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X ni O° N fi o a~ Qv D)3 I ° ED m v av 7 < a 3 o 0 oc°D 0 ° ° CCDi ti CL '0 CD ° o A a A o N O ti Form -STC - 104 * AS BUILT SANITARY SYSTEM REPORT II~ I OWNER oYl l P. SCPI~S / TOWNSHIP ~j- -l~j ,o SEC. T W ADDRESS 4QZ ST. CROIX COUNTY, WISCONSIN Day/ l~ I~hG~ir~ ~f/T s elo SUBDIVISION LOT LOT SIZE` PLAN VIEWS eo, Distances and dimensions to meet requirements of I1HRR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ie, q6 ,t `hes 0 61 6 VI T 6 e 1000 I Ga f. o s PST ` 60Ra by'j :'>e i b INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference ,o ipt used ~j ~ cONc✓ ~C 't 10M O~ (9& ✓k~~ Elevation of vertical reference point: /L90 Proposed slope at site: SEPTIC TANK: Manufacturer: w,ee Liquid Capacity: (a / r Number of rings used: Q Tank manhole cover elevation: S S~ Tank Inlet Elevation: (01116 Tank Outlet Elevation: rah r Number of feet from nearest Road: Front,O Sideo Rear, O y(J 0 feet .From nearest property line Front 10 Side 10Rear,O 0 feet Number of feet from: well ,f building: /S-11 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER nJ~A 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: r1 Length: Number of Lines: Area Built: qAO Fill depth to top of pipe: rckti5gs -,on, 3(J"7 e GZ~L. Number of feet from nearest property line: Front, O Side, ® Rear,O Pt . 3 i Number of feet from well: /00 Number of feet from building: (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 ~U 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:. ` ' saw Dated : X41, 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 BUREAU OF PLUMBING MADISON, WI 53707 ~j : 19 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number ' ❑ Holding Tank El In-Ground Pressure ❑ Mound of a-9ned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: /70 John Klescewski R. R. 1, Box 183, New Richmond, WI 54017 -'~`sj~~• D~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: \ REF. PT. ELEV. CST REF. PT. ELEV.. SW SW, Section 29, T30N-R17W, Town of Erin R,rairie Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number Gaylord Worrell 5285 St. Croix 64923 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID A A 1 Y. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ~p PROVIDED: PROVIDED: No I . L L YES ONO DYES ONO BEDDING: VENT DIA.: VENT MATIL HIGH WATER NUMBS OF ROAD: ILINROPERTY WELLBUILDING WENT TO FRESH ALARMFEET FRO~N AIR INLE VYES ❑ NO 1. ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. 1PUMPMODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: rMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. JBUILDING. JV(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ONO NEAREST III SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILI d, I H DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) I MAIN CONVENTIONAL SYSTEM: ~ BED/TRENCH WIDTH JLENGTH NO DISTR PIPE SPACING COVER NSIDE DIA #PITS LIQUID /Y TIROF ENCS. / M ERIAL• PIT DEPTH: 1~ IT DIMENSIONS U `JI GRAVEL DEPTH FILLDE T DISTR. PI P IF/- E DISTR. PIPE DISTR IPE MATERIAL: TR. UMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE C VER. ELEV. INLET. ELEV. END P