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HomeMy WebLinkAbout020-1164-60-000 1 tip r m n 0 v1 ~ ~ f c of o fD T m n S Di o m 0 .r co 90 ( c O N `C O• 3 a N Q ICI k = O C a ~ n N co INa ~ (n I -~~A n O N O O O J O 3 3 N O M ~1 CD 'O O O W > CL y y ~ V d O W '0 3 a c r O 3 O w y CD 0 3 3 O m to co 3 con COn c°Dn o. Q • z 0 0 0= M ~M Z OOOa' o (n lo o c y co = co m c'D :D. Vj' cn 'D 90 a o ! a) Cil G .r y N < 3 ~ rn ~ ti Q 7 N N z 3 u, C co z :3 CD a 7 ~i p ; o s o m v CD ai X C m CD c m w CL a 3 5 z CD <p ~ N o y o .P Z <D c s 3a - n A O 0 (n N V W o O Z 3 j as m o z co W g a N N Q (D3. ~CD _ O m-0 o c O y CD < ~z~ }`y c m n CL A m C.0 co CL b CA c" x c a I 3 I o N ~O O N A ti ~ ~ II ti a O O oy I O d ~ y I ~ Parcel 020-1164-60-000 12/14/2004 08:00 AM PAGE 1OF1 Alt. Parcel 7.29.19.981-984 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner COLIN M & JENNIFER J STOTT * STOTT, COLIN M & JENNIFER J 317 HARSHMAN DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 317 HARSHMAN DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.516 Plat: 1929-EDGEWOOD ESTATES SEC 7 T29N R19W EDGEWOOD ESTATES LOTS Block/Condo Bldg: LOT 51 51, 52, 53, & 54 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/23/1999 609116 1451/143 WD 07/23/1997 955/291 07/23/1997 725/345 2004 SUMMARY Bill M Fair Market Value: Assessed with: 49036 233,300 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.516 40,300 140,200 180,500 NO Totals for 2004: General Property 1.516 40,300 140,200 180,500 Woodland 0.000 0 0 Totals for 2003: General Property 1.516 40,300 140,200 180,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 0 CA O i 3 'o o G r~ ID 3 d CD 1 [CD rr n O Z O W C CD CD S m QO FBI (D m N z N (O = CO .a (D CD d 0 1 = O N o 0 piOp O fD ° A ~ CYN 'a 3 3 0 0 U, 0 cn o p m a j (D ~o D cQO . 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CROIX COUNTY, WISCONSIN SUBDIVISION el.Ja~~ LOT f`~ Z LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G ~Gl~O E`~ Qv f ~ SR,t INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used, Elevation of vertical reference point: e Proposed slope at site: Zer SEPTIC TANK: Manufacturer: W„r,~ Liquid Capacity: /6 &--0 r Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,© Rear, O 1-7 feet From nearest property line Front ,O Side,O Rear, O ~ feet Number of feet from: well , building: 1&4- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE J r i s 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. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 14- Trench: Width: Length: 5 Number of Lines: Area Built: Fill depth to top of pipe: Lf ,P Number of feet from nearest property line: Front, O Side, O Rear, pt. /_17' Number of feet from well: 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 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ~~fu%---- License Number: Jn2= A/4 I 3/84:mj DEPART,jVIENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION '$.0.130X 7969 BUREAU OF PLUMBING MA-ISON, V 153707 ERCONVENTIONAL ❑ALTERNATIVE s,a,e Plan LD. Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION PATE B & H Development 836 St. Croix St. N., Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REFS PL 4-V.