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HomeMy WebLinkAbout030-2027-50-000 0 O °m' 0 C 1 M 7 ~ A p• fnD N cn 0 Z O O cn N OW ~C . p p N p m cD 3 9 co 0 0` W O p' N Z cp'~ N Ul _ N PI) CD N N CZ, Q 7 N ? N O A J M. C.0 O (D 7 F O O A7 O O O r. o N 7 O Q N C A O ".3 CD N C/) D CD cD o N d W of c m N u QO o o lot i A W "-44 < CD CD<nrcn N Cn Co OD ccnn o to o c a o :2 c z O O O ~y~• o . N N CD 0. v v v A N :3 cu -0 CO .Z1 CD N Q !~i N N 3 - d =3 (D r N z z l~ p z CD Z O O D m a o N• o m CD N (D o N (n N C (D N (D W ~ d n 3 7 1 N Z (D p 7 O A Z CD cl~ c zt ~a _ C) , z O 9 n O o. N O W o N G CD : Z p Z1 0 N 3 c, °O< N ~ < CD A p~ N N 0 7 > 3 7 N Q P-Z' C d AQ C =3 cn a W N - 7 o, z a 0 m aO - -o omCD' x N N CD c D N z a- m N ? ~ Ve a n p 0 =3 (D 0 Q0 c CD cu fi X d d N _ oro c° co 02 N x N CD 4' C) O N CL A 0 w p N Hi O A O V °o a Parcel 030-2027-50-000 02/18/2005 03:03 PM PAGE 1 OF 1 Alt. Parcel 22.30.20.439H 030 - TOWN OF SAINT JOSEPH 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 * CAPISTRANT, BERNARD J & PAULINE BERNARD J & PAULINE CAPISTRANT 1442 TRIANGLE DR HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1442 TRIANGLE DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W S 127 FT OF N 381 FT OF Block/Condo Bldg: E 340 FT OF GL 3 OF SEC 22 T30N R20W Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 966/576 07/23/1997 868/636 07/23/1997 722/507 2004 SUMMARY Bill Fair Market Value: Assessed with: 5930 147,200 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 50,000 94,800 144,800 NO Totals for 2004: General Property 1.000 50,000 94,800 144,800 Woodland 0.000 0 0 Totals for 2003: General Property 1.000 28,200 79,200 107,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT O~YNr / 0 ~O al/ TOWNSHIP S r Sf 2 ; ,3G, //s SEC. T N-R 2~^W ADDRESS 3S ST. CROIX COUNTY, WISCONSIN SUBDIVISION - - L-OT L-OT-- SIZE PLAN VIEW I -I I~l ri \Pe / Distances and dimensions to meet requirements of ILH,R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~aTREF P ° P toi~- l=iecv / ~ j y 30~ ~5 \\-41 .5641z=- 3o' imp & " ~Z4 So L-o 7-. Z-1 TO / f. sd Li INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~ 4,e O3tl,(c„vG,.tiy I) OG,l' Elevation of vertical reference point: /00-0, Proposed slope at site: ~J JO ~L-7- E / ~C trC l~t (Ir- fSSEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: i Tank Inlet Elevation: Tank Outlet Elevation:' 70 Number of feet from nearest Road: Front, Side,O Rear, O feet From nearest property line Front,OSide,(D Rear,0 feet Number of feet from: well t/(0 / 1. building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE Form - S T C - 104' AS BUILT SANITARY SYSTEM REPORT s r G SL SEC. Z Z T '3C N-R 2 W O~: ~ / 0 C)L TOWNSHIP ADDRESS 35 ST. CROIX COUNTY, WISCONSIN 57' LOT LOT SIZE SUBDIVISION PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Vt ~x~sT,a c~ ~s 'x Y6 o I 3 0" 6' ~ZG .p - -ILL. L-o F. To i V# 7 1 e) l~f~E,Q INDICATE NORTH ARROW 77 /7,77 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /cc.c slope at site. er _ I S C /C"" !L- S~ ~CL'C l~t Liquid Capacity: