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Parcel 026-1110-60-000 05/25/2005 07:38 AM
PAGE 1 OF 1
Alt. Parcel 4.30.18.623 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
' WOLDEN, SCOTT T & KELLY
SCOTT T & KELLY WOLDEN
1736 174TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1736 174TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 2573-VIEBROCK'S RIVER VALLEY VIEW
SEC 4 T30N R18W LOT 24 & 30' STRIP DESC Block/Condo Bldg: LOT 24
IN 598/409 VIE- BROCK'S VALLEY VIEW
ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/23/2004 754891 2514/095 WD
07/23/1997 1078/91 WD
07/23/1997 1078/90 WD
07/23/1997 818/99
more...
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 04/22/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 63,500 114,800 178,300 NO
Totals for 2005:
General Property 0.000 63,500 114,800 178,300
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 63,500 114,800 178,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 109
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
VO
Viebrock's River He
to
Town of ichmm
Located in the N 1/2 - SE
ATE MORTGAGEE a
r relsaM HaMp aN Ler• •taesM.e•. • ••.►or•r/eo Ntf erleauN eas :.is uwe wNv eM M vlulro of
Pas bo sp~N e/ "a LAWN Naartsol mad, Mes es.ob Naaaat to IM somlice, Nvt~•e.1seN1M ea• Nf,ew O
Y /M/ N/fMN MsM/ MMf.s to me Ni1NN•q of Q/sMl a Ow"ret vie"", as sod J. a N/y W It, riemer
1 •4 salasre. N 8
weemo s dal farisls eae &.eso aisMfNa w saes". so" eress"* r* so sie•od M "*'sec.
hed Neesas IM M/ awotMot of eIf HvieNr, ■laa•asla. oae Na *Woo"*@ essl to M aovr•te
Mwte1•r.1Y~s. 103' Q~a~e 228.OC
A:
2 od 31;
.z,"i-~"~ ~ 10' " •t ~a
C dal ro
nrtNa 1 _ a:' i
74' : 195-0f.
v~_ ,cam /6 ~C ( ti ry Q n N e 3 ° S~L~
ij-o *.a
Y. t t~
•41s •N tab " "-Ml of November. Iles. Ie•.et C. sore, Meatsewf, Me rrs• e. /e MS•, vlp po.Net of /so aoov• ee
ivi to to of tMr"as also osaNSee as ft""•e taetvalsewt, awe N no stteal• so ara mealoe•t a.:. vise
,s, old oetowto= /aetlaq es"Wes fee Movelwr i-ti, ••sea11 Meers N as tae Ioe1 N seta do,rellew ®y.
~ ~ N1•76 /
i tt
a , 1 /aa c. < ,4'11 a v if
i1 ~A • /Si' 00
r e
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100 \ ~j, OJ s. 30, \ 101
oti 4.4
94, 9 1 A 1ti
n. 5, 1966 95.80 ~Jf `O~ Nil°c2 E 241
35 \ : ,re/e,146•~ 27fb• 7 •s't~
75 ~°3 f ~ ~ ~tse
\6`, ffeesy. a ~a~ad:tf ~
o 26 25 \S c~ !y So ~2.ISD
175 23 fir
E1 d~ !o a
East
-
tta iO East 154T3
6 , 2 4 b 64.7 90.00 608 7. 50 46,8;
R.~\ v o Oi, \ / : ,rte
d t 8 ~ ~ ~ • ~ ~ e '!°'Vf" ~°.l'p o q.~~ fie, ~ ee .
Qtr j~~`9 y. ° y v \ts'~ t0/ o\rO~ f~ 0 10 O O O O
c I I 10 O O O
NY AI watermark 9
r<.~' 3 ° ~t V
IOYf . / o i!!! y 9. a : Q 2 fc o tl! ty
49
~t RR R N •aiao.z',a , • 1
kk 6 e°p; a 190.26 0• 95 00 p 30. 87. 50• ZIC
8 t 2 too 6_
4 000 132 0 East 375 26' t Xtst •
ee 74.4 _
7' °o \ -
-
water mark CS rr l R~ _
2'coM 1.,\~°/ . 87.P JtO i05 ~0 0500 IQ` 0C 105 15.00 d' 4~e
y'A
l 21 i0 .
