC Block/Condo Bldg: 12, S 89 DEG E 1324.11' TO POB, S 89 DEG E 381.72', N 1116.71', TO S R/W CO. HWY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) H, S 70 DEG W 406.06', S 973.60' TO POB 12-31N-18W VIL STAR PRAIRIE FKA PARCEL 220F EXC CSM 15/4238 Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 861/298 07/23/1997 745/390 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 20,000 169,700 189,700 NO PRODUCTIVE FORST LANDS G6 6.000 24,000 0 24,000 NO Totals for 2006: General Property 9.000 44,000 169,700 213,700 Woodland 0.000 0 0 Totals for 2005: General Property 9.000 44,000 169,700 213,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 182-1026-40-114 05/10/2006 07:59 AM PAGE 1 OF 1 Alt. Parcel 311812-24-04-00-00-001 182 - VILLAGE OF STAR PRAIRIE Current *1 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 VILLAGE OF STAR PRAIRIE O - VILLAGE OF STAR PRAIRIE BOX 13 STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 601 HILL AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 0.060 Plat: 4238-CSM 15/4238 SEC 12 T31N R1 8W SE NW LOT 1 CSM 15/4238 Block/Condo Bldg: LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 04/15/2002 676290 1872/363 WD 07/23/1997 861/298 07/23/1997 745/390 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/01/2004 Description Class Acres Land Improve Total State Reason OTHER X4 0.060 0 0 0 NO Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 z.. Form -STC-104 AS BUILT SANITARY SYSTEM REPORT c OWNER r~ l --f • S l~ ~1~~~ d SEC. / 2 T ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIONS LOT .7- LOT SIZE d PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0~~(1 l~ '2 ~3m ~ 1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ~ 0d ~ Proposed slope at site: 2 po SEPTIC TANK: Manufacturer: W e F- (K S Liquid Capacity: ~n ©Q 2n.:911 t Number of rings used: 0 Tank manhole cover elevation: p 2 6 Tank Inlet Elevation: -7-7 ~7 Tank Outlet Elevation: Number of feet from nearest Road.: ~-7 - Front,®Side 0 Rear, O / feet -From neare8t property line Front,OSide ,0Rear, O -LT 7 feet Number of feet from: well ( L~ , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) CFF RF~7L'DC~ ornn PUMP CHAMBER Manufacturer: Liquid Capacity: pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of in Bottom of tank elevation: Pump off, tch elevation: Gallons per cycle Ala anufacturer: Alarm Switch Type: umber 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 Trench: Bed: Length:1 O O Number of Lines: Area Built: .5-o a, Width: „S Fill depth to top of pipe: p Number of feet from nearest property line: Front, O Side, Rear,O Ft. i Number of feet from well: L/ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid dep Bottom of seepage pit elevation: Area B lt: Has eit r 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 sed• Elevation of bottom of tank: Elevation of ' let: Number of eet 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: i Inspector: Dated: 2 447/ G l? Plumber on job: License Number : 3/84:mj =MEN • DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ' LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. B63X 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, UUI 53707 BUREAU OF PLUMBING MX CONVENTIONAL ❑ALTERNATIVE state Pla LD Numher ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound QnPtil NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE. R S i Rt. 5, New Richmond, WI 54017- ~ BENC AR H MK (Permanem reference poutt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELE V.: CST 111, PL ELEV SE NW, Section 12, T31N-R18W, Town of Star Prairie Nerve nl PWmber. MP/MPRSW No.. County: Sitoo,y Permit Number Gary L. Steel 3254 St. Croix 83803 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY q~ TANK INLET ELEV. TANK OUTLET FLE V. WARNING LABEL IP OCKING COVER /J/ ~//JKip IP O IDED R OVIDED ` 4 V v 7 / (`~Z~ YES LINO ❑YES N BEDDING. VENT DIA VENT MAlT L.