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HomeMy WebLinkAbout020-1004-90-001 A > > 0 3 r. CY) 0 ~ so v a~~1. I ~ 0 0 N 0 O O A ID' C OJ NO • 3 C (O a N 00 cl d a N rn O CO O N C 7 W W y co O N a N N N 3 O CO CO O 0 CD CD n O p O O1 O O r I 3 W 7 W ~ ~ O 0 C i O 0 E3 a c 0 u> D (D N N a W c fl W 0 x 3 O s o ::z "NINA y m CCn a ! N Q 0 m of • O ~ o 00 OIQ 13-1 a C.0 CA CD o cD CD c CD 5'i M go p CD o 0 3 d 7 m y a T z N I z co z O y CD 0 O a cn • CD N CD C CD N N Q 7 C CD N CD (a ~ CS a z CD co A Z c~D 0 w a p G 0 m ~ -4 CD .o CD co N z 3 c 0 m z I w CD I .O N N O7 a m ~ N CD N C . C1 a OZ O. 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CROIX COUNTY, WISCONSIN 1~,~ , 3 rte` S SUBDIVISION LOT LOT SIZE PLAN VIEW' 0ZV-la) 7-~70 ~f Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ Q. BI'1J. r boo, v lip 1 zIYJ° , I 'Ar i s ~ s v Nz INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used (0tP"0a__ Elevation of vertical reference point: 100,6> Proposed slope at site: % 5 w~ SEPTIC TANK: Manufacturer: L!/2 t' Liquid Capacity: ff~d Number of rings used: Tank manhole cover elevation: q ?,9 O Tank Inlet Elevation: Tank Outlet Elevation: 27. 3,2 Number of feet from nearest Road: Front,O Side,kV Rear, O feet From nearest property line Front 10 Side 10 Rear,0 ~D feet i Number of feet from: well z v / , building: z 7 ~~jom Sw (ev rt r r icrw' !5' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER w 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 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: a.,,4-1 o,-,o j' Trench: r ~ Width:_ Length: Number of Lines: Area Built:(. Ys,:) Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ® Rear,O F't. S-0 q '10 Number of feet from well: ai'o Number of feet from building: S / ~6' 3otFov~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 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: --t4 3/84:mj EPARTM ENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS BOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BOX 7969 BUREAU OF PLUMBING MADISON, 3707 4 NYC ~~1~ONVENTIONAL El ALTERNATIVE State Plan I.D. Number: D Holding Tank E] In-Ground Pressure 1:1 Mound (If assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTI N DATE. Sam MiUeA R. R. 1, Sax 282, HudtSan, All 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF T. EL CST REF. PT. ELEV.. 'NE SE, Section 7, T29N-R19W, Town o4 Hudson, Lot#14, Eagte Ridge r Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Doug StAohbeen 5432 St. cu ix 74956 SEPTIC TANK/HOLDING TANK: r?7- 1 9 7-40 MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /j PROVIDED: PROVIDED: A( D l~O r e O DYES ONO DYES ONO LLZ4~9z& BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: JPROPERTY WELL: BUILDING: VENT TO FRESH !1 ALARM FEET FROM LINE LAIR INLET: YES ONO OYES ONO NEAREST QD'A DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: AND CONTROLS OPERATIONAL. NUMBER OF ~IROPERTY WELL BUILDING. JV(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) PUMP DYES ONO NEAREST - SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing It FN(,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA.: #MTS: LIQUID WIDTH: LENGTH JNO.OF DISTR PIP SPACING. 