-:C5T REF. PL ELEV.: SW NW Section 7, T29N-R19W, Town of Hudson, Lot#51-52,Edgewood Est. Name of Plumber: JMPIMPRSW No.. County Sanitary Permit Number. William Schumaker 6382 St. Croix 69629 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PO IDED. PROVIDED. LJYES ❑NO ❑YES ONO BEDDING: VENT DIA.: VENT MATT J'HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING: JVENT TO FRESH ALARM a FEET FROM LINE- AIR INLET.. ❑YES ❑Wb ❑YES NO NEAREST 70 S'd /l, DOSING CHAMBER: MANUFACTUR ER. BE DDING. JLIQUID CAPACI TV PUMP MODEL. PUMP;SIPHON MnNUF AC7UHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROL OPERATIONAL - NUMBER OF PHOPEHTY WELL BUILDING I (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing u1nME rEH IIIATI RIAI 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 JLENG-EH NO OF DISTR PIPE SPACIN1, COVER - INSIDE DIA PITS LIQUID THE NCHES MAT E RI_AL: PIT DEPTH: DIMENSIONS G REVEL LE I'TI FILL DEPTH DISTH PIPE DISTH PIPE DISTR.PIPE MATERIAL NO 15TH NUMBER OF PROPERTY WELL. EILDING V ENT TO FRESH BE LOW PPES ABOVECOVER EI FV INLI1 ELEVEND PIPE FEET FROM LINE AIRINLET.,. 1, NEAREST 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 ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PEITNIANE NT MARK EHS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL r_ESEE DFD MULCHED CENTER EDGES S. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH LATENAL SPACING GHn VEL DEPTH BELOW PIPI- FILL DEPTH ABOVE COVER . BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.'. ELEV.. CIA. ELEV. PIPES DI A.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE G ❑YES ❑NO ❑YES ❑NO NEAREST---~ t Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. ; DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT DILHR - OEPRRTR (PLB 67) COUNTY enT OF InOUSTR 1,LFIBOR&HumRnRELRTIOnS UNIFORM SANITARY PERMIT # (OyV/ .9 9 -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 OWNE MAILING ADDRESS slt- Lill: S7' 4!,r 66, P P RTY LOCATION CITY: Si) 114 91/4, S - , T 4N, R E rYW, TowN oF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 7" TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ :PUPublic (Specify): THIS PERMIT IS FOR A: At New System ❑ Tank Replacement ❑ Repair L] Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit El Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber - Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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): /$1 ev 'j- Vv I) Q'/su ~f Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature:. MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: ape" r COUNTY/DEPARTMENT USE ONLY Signatur of Issuing Agent: Fee: Date: Ou' ❑ Disapproved ..~/i~s ❑ Owner Given Initial Approved Adverse Determination Reason 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 y • 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. OEM 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 6 rAY 4 -J-tJC. Location of Property f~4 _~4, Section 7 T y N- R W Township Mailing Address ~ , LoiK ~X /u' 171,,,46N Subdivision Name C(GC~LQ~~C/ Slrs Lot Number Previous Owner of Property f''f~t1~'1!'