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if) in
4 A 7 16 154 I
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ec° nr ~05.0C' 0500 105.00 t 00' • 1
,5000
h 8C~ 24 ( 00-' -o-_ -
West 1016.00• I/-~,~~~
E Jnpiotted onds C,-,aJNTY
S,' ATE OF "S(
sby cert he ST CROtx COU
TOODCA within lands known n5 VtebrOCes nicer VOlley View [lddit~.0n 10 the Tot-- Of Ricnrnpr d, County of 51 rr0'a and art
the
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R / W
ADDRESS ST. CROIX COUNTY, WISCONSIN
r~~~ r I 3 6 !7 0_',4W.
021x- ///o- 6o
SUBDIVISION
LOT 2 LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
P
k ~J
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used iz ZJ k:v
Elevation of vertical reference point: Proposed slope at site: `
SEPTIC TANK: Manufacturer:
~ ,IfSquid Capacity: 47,4
Number of rings used: - Tank manhole cover elevation:
Tank Inlet Elevation:_2 Tank Outlet Elevation: 9z z' :
Number of feet from nearest Road:
Front,
Side, Rear, O G~ feet
0 I&
From nearest property line Front,O Side,O Rear, feet
Number of feet from: well building: lc /
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
3
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, 0 Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Lenith: Number of Lines: Area Built
.5.~
,iii
Fill depth to top of pipe: r-
2(-c2-Number of feet from nearest property line: Front, O Side, Rear,O P't'--
Number of feet from well: 9Z~
~ r
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 0 or distribution box 0 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: ~f Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS
DIVISION
IvTNDISON; WI 53707 BUREAU OF PLUMBING
XXCONVENTIONAL ❑ALTERNATIVE State Plan LD. Numbec
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER
INSPECTION DATE:
Scott Needham R. R. 4, New Richmond, WI 54017
BENCH MARK (Permanent reference p_U DESCRIBE IF DIFFERENT FROM PLAN.
REF. PT. ELEV.: CST REF. PT. ELEV.
NW SE, Section 4, T30N-R18W, Town of Richmond, Viebrack's Addn.
Name oMP/M
PRSW NoSanitary Permit NumberCaers 1563 St. Croix 74962
SEPTIC TANK/HOLDING TANK:
MANUFACTURER
LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COV
PR~ O~VyIQED. PROVID D
L1YES ❑NO El It ❑NO
BEDDING: JVVENT MATL. HIGH WATER
MBER OF ROAD: PHOPERTV WELL BUILDING. I ENT TO FR ESH
/ ALARM.. rNE
ET FROM LINE AIR INLET
❑YES y ❑ 160 ❑ YES ARES
T
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER
WARNING LABEL LOCKING COVER
PROVIDED: PROVl DED
YES ❑Np ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND C ONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING (DIFFERENCE BETWEEN FEET FROM LINE JVENTTOFRESH
AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENanI 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.) CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR. PIPE SPACING COVER
BED/TRENCH INSIDE CIA sPlTS LIQUID
TRENCHES MAT€R1AL PET DEPTH.
DIMENSIONS ~ - ~ ~ ,
ORAVFL DEPTH FILL DEPTH DISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL : NO. DI , H
BELOW PIPITS ABOVE COVER ELEV. INLET Et EV. END NUMBER OF PROPERTY WELL= BUILDING: VENTTO FRESH
/ PIPES FEET FROM LINE: AIR INLET'.
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 ❑NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED ❑YES ❑NO ❑YES ❑NO
CENTER DEPTH OF TOPSOIL SODDED SEEDED. MULCHED
EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF ETV SPACING FILL DEPTH ABOVE COVER
L DEPTH BELOW PFILL DEPTH ABOVE COVER
DIMENSIONS
TRENCHESMANIFOLD PUMP MANIFOLD =AN DISTRIBUTION PIPE MATERIAL & MARKINGELEVATION AND eLev ELEV DIA DISTRIBUTION
INFO
RMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ]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
t L1 YES 1:1 NO ❑ YES ❑ NO NEAREST
I ~Y ~ ~j 1 l
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE.
DILHR SBD 6710 (R. 01/82)
wscizi,sin APPLICATION FOR SANITARY PERMIT
'Z~DILHR COUNTY
(PLB 67) UNIF RM SANITARY PERMIT #
OEPFlRTTTIE IT OF
IflOUSTR V, LABOR 6 HUTLIrI RELGiTlOrlS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAIUING ADDRSS
4 24i
PROPERTY LOCATION CITY: "
1 VILLFtGE: f
1/45 1/4, S , N, R/" E (or) W TOWN OF LOT NUMBER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New 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.
P1 Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
, ! f~
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity 1 n
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):
i~ C ' Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installatio f the pri ate sewage system shown on the attached plans.