19c21 BEDITRENCH~ TRENCH /E PIT DEPTH: DIMENSIONS 6 GRAVEL DEPTH FILL D P H J DISTR PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL: BUILDING VENT TO FRESH BELOW PIPES. ABOVE~fOVER ELEV_yfV'~L}yET~ E VIN O PIPES FEET FROM i LINE: Q>< AIR IN~LIET 41 I : pC /~~JOi% -CD ~J NEAREST- MOUND SYSTEM: b d 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 NO meets the criteria for medium sand. TIONS MEASURED. O SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS. OYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER: EDGES: DYES ONO OYES ONO DYES 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. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.. ELEV.: DI A.. ELEV.. PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: _ DYES ONO DYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER©F PROPERTY WELL: BUILDING: FEET FROM LINE: OYES ONO DYES ONO NEAREST- , II F` Sketch System on Retain in county file for audit. Reverse Side. -I _N SI NAT E: TITLE: '_HR SBD 6710 (R. 01/82) Q/ ~ InDUST wlsconsln , APPLICATION FOR SANITARY PERMIT D' L H R COUNTY - D!D FUSTYRY, LRR OFBOq 6 MUTgn RELFTIOns (pig 67) UNIFORM SANITARY PERMIT # 7 -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 M ILING ADDRESS S;-. 14n , • 14 if 2V PROPE TY LOCATION _ A1,15-114:56- 1A S , T 1, N, R 11 E ( r) TV WN OF: LOT NUMBER BLOCK UMBER SUBDIVISION NA NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER '4 le a( TYPE OF BUILDING OR USE SERVED t' 1 or 2 Family Number of Bedrooms: .3 ❑ Public (Specify): THIS PERMIT IS FOR A: ~Q New System El Tank Replacement El Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. LX 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 - 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: 6t,-, IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total of Prefab. Site Steel Fiberglass Plastic 11#4 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): Private El 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: MP/M1 No.: Phone Number: D go- S+ co s ew, e -4 (zY"7) 3 Z. 3 Z Plumbe s Address: ame of esigner: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved o-17'P5El Owner Given Initial 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 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 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 Location of Property 14 Section , T Z45~ N _ R `7 v Township h/ e / a .-7 Mailing Address ~eZ41e- / Subdivision Name V G. Lot Number Previous Owner of Property W a u y Total Size of Parcels' Q Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 2 5 _ and Page Number 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 Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i (We) eenti.6y that a t statements on thiA 6onm ane t ue to the beat o6 my knowledge; that I (we) am (ahe) the owneh (a) o6 the p'C 6 y (oun ) n6onmation 6onm, by v.A,tue o6 a 6 Op~y dedehibed in thid i wauanty deed neeohded in the 066ice o6 the County RegiAteA o j Deedd a6 Document No. 5 ; and that I (we) peed entty own the pto poa ed site bon the a ewaga Vi4poA a ya tem (on I (we) have obtained an eaaement, to hun with the above de,6c ri.bed pnopehty, bon the con t4ucti.on o6 said ayatem, and the aame had been duty %ecohded in the 066ice o6 the County Reg.idteh. o6 Deedd, as Document No. SIGNATURE 0 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 14 - DATE SIGNED DATE SIGNED Ir L " 1 . SE.~ TER~X .h.