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HomeMy WebLinkAbout042-1085-70-010 0ca0 3.00 ty O O I ~ C 1 ffl o 1 ~n w m vN, o ! m °a• C7 U] C] 3 C " IV N FBI ~°s O N O W t a a s 0 ~ a m 00 10) CL a ro 0 rt N FNI c m coo n 3 W o E • (n by 3 Z rt HIV H W ° o o p v, rt (IS m ? y am a w I. (j m 0 o I V, 9 ° N p = W I L ? T l~ { 00 00 ~ i 4 O CO) a00 00 ) 00)i p 3 rr Q H ooo`~' (D ON H H U)V\l ~ O ~ Cr1 (h , ~p 3 y , c n Z n vi p 0. 00 cn Z w z O (D @ O D a 7 D t rat ~ o CD to lfr. n OQ m v\ o Q ~l (D CD fC N _ ~f H C CD fD uV rt W I w ~p a Z 6 `-q U! ~ p A Z n A z 0 a m N oo~ m<o a(D ~z z °o co y m z C w I m a a o c I ~ o c I ~ I w CL t CL R 7 I.t fi O I 2 oc I ' °O I A o CD All a Parcel 042-1085-70-010 02/08/2007 09:53 AM PAGE 1OF1 Alt. Parcel 31.29.18.479B-10 042 - TOWN OF WARREN Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/21/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - CLAPP, WILLIAM H & CAROLE A WILLIAM H & CAROLE A CLAPP 995 65TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 995 65TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 9.970 Plat: N/A-NOT AVAILABLE SEC 31 T29N R1 8W PT SE NE & PT NE SE BEG Block/Condo Bldg: E1/4 COR SEC 31; TH N00' E 490.63 FT; TH S79' W 627.36 FT TO A CURVE WHOSE CHORD Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) BEARS S67' W 248.32 FT; TH S55' W 11.31 31-29N-18W FT; TH S00' W 372.47 FT; TH S89' E 855.08 FT; TH N00' E 106.19 FT TO POB. Notes: Parcel History: Date Doc # Vol/Page Type 11/21/2006 839275 QC 07/01/1975 327877 525/359 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 01/10/2007 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Parcel 042-1085-70-000 02/08/2007 09:53 AM PAGE 1 OF 1 Alt. Parcel 31.29.18.479B 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/21/2006 00 6 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RETIRED CLAPP O - CLAPP, RETIRED Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W 10A IN E1/2 SEC 31 COM Block/Condo Bldg: S099.6 FT S OF NE COR SEC 31, S 597.8FT, W 855.05 FT, ;N 318.2 FT, N 63 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 176.5 FT, N 78 DEG E 710.9 FT TO POB 31-29N-18W ASSESS WITH P488B (NKA 042-1085-70-010 4796-10) Notes: Parcel History: Date Doc # Vol/Page Type 07/01/1975 327877 525/359 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 01/10/2007 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 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 TOWNSHIP SEC. T N-R W (I V ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G9 ~l~k"!/l If ,ro, 5 7 ClerA out- - --_U~ 6 c4 " 3 I/ ?CAN /z x 5q y 3 pie 19, INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: 5EPTLC T lancre `:4 Liquid Capacity: fames. Number of rings used: Tank manhole cover elevation: X08', 3 Tank Inlet .Elevation: Tank Outlet Elevation: A~11 7y Number of feet from nearest Road.: Front 10 Side Rear, Q 60 feet i From !,nearest- prop qty line Front 10 Side,(aRear, O 7 zt~p / feet Number of feet from: well > p , building: ~?S t ,.nclude this information of the above plot plan)( 2 reference dimensions to septic tank) W "14 Ant "V1 - 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. E Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed:!!/ Trench: Width: Len the Number of Lines: _2,_ Area Built:-WZ~° Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, 0 Rear,0 P't Jam` s um a feet from well: ~ l4'D help i~f n er of f from building: (Include distances on plot plan). G .2o Y' SEEPAGE PIT 'k c o7/ 6 *A /0, 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. i Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: 8 zo'o Inspector: ~4xf Dated: A/Agh Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS ' PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 1 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME PERMIT HOLDE L` JADDRESS OF PERMIT HOLDER: INSPECTION DATE: / --7? BENCH ARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW Nn.. County Samtary Perm,, Number. L-Adpl Z) F ea T jx Y- S7l filed ` ~D Sly SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOU10 CAPACITY. TANK INLET ELEV.. TANK ~LE~;~WARNING LABEL JLOCKING COVER e ~K S PROVIDED PROVIDED V ~J__' 7YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATT HIGH WA7EH NUMBER OF ROAD: PROPERTY WELL: BUILDING. VENT TO FRESH it /j ALARM FEET FROM LIN t AIR INLET. YES ❑NO i/J ❑YES ❑NO NEAREST _ d DOSING CHAMBER: MANUFACTURER. JBEDDING: JLIQUIDCAPACITY PUMP MODEL PUMP; SIPHON MANUI AC T 1111111 WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [-]YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: --]PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH )PEHTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET. PUMP ON AND OFF) ❑YES ❑NO _ NEAREST 0. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I T11 JDIAMITEH IMATI 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: BED/TRENCH WIDTH LENGTH NO. OF DISTR PIPE SPACIN1'11 COVER INSIDE OIA =PITS LIQUID j / , THFN EHIA~~ PIT DEPTH. DIMENSIONS G R,V, EL DEPTII FILL DEPTH UIST H. PIPE DISTH PIPE DPIPE MATERIAL N ISTH NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPE ABOROVER ELL FV. INLII I ELEV. ENUy P ES FEET FROM LI q NL _ AIR INLET. t/ r+rG JISTFL ~y N_ EAREST----►d~(/ 1.3 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 PFHMANE Nf MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED JDF~EPT H O V FH TRENCH BED JDEPTH OF TOPSOIL DDE IJ SEEUFD MULCHED CENTER GES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LA TEHAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING CHILLEO COHRECI LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT M ARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY ]WELL BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. JS ATU E. TITLE DILHR SBD 6710 (R. 01/82) wmconsln APPLICATION FOR SANITARY PERMIT 1 • (PLB 67) 6L ZCOUNTY rp,:., menTI UNIFORM SANITARY PERMIT # ~ ..'1DUTgV, lgBOq 6 MUTgn gELRT10n5 w ~Q 4/6 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAI ING ADDRESS l C,~ s~. G? u_~ PROPERTY LOCATI etT-,t_ SE 1/ /4,S • , T 1 NR IS, E (or b r8E: TOWN OF: LOT NUMBER BLOCK NUMBER UBDIVISION NAME NEAREST ROAD, L STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED oYa - do~s_ i1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: LLB 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. ELYSeepaye 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 - El 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: L } IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound El 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): o S- V// 5- E~4'~Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. e of Plumber (PriRZ _ nature: MP PRS No.: Phone Number: P mber's Address: _ Name of Designer: c. E ~RY+ t> S`4 r COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date:: ❑ Disapproved ❑ Owner Given Initial Xewl-z Approved Adverse Determination eason 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 i 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. i 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 T0- Location of Property f It, Section , T .2 P N - R W Township Mailing Address" Subdivision Name Lot Number / . - Previous Owner of Property L„" ,-o'n Ja cza0gou Total Size of Parcel / Cl c r es , mor L d r Jws s - Date Parcel was Created j -Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes ✓ No volume 9,.-6 and Page Number 1 5 ~ 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 Nap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) cetti.6y that a t atgee nts on th,.a 6onm ane true to the best o6 my hnowtedge; that I &Q am the owneh.W o6 the pupenty dea cA i bed in to in6onmati,on 6onm, by vchtue o6 a ukVvcanty deed neconded in the 066ice o the *County Regiaten o j Deeds as Document No. 3 a ? b' 7 7- ; and that 1 r(e paeaentey own the proposed cite bon the sewage pos Ayatem (on I (we) have obtained an easement, to nun with the above deachibed pn.opehty, bon the conatnucti.on o6 6aid 6ystem, and the same has been duty neconded in the 066ice -)~o6 the County Reg-i.aten o6 Deeda, as Document No. -v- ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 0 / ~r/ DAT SIGNED DATE IGNED i JO8 N0. SUP VE Y" AM P F0k Description: Y` '-:~r• That certain parcel of land located in the east one half of Section 31, T 29 No R 18 W. Town of Warren, St. Croix County, Wisconsin further described as follows: BEGINNING at a point on the east line of said Section 31 a distance of 2099.6 feet south of the northeast corner of said Section 31; Thence south along said