LINE: _ / AIR INLET- FEET FROM 77- l r 1/. NEAREST-~ 490~ U, 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED. CENTER. EDGES. DYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.. ELEV.. PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES ONO COVER PLANS: DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ONO OYES ONO NEAREST Sketch System on Re county file for audit. Reverse Side. SIG AT RE TITLE: DILHR SBD 6710 (R. 01/82)^. i w ILIsconsln APPLICATION FOR SANITARY PERMIT D I L H R COUNTY oEaRRTmEnTOV (PLB 67) UNIFORM SANITARY PERMIT # InDUSTRV.LRBOR 6 HUn1Rn RELRT10nS / ,l n 2 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ec PROPCRT7 O A I CITY: I 1 /4 , /4, S , T 0 N, R 12 E (or W V L E: &17 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE R LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 2 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair X, Replacement Soil Absorption System ❑ Revision ❑ Privy EJ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 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): REQUIRRjE~D (Square Fkt) PROPOSED (Square Feet): 1 / Z 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): Si~ yt MP/MPR3W"No.: Phone Number: .i~lct C' Ct> 5~ S" (~/5 )a9Y 360 Plum Address: Name of Designer: r cj". COUNTY/DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: ❑ Disapproved { -j ^7 .~j ❑ Owner Given Initial (~C/~ / ~ OC / a S Approved Adverse Determination Reason for Disapproval: I 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. 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 TO~ b ~aYe1^,1@.SCe~ S [~1 Location of Property SW ~4 SW ~4, Section aCA__, T 30 N - R L_ W Township F„r'~V` Y1 E Mailing Address 11 D & 3 ~w ~R c1~ ►.o KA , W i SOLOh 544q Subdivision Name Lot Number Previous Owner of Property S e °1- So may-CL YoLtlctK Total Size of Parcel -ine. 37 1 dF~~►E. S_SLtK y(A jS~'~" tl~ e w.y isww 6+ S0--0&16vn. A9, T` ON Ra»9e 17 W Date Parcel was Created Are all corners and lot lines identifiable? y Yes No Is this property being developed for resale (spec house) ? Yes No Volume C;3rj and Page Number 39-3-- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: V 1• Warranty Deed 2. Land Contract 1. 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. PROPPRTV OWNER CERTIFICATION **(We) eeJUti, y that a22 statement6 on this ~otm ate tku.e to the best o~ If (out) k.nowtedge; that i (we) iW (an.e) the owneA (s) o A the ptopeh ty da ch i,bed in .th.us in4o&mati.on Aotm, by viAtue o6 a waA arty deed teeotded in the 064ice ob the County Regiz ten oA Deeds as Document No. 33 ° ; and that iP (we) pAe,sen ty own the phoposed site ion the sewage pops bystem (&i (we) have obtained an easement, to nun with the above de6ct bed ptopehtty, {ok the comtttuct%on ob baid system, and the tame has been duty tecotded in the O~6i.ce o4 the County Registtet o~ Deedb, as Document No. 33aaAc ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 6 7 DATE SIGNED DATE SIGNED J H z cn H ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z ' d 9 0 WNER/03*6' SOVK Kayew MesceWSK' ROUTE/BOX NUMBER R& I sax V,%3 Fire Number U CITY/STATE Mew ~~1C~yv~OK0~ W %SCOK$l V% ZIP 54 017 JV PROPERTY LOCATION:_SW 14, S\A1_k, Section T3() N, R1"W, Town of rCV'1V1, Pr4:141e, 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. 