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HomeMy WebLinkAbout030-2081-90-000 0 c o to > 0 3 CD (o ° y 'U CD CD ~ O U) 2 z o A D cn (N ow ti s v N o (D 00 Z d o N O P- 0 O IV V) K, 0 ~CD °00° n N Cl 0 CO O tD ((D (A O O A7 O (n 3 0 00 j N CO 7 O .Ni r (O O v co ~ D W C. D N O. 0 N I a a o 0 7 c 0 O o n i w ~ n CD CD ° c cc) l car, °c N 0 r- (n 00, Cr o ~i Q O O O• cn ~y A C C \1 =-i ~E' cncncnA 0 0 n U T o o co Nd s Q N 2 ° 3 m N (D - (n z I~ N z z O m p ~ D 0 j n o C !r m m Z m CD • C CD C -0 N (n a w (o Q j z (o -i cn CD p Z (D Cf) c - A - :3 A Z o v nn 3 i o M w (N» W (D M O (moo r z 0 3 M r: z N ° m o y Z s CD ~ w ~ < Q - m Q N a 0 m c m ° m ~ a v 3 z a c c m o N 3 0 m 0 s~ m N 0 OO_ 4 Cil v C) o C) 41 N C N _ N O O O O n O A o b A D A A ~ ~ o O o ~ b o b o a ti I o Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,/y er ARCio L2 TOWNSHIP SEC. ZS T N-R 20 W ADDRESS ST. CROIX COUNTY, WISCONSIN Gv,017,P44AP C- S-/. 6 LU f Cy0OP4A.c,~ /////SLOT / 7 LOT SIZE ,z SUBDIVISION PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Cam/ 4 v4 say ~ vilf - /Of - PT. I&s , FAQ zei.ucA 1s S kSo ' y I Sc q /-e 20 VfA)C 344- - NEV.- 77, o~ 77./0 7&F - fir v - 4 1.13 77 OF ° FRoar poa,~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used C u~ • L)A - .SAC . Elevation of vertical reference point: /00' 0 " Proposed slope at site: ~D -mod 90 SEPTIC TANK: Manufacturer: wce-ef eem-c - 4 /000 Liquid Capacity: ~j Number of rings used: A- Tank manhole cover elevation: ~j ~ p 0 Tank Inlet Elevation: Tank Outlet Elevation: u Number of feet from nearest Road: Front,Q Side,0 Rear, O feet From nearest proper line Front,©Side,ORear,O ✓ ' feet N0 T- iAJ / ~(G f~ . Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER quid C ity: Manufa t~urer: L:~a~ ufacturer: Pump Size Pump Model':. Pump/Siph n Elevation of inl~ Bottom of tank elevation: Pump off switch ele t n: Gallons per cycle: Alarm Manufa urer: Alarm Switch Type: Number feet from nearest propert 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: Trench: X 13 Width: Length. / a Number of Lines: J Area Built: 'y~X v~l Fill depth to top of pipe: Number of feet from nearest property line: Front, Q Side, O Rear,0 Ft Zd Number of feet from well: ~lJ ~S NOT /'y N Number of feet from building: S 13 (Include distances on plot plan). SEEPAGE PITS, Size: Number of / Diameter: Liquid depth: Bottom of seepage pit elevation: Ar uilt: 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: Elevation of bottom of tank: Number of ;rings us Eleva%i' inlet: Number of feet from nearest property line: \Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet -f,b'm nearest road: Alarm Manufacturer: 3 111 n Inspector: Dated: 1U( Plumber on job: 149*646 SEPTIC PhumoiNG co ItT. 39NEIL RD.: HUDSON: WIS. 54016 License Number : ROBERT ULBRICHT WS--M9WP-LUM9ER LI . MINN. INSTALLER & DESIGNER LIC. NO 00663 3/84:mj DEPARTMENT OF INDUSTRY, -INSPECTION REPORT FOR & BUILDINGS LABOR & HUMANI RELAT.ONS PRIVATE SEWAGE SYSTEMS DIVISICN P.O. BOX 7969 <UREAU OF PLUMBING MIADISUN, WI 53707 ~~CONVENTIONAL AL--ERNATIVE D Number. ass 4 >bl _J Holding Tank ❑ In-Ground Pressure a Mound I ( NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER'. INSPECT N DA E'. I r M & Mrs. Kurt Arvold R. R. 1 St. Joseph, WI 5, J BENCH MARK IPer-nent reference point) DESCRIBE IF DIFFERENT FROM PLAN REyF. PT. E V.'