~-f fi1 ~ A r .r Total Size of Parcel /4!r~ Date Parcel was Created Are all corners and lot lines identifiable? X/Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 7 W as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 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. PROPERTV OWNER CERTIFICATION I (We) ceAti.6y that ate statements on this 4onm ane t)Lue to the best ob my (oUA) knowledge; that 1 (we) am (are) the owner (s) o ~ the pnopen ty de s ch i.bed in -tW in6onmation ~onm, by vi tue of a wa Aanty deed neconded in the 06jice o~ the and that I (we) County Register o4 Deeds as Document No. 3V, pnmently own the proposed site ion the sewage di6pp -.6a-T-.aystem (on I (we) have obtained an easement, to nun with the above descAibed pnopeh ty, 4on the con,stAuction o4 .said system, and the same has been dui neconded in the 066ice o4 the County Reg.usten o4 Deeds, az Document No. 3 1 ) ) . SIGN TURE OF 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED l_ Y 403744 6 I+ 11 PA[ REGIVERS OFFICE ST. C"X CO., WIS. Recd for Record this 22nd a 4 of Ju1Y A.D A F F I D A V I T t 1:35 P M; - ReglN~r o1 Ds.di 'e.. STATE OF WISCONSIN) ) SS ST. CROIX COUNTY ) I, James E. Rusch, Registered Wisconsin Land Surveyor, hereby depose and say: That I have surveyed and platted Edgewood Estates, located in the SE1/4 of the NE1 /4 of Section 12, T29N, R20W, and in the SW 1 /4 of the NW 1 /4 of Section 7, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; That there is a proposed on-site liquid waste disposal system intended for, and a percolation test completed on Lot 51-52 of said plat; That said system is intended to serve a home intended to be built on Lot 51 of said plat; And that I make this affidavit' to inform all future purchasers of said Lots 51 and 52 of the possible existence of said system. Aubscribed and sworn to before me this N~ day of J v~Y~ 19~-~ M sc N. 0t y Public, State of Wisconsin M corrimission expires June 14, 1987 This instrument drafted by: James E. Busch . z i H STC - 105 r 9 y SEPTIC TANK MAINTENANCE AGREEMENT 0 l St. Croix County z OWNER/BUYER y` L S E [J~11~!•~ 4- tJC nn ROUTE/BOX NUMBER X11'4~cllu d,~__Fire Number CITY/STATE ZIP i PROPERTY LOCATION: _~4, N 1Z, Section 7 T~N, R W, Town of I'Vtr't2"(6A) , St. Croix County, Subdivision C/ iJLz . , Lot number- I 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, r^* 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 I/WE, the undersigned, have read the above requirements and agree czn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►0 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days f of the three year expiration date. SIGNED DATE- 7' D St. Croix County Zoning Office P.O. Box 98i Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. o y m °.3 v~°www'7w C :3 :3 M :E 0 - CL ~ °fm°- m mo00 =wvm ~cu~n'~ Rr 0 3 c. o ~°co~ w ° ° c o w o p O C- c' ° 3•Zco c r- 3 .0 c,< v3 f N - w w~ C =Dr ° • co-.vv D A ID C N N , cD N 0 O D C m ~A p n- w n p w ~oC5•* O o Q amco 00 w w C U) 0P ° CD CD -*LA 2 ~g NO N w~cc o Z 1m p N ~D O A = 1D a aw0 3 D wC° ='w° ?va, ~ =-o > > w <D fA =r a cc g (0) V viw° ac°*cD C m pv CD C=r O O 0 ~ y N n m CD Qw Z a 9 m m p` y 0 C C ~p O W CD A N w Y/ a0 * ai c C 0.w o m w 7 w Oa E a . pa p y p r;~ CL cr CL 0 ~ cr m ` n ~c m ~Q"m=r (D ..3 00 -to GN~~yO Qo g o(O c N <D c m S C -1 w 144 .Ey...: f°3 03 0°3 ~a ' 7 , 9~ CD C) no s : .fir Qr1 CL < :391 1. s3Xdri" O INDUST Y,. OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,. DIVISION LABOR AND PERCOLATION TESTS P.O. BO" 791 i HUMAN. RPLA IONS (115) MADISON, WI 53707 7 (HS3.09(1) & Chapter 146.046) LOCATION: W MUNICIPALITY: T NO. LK. NO,: SUBDIVISION NAME: S v~ '/4m0/ -7i /T r H/R i141or 14 uIN °soN r-S2_ • IiEh-41EW66L COUNTY: W E S R'S NAME MAILINU ADDRESS: s(' & t` keyit~~"~" NolkT,4 w~C~ I t USE DATES OBSERVATIONS MADE 1COMMERCIAL 15i=>` t 1PERCGLATION S: Residence U New ❑Repiaca PJL t.t r 6 f S o t Lt Rome Pre 4S SO IL,% a Js - S F-W F_T'i RATING: S- Site suitable for system U- Site unsuitable for system S04% a Sa44 PA6 o ON M U ~N_ FILL Cll IN T UKf4ECOMMENDED Ti 1, U O S AL (op if Percolation Teats are NOT required DESIGN RATE: sir Lift any portion of the tested area is In the under s.H63.09(5)(b), Indicate: - j CL &< •a K-, T Floodplaln, indicate Floodplain elevation-. a. VT PROFILE DESCRIPTIONS BORING AL ROUNDW ATER-INCHES CHARACTER-OF L IT H CKN S, C00514, TEXTURE, AND DEPTH NUMBER EpTH-W ELEVATION BS RV TO BEOR CK If OBSERVED (SEE ABBRV. ON BACK) _ B- ( /,3z,, f...~'~n(e. } j G-).4 8r+'StL 1,4- n-9,G - t6v l di r r {-s._ y+, $ti, f I. C~-~• d # RN Ss LS Z.<-?.'1 1' k"-i 9L ~r v# ~ +Cr•~ i2X o& 7"'? ee.at r 4S~tr ` ~ • : ♦ (y ,lbt•'7`~t~` Nj~,.?. t,-z`C4 -I . f . ,.y: X - r , d L.'T "ZaF.1J s..i 7 1^ I. I' ° `."e4 F.. T..( 1~3 ? L "'a > .K_, , K.A .r , . w 0- ° t I Wn f,; ~i h ~ - -0.1 CTLIkrJ it C6 014" k't1l r: ru# IAA t i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVIL-INCHES RATE MINUTES NUMBER i AFTERSWELLING INT RVAL-MIN. PER PER INCH P. lc 2.0 P_ d 3 cS i(" r.: FIP ®7rE g E R T6 T M PLOT PLAN: Show locations o 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 s a' 5-x-% Lo ac lot :Frost " j - i € .Y K I i e r 1 1 hC 1 ' i r =14r 96 10 io~.e C iALTQfs~rT db At A / AeMfH ¢w o No-rr o LartS S I-S2-53 4(liz 76 Aftla F;-- 1 • r LEV E r+i Q L 40 4 4. i p QBeG. N4LLg ~ 'C'~ 17j ~ ILI, ' 1, the undersigned, hereby certify that the soil tests re rted on this form were made b me in accord with the proced s and j~ ds specified in I\ cousin Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and lief. NAME print : D TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBE-R-.' CST Sl ATl R l i., DISTRIBUTION: Original and one emy to Local Authority, Property Owner and Sail Tester, 0iLNN-S8D-1.:395 (R, 02182) OVER .~•~fy,8., W.>.- 4'~' a Vic: ~~dv.7~i~s,=.~~'' INSTRUCTIONS FOR COMPLETING :FORM 115 , SBD - 6395 rc Is.' .a completct am.i accwat, •;()it lest, your. rt!1"ie7rt must include; it . t. ('.,!nt~iela I,~aal rlr,,'iirallnn• J I ho tof. 1(),l 1,10:,! C i !•,i ly imti, o.v wh(.doIi this Is.a ra;siderice or corhmercillproject.; MAN IML)M iturnher cat imIrt)om:;!c'Ar r.ornm01rt,t1 Usee, p1drined; ! 1, 11'0s 'j, 11(" of wplacemplit system; Colon)!-' the` Yaatahility i:mny boxes. A SITE IS SUITABLE FOR A HOLDING.TANK ONLY IF ALL fll;1 IIa OW BASI: t) ON SOIL CONDITIONS;. G. t't I- ASF oil, thv• All,; k-vi;al iom ,h(mli liar" for writing profile descriptions•and c3omptetinq-the ptcst;plan 7. MAKI: A LEGIRLF dt+tgrArn rarcrtrately locating your test locations. Dr4wing td scale is pref rted A L'af~.p .ii 3 t>li? t't III iy tiv trsvd 11 desired; 8. Mok" sue yout lwnchmark and vrntical elevation reference point are clearly, #h#Wn, aM'are, pet manom, . 9. G 11wg,'t" all appiolai istte boxes as to elates, iiames, addresses, flood=plant Y35t` ; percolatian'test'"6n) ' t:,,~t, ;r ral~prnl'niate; , 10. It I-w mic)+rand0oll (mch ;a,, floor! plain, elevation) does not apply, place N•A in the appropriate box; 11. sirln rim torm and place your current address and your certification number; i:. Niake la{lible rolaies ,•tnri rfistributtl as, requinsu. ALL SOIL TESTS MUST Bt FILEb' '1NI"IH 'TrIE4 I. i1(;:r l AU 1 h ORI (Y WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOiLTESTERS S.