SEPTIC TANK: Manufacturer: Number of rings used: Tank manhole cover elevation: f~ t Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from Road: Front O Side 0 Rear, O /zo feet nearest ~ feet From nearest property line Front, Side,0 Rear 'o Number of feet from: well building: SEE REVERSE SIDE septic tar (Include this information of the above plot plan)( 2 reference PUMP CHAMBER Manufacturer: r` Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: - Pump Size Elevation of inlet: 1"--- -_ttom of tank elevation: Pump off switch elevation:: - Gallons per cycle: Alarm Manufactures Alarm Switch Type.. Number of,.-f-eet from nearest property line: Front O Side, O Rear, Ft. 0 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Ct' Number of Lines: Area Built: Fill depth to top of pipe: 3 rv Number of feet from nearest property line: Front S" O Side, O Rear, O gt Number of feet from well: Number of feet from building: -2 s / (Include distances on plot plan). SEEPAGE PIT Size: `Number of pits-,.- Diameter: Liquid depth: Bo£tom-of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box been used on a~of the above soi absorbtion sytems? (Check one). O 1 HOLDING TANK Manufacturer: Capacity: _ Number of rings used: evat-io-n of bottom of tank: Elevation of inlet: Number of feet from nearest property line: t,o Side, O Rear, O Ft. Number of feet from well: Number of feet,from building: Number of feet from nearest road: Alarm Manufacturer: t~ Inspector: Dated: Plumber on job: License Number: RT. 8 O'NEIL RD.; HUDSON; WIS. 54016 wIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINri. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7669 PRIVATE SEWAGE SYSTEMS MADISON, WI 53707 DIVISION BUREAU OF PLUMBING NiCONVENTIONAL ❑ALTERNATIVE State Plan I D. Number y ❑ Holding Tank ❑ In-Ground Pressure 1:1 Mound of assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Pat Wood 1 PE DATE. R. R. 1, St. Joseph, WI 54082 • BENCH MARK (Permanent reference pomU DESCRIBE IF DIFFERENT FROM PLAN. NE SW, Section 22, T30N-R20W, Town of St. Joseph REF. Ti LIE V.: CST RFF PT ELEV Name of Plumber. MP/MPRSW No. County Robert Ulbrieht 3307 San Perron Number St. Croix 69 695 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET FLEV.. WARNING LABEL LOCKING COV ( PR VID PROVI 1)t ~ I ~ . t',~ BEDDING CIA ❑NO NT MATL.. j"I H WATER U ES ❑NO Y ALARM. NUMBER OF ROAD: PROPERTY WELL BUILp ING: VENT TO FRESH FEET FROM uNF 7 ❑YES Q ~C IAIR INLET ❑YES O NEAREST DOSING CH MBER: MANUFACTURER. IBE DDING. LIQUID CAPgCITY PUMP MODEL ~~CJ77 PUMP/SIPHON MANU A URER f/JII WARNING LABEL LOCKING COVER YES ❑IVQ PROVIDED PROVIDED GALLONS. ER CYCLE: PuMPANDCONrgoLSOPERgno"qL ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN j NU BER F HoPERrv WELL BUILDING VENT ro Fq ESH PUMP ON AND OFF) F T F,RgA?"'' LINE I AIR INLET.. YES O A ES SOIL ABSORPTION SYSTEM. Check the soil moisture at the❑d pth of plowing NO r GrH or excavation. (If soil can be rolled into a wire, construction shall cease until FO E NTH gMErEH MgrFRIAL AND MARKI"° the soil is dry enough to continue.) M N CONVENTIONAL