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HomeMy WebLinkAbout040-1122-90-000 St. Croix RONALD MICHAEL THIFI EN Municipality. TOWN OF TROY W12138 850TH AVE Permit Number: 34826 RIVER FALLS Parcel Number 040112290000 WI `-14022 All Parcel Number: 32.28.19.511A? Site Address. 496 CTY RD V Components Component Manufacturer Description Last Next Status Schedule Service $erv[ce Septic Tank Septic Tank 10!1112013 10,1111'2016 Current 36 Conventional Trench - Seepage Trench - Seepage 101112013 10/11/2016 Current 36 Drainlield Maintenance History Service Date Maintenance Name, Gallons Pumped 10/06;2008 Not Available 0 1 011 V2013 Not Available 0 Notes _Date Text 7M;1776 12:00:00 AM ADDITIONAL NOTES. Plumber marked "new" but house is already there and re-used existing septic tank. [abandoned a failing drywell] Added new 5'x 100' trench - attach notecard to file MIGRATED ON. 09104.!2015 'No data found for Notices, Violations ~7 70 O N O O C o a tr, N p L O m e'l cu C L c a ~ m A .c) 7 C X Q L ~ 1n ' 7 •V ~ y C y tp; ~ N 3 c Q N y 'x o ~ m=c v Z mz C c E m L 9 N O ~ T 7 L N -C E C r~ v E ¢ a m•~ ° c1 c. a u rn rn W O ~ v E .a W ~ \J 1 co tl co f T n OD o N o W N L+ 10 o z:t C u _ OC 4~ it m ~z ° N a y C? c Q) 0 O c Q i Z F- Z o ~D t~ v a N Z 00 F m I J C d H CD i ~ l n a a s T O c~ O O d ~ - ~ •r O Z N> co F N - d H L 5•4 t •N a a ~ a. 7 F, N w T G a 3 O N LL co omo N C N CS O }~j to J U y rn rn ~ ~ :.n U 04 O O 3 ~ j 9 n U U7 ~ ~ N C a O C O N to C (y ~ O p 4_ O C' C U 0.. O C +U O L N ~ ~ C7 w ~ N r` O C C 75 j N d C d 00 00 c r- K N O 0 C N C) CL. Vfti • O cn F- 75 ch O z c F- U1 O ~ V ✓ `m m ti 3t _G ` a • ce a d u m y c E c c Q 0 CL E 0 N U -0 o Q) CD p°vo, er ~ ? c Y ~ 111 Q S` Ki a Q ~ y rq W v j f0 a ~ O j ~y1 LL C ` C 3 U V (U ~ V ~ O 00 N 67 N N w a co r7 H U) L O C z U O 2 ? Q: fl T m Z' c E ~ N N .C G1 V t, U a N O C 01 76 O C U Q w Z m z Q r z N d N. n cu E ` m ~ is y -t o m ` c ° N o o a E m E L) o m u~ cn E Q N Z N> 3 3 3 a 0 a Z a a a y a m 3 O N LL co M co co !A J U y rn T O z ti r N U c o E a 5 ~ p ~ y cn y of N c a C O O o N a N E < E to l o_ ti c u d° c L 0 0. C'4 A V 1~ N Qi C N C V ~ N Y U N v - 3 1 :J ~d N C O~ O p t \ ~ E ci) a, m ~ a V dt a ` a S a m c rw E i c c-S S Parcel 040-1122-90-000 11iCT2005 04:27 PM PAGE 1 OF 1 Alt. Parcel 32.28.19.511A2 040 - TOWN OF TROY 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 RONALD MICHAEL THIELEN O -THIELEN, RONALD MICHAEL W12138 850TH AVE RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = F irnar; Type Dist # Description 4~4r .:TR- 6.1 SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH i Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE SEC 32 T28N R19W 2 AC IN SE SE LOT 2 OF Block/Condo Bldg: CERT SURVEY MAP IN VOL IV PAGE 931 Tract(s): (Sec-Twn-Rng 401!4 1601!4) 32-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/01!2005 796393 2812/506 JD 05/05;2005 794149 27971093 QC 07/2112004 769405 2621/127 WD 07!2311997 12321192 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 48,400 200,900 249.300 NO Totals for 2005: General Property 2.000 48,400 200,900 249,300 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 48,400 200,900 249,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 S BUIL SANI"rAlzY SYS'1'i:,t I, - Q ' I cy 'l a W N S H I I' ~ S I. C OWNER ADDRESS _s ST, tOIX COl^!Il', WISCONSIN. SUBDIVISION LOT - LOT SIZE - 1'I.AN VIEW Distances and dimensions to r:ceuL requirements of 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM TTD ti- i J_ 5 I7U S I az 17 Ir di at f N r h rrc w BENCHMARK: (Permanent reference Point) Describe: !