►~. ti 343• 35. - ter; 15 . FOR ROADWAY N0 2.29 ACRES' H CUL-DE-SAC i NORTHWESTERLY 00 R/W LINE OM Wp ~ to ft) ~ 2 T4 60 NE-SE S 1 R=37i p 0. Q W f / AlT- 2 0 N • / ` o ~ a. WESTERLY EA T4E R LY ALINE d~ krtV LINE--- J le. A - _0 r ~ w L. tES i3 , c POB -8 ; .c J - O N - ~Q M N D ~o V ; Y N a !50 16, .40 963 6 e 4. T "4 43 6; L 6BE~ •1 ' • ( C Q 4 Z ACRES N~, a 14 R • in P128 T 1 ` Ul _ N . 7.48 i d, W . 5 so; Se 25-Attr 5 P.0a-13-~,~p~ ~ s 8VO4 C^„ ZO- 312.00' J~+ ' C. E SOU` 04WESTERLY// 4-9V 7 R/W LINE 1. S 1. t r ST. CROIX COUNTY uz w'~=7 r WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) j 425-8363 (RIVER FALLS) HAMMOND, WI 54015 December 3, 1985 To Whom It May Concern: The sewer system for the house located in the NEk of the SEk of Section 7, T29N-R19W, Town of Hudson, Lot#14, Eagle Ridge Subdivision, is approved for three bedrooms only. Any additional bedrooms that may be added are the responsibility of the homeowner. Sincer ly, Harold C. Barber Zoning Administrator mj 03/31/2006 12:14 PM Parcel 020-1004-90-001 PAGE 1 OF 2 Alt. Parcel 07.29.19.9&10 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current [X_'i 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 - PETERSEN, ROBERT G & SANDRA K ROBERT G & SANDRA K PETERSEN 1031 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1031 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.120 Plat: N/A-NOT AVAILABLE SEC 7 T29N R19W 3.12A IN E1/2 SE1/4 COM Block/Condo Bldg: SE COR; N 938 FT TO POB: N 1111.3 FT; S 44 DEG W 144.43 FT; S 15 DEG W 334.86 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT; TH S 13 DEG E 331.93 FT; TH S 10 DEG 07-29N-19W E 91.66 FT; TH S 8 DEG E 212.88 FT; TH S 27 DEG E 71.44 FT; TH N 89 DEG E 22.48 more... Notes: Parcel History: Date Doc # Vol/Page Type 04/29/1999 602217 1422/489 WD 07/23/1997 878/490 07/23/1997 728/99 07/23/1997 725/358 2005 SUMMARY Bill Fair Market Value: Assessed with: 91391 241,200 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.120 72,400 173,600 246,000 NO 05 Totals for 2005: General Property 3.120 72,400 173,600 246,0000 Woodland 0.000 0 Totals for 2004: General Property 3.120 43,400 145,100 188,5000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges 00 Delinquent Charges 00 Total 27.00 Parcel 020-1004-90-001 03/31/2006 12:14 PM PAGE 2OF2 Legal Description: cont. FT TO POE I I I Parcel 020-1005-40-000 03/31/2006 12:05 PM PAGE 1 OF 2 Alt. Parcel 07.29.19.12A 020 - TOWN OF HUDSON Current X 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 - JOHNSON, JEFFREY J JEFFREY J JOHNSON 1016 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC i Legal Description: Acres: 3.220 Plat: N/A-NOT AVAILABLE SEC 07 T29N R19W E1/2 SE 1/4 BEGIN 938' Block/Condo Bldg: N OF SE COR SEC 7 TH W 312'N 13DEG W 745,05'S 84 DEG E 235.46' TO RD S 26.27 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT; S 13 DEG E 331.93' SLY & ELY 356.8' 07-29N-19W POB EXC PARCEL 12D ALSO INC PT LOT 18 EAGLE RIDGE DESC AS BEG SE COR LOT 18;TH more... Notes: Parcel History: Date Doc # Vol/Page Type 12/26/1997 570369 1281/472 PR 07/23/1997 1120/500 TI 07/23/1997 814/148 07/23/1997 724/496 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 91396 22,100 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 3.220 22,500 0 22,500 NO 05 Totals for 2005: General Property 3.220 22,500 0 22,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.220 14,500 0 14,500 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 Parcel 020-1005-40-000 03/31/2006 12:05 PM PAGE 2 OF 2 Parcel History: cont. 07/23/1997 705/348 Legal Description: cont. NLY ALG TROUT BROOK RD 111.34'; TH N 84 DEG W 258.56'; TH S 13 DEG E 116.35'; TH S 84 DEG E 235.46' TO POB H z . cn ` H STC-105 r" r a SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z 0 a OWNER/BUYERyj 3 ROUTE/BOX NUMBERteof-r RIX iW 2 gZ Fire Number- CITY/STATElc 5dma.