SYSTEM: WIDTH. LENG BED/TRENCH iH NO. OF DISTR. PIPE SPACING COVER DIMENSIONS TRENCHES h1ATERIgL INSIDE DIA uPITS LIQUID PIT DEPTH. GRAVEL DEPTH FILL D H DISTH P ABOVE COVER E FNLE7 ELEV. END PIP BELOW PIPES DISTR. PIPE DISTR. PIPE MATERIAL: ISTH NUMBER OF LPROPY IN WELL: BUILDING. VENT TO FRESH . f" F PPES FEET FROM u ~ ~ AIR INLET. NEAREST--~. MOUND SYSTEM: Mound site plowed perpendicular to slope upsl and furrows thrown rpe e: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rexruRE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH'BED DEPTH OVER THENCH/BED ❑YES ❑NO ❑YES ❑NO CENTER EDGES. DEPTH OF TOPSOIL SODDED SEEDED MULCHED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH. LENGTH. NO. OF LATERAL SPgCING. GRAVEL DEPTH BELOW PIPE DIMENSIONS TRENCHES FILL DEPTH ABOVE COVER MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV ELEV DIA ELEV. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: PERMANENT MARKERS DYES ❑NO ❑YES ❑NO OBSERVATION WELLS: - N wUMBER OF PROPERTY WELL: BUILDING FEET : j ❑YES ❑NO ❑YES ❑NO NEARESTOM LINE M, o~ I Sketch System on Reverse Side. Retain in county file for audit. S I G NATu nDILHR SBD 6710 (R. 01/82) f~ s . wlsconsln APPLICATION FOR SANITARY PERMIT r S( '1(~~ DILHR (PLB 67) COUNTY OEPggTTEnT OF InOUSTRV, LRBOR 6N u,Rn 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 OWNER PAT Lki; L)0 l~ MAILING ADDRESS P Fli PERTY LOCClATION// I ) T~fff o Zt y ~1/4 5 ('4/4,S T N,R E (or W owNOF: J'.5~ LOT NUMBER BLOCK NUMBER- SL16 )fVibfUN-NAME NEAREST ROAD, LAKE OR ANDMARK TSTATE PLAN I.D. NUMBER NPR ° 3S /t~' . ,4-IVJ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. Q3a o`~ba7 Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Re air t. Replacement Soil Absorption System p ❑ Revision ❑ Privy ❑ Alternate System Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. LX Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ System-In-Fill ❑ Holding Tank ❑ In-Ground Pressure [11 Vault Privy [:1 Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: - , !L?,v La c> IF THIS SAN ALTER STEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure I #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufactur PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: 7 "L eq Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumyber (Paint): IEd /r? Signature: Number: Plumber's Address: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature :Issuingg Agent: Fee: Date: Disapproved ~v/-~5'-5'~ L~ Owner Given Initial Reason far Disapproval: / v A Approved gdverse Determination 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. .iOMESITE SEPTIC PLUMBING CO. RI. 3 O'NEIL RD.: HUDSON: WIS. 54016 APPLICATION FOR SANITARY PERMIT ROBERT ULBRICHT `RASTER PLUMBER LIC. NO. 3307 M.P.R.& S T C - 100 NSTri_LER & DESIGNER LIC. NO. 00663 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaoies 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 ~Uy6, e ' 1%7- -rON Location of Property N e Section T 30 N - R 20 W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property lei 36 n Total Size of Parcel J27 i X 3(je) ' Date Parcel was Created a-A~~X. J gq Are all corners and lot lines identifiable? 