*at 1,ah.arat(:ti mrrtl-Taxtures Other Symbols st ,ilom! lover 10") BR - Bedrock roo - coolile GI 101 SS - Sandstone yr Gravel {und(A r 3LS - Limestone s Sand HGW High Grimindwater I , r Co :r.,;~ S.)wi Pfltc Mircolatino Rata fs fine S,nid Bldq Building. ' is Loamy Sane.i i Greater than t~ k . `l Sandy Loam Lr-ss i.tsar.;• I L raarn Bn Brown ii Silt Loan-, 61 Black Si Silt: toy sari y cl Clay Li,-,am Y - Yellow SO - Sandy Clay t_natti R Red , • sit;! S.Ir/ Clay Loam mut. - Muttfes> Sc Sandy C!ay WI - With `R ~>T sir, Silty Clay fff - few, fined faint "r, Clay cc - cornmon, coarse Y pt Peat mm ^ Many, r4diurr m Muck d - distinct p - prominent HWL - High water teve1, %ix gcrural soil t:extiin! startace water !Or liri,.ii+.! ~.••::a>,t.c dis)0",I! 3M Bench Mark VRP - Vertical Reference Point TO THI (WVN*,IEi$ s .,t I aport. is the test stela in sects rr•tg a sanitary permit. 1 lie courity m the Department may request lh Fiviel idlest to b-!riit isSr~,a~u;r . A e.ompleti` Sol; (11 plans for the t)tivat,: ,;rrii l,r.irrt 8+.?n!t ..~Srt mu;t hr, sl,hmittLd il'a Ihe,:~l?ululariale' tot'a1 Iutla'!r;ty i;1 ~.>;c1,.I •)j.t Ih •i'I'1~ ittxro it 1"llf^, 1' tw o!1.,Wmd aIod r3;tritfl it+ oI ail the Start !j tr,'y !'t7'15tY1ad:?t')r~ - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY $c BUILDINGS INDUSTRY, DIVISION 70 'LABOR AND ,IONS PERCOLATION TESTS (115) P.O. MADISON, WI sax 533707 HUMAN RElr,T 7 (F163.090) & Chapter 145.045) LOCATION: SECTION: T NO.. LK, NO.: SUBDIVISIQN NAME: W , t NIUMMUNICIPALITY S Val ~/4r1V~~ -7 / f -P dirt 44(or {Y C~~54h) COUNTY: O NE S S NAME: E.'ACK' 4-T ~TCRc~t~~T.n(4~Ttj USE DATES OBSERVATIONS MADE cc~ B COMMERCIAL TESTS: A Residence 'New ❑Repfaca 6ULY /6,/t 17, 1 -,y 5 o, t vs ~tScclt i ► 4S 5oms JS ~ ew err RATING: S- Site suitable for system Un Site unsuitable for system S,C'X - Sr4WPA60 ONV M U D:j~ IIV G_ _UIV`t R~iii FILL OLDING T. iC: RECOMMENDED SYSTEiM:lopt' nai! S QY S wu S oV 0S El S ' u C~nt_ ',TraAlAI- t L If Percolation Tests are NOT required DESIGN RATE If any portion of the tasted area is in the under s.1-163.09(5)(b), indicate Floodptain, indicate Floodplain elevation: ~ 7 PROFILE DESCRIPTIONS BORING AL ATE -IN H CHARACTE R F Q WITH HICKN SS, C LOR, TEXTURE, AND DEPTH NUMBER DEPTH7~1, ELEVATION OBSERV D EST. TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _ B- ( P 1.4 8,) 'S, L 1.4 w: 'd~ a *i . t I r i~, ti ^5 { L f. d - I . t {1 dP.t~l i `s ? t` . tt.~,f Y I'. G B- Z VA kS or M ed L r't~ t, Y B- -V crapp 1.4*- S.-7 RLg-F 1,~, r B- ~ S ~ ~f.1 LT'{y1't:i /,#°J.4 !.~...`fT~{c°t.~~~:,4.. y f"- ~t+ Eli/ C-e%6 J (3 _ r 4.J CT$eN JtC. Ct1 •C: 1. 6••j'..~...~ Ptl atL ';•t ~ B' a G tyCi~l4s SL S.z - a.a rw-0 ( $r.t{P4 6-4 .3 Yh ed z t, ► PERCOLATION TESTS TEST IN H TEST NUMBER DEPTH FTER SWELLING INTERV~ MIN. DMOP IN WATER L RAPER IINCI! E5 P. t73' '/4 f.o /.t3 ~l P- tt,.., r<;(.'