✓unr Elevation of vertical reference point: -Slope at Site: SEPTIC TANK: Manufacturer:- Liquid Capacity: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation-: Tank Outlet-Elevation: PIMP CHAMBER Manufacturer: _ _ --Number of fallons _ Number of gal. pump set for a cyc]e gallons; 't'otal capacity of distribution lines gallon: Size of pump head; gallon per minute - horsepower ----;brand nawe of pump and model number 'type of warning device HOLDING TANK: Manufacturer _ Nurlcbt+r of gallons Elevation of manhole cover 'type of warning device _ SEEPACE P11' SIZE; Number of pits__ _ feet diameter - feet liquid depth_ _ seepage pit inlcL pipe-elevation- hotLom of seepage pit elevation__ feet. SEEPAGE BED SIZE: number of lines width len-th tile depth SI.I;PACE TRENCH widtI-1- r0 N R A f L ;\lt - Fi\ RE UfRl:l) AREA AS BULLT~sy 11 - - _ length _ LkC O I, AT 1 INSPECTOR ` 7~ PLUMBER ON JOB DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P,CQ. BOX )~89 L BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL -1 ALTERNATIVE Swa PI- IDN.Mt- _ !II :u yr n:l L_ Holding Tank In-Ground Pressure J Mound NAJ7E"FGary Moelter JADDRRRESS#OFP3'Ir1liDghway M, River Falls,WI NSPFCTIDN'tE d$ =j - if ;G a 3ENCH MARL P. ,r r ~ . F.•„T DESCR BE IF DIFFEREN- FRONT FLAN FIEF. PT. ELF% 'JST PFF Pi ELEV SE SE, Section 32, T28N-R19id, Troy Township I,-,t ~1 Pi ur,I: •\1P•\1VH5.'. V.c.. ~ Sa :,•v Pcrm!I Nor-rorRoger Timm 3224 St. Croix 34826 SEPTIC TANK/HOLDING TANK: i\1ANUF AC I UHI: IOUID CAP ClT" -ANKINLE-ELEV. TANK UUtLLI L LLV. N'A RN-N6 LAUFI LOCKING CCVLH PRO)DLL1 f Pw UVIDLG. V J'•j J - 7I YES -NO I _ YES __1 NO 3EODINI, VENT DIA. 1',' Ni r.IAI LI wATFF NUMBER OF ROAD PROPERTY IV, ELL BUILDING 1,'1F%7 TO FRFSH 1-1 ARM _ FEET FROM L NE (AIR INI FT -I YES -]NO ❑YES _!NO NEAREST DOSING CHAMBER: _ VANLFAC'URLH HLDDING. LIOU IDCAPACIT~ MP MODEL FBI •sH'! JpA"JU AL IIIIJ I WARNING LABEL (LOCKING COVER PROVIDED PROVIDED YES ❑NO ❑YES NO -YES NO NUMBER OF `I;` v'JE LL BLILDwG VEN ^LO SI' GALLONS PER CYCLE: P177- CONT LS OPERANAL INEAREST (DIFFERENCE BEIWEEN FEET FROM PUMP ON AND OFFI ES NO - ~ SOIL ABSORPTION SYSTEM. Check the soil moll eat h' epth of v ovying R L ar.,F TFR MAl' HIa_ ANU r,,An INr. rn P.xcavatio"I (If soil car be rolled into a wire, nstructlon shall cease urUl ORCE the soil is dry enough to continue) MAIN CONVENTIONAL SYSTEM: _ :'I E' I' IL '11:7 1 IN' DF IL.111 "I"I '.0A1. N, I~Ci I'EH iN$I ;7~ DIA =P' L.11G BEDITRENCH - rRFNCrES vn I u DIMENSIONS PIT L CEI'T •I -1L1. GE PTH '.)iSTH PIPE C STR PIFF DISTR. PIPE MATERIAL `JO NUMBER OF -~PFIoPFR-Y AFLL BUILaiNG VENT TO FRESH nair:E coven F NL - r ELEV LNG C PIP= FROM 5.50 uN / A FNLET 85 aL. 7 (o 2 FEET FR 1 NEAREST-,J d f f L~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check