0 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro 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. i SIGNED tteAdvk DATE St. Croix County Zoning Office P. 0. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. . v LO . m to~NNN ^m m o o m « o ~ a3 vcO ~~m cc Ca su C5 m 'a c=r D -0 a M (D 0 A $ ap0 w o -;.cam cn 'F 2-0 N'C O N x CD w w CD cD cn cn CD 0 n ? (D Co n a O - ~ cQ O GSA O cD .O..O. =r tp = Al O O 0 O ? L C 0_ Z~ c*<3oao =c.. rm~,wv, W CD _O L O 0. 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JP"O t311 is s r f~ ~ ~Z.sz /C s , Richard Diers, C. S. T. Soil Scientist Route 1 - Box 15 Balsam Lake, WI 54810 ,(715) 485 •3368 C S u PPLEM R N TT/4 L &MRT 12 CoNVEN T/o~v,¢L tT QIA/FI,~ ) TM OF REPORT ON S BORINGS AND SAFETY & BUILDINGS TRY, , DIVISION FOR A PERCOLATION TESTS (1151 P.O. BOX 7969 .OMAN RELATIONS \ / MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: O NSHI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: .S wig/ 5 '/a /T3oN/RI7E (or € AQ NA A COU TY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: s o OM J. SCF_ w fit, i wFW RIc%i~c~Io D wr ~/or7 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~T PROFI LE DES IPTIONS: PERCOLATION ESTS: XResidertce ~1 AI A ❑ New /Replace RATING: S= Site suitable for system U= Site unsuitable for system 7 7 I ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: JSMINFILLHOLDING TANK: LAAIMAID-OAVAL ECOMMENDED SYSTEM:(optional) ®'S ❑U ❑S A JAS ❑U ~ ❑S U r If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: NOV E PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF O SER ED (SEE ABBRV. ON BACK.) - le 8 llf .9 0 e le C/ an $ ' , i. - 2.6 olee., s~~. B 6 3c. ' 0AF > 6• kRn in S- ~6 r fr rf S w K N+ i in e r c f specs o oh ox. f lu+ti oK. B a Coma a j# K o 'PLO &Wq Sys o-I.oh+rxt vdk_0y gtitf 9i's i 8 5 B-~ lo. 91 ??9.31 AIO A)E. > a.9 'S/ IS /.6-~.O Bn IS d' $ s a B n S - .S / 3.4 -'Y6 8n , 9/ RBrr r- it IS, l M odo%es f'o ) g Q' • .o .l/ m6red ZK 8,, ♦Qn i, SI,, A ry, ~.0-3.8'v k h B- 3 7 97.5 AIQ A1,E 7 6 Al I, - ♦ Su65oi S. I -6. i y ~S (0.i-7.6'RB.,-yRS ,7.6-7.9 43nROAS WCJnf B 8 RAn -8, PERCOLATION TESTS s TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIO PERIO 2 PERIOD PER INCH P- .o' v 340 P 1 .a ' Z 44fi P- AlAVE 30 P- P- P- MOT 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 9la,.l >,X _ Vii. M c c►c~- s l a. • b ~ SC: f e r i•+ c'Z i,) S ~ GD f GI'- d " 0 ar aJp e_ ine-1 6 of 0,1 P7 (NA) cornof Q-} S~a~ (~X L E'r-nal~ • , Q OI CI'"It~ I.ro.n ox.-M;n-o r, t1.e N.G 87TP -A 2$-l_Fa~P~02c2r'S to d'e f 0.1 c:rE'!rae ox f T~ ✓~uf~fAgil ° l14 45 t~ ;ice ~ fQ, T3er~ S~asor,a~ }s±/fFd br=;f4~ odors ~h c4 Sy✓AoriZvn: hot - A:9-3 r ~ ~ afura~ro~t l,y t A4h no u/e"s ' JWs7 alovi2 loa /a},~~ cov/d Lie- SW SW%Y se ag Igoe- 114) i"Ih.. pe r-c~ PG~ a ur_ 1~o,a. 3 { f . - ~ "Z a,,P art L3 - ~ ~S' 604 s!; r:e / _ SPa'sgy,2~l, S ~ 0 r-a f ~ ~i'I.en 60 c i,e -to ' 6 ri - 7-kt"~ eI-C ~°(e a Pr %ve wr l•~e -14 0 P10 104'ak nosy-eX~/aii~ 7i. wec rc Rlef6 4010-pzr~eOl p-! P-Z Th ,1-QCO.