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH 1 A ARM FEET FROM LINE a ` JAIR INLET ❑YES O YES LINO NEAREST PIZ JC1 DOSING CH MBER: MANUFACTURE BEDDING LIQUID CAPACITY PUMP MODEL PUMP: SIPHON MANUFACTURER - WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. [-]YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PHOPEHTY wFLL BUILDING VENTTQEHESH (DIFFERENCE BETWEEN FEET FROM LINE JAIR I"LEI PUMP ON AND OFF) ❑YES NO NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAnaF rE Is n1ATI HIAI 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 TNO OF I HENCHES DISTR P r s clNG COVER INSIDE DIA TRNC LIQUID DIMENSIONS M RIAL: (J V PIT DEPrH (;RAVEL DEPTE FILL DEPTH ASI PIPE STR. PIPE DISTR. PIPE MATERIAL NO. DI HE LOW PIPES ABOVE COVER EI FV INI. F D DI P NUMBER OF PROPERTY WELL IWAIH NT T ) Ff 511 4 PIPES FEET FROM LIN EMound site plowed perpendicular to slope and furrows thrown upsl Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM ope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES LINO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TExruHe PEHMANE Ni MAR-K-11- ()Bti!I7VA I ION WI I I ti ti DEPTHOVEH rHENCH BED DeP T(aveH THE CH BED - ❑YES LINO _ 1:1 YES _ LINO CENTER DEP TH OF TOPSOIL SOI)DfU SEE UED ED(iE5' MULC:Hf U ❑YES NO LINO ❑ NO ❑ Y ES YES PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATEHAL StPA EPTH BELOTRENCHE SILL DEPTH ABOVE CUVEH DIMENSIONS MANIFOLD UMP MANIF OLU DISTR PIPE TERIAL N ODISiH~j; lS rVt PIPE M /`,1f Vil Al 7L h1AHKIN(, ELEVATION AND ELEV ELEV DIA ELEV PIPES DIA TION INFORMATION HOLE SIZE HOLE SPACING DRILLED COH HFCiIV VFH MATERIAL vEHncn( LIFT caRHESPDNDS unPPH(IVl PLnnis COMMENTSPERMANENTMARKERS~YES _ o ❑YES NO asERVnrIONwE Ls: NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE - - l J I ❑YES ❑ NO ❑YES NO NEAREST S ILP A i - LSketch System on rse Side. Retain in county file for audit. SIGNATURE TITLE R SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION DILHR COUNTY ~~e,,,,, In accord with ILHR 83.05, Wis. Adm. Code c-Jl. - STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 3 ?43 8% X 11 inches in size. STATE PLAN CD. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PETITION RTY OWNER FOR VARIANCE ❑ YES 1:1 NO S I S PROPERTYtC~ATION P ERTY OWNE 'S MAILING ADDRESS LOT Y. NUMBER ~/~4, S BLOCK T NUMBER ' N' R SUBDIVISIQ~ Or) W NME CITY, ST T ~ZIPCODEPPHHONE NUMBER CIT NEAREST ROAD, LAKE OR LANDMARK ~ VILLAGE - 01,. r4.d 414 0.5 II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ORE] Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check 2,3 or 4, if applicable) 1. a. New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. System System Septic Tank Onl ❑ Repair of an Y 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. ❑ Seepage Bed b. See a e Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 5✓5 ~4D 'F' VI. TANK CAPACITY / Feet Private ❑Joint El Public INFORMATION in allons Total of Prefab. Site New xisting Gallons Tanks Manufacturer's Name Con- Steel Fiber- Plastic Exper. Tanks Tanks Concrete structed glass qpp. Septic Tank or Holding Tank G El 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. Plumber's Name (Print): Plum Signature: (No St Ps) fOtP/MPRSW No.: Business Phone Number: r s ddress (Street, City, State, Zi Co ,/fjt Name of Designer: rV . c. VIII. SOIL TEST INFORMATION Certified oil Tester (CST) ame j CST # / _91 _11 CST's SS (S eet, City, State, ip ode) t Phone Number: IX.'-COUNTY/DEPARTMENT USE ONLY ` `C ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stam s Approved ❑ Owner Given Initial / D0 Sur h ge Fees p) 10 Adverse Determination X. 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 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 Perm;t 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 syster!i, 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: 1. Property owners name and mailing address. Provldr, the legal description where the system is to be installed; II. Type of building or use served: I' public is checked, indicate 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; Ill. 