th texture of ,the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound y tems to fnake cerl in that it ON REVERSE SIDE. SHOW ELEVA- _ meets a riteria r rnedium s d. IIONS MEASURED. _YES f IN( SOIL COVER rE ToRL FEH9JANLN-r:4R.If: _ Y,F ❑YES ❑NO ❑YES ❑NO MUL~HEG LI! PTI11.1': F1~ _-%L.H RFFI L1L •'-HfJ'VFP TRENC'1 BED IJFP II Or T P<.: L 50:)DF[) ~LLLEI 11 Fr1TF11 II!; F: r / i ` ❑YES _JNO -YES LINO LYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: r1I i , L LN, II i NU OF : ATFRAI WA/NC. 1GRAVEL DE H BELOV. PIFF FILL DEPTH ABOVE COVER BED/TRENCH TRFNCHES DIMENSIONS _ \1ANIFoLD PUNT MANIFCLD C'ISTP PIPE 'ANIF-003 MATERIAL NO II DISTR PIPE DIS-WBUTION PIPE MATERIALBMARKINL. E LE'J ELEV CIA Et E'V. / ELEVATION AND P DIA DISTRIBUTION - INFORMATION 1'J F ,.17F 1,1O. F sPACIU:, DHILLED 11,14111- C' P ATERIAL CA- LIFT CORRESPONDS To APPROVED vl r.S ❑YES ❑ _ ❑YES ❑NO COMMENTS: rF 7mANFNT MAR KF RS O FHVAT DN WELLS NUMBER OF J`"nPFRTY WELL BUILDING _ FEET FROM NE DYES Not _YES JNO NEAREST ~o oa J I Sketch System on ain in county file for audit.77 Rcvrse Side. J' r,NA I uljTr TIT LL : DILHn SBD 6710 IF. 01 X821 i DEPARTMENT OF ? APPLICATION £ SAFETY & BUILDINGS INDUSTRY] - FOR SANITARY DIVISION LABJR AND PERMIT P.O. BOX 7969 HUMAN REL'ATI'ONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: Property Location: City, Village or,ignubia; J County: 7 '/a~ ' %S - / T NCR ! ? . W ~__L - Lot Number: Blk No.: Subdivision Name: NP.are oad, Lake or Landmark: State Plan I.D. Number: (if assigned)-- - ~ TYPE OF BUILDING 7tt Number of .J Public* U Variance* ❑ Other (specify)* l:= Bedrooms- N 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- THER GALLON OF TA K CONCRETE PLACE INSTALLATIO MENT Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP IANK,`SIPHON CHAMBER L/ _Pf NIANUFACTURER EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA iMinutes per inch): PROPOSED (Square feet): ILA New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit A ❑ Alterna ecif ~ Seepage Trench water Supply: Owner's N~aln.t: as Listed on Soil Test Report ilf other than present owner): JX Private ❑ Joint ❑ Public 1(~ f[{j- I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. I`,1eruP of Plumber: u re:, ' MPIMPRS"o.: Phone Number: Plu be s Address: C Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signatu a of Issuing Agen F. Date: p Sanitary Permit Number: e OV APPROVED `d 3 JCI D SA PROVED 3'T`O ~(P Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau nt Plumhing, Pink-Owner, Goldenrod-Plumber D I I-H R -S R D-6398 I R.07,`81 'I i DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND • PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 81/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must hp 0-i m- n. A legible reproduction of the soil test report or the owner's copy must be included. -1-oce~y 0,,,,ner: Va u r ress 'I ~l e ~ ~e 3 ` '1 i ure- r Ya z Property Loca n: City, Village or Township: County: _ ` '/a`'/eS 2~T NCR E (or - ?v Lot Number: Blk No.: Subdivision Name: Nearest Roa , Lake or Landmark: State Plan I.D. Number: 'N yy~ (If assigned) TYPE OF BUILDING pl ' Number of ❑ Public" ❑ Variance* ❑ Other (specify)" Bedrooms: fJ 1 or 2 Family 'State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHEF GALLONS OF TANKS CONCRETF PLACE INSTALLATION VENT (Specify SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New K Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit /i --5 C70 ❑ Alternative (specify) ~A-SeepageTrench Water Supply: Owner's Narrte as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public r I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signattuu MP' P&E1W No.: Phone Number: 3,zzy (765)3£b re. y , m tom: _ Plumber's A ress: Name of Designee 1U6_S r.~ COUNTY/ DEPARTMENT USE ONLY Signature of issuing Agent: Fee: /i Date: APPROVED San!tary Permit Number: / V ❑ DISAPPROVED T O Reason for Disapproval: f~ Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation- Failure to comply will void the sanitary permit. DISTRIBUTION: Wh:Te-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6jU8 (H-0//87! Fu rni - S T C 100 Owner of Property_ JC ) e f-- - - - Location of Property Sei:tiull N R 1_`Lw' Township - - i p - Mailing Address f 4'c.~S J C - Subdivision Name - Lot Number - Previous Owner of Property _ Total Size of Parcel Date Parcel Was Created- - Are all corners identifiable? Yes _Nu Include with this appliCatiun one of Lite fullow1119: .Certified Survey Map .Deed .Land Contract, or ,Uther Legal Document which describes the property 1 PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 3707 C' 3 ?7 ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF OWN N SIGNATURE OF CO-OWNER (IF APPLICABLE! DATE SIGNED DATE SIGNED K.~ DEr AF_T'./.NT OF REPORT ON SOIL BORINGS AN SAFETY & BUILDINGS INDUSTRY„ LABOR ANN DIVISION PERCO~.A,TION TESTS (1155 P.O. BOX 7969 .U,AAF;. R'%%; LArdGNS ~ , J MADISON, bVl 53707 (H63.09(1) & Chapter 145.045) : 't / ~LCCATION sECT'ON: ITO4"JNS:IIPrAIUr.I(:IPALITY: LOT NO.: UG. NO.: SUBDIVISION NAME: 5L Z IT29N/R t9 E for TPa - ~ COUNTY: OWffNER'SBUYER'S NAME! ~ fv1Al LING Af)C)RESS: S>~ • cl-M ) J VII - "'l lo/ s 5"~o ? L USE "Bi - DATES OBSERVATIONS MADE Bc"DAMECO'"'I~'HCIALOESCRIPTIT__ PROFILE DESCRIPTIOi\'S: PERt~OIATIONTESTS: Residence 2 4/+ ❑ New Replace RATING: S- Site suitable for system U= Site unsuitable for system 10, //l ONVENTIONAL: PAOU'JD: IN-GRt~I NPPESSURE: rYSTLr:1,1-i',j-FjiL HpLDING T4'JK: P.ECCf:?'.~: `.UcCY5i=N,1 (opronal' rtrlt/'iltv~L ~S DV ► •S [:]U ®S ❑U _ DS :'U I ❑S CJU s If Percolation Tests are NOT required DESIGN RATE: [Floodplain, f any enruon of the tested w ea is in the Her s.H63.09(511b), indicate: indicate Flooaplam eleva fi PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR0UNO4vATER- - CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTNfgI, ELEVATION 09SFRVED FS T. HI GIIES; TO 13 E0ROCK IF 09SERVFD IS EE A . 9S ~ r 1 r ni aAC i- - - - - B- l ,5 Ito- > 9S A33'-A`-AA1, - , /-1 ' a,v - sr~ 'Ly-a,,, sL, 6.3y r~ 1.4.,1", "A4. S W' 10.r /34.. 5z 0e'(,E'r'r5 B- I S~ 7 ?1 p J o , > 7.r ' ~l • ,~'L , . (6 2 ' ,BA. SL, O,? ' ~~•,E3 t1. SL 5/~s 'Av S Cc or e- c') `'.,f,', 5Z-- 1/00, 7Y' 27,- 13,v.5rL, .3~',6A'; .s,~~ •.