>►~me,r/s 2 be Brae was.Pr~ati ! p ~'l~ fo corrreti s a for /oamy S ub so.i /h 13 3 of d, „ 1, the and rsigned, here y certify that the soil t is reported on this form were made by me i 411~s ccord 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 N: I CWARD Jf+l' S Jill 1 4 4#/,o ADDRESS: CERTIFICATI NUMB R: PHONE NUMBER(optional): CS IGNAT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 11LHR-SBD-6395 (R. 10/83) - OVER - ' . A To b 1. C,ornp`t [r'~ The u! -P- ei" tll ~ .6Jt3'll'rcEal project: . MAX' -rcial G-, 4, is iLy O. 7, e, is referrc ; 9 _~ittd 1C~. [f r ~ ~ ~ a; 11, Sign t 12. Make leg•.`e ti d di= to s ALI_ MUST BE FILED WITH THE LOCAL AU t l'r i, jet D~-% ~ ~E~ir~•~.L t 3aR~~. 1ty 1 e 1 IT', 01' .q e oil'Se ari ".,,tares ~ €°nbols. Sto _ c Co 10;; . G. Sar coy a~d' rz . . ksl Lo %ii L >am RI - black s; Gy C, c! ; y Loam Y - scl _ Sandy Clay Loarn R sicl C Loam mot sc - Cl. I? sic. sf1: tae, faint p` ni ck LT' _ l n t TO THE OWNER This soil test report is the first step in securing a sanitary permit. The coup' r the Department rnr regi =st verification of this soil test in the field prior to permit issuance. A co i set of plans for e sewage system and a permit application must be submitted to the appro. ..)Cal authori~ , to obtain a permit, The sanitary permit must be obtained and posted prior to the start of any construe a. ~ i' A x l.rgor~'W.Z + ~~of P/an ~or <~es ce wsk~ ~roPer~r- Rf/ Box/83 /VowR1c / if jWI7 SW% 5V, k-Y Sec 9 T 3 0~, R / 7AV n Pra l r;e twp \ a,4N A.e a / 1 o ; CA G ac I've e/m 6km 63 P3~ -VIA 3 r n Park i vi ~ ~ ase me„ t 6wcre e S~ver~~ G'~elow ~ .E'~C~sf~n CyCu6a on aC er i 70 O~ ~rc551'aU W 1445 . ~ 30 AY E a e Lie OY- 1 1~1 ' • f o Q~ t Q o o c a r) ILA 5 M ro nw0 I3~0 C7 r~ c c C `11 CD (D ,D n o o N O a m m C SJ S d 3 C CD O W N 1~1 rl • z C-0 (D 0 Cn (D x w N CD CD y N J~ O'! 1 \ r(D ~ci CN C M CD C W O (D 3 r1i CCD m rt O H CD (d (D N a ."3 N CD c c CL (D w o 3 N x 0- O V < t~ N w Z z CD F- ° 00 Cc (nn cn CD r Q Z ~ ~ h 4- a r z O O O !V • y o < tai ° 3 cn cn to a CD h f" Rc I I Cn a N d y O O V o 3 m c 00 I N a - a In Oo H H ~ a » N In W z D D o O p rd 0" _ rh r a Z) CD m o N t o w cn rt ~-d p D rt CD -4 C/) I-' W IV Z p Z CD F'• l0 O N , .a a r• ? z fD O O Cl) o N) W A CL 1 z 3 0 c) o r ~ ISE rrt w m S f!j 0 o r~ry ~F F a N 0 D 3 f 7< Q C 7 5- CD G~ O EEn (p ~j m N N • H o O o ~ ` N N CD tU Z d N k-4 CD --Oa cD 3 3 Q N CD N N N Sd 3-_v Al • O Q 3 CD =r A o CD _ Nam ~07~ A 7 0 pCD n 7 CD A 0-9 a3 a 0II7p-0'o O C O CD Oki N p d m °o a CD a a CL ti i p I ' CD Oro b A cfl O r N a CD Parcel 012-1063-40-000 01/09/2006 09:52 AM PAGE 1 OF 1 Alt. Parcel 29.30.17.4428 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - SCHUMACHER, WAYNE G & BARBARA J WAYNE G & BARBARA J SCHUMACHER 1616 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1616 130TH AVE SC 3962 NEW RICHMOND SP 1700 WITC ru l Legal Description: Acres: 9.300 Plat: N/A-NOT AVAILABLE SEC 29 T30N R17W 9.3 AC W 871 FT OF S Block/Condo Bldg: 465 FT OF SW SW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 748/16 07/23/1997 464/221 2005 