+ Cl /f2 /3/4 Z•E~ P- ts... l J P_ P_ t~t9T~ E R '7' T v M 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 3 moo' ao iwr t lout aw. y. Jp' i. f_. w,ro. i ! S , - ia~. a • ita f Ifi; BETt.1>~l~/ 51 4 17 u. Maa~c~ Ala [4olt t4wrt'S AT.R~ i , ' .a . C-La - /CIO. e t 19 Tb P4~ Peif~t~a~w 77 No-T o ~CTTS 51-S -S3 4 A tEI4 t i ~oRi3 7antwfs s 1-r ! s l o hire- 140LE5 4 o' 1% 7' I, the undersigned, hereby certify that the soil tests re orted on this form were made by me in accord with the proced s and methods ipeified 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 fief. I NAME (print : j TESTS WERE COMPLETED ON: ~YQNir "J) tT ADDRESS: CERTIFICATION NUMBER. PHOM NUMRER(o ti,^.n..,i?. CST S ATURE ~ DISTRIBUTION: Original and one cony to Local Authotfty, Property Ovvner and toil TE:ctemr. DlLJ4R-SBD-63gS (R. 02/82) ()VER -.way . ~~t~kR+~~.;~ ~ INST RUCTIONS FOR COMPLETING .FORM 115 - SBD -6395 ' f ho ,r cnrrrphlo ai)d ac kiraty ,uii test, your report mast Include: 1. C,1-111lletell+:prl,G:dvtIll! if ur J I1w tr]r• I1-, iy io,i, io, wtwuiar this is a resilience of cos,,mercla) project; fvu1x imm rturnher of alalrlrnm;.!rr ..+,rnmr.I~;r,al use plannod; s 4. i.: this d new or rel~lacenrrnt systeltrt; - !t, t.:c.rntdrtl 1111, 'ant-rhrlrty r.,tiny hw.es. A SITE IS SUITABLE FOR A HOLDING TAuX ONLY IF ALL rt I J 1; ,ri n,', ; i.l inii l'I t t.)U f BASi:I.) ON SOIL CONDITIONS;: G. PI I` A~,F 1,;1• IIt,, ,1ht,:,~viii Ii<,nr: %huwn hurtt for vvrrting profile descriptions and completing-t116 plotiplan; ; 7. MAKI. A LEGIIiI.F 1ha!lram .mnurately locating your test locations. Drawing to stale is preterred:''A ~5el1ar010 0)(14 rn1y he 1eW1i If 1it!,jrecl; * k'." k. Y,. Mol"', su: r:• your Irenctururrk and veer tical elevw ion reference point are clearly sh..own, and"Sr# petrrrianent,, ~l, 1;r117rt+i !I.r all apptopl iate boxes as to elates, names, addresses, flood plain tlact, jvrcolAlnn"test exetvap t,mm, it alftrrnl-itio e; 10, 11 the jnttrmatioll ("(Jnit as floor! Alain, elevation) does not apply, plaoe N.A. in the appropriate,.hox; l 1. Siren the tourn and l:)lta;e your current address and your certification number; 17- Make k.gii~ile copies and elistnbuw as required. ALL SOIL TESTS MU T`BE rIL'EpVtH `f4r= l.i)C/Nl AI►THORI fY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL;tESTERS. Sail 'agmratr:r laird-Tcxttoes tither Symbols q Stolw fovef 10") BR Bedrock roo Cobble (3 1I):,) SS Sandstone qr Gravel (under 3") LS - Limestone' s Snud HGW High Grotmdwate► C; Co :ts;~ Sand Prat: Perrotatinrl Rate ~,t.:,! ; A;h.,tjuu+'~,rr,tl kJ VG~•fI - fs f ill! Sar1d BId(J building Is Lo anty Sind ,l Greater 'than. t r ' ~?w i `.iiLirfy L:a:9n; t:eaS 14fari.. "I 1,;lani Lin Brown sit `ill I.oarra 61 black si Sill. Gy - t;iuiy cl Clay f.crtnt Y Yellow v.1 _ Sandy t.aay I.oant R Red sir] Silty Clay Loam mot - Mottles ,`",anely Clay w! with sir, Silty Clav fff - few, fine; faint ,t 'c Clay cc cornmon; coarse pt Prstt mm - Many, midiuln to Muck d - distinct , . Ia prominent HWL - High water le'vel, Six general sail text,rn*, surface water 1 !;;ti1.f I.[t! rS15pd~s,a! BM Eltmch Mark VRP - Vertical Reference Point TO T•Hf' 00!N1 E Vi 17 i., ao,i t: ,t re1)011 IS the! hest Stet.? in securing a sanitary perrnrt, The county or the Department rnaY request ~ir,t t; .>I !1,j~ ,.:+iE 1!1• I!' if! Ii1jr,t ter p-!Ylit issr!a:cc A (:01riplow silt ,d plans im 11-ic prival- „C1(t s, t'r'St 7 r ill '1ni It1USi; he Al,ii?n 1lit(;(i I') (l{Q_.ir)t'l r,)I lrlatff 1w:.11 "IUiltiti~F't'y' iii ~.)tc l;'! - ~1':,i-. f-~11' :;tt-~1. 1 y _"}t"~tr.ii t,?Yil! nt?.(rI`,' i1.1:.:.i and ~;,°i1,fl ,1 Ttl Tt1P. -Glatt :.>t~ -1~1y,)t;=tart t~••.;i)r