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HomeMy WebLinkAbout020-1119-20-000 ' o N 0 3 d 'a 0 o t~ 3 3 m d x \ 1 (n 3,' 2 cn Z A N rt Z _ N y O O O CA 1 C CD CO a N W y v 0 =5 IV CD CD O R l o ro o M o _ C) y W J O O C l~ 3 °W D CD c U) W ° OX v _S 3 ° c°o ~ o lot O n CD m N co co _ N O Q yr !T CD ~Z MO SOS OSS? "w• 0 0 CA CA (1) ~5: O f ' o u~i cWD C) 00 I-1 c p 0 (D Ln O rat ro v :3 0 H F-- 0 CL a z y r N D co 0 0 O a 7 !1 (D CD Cn 7 ~ N Oo O H trJ c m N -t- In rt to u, m a z Oo a, I CrJ ° m ' :d z cc -I N In A Z v a A G 3 x ct rt _ rt Fl- O W z N U~ \ ~ W Q z F- ;o F~l~ O O 00 0 3 (A ~p 7 x H z (D a ` ~ ~ Pte. a I C.0 m I a I o ~ m c oz CL I m I I t A A N O O~ A ti 0 N N ~Q to O o o ~ O "b O L ti Parcel, 020-1119-20-000 03/24/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel 17.29.19.509 020 - 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 - PETERSEN, RICHARD A RICHARD A PETERSEN 377 BROOKWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 377 BROOKWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.090 Plat: 2553-TROUT BROOK WOODS ADDITION SEC 17 & 18 T29N R1 9W TROUT BROOK WOODS Block/Condo Bldg: LOT 6 ADDITION LOT 6 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 905/238 07/23/1997 771/584 07/23/1997 709/616 2005 SUMMARY Bill M Fair Market Value: Assessed with: 92379 285,600 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.090 81,400 209,900 291,300 NO 05 ~ Totals for 2005: General Property 3.090 81,400 209,900 291,300 Woodland 0.000 0 0 Totals for 2004: General Property 3.090 46,500 214,400 260,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 135 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 I~ Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT d OWNER 0 TOWNSHIP SO fJ SEC. ` T~ Z l N-k_L-W ADDRESS ST. CROIX COUNTY, WISCONSIN (10 AS SUBDIVISION LOT T LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 /7' CV /o( o OL vaJ II s ~e (f. g0 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used L c'rj ' } Elevation of vertical reference point: Proposed slope at site: 'o SEPTIC TANK: Manufacturer: W~ zj~~ Liquid Capacity: Number of rings used: ~ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side Rear, 0 feet -From. nearest- property line Front 10 Side 0Rear, 0 feet Number of feet from: well , building: L 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lp Length: ~ to Number of Lines: Area Built: L9 7 Fill depth to top' of pipe 1 a, 1 Number of feet from nearest property line: Front, O Side, Rear,O Pt. e%1 I 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, 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: 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 537Q7 ,'.CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dean Hanson 206 2nd Street, Hudson, WI q~7' s • BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE SE, Section 18, T29N-R19W, City of Hudson, Lot#6, Trout Brook Rd. Name of Plumber: MP/MPRSW No County: Sanitary Permit Number: Richard Hopkins I64845 St. Croix 64845 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE V.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER I Li TT C~ PROVIDED: PROVIDED: l/l/ d 0 V , '/0 9 5.39 DYES ❑NO DYES ❑NO BEDDING: VENT DIA.. VENT MATL: HIGH WATER NUMBER ROAD: PROPERTY WELL B UILDING JVENT TO FRESH C I ALARM FEET FROLINEN y ' ^ AIR INLET. DYES ❑NO DYES ❑NO INEARESTR-~ ~f `t- 0 / DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL 11JULDING. I (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 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.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING. COVER INSIDE CIA #PITS. LIQUID BED/TRENCH TRENCHES Q / MAIAL: PIT DEPTH DIMENSIONS Is - bNAJ/fJ GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI T 7FEET UMBER O OF PROPERTY WELL BUILDING: VENTTO FRESH BELOW PIP//E~S~ ABOV VER ELEV. INLET ELEV. END. / 2 PIPES. LINE AIR INLET: t(/+ ~L. I NEAREST IIJS 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- D meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED 71EPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER. _ DGES. DYES FIND DYES 1:1 NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA.. ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 4 0 S DYES ❑NO DYES ❑NO NEAREST 0 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) .~ri~ w~s'~ons~n APPLICATION FOR SANITARY PERMIT f ILHR Sf' CF- 04 2, COUNTY a DEPR TMT(PLB 67) InOUSTRV, LRBOR 6 HUmRn RELRTIons UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY 6WNER MAILING ADORES U a N. u 0J PROPERTY LOCATION CITY: r tt A) 1/45 1/4,S ,T41N,R11 E(or).W TOWN OF: .T 010 - Up LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ' 1 NEAREST ROAD, LAKE OR LANDMA K STATE PLAN I.D. NUMBER w Tr' ®U Roo W 00 A QU TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): Couv tU, N THIS PERMIT IS FOR A: C:~KNew System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 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 Concr to Constructed Septic Tank Capacity (040 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): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of Plumber (Print): Signa re: PAP/MPRSW No.: Phone Number: c Lc/ /!7 (7/ ► o`t ~6 Sy Plumber' Address: Name of Designer: t COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 9 / r) vQ{ F-1 Owner Given Initial ICS ' 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 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. APP I tI' 11 11 1 111t 1111' A1,Y PI RMIT °i 'I' t 100 This application fot:m In Co ho (:crrnll)I(:Ied In Iu1.l. and signed by the owner (s) of the property being clevc.1olin(l. Any anndt tlu;t~ It tt w1.1.1 only result in delays of the permit issuance. Should l:h.ltl duvu11.1pIlleli.'hn 1.ii te.udud for resale by owner/contractgz, ("spec house"), then a sucoml JOL11i zrhuU.ld hu i-oL tlnud and completed when the property is sold and submitted to 1..11111 ctl I .lr:u w1 t 11 Hie appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property. ) Location of Property St!ctaon T N - R Township s / < Mailing; Address[ , " ,t~/J S / ✓~s a>0i f i.~ Subdivision Name 6") A 4-)o C)D-S Lot Number Previous Owner of Pr0jW1 Ly r,;7 C4-S1 Total Size of Parcel Date Parcel was Crel1t0+I/f_L'_ Are all corners and lol. liner ident.11Iilbl.L!? Yes No Is this property being, developed for rest l e (spec house) Yes No Volume _ and Page Number as recorded with the Register of Deeds INCLUDE WITH `L'UIS APPLICATION ONE OF THE FOLLOWING: 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) ceA_ti.6y that ae...L s.taternen.t6 on Oi s 6mm aice taue to the but o6 my (OuA) knowledge; s'ha't I (we.) am (cme.) the owr,tcit (s) o6 the plcopurty deacAi.bed in tW -irt6oltmo-tion l6onm, by v.0t-tue o6 a wccnurtnity deed )t.econded in the 066ice o6 the County Regis-teA o6 Deet1:5 a,5 Docriutert t No. e / and tfia,t 1 (we) p~relaent.P..y an Arun :the. pli("fl fn,Sr.d 611/r f11r~ st,lotrrlC Wtsposa by~stetn (oa 1 (we) have the vbtz t.t- to r rtr1t 10,01 rfr,, ~ti 1 1 t(t,ti e~c-tr, 6on . 1 r tbcd rrnop J i.cd c. s t u t cuns,r'.rttr„t,,i.o1; o6 ~ ~~Srrilf .-~IfS 11.111 ,ti1if Ow ,Muir h.1, I t,t rl t tG(t r.e o tded in the 066.ice 06 '01c Coilitll l~ h't'il(,', ~A'h u6 (r4't`11 (I'i lii+~!IiIIU'!I r NU, 4 L ) . ' SIGNATURE OF OWNEk SIGNATURE OF CO-OWNER (IF APPLICABLE) _ J DATE SIGNED DA'I'S SIGNED H N r • S T C - 10.5 r SI.P`1'IC TANK MAINTENANCE ACIM.MENT St. Croix County OWNER/BUYER ~~..'.SC~J ROU'T'E/BOX NUMBER fik, A0 Fire Number CITY/STATE 2)sci) y0/ _'Z 1I' - PRUI'Elt`1'Y LUCATIUNI4, Sectiun~ I' 29PI, It Town of /[JL-)SC% J _ St. Croix County, Subdivision 1,/004' Lot nuniber 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 Lin Li . WI►at you put into the system can affect the, function of the .,Lz-htiC tank as a treat- ment stage in tl►e waste disposal systen►. SL. Croix County residents mja! be eligible to receive a grziaL ..L)r a maximum of 60% of the cost of replacement of a failing system, which was in operation prior co-July 1, 1973. St. Croix County accepted this program in August of 1980, with the require►c►ent that owners of all new systems agree to keel) their systems properly maintained. - - The property owner agrees to submit CO 5t. Croix County Zonin,, a certification torte, signed by Elie owner and by a in-aster plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal syste[►► 