SUMMARY Bill M Fair Market Value: Assessed with: 105121 179,300 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.300 70,200 115,200 185,400 NO Totals for 2005: General Property 9.300 70,200 115,200 185,400 Woodland 0.000 0 0 Totals for 2004: General Property 9.300 15,300 77,700 93,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) IN STATE OF WISCONSIN DILHR Detach And Return Upper / DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 e t MADISON, WI 53707 608-266-3815 DATE: PROJECT: A ; r PLAN ID. DETACH HERE PROJECT NAME PLAN ID. This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County cnsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification to Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing (~)DI LHR P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. ! _ t _ 10 cPp Gallons Per Day -Z Edpl _ s ~ X " PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description C y ❑ City ❑ Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DLHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) 4§ STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence tl_ ~i~a P.O.BOX7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: tr e ti PLAN ID. - _ - - - -DETACH HERE - - - - _ - - - - PROJECT NAME PLAN ID. This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. ST. CROI X COUNTY WI SC O N S I N ^ ~Y pia M ZONING OFFICE _ 796-2239 (HAMMOND) 425-8363 (R I V E R F A L LS) HAMMOND, WI 54015 Ocrtoben 22, 1984 Viv.usion of Satiety and Building Bwceau o4 Ptumbing P. U. Box 7969 Madison, Wl 53707 Dean SiA: An on-,site investigation jotc the John Ktucewski ptcopexty .located at the SGI% of the S(U% o6 Section 29, T30N-R17W, Town ob EAi,n Pnai i.e, St. C&oix County, uveaeed suitabte so.iU at a depth o6 30 inches, below which seasonabte high gtcound water was noted. This site shoued be zuitabte 6otc a mound system. Shoukd you have any questions, ptease 6eet Jteee to contact this oj6ice. Sineenety, Thomas C. Nets on Assistant Zoning Administtcatotc TCN: mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS - DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Cxoix Location SW 1/4, SW 1/4, Sec. 29 T 30 N, R 17 ~ W Town OA)M(!t?ft}t EAc n Pnaiti.e Street Address Lot No. Block Subdivision Landowner's Name: John Ktu cewslu The application for this site is for: ❑ new construction use. 2 replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: 1to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers ssue o you.) ]one of the applications needing a quota number. The quota number assigned to this application is - - [_]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [_]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. [...]for an application on file prior to February 1, 1980. [A for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ~a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check hefie.l--l I certify that the above information is true and accurate to the best of m knowledge. Name Thom" C. Neaon --Signature County Official Title A~szi6tan-t Zoning Admin.y6tAaton Date Octobeh 22, 1984 DILHR-SBD-6158 (R 12182) y STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Towns