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 ONE OF THE FOLLOWING: 1. Warranty Deed ' 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ee4ti6y that ate 6tatement6 on -thiA 6o4m aAe t ue to the but o6 my (ouh) knowledge; that I (we) am ( cute) the owneA (6 ) o6 the pnope&ty du cti.bed in .thiA in6o4mati,on 6oAm, by vittue o6 a wamanty deed Aeeonded in the 066ice o6 the County Reg.i6•teA o6 Dee6 a6 Document No. ; and that I (we) ptezent'ty c;.s;n the phopo6ed 6tife lan .the. 6ewage tepo6r 6ptem (o I (we.) have obtained an ea6emen t, to nun with the above deb cAi,bed pnopeAty, bon the con6-tAucti.on o6 6aid 6y6.tem, and the Game ha6 been duty neeonded in the 066ice o6 the County Regi6.teA o6 Deed6, a6 Document No. ) . -4Z ZA~~~ I - i SIG A URE OF OWNER SIGNATURE 0 CO-OWNER (IF APPLICABLE) • ~ d ~ DATE SI NED DA E SI NED H ST C- 105 110 r U)OOP r HOMESITE SUN 131.9MOING CO. y SEPTIC TANK MAINTENANCE AGREEMENT RT,30'NEILR®„NU010N,WIJ.54016 H 1 St. Croix C o u n t y ROBERT ULIRIONT ° a WIS. MASTER PLUMBER LIC, NO, 3367 M,P.R,S, z / ~..--~j► SOS/ MINN. INSTALLER & DESIGNER LIC, CIO.00663 d /~itT ~tJd01~ OWNER/BUYER 9 H to ROUTE/BOX NUMBER tpp r l Fire Number CITY/STATE_57' SyD~2 ZIP PROPERTY LOCATION/46 .SZ'() 4, Section .ZZ, T N, R 26 W, Town of S7'1 -ZN St. Croix County, Subdivision o num e 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. 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- ro 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. a~ SIGNED DATE( St. Croix County Zoning Office G~" ~OO~ /r P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. i v m r s m m m~ w c)v,n)3O c ~ ? ~m~~'•<00 CID m 1 0 0 3 C w w CCOD ((DD :03 FD' 'D OL '0 05 CD CA a p 0 w o ca 05 CD CD :E CD 0 CD .4. CD < ~p w n Ef fD -w 7 (D R r CD % (COD CD CO O (D _ C to Ca > > (O O w O C 0 w C G W" I =r w 0 w w N o~ m ~o0a v D 0 w m -o~o~c 0 CD < N ~~co Qo ' CD c~ o D c cp °0 =w0 0 7J .~C cow ~0mMCLof Q 0 Y) CD Z =r 0) CA • Z : a(NDo 3Na D D m . „ ; co -1 c a o w Mo ?o Cr R1 om =CI-0M ~ =r w a a C a0 0. co CD C m ~o 3cs '0a~CD=r (n CD CD Fa* CD w 5* It ac° mm ° - 0 o 0=c~co a w a m-,o0 vao~ Uccawo m w (D w a (D w m a$-1 :acv; aN ~cQ w =m 2. 0 0 G) co m 0 7N 0 m o a, 1 CD C -N CL 0 7 0 n a c " cn 7 a joa ~°.=w m c -0 =r c °3 cDO°3 m is w a a m 0 3 vi 3a o< ~O» td c° o o a 1 i> ~yE~e : f'rf'7' 4700 So.v o f ~y/~' Gv coa2 . 3TMENT , OF SAFETY& BUILDINGS " _TRY, REPORT ON SOIL BORINGS AND LABOR AND P.O. BOX 7969 PERCOLATION TESTS ( / 115l DIVISION HUMAN RELATIONS (H63.090) & Chapter 145.045) ` / MADISON, WI 53707 LOC,fiTION:s SECTION: TOWNSHIP/ AIE_ '/4 ` 2Z /T.30N/R-2 (o ,S'f LOT NO.:BLK. NO.: SUBDIVISION NAME: COUNTY: OWNER'S NAME: MAILING ADDRESS: USE rr~~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE V~ttesidence P FILE DESCRIPTIONER❑New Replace U RATING: S= Site suitable for system U= Site unsuitable for system 5C.5 33 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL H OLDING TANK: RECOMMENDED SYSTEM:(optional ~s ❑ u ©S ❑ u o S❑ u EIS Z U n S o u rav VE~v Tio~v~L 'X If Percolation Tests are NOT required DESIGN RATE: under s.1-163.09(5)(b), indicate: G'Gi9SS :z- If any portion Of in the tested area is the /e~ _ _ Floodplain, indis cate Floodplain elevation: 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 BSERVED (SEE A BRV. ON BACK.) 01 i B- '9 lto- >70 J* ,f3' pv-- au is, o • ,au , s w Zoe.) /7 -4 ly• of RT 7o'-c:Vks B Z 7 /o% g~ > 70 )(34 • PAX- J)4 PJ 7 A O /3,v. /s s,•c.T. B .3 7, /6/.b' > >d • s' o~ 13N . Is) s' aj. is . sj' SN. S' 6:4 . 33 Bv -PC A rr/P•3CS O" AN S.4 SMA( B- 12ouuDED 4%MES>0Ajc 4~. H 1` . 7.0 r- L~•~,E• R. le . AP. B-s >3. ~s , , -2.0 , e! ~'tn AA- $-R . R . 2 - t~'HESToaE13 . lZ. /fVD/D //*ifS 0 f 8 4 s 13. P. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST ME NUMBER INCHES AFTERSWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / GGOA 'T, r P- j P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, SYSTEM ELEVATION - _z /JP - f W t I L , I t.. ~f° i. I E C= M r.. . Ca4),~EAJ,~~~~ f I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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): h1tjME5ITE SEPTIC PLUMBING CO. TESTS WERE COM~PjLECTED ON: ADDRESS: ~ ~a J ROBERT ULBRICHT CERTIFICATION MBER: PHONE NUMBER (optional): NO, 3307 M.P.R.S~ SS'- D Z y~ 3 MINN. INSTALLER & DESIGNER LIC. NO.0 CST SIGNATURE: I• DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - { f t` 7e y !%A NI, d t d t 3t s is F Si l ( 1 b~ { D l~tt b~ F ~~5 r t<~ I-) F L 's e: a c ~x ~ t ~ r 3 iF9 ~t} be i ~tio s ai ,d r n1' ~ t 1", i of F =!i ' k r J 3 r g' lb~T rl s"3) 'a It e i;i t it}'~,'{' Mw, v£., tt`a`t 0S)} o,~.r1:sc, b;4~Yi't f.,=t ~.Et, 3 aq_ , s a apt r =',1 ~~i E t e 5 ; F 1 L3v - 7 T b ma C ~V F- . #;i j y f?i;"ft+c. he &';9d➢LYYY~,t7C 1ymy request A ,.t. ,}mot.. ti set (A piwlS 1o, the t = 3 . Or, ',le local juth "3 itv l,`'3 i'li;,Jci to `REPORT ON SOIL E30RIOC7S ; PERCOLATION TESTS IIS e~ . CPS T u'oo~ PLor PL AM PROTECT rD 10 /1. HOMESITE TESTING CO. 11"i,3, VNEII.. ROAD BOB UAT,I;] ' :3C t7tbi, WIS...._. 54016 C5 T" - S- GL yfZ r PROPOSED HOSE MUST- LiE 2~- Fr. oR MofE "0,41 .4L~ TEST f}~E~3S. PROPOSED WELL M USr or 50 FT o,e MOPE F&M ,q~L T£ST fj,PE/}s, C3,g l.~fj~DE f ~T S O= E~'iST/~16-- W E L L X PEG /DC~¢T/D.t/f = H,4, p f} of EoPEC e), .e 540a'CL 13cieE S ■ ° #0A . B M VCRri c,*L ~EFERt ~UOE' poi r r"10 ~ ~Poa1pP,~ 0v - LE GE N D 64714Tdot/ o~ t/Mr p ~~P O ~x'S j ~Nc~r _ I l7 _ '~~vP1I~p , v~,I. ReF Pr '64 ~ 25' \ ~ ISM .2o / c 3 sy~ ~D b 1"k),0 s a5 ' F,Po~ UE,PT ~'ff i°T. y~ C ^ Tor of C&-A ~ \ 1 GAO D ~ tB'~l y!~ ~ p,p~iuf%F~ 0 w 133 yy New \ i -y-- - ~ S/2,06n'~P,QDOED 2Or ~iti U U ~ 1 S9 r ~ / i y Fx1,5 r,N6- 0 p~owc ~ ffi/FD s° Lo r 1-11'ule-~ ~v Fresh Air Inlets And Observation Pipe a h < Approved Vent Cap Minimum 12" Above Final Grade Above Pipe 4" Cast Iron Pipe Vent Final Grade Marsh Hay Or Synthetic Covering Min. 2 Aggregate Over Pipe S°/~ Distribution Tee .jE S Pipe -00 0 0 0 /fvlt Tio f Be eatthePipe ° Perforated Pipe Below o Coupling Terminating At 9~. 30 Bottom Of System r`i • • 'I ' `J T