Namepf Prumber (Prigr Si a re~ MP/MPRSW No.: Phone Number:
Plumbef's Addr ss: Name of Designer:
r i E 'rte
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
` ~I ❑ Owner Given Initial
~ 5_E M 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.
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 4 Section , T.,_ N-R W
Township ' ~a. ,.`ci
Mailing Address
Address of Site Subdivision Name
Lot Number
7 _
Previous Owner of Property a - rD
Total Size of Parcel
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 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (foe) eeAti4y that att statements on this 4otum atte tAue to the beat o6 my (ouh)
knowledge; that I (we) am (ane) the ownetc(,s) ob the ptcopeAty de~scAibed in th.i,s
in4otrmatl.,on boron, by vi tue o4 a wa Aanty deed ucotded in the 044ice o4 the
County Reg.usteA o4 Deeds ass Document No. 35 3 »,S ; and that I (We) ptcez entty
own the pupoz ed site bate the sewage dis poi syst ( ott I (we) have obtained an
easement, to nun with the above de~scAi.bed p)Lopehty, botc the eovsttcuction ob said
,system, and the same hays been duty heeottded in the Obbiee ob the County RegiztetC ob
Deeds, as Document No. )
A
~
se'te yZo~ e,
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED y
F--1
W
H
a
ST C- 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
d
a
H
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
CITY/STATE f Y' ZIP
PROPERTY 14, Section T. N R W,
Town of 'z- St. Croix County,
Subdivision ~ ~ Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- It
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.
SIGNED/!
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.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
HUMAN LABOR RANEDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76
N, WI 3707
(H63.090) & Chapter 145.045)
LOCATIONSECTI N: TOWN IP/MUPd+G4-PALITY: LOT NO.:BLK. :SUBDIVISION NAME:
(or / % l7
COUNTY: OW4ER'S/BUYER'S NAME: MA LI G DRESS: )
USE DATES OBSERVATIONS ADE
NO. BEDRMS.: COMMERCI L DESCRIPTION: PROFILE DESCRIPTIONS=z--
4Residence ❑New
f ~ Replace
Z2
RATING: STS:
S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUNN-GROUNDPRESSURE:SYSTEM-IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM/: (optional)
❑ S ❑U ❑ Si ❑UU -Y S ❑U ❑ S ZU ❑ S ❑11
If Percolation Tests are NOT require DESIGN RATE: I If an
IL y portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING ITOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHi-N. OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B
i
S.
B-
B-
B
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IN4C#ES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERIOD3 PER INCH
P°) i
P__
P- <
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 th'e..surface elevation at all borings and the direction and pgrcent
of land slope. /
SYSTEM ELEVATION ~c<~
ryir///yll ~
4
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in a,c°cord 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.
NA (print): TESTS WERE COMPLETED ON:
A ZD'SS-: CERTIFICATION NU n PHONE NUMBER (optional):
r l S. S~
CST MNRE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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PAGE OF
CrosS Szc'iur, o'~ ;1r,~ SySEr~~'~
t
a
Fresh Air Inl*16 And Ob6orvollon Pipe
J Y1.
7 ~1---- Approvita Vent Cap
Minimum 12° Above
Final Grade
c?0- 42" Above Pipe _ 4" Cost Iron
To Final Grade Vent Pipe
Marsh Hay Or Synihefic Covering
min 2° Aggregate
Over Pipe
Dlurlbulloo -Tee
Pipe 0 0 0 0 0
e Aggregate
Be 0 Perforated Plpe Below
o Coupling Terminating AI
Bottom Of System
~~cJ•.~It o,1 ~ j
SOIL FILL
DISTRIBU`r I01; PIPE APPROVED F_TIC COVER
° "MATERIAl- OR, ""OF STRAW
21 OF AGGREGATE OR MAP SW HAy
n o ~F,Z 2/7 AGGREGATE
t,L E V OF 'f FEEL
DISC RiBUTIOIJ PIPE TO BE AT LEAST INCHES BELOW ORIGI"AL GRADE
AI,IL AT LLASTZO IUCHE.'~ PUT LIC) MORE THALI y2 IUCHE5 FALLOW FIPJAL GP.ADE
MAXIMUM ®6PrH OF EXCAVATIoij FKOM 0KI& NAI 6KAoF- WILL BE INCHES
MINIMUM PEP" of ENCAVATION TOM. (*161WAL (3R40f- WILL P,E INCHES
SIGAIED:
L.IC E U SE IJUMBE R:
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DATE:
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