hip/XK(AkftQ1 SW 141 SW k S 29 T 30 N/R 17 V" w Bt in PtcaiAie St. Cttoix Street Address: Subdivision: County: i Landowners Name: Mailing Address: John Kteseewzki. RR# 1, Box 183, New Richmond, W1 54017 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: i 15 zQr`l aAlrc-//, 6ay /o r- Gcb~-~ r _ rs my a-tX er, /P h4,3 ~ ~ v P~► /Wf yo !'r r e Er werk sTar7e~ ~P C 7~ ' r -/-/e - v vncfQ s Tie r, p p ~ 0~''` yev % 0 `howjn --thln5s are rye&Wecl -r-e- _ settc( Clown -T tke sT Por' 'i~ ~ /va _ ai'-~ 76- - r-f lov lravc -r4Pry ,/Pa s e sehcl 7~~m ho ~ Y yov ~o 7 An ve -(Aem ov Will/ hav 'To cats your court house 7on►p\c o~ C avid -tke wx - Co W, C'_. O va PLC 47T, our 5 5 em G~lvplrraT i~,m - -Par vse o-~aN C lrerNa~`rvP sysfio,~. - - --CD7LHR- SBb- 6AI13) signed and Abld rt2ec by owAer- - -3 • UG.''r ` l cart ~'o r~~ nr. s t g t~ F~ by c v v i-na D ice- 3 A o y ~rss3 _ P.O. 60)x yy _ CpvlTvri cx- t~L, Sy~dy_ - - - ~ I YOU have ally _?ues-ridiisf DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND~JSTRY, G DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53709 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.:BLK. NO.: SUBDiVI:SION NAME: sr✓ /00/ .2 91T3aN/R/1E (a W .EK)Al PNAI IF tl_A. NA- COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: St CROIX JOHN KL,c5CfWSk-1 7~f. l Bok 183 IvEW /?/uHMoA~D wIS/O/ USE DATES OBSERVATIONS MADE i NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence i A/A• ❑New Replace 71.25-~26 Q t 7/?6 841 RATING: S= Site suitable for system U= Site unsuitable for system u CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S D< U X S ❑U E S KU ❑ S >gU El S XU Mo,,Al0 erm. ;o;l t j/ k/ 7 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: AfA lFloodplain, indicate Floodplain elevation: No /U£ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /oTCy13 Si Gr$n 5; ~o iC3n Si / n B- A/oAjF 39 / - CI .Z'%n1 'AYR S Is w »t►s / f 3"AYRs % c~ 8M 1 )2 " Gy8 y' G• 8„ S~ 8' l3n s d 7" Bh S(/S)~ I►a1 11 B- 615' /aa. 9 » ONE 30 SR Bn s Is v c YRbre 13''R0„ $I w - R mot, I GJ ronsAn 51 ♦ M "Aft 91 8,, B- 3 (00 1M. 3 NOAJ 3 a 7' Gy o s; , 7 Bn r S C ' B 3 ii /?Bn S/ 13 "R$ _I Sean se o d w1f cc y? a„ B- hi0 s yin Cff Bl ""Jules AY y' -s lled t/,. (TA is all B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ 2S A/0 o 1/ , 'y 771, P- 2 2 p 3 l3 .3 3 3 P- :2 3 v 30 3 f P- P- 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- 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 _ /0 5. L.~E'GE~U e R NN Iyo~e sce a c~ 'lee q -T i a 'R on•IM S BOCKe /-ivCr 4 - Ike rco ,d, o h Te s ts,9 ~ P Via.. , I Jyer~Ktd~_~n 12~~ h etc ~ to /N e.ohc lv We rete at~/ s o We .Ar le C.? IC.._ Ft>_le_ we-4 fN r .4 ' Sui~ [C 6tXG0. r moor 0%, ~ t I t t i Gasey 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 OMPLET D OIV: ADDRESS: CERTIFICATION N MBER: PHONE NUMBER (optional): l / 5 A L_ -5A 4kE w1 S lia 34/3,3 S- 3 8 CST SI AT E: .~7 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - se -it X, i M1 IJ M is 0"is "c' F, Unudup On A 571 1S SUI TAB! . PL a. TF z.F.e F ti a,... m um 5 oGm ' JOa q_ ~r. ur's,,,t Otkm €.I:3 v67Ea €1`.;'ur ng kfio } tcL r . _ syl, >s 'C:' .i:,. a,. ,,ir3g to Sinic fJ$'efz.,m., rcquare " E osed if ift'my I, Via v , W 3 mK and z ,a,£bi , t °^C< .