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 --7 commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill' Groundwater included the creation of surcharges (tees) for a number of regulated practices which Wiscorisin'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'tc the groundwater through your soil absorption s system or the disposal site used by yofding tank pumper. The monies collected through these ircharges are credited to the groundwater fund adminis- tered by the Department of Natural R'sources. These funds are used for monitoring ground- -t~ water, groundwater contamination investigations and establishment of standards. Craundwatei it's worth protecting. SBD-6398 (R.03/86) 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 inadequaoies 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 y► ~jGf j Location of Property )%W _Wk-. Section T 1 N _ R W~ „ 1/7-2~ Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ~Q Date Parcel was Created Are all corners and lot lines identifiable? L/ Yes _ No Is this property being developed for resale (spec 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, 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 I (We) eexU6y that att statements on this 6oAm ane tn.u.e to the best o6 my (ouA.) k.now.tedge; that I (we) am (one) the owneA (d) o6 the ptopen ty ded c i.bed in this .in6o4mati,on 6oAm, by viAtue o6 a wauanty deed teco&ded in the 066.tee o6 the County Re9i6tet o6 Deeds ae Document No. ; and that I (we) p4e6 entey own the ptopoa ed ei to Got the sewage poA a yAtem (oA 1 (we) have obtained an easement, to tun with the above dew ibed ptopeh ty, 6oA the conutn.ucti.on o6 said dydtem, and the name had been duty Aecotded in the 066.iee o6 the County Reg.cuteA o6 Deeds, as Document No. ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ' z • cn • H a STC - 105 r" r 4 a SEPTIC TANK MAINTENANCE AGREEMENT ►H+ St. Croix County z d O I E"BUYER Q} ROUTE/BOX NUMBER t Fire Number CITY/STATE ZIP_~~~E'~ 1 7 PROPERTY LOCATION: SE- Section T 31_N, R W, T l E ~CN7'y7° St. Croix County, Subdivision Y , 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. 0 I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v 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. e SIGNED 12 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. 'DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRh', DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 "HUMAN RELATIONS \ / MADISON, WI 53707 • (H63.090) & Cha ter 145.045) LOCATION: ,,,1 SECTION: TOWNSHIP/ Y• LOT NO.: BLK. NO.: SUBDIVI I N NAME: S C / T3J N/R 8t~ (or) W COT 11 WNER'S UYER'S NAM MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: [AWew: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑Replace A -a Z6t-e6 5-a&-s4 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYS76: j A21 (optional) A 54S ❑u au as ~u s~u If Percolation Tests are NOT required DESIGN RTE: [Fl n y portion of the tested area is in the under s.H63.09(5)(b), indicate: odplain, indicate Floodplain elevation: Ls PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SO L WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEpj7r IR, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ! e3 j ~ 0 ~ ~ ~O e 3 0 ''%ri • . Jr -,TO o l3 s. 'L . - . 4 , B- Z Cvs~ 10045 NO t0l y~ 58 ' 1-00n.~.J... ~ ~isn 95 B- p~c~i~p i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- I 3 J- P- P- _P_ PLOT9O (F, P_ P- PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distan s the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bor' a the direction ercent of land slope. SYSTEM ELEVATION q7 j~ ~ .F , - i r I I i ` f r u. E ~ E s~ z E{ 0 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): TESTS WERE COMPLETED ON: ADDRES CERTIFICATION NUMBER: PHONE NUMBER(optional): 8 >L d z z s 8 1!'~ 2 t'- - 6 Ze-in CST SIGN R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS FAR COMPLETING FORM 115 - S BD - 6395 Tr w rn~r *v ' ici -r<urate soil test, your report must include. 2 y indicate i r i,,sidence or commercial project; 3. 6 s planned; 4, sy ern; 5. ng boxe 1JITABLP -OP A HnI.DlNG TANK ONLY IF ALL _ED Ch, -)CT JV 6. PL rA low completing the pI t; 7. M K :cur test loc > scale is pr( A id ai it; 9. C I o as >rcolation to xemp- iC p y, in the appropriate box; 1 7 FILED WITH THE L C -y 30 DA'. APL r "I," TI N Ft E TIEI'LLf - Ott) co ; gr" L s Is - L sel - Si Rill' r f0i rE rr ' TOTF._ v request -3 private order to Now • ~-o -vi `j So A) Nlo It) t3 rn a o ~t ~7s--~` ---5'--~ ~ v SAo.-,t 7'J- 94