~3'/3~,-O,f'.sL, A 5f, y o a I9. ?s' > O 4 I ''6_1 s~ , • emu. - - f L- vEi.c. - rI'• w,Jf- OUCH - ,vor ~ C B /j/I vV Acfe S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATEH LEVEL-INCHES HAT= `v?INUTFS NUMBER F5 AFTE:iSWELLING INTERVALWIN. pERIOD t PE51C0-2 _ r Fi._c PER INCH 4 7 P P- : o f j 77 P- ~P_ n - y y LY- 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- .,ontal and vertical elevation reference points and show their location on thhe,tplot plan. ~fShow the surface pelevation at allll+bnrings and tha direction and percent of land slope. 130 /l e.'4 %J E c41 nT P4 /C.~~ - SST /j ielm - ✓ ~L " Y t ~'l~ I , SYSTEM ELEVATION i '.SEA SE,orE' _TTi4 ~GQ ,L~~t1 J'ItEET f;,u~~ f,~Ap~ ~v~/i APE- S'61 14 V/ o~- /0"", `4 ' i3eiRe p# - vv~ R Pc1c ~~•~F - t N fi'o~~, rE~ F/~✓~rio,c~ /'EO 'loo /?D N 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 Adrnlnistrative Code, and tnat the i!ata recorded and the location of the teats are cor•ect to the best of my knowledge and belief. ,+ANIE (print): TESTS NI ERE COMPLETED ON: APB%~- 7 /983 ADDRESS: •:_3j CER I=(CATION NUMBE=R: PHONE NUMB ER(op,ionall: 'f 10 1 C;;T ;iIGi:'ITUPFL -  7)STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil T~szer- - t HR-S80-5:395 P. 02' - O'v'cFI - ?DEPORT ON SOIL. 13CRINGS PERCOLATION TESTS ~ ~S PLoT PLAM ppo?EcT D. A/iX~,~. DAr/-tom h+OMESITE TESTING CO. n-L.3, ON E.-IL ROAD BOB AUUS N, WIS...- 54016 Cyr o2y~z PROPo5ED HOUSE m o s r LIE 2~ r- 0.4 MORE ",0.4f 44 TEST f3APE.45. PROPOSED WELL M V5T LIE 50 F!' o,Q trORE` FiPoy1 ~qcG TEST" f~PE/!S. • = D,3ayoE PITS Q = SXiST/`A) 6- tvELZ- //,4A/,P f9v9EIOPfD o p S~edfL 134ef S r ` MA10;4 13M ~P Poi l y' ~u~L AL ff~ .UC6 T--' ` pipe LEGEND /EV riov oc lJ r ~cf. PT, i~v, dp rr, t3, • o 4 f3 it fir/t D OP i ~ 5= It fsr.~%'` (o ~ I1• sZ 7- lie iC M,oe-it,2 ,yG~ J e"v:; 7- 4,c T/~ ~r7 I,~o >E' vERr ~Ef ~r• r i  ► p L)c A'1 TO 0.0 /C e: 3 5t ~ /3c ~o TMFNTOF REPORT ON SOIL BORINGS AND S"FFTY&BUILDINGS INDUSTRY- DIVISION N LABOR PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN R RE ELATIONS ` ) MADISON, bti153707 (H63.09(1) & Chapter 145.045) LOCATION SFCI ION TOWNSIIIPiMUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sr 1/ 1/4 32- /T % 6N/R ~y E ;nrLW i any COON I Y OWNEH'S/BUYER"S NAME: IMAILINU ADDRESS: ~1 yai~ USEDATES OBSERVATIONS MADE NO-BEDRM1AS.. ICOMM1,1ERCIAL DESCRIPTION: PROFILE DESC:RIPI IONS: PERCOLATION [STS: [~QResideri New XRep /A lace 2J t J f ZS `d RATING: S= Site suitable for system U= Site unsuitable for system W/'O' TRf-l"t ° /00 CONVENTION tt : M1cOUND: IN-GROI:VIIPRFSSURE: SYSTEM-IN-FII I HOLDING TANK: R COMMENDED SYSTEM: (opti nal) 2 Li',V s - $ 1A ©S CU ®S [_]U I [~]U ❑S CCU ~avvfvrvv.,<~ I° Percolation Tests are NUT required DESIGN RATE: [14 any port on of the tested area is in the under s.H63.09(5)(b), indicate: loodplain, indicate Floodplain elevation: F~ . PROFILE DESCRIPTIONS s`S /'///o T SGT OAS 50RING TOTAL DEPTH TO GROUNDWATER-P, ES CHARACTER OF SOIL WITH THICKNFSS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH rN. ELEVATION OBSERVED EST. HIGHEST TO RFUROCK IF OBSERVED iSEE ABBRV. ON BACK.I B / - - B- 2 E =~E.yi /~v~i o 4P x/ L 7-F3 13f B- If 3 - J G1, AV - 0,,C 5, o O - { B- ~ PERCOLATION TESTS TEST DEPTH WATFR IN HOLE TEST TIME DROP IN WA I ER LEVEL-INCHES