-s G1J.` S ZIP 5- PROPERTY LOCATION:/ 14,,E 14, Section, TN,~&~ , Town of fcrSayi St. Croix County, Subdivision Lot number J Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree En 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. SIGNE ~p 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. - mF = 1 b; 0 to 0 C 4) 00 :,x It 0 0 .p 4) 'm = Z' O O N 7 cm O ° N V i U) 0 C 0 (f3 O N 4 Emmrn>. C O N ' C 3 M N cd C.0 ~ O'0 N L 3 ) N C N m C- N td c O W ° 3 c~ v E Oo t9 (dNC~=may moo; ~ >°.0 - d 1 t.. = N c o = aci a V t~mc0)a -"0E ° d3 ola ~Nm cad C C V N L ~ V cd *O V 01_ 3 L O d " W ui 0) 0 CD -a Q ~ vt m o f ° c Q d L V c? L 0 ~~~3~ N~~ a Q Z N3:~atc rn(D N = ccdd c -p w° 0° 20 O 3: 0V CL Gov, ci 4- ed - O cc 0 °m°5Q-N °0Ni> C'f ~aaa 0 ~ccc U 0. CL CO N N m O QL'o o~o c a; c 1_ _ N c 0 T= CM c .Zc 3 c0~-0 OE>>. 0o E 0 -r- (m 0 L 0) cm o oyd°° -0 E N V rnt ~ ° L ~ sr c m ^ _ co c .v O° cd i N c O of N N 3 y N L 3 a C c ° TY ~ cm m L- L- a O a O~ Q1 O N N L 0 .Y E~ 3 c 0 o 5, i i O c o` cd N m m O E N N in w H 3= 3 N W Q C = D/ J N O DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (1,163.090) & Chapter 145.045) ION.: SECTION: p TOWN HIP MtfMieWAL1'i'Y: OT NO.: BLK. NO.: SU~BDISlp NAME: /4S y ils~9 N/It M (o ! 1c /[NP Lv1 allb a 3 dN f ~w• i COUNTY: W E BU R'S NAME: MAILING ADDRESS: L- S-1. tt tt ller J hut,.- i-ov u I)4I USE DATES OBSERVATIONS MADE NO. BE MS.: COMMERCIAL DES RIPTIO R F NS: ERCOLATION TEST S: Residence 2 1 ew ❑Replace I /0_ a_~~ _/0 y~ 1/4 N 5,0"1 Ath'oo RATING: S- Site suitable for system U- Site unsuitable for system PC 'y9 ,t. ~,y► Si~+c~ ONVENTI NAL: MOUND: IN-GROUND 7ESSURE: S STEM-IN-FILL OLDIrgN K: RECOMMENDED SYSTEM:lopls ou a s ❑u ®s a s ©u o u t O,u uG.vy.IoNf If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation: /"l PROFI E DESCRIPTIONS rpe, BORING TOTAL/ DEPTH TO GR UNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH.W, ELEVATION OBSERVED EST. H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) W e.- 77-0 . S 0/41 / All, 611 Cr 15, 9, / .S•r r 0 q. 0' ,S7 Z * 144e s taote d rdr•tA Sot.#s o f 7.0' / ~.jye S N t s .J B- 3 '7.C),--. 9 •3 /L+'!o 7 7• C), . S 81 S/' y is 3.6 An G.• . n 04 Si-r S 6.-Is aE /u.re s~awr Bssrc,t f fitY-I'j or xv• B- 7.0~ / utter O / /S a., Cr S S Y, t`wt~r14.-t j&0 S14-41 A 7.0 r p, / ! 7 .0 r r S s /d s 3 f Cr/j . 7 #A S5+,ik 4-!s B- ' PERCOLATION TESTS TEST DEPTH/. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER JAICWicS AFTERSWELLING INTERVAL-MIN. PER INCH P- I IS, to r 3 • y / X x_ `,t P. A , dI o S 3 .2 3 Z d Z P- ' o 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. / Cs'•'t•`~'is~ Eltv,!•~'tlw 7`o >F/40k SYSTEM ELEVATION 9~c• / 3,v• ~6a~~ //~;.,c.sf~+~e red. gelid . i TOf f 00. II r - 2^ I' 17 NAi t do"! 12Z A" 4 t 1 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: • Cl r:s fo o ~o -yam ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): Lr~ / t'- K O cis 7~r3Ji'•S CST S NATURE: 6 j-.x-;47= ` DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ~r1 It ~ f r, Lo A p 1Tt 4 11,404 EAV. i rl L~ i I i { e ' ! I st I 7YLo I • i i LA X ! P VI 'Its t ~y P is lilt t