`€'!Fl€ jrp m;,f r . -lamn moo .e , f m _ Was, Nno, its.,, dot'-"" n p77° 7 S ~ =tar 1 a a sumc Q04 a ,.5 , N Red „z (own! WWI 1, S Lmm*a SW v; , 3 Pat 1 05 Qn," Fr1rr in 5"p RVol 50 _i Unly Lomn Lei, H No - ? 's 0 A; G 'd (Aw Loan ,E rya sk So Q fH 01 Fzi~ mm MY, n-1 00- LF o~jiov pF %!pmW ;UK Oman- 10- 14"N! swam SRI 'An oil My TO THE 10MEW N c o t << ...r 4, a Y r,., a ...t y or <,'l.,tw. may c k E 1 n ~ t r ~ ~ Esc ~ r 3 r ~ ~ I~,~i €i t n esc e.k - -lVe~/~~o,►d-S~/o~7 Part<i E /O ruro r R a 5 Go ro tr it>rV~ ExtSflr~ aI'.bCL4e e( flew, Q ~y rn/'=IeU -4 j *y rev c~ NO r ea rr H k~ r C Rd. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUMAN REDATIONS PERCOLATION TESTS (115) MADP.O.ISONBOX WI 53909 (H63.09(1) & Chapter 145.045) LOCA1 ION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: sw '/s0/ .2 9 /T.3oN/R/7E (o W fKAJ PNAI J.~ N_A. nlA. COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Si, CRo/X J-0//A/ Kkr5CEwSk1 7~f. ! Bak 19 3 NEW /?icHMoAtD wl53,1O1 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: %Residence 3 A. ❑New eplace 7/~,!, /?6 N ~~dy /ay RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK RECOMMENDED SYSTEM: (optional) ®U I NS ❑U (~lU NU ❑S XU M OA12) (Perm. so;1 wH /7- [under Percolation Tests are NOT required DESIGN RATE: I If an any portion of the tested area is in the r s.H63.09(5)(b), indicate: Af A Floodplain, indicate Floodplain elevation: /V Q N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 10TGr $ 5; 6y 8'n 5; B- 45' /oa. ti0NE 39 - 7« 6„ 51w1 / - Cl' %n1Y YR S OW/hon f 3YRs0 'C ai it I GY8 / y/ G 8n S~ Dn B- (oJ`~ /00.9 NONE 30 S loe RB„ 50S) w c YR)"et3 Rsn s'f w R al r n f t M fwd B- 3 60 0 /,00.3 NOM 30 7" 6Y D Si l 7'/ 13 rt S: /1 8" Bn l - C/ ) !L1 bier. 5(15% ' i B B 3~ n wVill mt S I 23 RA _ o SI w YR d a., ri 1 o s am c~ P B nodules a 411T SSi"c/~pt/, . B T ~ S b blewed 5a-d) B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD3 PER INCH P- _ Q y P- 2 z Al I o 0 3 l3 P- 3 U P- P- 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- 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 E ~ I I I i I ~ C~ e Se Q a, cy~ It 'd -5; e e ( a Re-1*1 • SvcKel At~rr ! 1 ftll 7Tesfs I I. ar h~o f~ f ~Q~n X; $M L J~~rKt0/) n IZt~ n f x t fd Le iff _ i Concrete ►v/ wes e~ IUe/~ A 3v~, Pot E/w~ { lea o i JIRP - ~/Q c / r~c . f'o % WA~ f ®f d'1"~vtKioi~, t N l e C_ f j 6WEO, r ou ,d s SfQrn' 3 / S g f }rte I ~ ~ j ' 1 ~ i 1 ( qs w, i~;fie r 1 j I ( 1 A~ } i i ~ i I ! ~ cAseY ~UKc I 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): TESTS WERE OMPLET DON: ADDRESS: CERTIFICATION N MBER: PHONE NUMBER (optional): / 5 A ~S l.~k~ 1,U1 S"/0 3 33 S- 3 8 CST SI AT E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ! Box 83 poi FJ~ .4AI last Jo km KIP- gr- ew,5*1- A ~ 0017 Pte, oc,, Fjeraf►o r a Sk eerntr ExrSf►r~ at.ba5e e~ 13 Gt ! Sto~rng /b.'4 s >r Q ~ ~'anGrer,C ~ I It I ~ f 0 `T~, 1+✓a~ l j Jujs~a~K ~ \ r c°~n aP3 Area ea ` Is, to 019, 6 4ro~en~ ae t I I o~ 14-. L ~V% Q 6 I ~ I j3 ar- ,N ; rf, F&►t c e ~aSe y ~~ke- Rd.