RATE MINUTES -NUMBER I S AFTERSWEI t ING INTERVAL-MIN. PEHIUU i PERIOD 2 PERIOD 3 PER INCH P. P- P PLOT PLAN: Show locations of percolatinn tests, soil borings and the dimensions of suitahle soil areas. Indicate scale or distances. Describe what are the hori iontal and vertical a evation reference points and show their ~location on the plot plan. Show the surface elevation at all borings and the direction and percent : f and slope. ~C~7 /~s l~tiC `5f -q- ` 9l~ SYSTEM ELEVATION ! /DEF. ALA) _ a SwIrn If L I(Jo 6,ei-G-1.14 L r-E5-7- ~ri~9s Dd cJ~ o,v i9/,t°, L 7 -~3 S^I S "i lle - /9z o M 4.-- /eS i i >o /f L ? 7-/ ~tM Gv fN 7o f~iP 0 U~J>E- ~9~DrTio,vg ~ 5,~~9CF_ - d~v ,P~.~i2 Ly1 k1~ F~~ I, t ie undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified tlr' l%1[, r ; 4.;rninistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and bchwl. NAME iprint): TESTS WERE COMPLETED C`,: Mimi ,P ! ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER ioptionall: ter 3 D.yEi~ /~tP . f~vosfl,J ~j/ f =a1- v L s~le CST SIGNATURE:  DISTRIBUTION: Original and one copy to Local Authority, Properly CAaner and Scr D' SRC-li', Ii~IS 1 Rt_1C r itJiv~ i=Ufi C:UNirLETIi~vC, FC~%? . ir~plete an i !le Iega: descr use seLtvor must `.XIMUM numl}er uD twdr-;uri',,,w co='ini,il ;!d: ul t- {",.:ju[ his a now ni -placernln::.Vstern; oD>lear t}i sti'}:ability'rntirlgboxes. A SITE IS SUIT AGL HER. Sl i"EP•tS ARE RULED OUI BASED ON SOIL CONDITI(Y ':ASE use tft- alibCRV atior15 shover hei'H tn~ bb`tUnq profiie desialp'! ,Kf A LEGIBLE d aiirarn ar:cura?elyY ktcatiny your tE?s' locations. I - ,<j:ae,h°er i~a/. he ! peel if ,j! :I1 n l;miiei J-;' L~ - L:~aestnne I f i G y y - i ^!!+h~riu' t" nrrinr to REOOPT ON SOIL BORINGS PERCOLATION TESTS IIS csA~' y /`'l O t c 7 die /'T -3 Pao r P L AA1 P Ros Ec i 17-D. //lvy-/ti DATE ;--5-43 HOMESiTE TESTING CO. 11'r, 3, O'INEIL ROAD BOB IJf I;h'~rC: 1 iUU4'*Q I, WIS..- 54016 CST SS- 02 PROPOSED I1ovsE MUST WE 2,r, Fr o.t MO~fE F~POM f}L~ TEST f~~PEgS, PRo POSED we u M VST LIE 5'p FT o,e J'lOfE FiPOH AtL TEsr A,PE~s, . = Qiq yoE P•rs wQ = ZX/sr/,V 6- LI~ELL //,4/uP AO9EQE0 o t 54edEL 134eES ■ ` f/oeiz . B M PEFtRCV4r Po1:07" 17oa,P R4 3 LE GE N p/~v~row of tar APE` P ~a c~. n ~T r' o pi pc x 13L 3 0 X )-o r 3o t 30 ~ f I' l y Y o ~ool C~ ~ EA 3/ I'' P P 1 _ ,~Lv  i ~ Irv " ~oME JOB ' ROHL & TIMM EXCAVATING SI-EET NO / OF Z 310 Arch Street HUDSON, WIS_ 54016 CALCULATED By r f DATE ~j7 L~ s (715) 386-8664 CHECKED BY UATE_.--) SCALE "JJ ' J -f- -Irk yo c. (r ` I _ I ~ 7 F'R::UC' 2041 ' I,: -1r M.,: !11171 ROHL & TIMM EXCAVATING MoD - - 310 Arch Street SHEET NO OF n_ Z HUDSON. WIS. 54016 CALCULATED BY- -DATE J Z (715) 386-8664 CHECKED BY DATE _ _7 _ SCALE ]a 'A a , • JOB S I o Q r . ROHL & TIMM EXCAVATING 310 Arch Street SHEE f NO. of HUDSON, WIS. 54016 CALCULATED By z ' n % Z' `f (715) 386-8664 C-IECKEO 9V y DATF SCALE 1 \ lb I fm G~ i C1 Q1 d _T, ? ; n G R ( # \f cv ~ i ~J ~ ~ v i c, -rzj ~ ~ JOB---- ` L`•C v - ROHL & TIMM EXCAVATING SHEET NO. ~ OF ? 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY 'C✓ ! i ~K Z Z (715) 386-8664 CHFCKED BY _ DATE SCALE J I Li.~ j/ t! !U v2 I i I ' r n4 r I v ~ ~ ~r h qq~ 761