Section line a distance of 597.80 feet; thence West a distance of 855.05 feet; thence North parallel with said Section line a distance of 381.20 feet to the 'oenter of a Town Road; thence with said rgad N 630 08' E a distance of176. So rest; ~thence N 78 54' E a distance of 710.90 feet to o~ point of beginning, the above described parcel containing 10.00 acres, more or less. Based on a survey made by me May 8, 19750 i Registered Land .4 q rveyor S_722 y ? } it } • r e ~ r o INDICATES IRON PIPE STAKE BASED ON A SURVEY MADE -5--/ 6/ 75 DATE 7-T e•$CALE 1-72-00 07AWN ~ f JAMES R. GRUBB Consulting Engineer CHECKED LL-0 C-31 -Z9-/F z H ST C- 105 r a SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County 0 z d a OWNER/BUYER 9& ~ a t-3 r~ ROUTE/BOX NUMBER- Fire Number CITY/STATE 9-~1.~ ZIP PROPERTY LOCATION:_,QE , Section T N, R W, Town of Gl/~il~fl~ 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 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 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 z 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 ED -f-DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. . c m x ~ x m c m N 3 0 :E 3 0 8 ma~~c~o o~~<oo m 7C A 0 m to C 0 (O ,Q O C O W N C Z 7 O= 3 a 0 0 - c CD 'a m 0 o wo~mocc CCD t, m -0 iF CD CO (n w Q (O 0 ? (D -w > > CO 0 a COD o 3 a o° m w om? coowoco c~ um 6* EL 0 w,Y,» N~mwwcn 0 w m ° ~O oaf' -CD -ono ,vv D <CN v:t Qo CD CO O n O_ w c O Ll c n c w n w _ Om 06 . ID O N CD N+ w o aU' m m m N =Dr (OD. cma =~o=or~ f11 ? w m CD CA w a ? a cp N w a c o (D m 3~s vn Wm u° m (A _ ac w -m-t o -1 010 1 elm FD-r,- 9 o a i ~ A a0 f cco c aw o m w 3 w m - » am v, CL a.. a0 - (D Q. =r0 C O N C <G m y~ n m'mc 0t°a oN~° g CL o 0(o CD CL ao a ?c =r 0 -0 0 o 3 0 ,.o l wan~ Mo3 3 CL ° < vi z » e ° o I i DEPARTMENT OF REPORT- ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS - \ 1 MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: WNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME: s '/l/a /Ta N/R y E (r► W {r e ) COUNTY: OWNER'S/0tnEfF6-4A-PAE: MAILING ADDRESS: X t w ~p~ 3 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: [7F ESCRIPTIONS: PERCOLATION TESTS: ©Residence ~lew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system K MDSEIU L: MOUND: IN-GROUND-PRESSURE: SYSTEQM-IN-FILLH(OLDIcNG ~TANK: RECOMMENDED SYSTEM: (optional) El S L=JV IT El! UJ U F ercolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the er s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL IT THICKNESS, COLOR, TEXTUR , AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / ~'.2 York 7 / ~A /f• e4 .GG B- z A/5- r , AU It, 'Z g c ~ B- y7, 2- S'lln.2rr er w 7,7 MS B- a, y s , s'' s s' g2 r /3,01 e- 1 f ' B S- 8 t L 7 3' / 3 f3 .3'-s/ w ' - ce6 c s/a, r w s w PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D 3 PER INCH P- 5U AppHC / , P P- P- 'Z' 21 He 3 s ? d P_ P_ - b H C i 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- 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. SYSTEM ELEVATION rsoo A. _f t E , a ~ E , E E f i I ` t - _ . w ,.r. _ IN E 3 E E 3 . , 1. 7 oy 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. NA E (print): TESTS WERE COMPLETED ON: v I d. CO Y &IFY ADDRESS: _j I CERTIFICATION NUMBER: PHONE NUMBER (optional): d eGe wx S o~ 3 3 7 - r CST SIGNATUR : DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR OMPLETI-" ~ FORM 116 - SBD - 6596 To ho ~ ra- mnlete and arcurate soil test, your rep 1. t" I d-rir n; 2. T mug ly ndicate whether this is a residence or commercial project; , is or commercial use planned; 4. tst>-rn; . boxes. A SITE IS SU'-!-A"`! FOR A HOLDING TANK ONLY IF ALL LED OUT BASED ON ' :'ONDITION; 0, . I own here for w ~ tions and completing the plot plan; 7, c urately loc is. drawing to scale is preferred. A is d; 0, cal elev arly shown cd are permanent; 9, Cc to elates, lata, _ is i test exemp- 10. 11 lain, elevat' in) i k. in riate box„ 11, t addr-,.. 12. '1 e as r# MUST BE FILED WITH THE LC- " 1 30 DAYS 0 iN. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS :gores _L sl c pi TO THE j may ~I - - J -c. t 1 1 ~ cy: r x 1 1 i ~ 1 U4 A 4-0 1 R Q ` 7 9 . 1~ ~ rr t A I v> 4 ~ ~ti ~ a c I 7V At ; , two 4 i ~I MINIMS tI 1 ~ X 3 Cv i i (n I Q ~ ' I i , , z 1 ~ ro x ~ C~x C4 o ~ ~ f fi C1 ~ o ~ o 1 7 A t