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 y to maintain the private sewage disposal system in accordance with x the standards set forth, herein", as set by the.Wisconsin Depart b ment-of Natural Resources.' Certification form must be completed and returned to the St. Croix County Zoni ffice within 30 days of the three year expiration date. t SIGNED DATE St. Ctjoix County Zoning .Office-, 1'ox 93 Hammoi d, WI 54015: , 715-75 6-2239 or. 715f425-3363 z. . g3 Sign,;; date and return to above address;a 1 O If 0 .22 4) :3 °=caL.. vpc a (D L. N O 0 0 c p v C p c O N V i to O C O M V m 0 o cn r- N G ca L o~ C33~ N m~ ov 3 C9 ~3~°m = vE~ V_1 (D c a O :3 y L_ 0 cm *0 cc .0 CO ~ V N C U) N 0 C O W = fL. c:)UU)a wit c m 3 O ° ° ca w ca °t..~ .v ca W oL O N `o (D 3 d L L U •O-. E U N G m la ° ca v. CU = _ ca «`6 Q N 3O O; 0 N la aY C N O ; cc r_ .0 O 3.oO~~ caica 74 L, -02 O U V c- n U p 7=; C 0) ~ N U) Q aaao ca N~ C ca a C 2) C p' O ~ O C O O ` CO cc O V3 C O O Z •C m C 0 O= Q E O to O 3: N O' C C L .r 0 C C7 0 - « E COOOOV O` N+ >`O 4 O~ G r- 00_4).c_ O GocNaCc(1)Y(1) -aai3 _ C a) O° 3 i V o O 0 U) 4) C m,o a ~L:3o o- m c z Y rnrnC E -0 Cl) ca w 0 :3 E a i N M== cm O E N 0 F- ~ 3 N ~ y W Ic a = y J D DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, f L DIVISION LABOR BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTIOjN: OWNSHIR/MUNICIPALITY: u LOT NO.: BLK. NO.: DIVISIOjV E: 10 0/ 59/ /O /T Q9 N/R I9 E hr✓t h - w K/,✓% COUNTY: O ER'S/BUYER' NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE MBEDRW COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: PERC LATIO TESTS: esidence A) New ❑ Replace 3 D /11 RATING: S= Site suitable for system U= Site~r unsuitable for system C N ENTIO AL: JMIN-GROU D-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) $ U S ❑U S ❑U ❑ S UOs J'A"JU C nvern i n -e If Percolation Tests are NOT required/ G DESIGN RAT F- If any portion of the tested area is in the ` Llo- T und er s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: N Q5 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.) B-~ ~ ~ lOd • 78~ Owe, > 1 t i ' 6'l ~ ► ~ I .DBE , 5~'~er► S w p~~ ; y~'~n ►33 B115 u? r ,5~~nS n,3y'8S w r --IP cob ..581 616L / .f 'i~ari C-S 9r , b~ nS uo1 1-33'13h 011145 5-1 B- (U f1 } w r'. ,5't5nme&S' n ~A ~S . 83' 8rX I'he $)-Q. S' r B-3 11.6' ->17 BtCS~IuO'BnL S)I.asAh ,.17, nVS~ - L-1 ` IOygS1 V)Orn l I , 2 18h48 U~ r.168y cs ' cg,-'cst~ B B- Iba ~r l~Qr~~ ►~''16151. 1. 3~6n cs I.6' 5~ .(c~~8/1 i J,75~ ~,s.w r. C;S u) 421 B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PERIOD 2 PER D 3 PER INCH P- ro( rd o S o 7( 6 D14 reS P- P I 6~©Cjr e!2 l/ 1/~ O~j P-_ p_ A G 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 a ~{r C ` S E 4" J { t V _ D f a a , a , 3 I ~ t o' re d'm f vti a_ Xwi 2,2o is 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: C Cie I~• V Q. f 111 3 ~ ~C g c~ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): uhson k0l SLi of to &L/L/17 7I5 ~.~8fv (0~3/ CS~ 4~~ ~IBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. SBD-6395 (R. 02/82) - OVER - y_ ~Y INSTRUCTIONS FOR I 1PLETING F(---M 115 - SBD - 6596 To be a complete and a curate soil to =cart MLJ< 1. Complete legal descr 2. The use section an-W rly indicat- or commercial project; 3. Ma 'MUM nu adrooe s or J; 4, a,- v c system; ing boxes A e f,BLE FOR A F1 DING TALK 04LY IF ALL ULED OUT AIL CONDIT"- 6, ons shown ig -ofile de i Corr- ,ig 7. a c A _ rn neat; tt t exemp- 10as fIc ; 11. ~ Q your r co. distri t ",L)THOFI Y WITHIN. 'EVIATIONS FOo r 71FIEI SOIL TESTERS a mbols cob sane ler 3") Is *sI - - n *I *sil Si - *cl scl sicl „ sic - c pt H11VL F Z t e 67 PLOT A N F)~POSS EC TIf\l a PROJECT PL M 1R rNAME UenN AME o(aZ4/ LOCATION_.- rz-fjp W~~ ~ L IC ENS E= ()ATE lop of T le ~,~,~,e ~ ~s fhe 1001 /000 01 _ Q y ~ 3 . s Qy Rory,Q 01 5 I a %0 FRESH AIR INLETS~AND OBSERWA110N PIPE SECTION 1 Approved Vent Cap Minimum 12" Above r7•(.S r,i (~~~e Final Grace I Ar" a. 4" Cast Iron t' Above Pipe Vent Pipe To Final Grad Marsh Hay Or Synthetic Covering Min. 2" Aggreg e Over Pipe 1 Distribution Tee Pipe '~eS Aggregate ~Y Perforated Pipe Below 3 I3 Beneath Pipe Coupling Terminating At Bottom of System v .