. CST REF. PT. ELEV. f SE NE Section 25, T30N-R19W,Town of St. Joseph, Lot#19, Woodland Hill ~N,f of Plumber. MP'MPRSW No. l!C,ur,,, Sanitary Permit Number Robert Ulbricht i 3307 i St. Croix 64907 SEPTIC TANK/HOLDING TANK: _ KING COVER C MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV.. WARNING LABEL JO PHDVIDEDROVIDED t / rl 9i~ `t ~,~lJ DYES ENO DYES ENO BEDDING. J I VENT DIA VENT MATL fLAR IGH WATER NUMBER OF ROAD PROPERTY WELL. BUILDING JVENT TO FRESH M . LINE: AIR INLET 1t P FEETFROM ' j YES ENO "41: DYES ENO (NEAREST- 1 J DOSING CHAMBER: MANU FAC CHAMBER: BEDDING LIQUID CAPACITY PUMP MODEL 7SIP1ON MANUFEIR WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ENO DYES ENO DYES ENO GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL. NUF PROPERTY WELL BUILDINGIVENTTOFRESH (DIFFERENCE BETWEEN FM LINE AIR INLET PUMP ON AND OFF) YES ENO NESOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N TH 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 contir f p MAIN CONVENTIONAL SYSTEM: 1.11 WIDTH. LENGTH NO. OF IDISTR PIPE SPACING COVER INSIDE DIA. =PITS. LIQUID BED/TRENCH _ TRENCH n RIAL PIT DEPTH DIMENSIONS ( v GRAVFL DFPTfI FILL DEPTH ILEILSETVR PIPE DISTR PIP DI.P E MATERIAL. NO. TH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BF LOW PI~'ES JABOVE COVER . INLEr ELEE1 END PIP FEET FROM ILINE{ AIR INLET. / NEAREST © x .5v MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO _ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO DYES NO EP D SEEDED MULCHED IDEPTH OVER TRENCH: BED rIPTI OVER TRENCH: BED DTH OF TOPSOIL SODDED CENTER DGES. S ENO DYES DNO DYES NO DYE PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. 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 VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS. EYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL. BUILDING. FEET FROM LINE: ' ❑ YES 1:1 NO ❑ YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLE.. SIGNAT RE DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT f~ 13 ' LHR COUNTY (PLB 67) UNIFORM SANITARY PERMIT # - InOUSTRY, V, DEPART nT OF f / j90 1 - - LRBOR6HUTF1nRELRTIOns {/G'/_ 7 7 -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 MAILING ADDRES >s R. s,`-W - TT f1~v6~v 127-•l S s PROPERTY LOCATION 5;E 1/4 N6114, S a5 , T 3D N, R E (or) W TOWN OF: / STATE PLAN I.D. NUMBER LOT NUMBER BLOCK NUMBER SUBDIVISION NAME N AREST ROAD, L- G>~aDtittiD f~iAjC Urf"~ T'PiriL /ll.,4 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify) THIS PERMIT IS FOR A: NJ' New System ❑ Tank Replacement ❑ Repair n Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. El Seepage Bed Seepage Trench ❑ Seepage Pit El Holding Tank ~ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy El System-In-Fill issued ❑ 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. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ~~f~S 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): 3 T'Rev66,e' C 'Isb ~,~b SDrxS ~ Private , Ll Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): g Si nature: P/MPRSW No.: Phone Num?beer:^~10~ p HOMESITE SEPTIC PLU BING CO. 330 715 ) ✓d Name of Designer. Plumber's Address: ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. N Q. MINN 10 11. COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Date: ❑ Disapproved ❑ Owner Given Initial Gv Approved Adverse Determination Reason for Disapproval: (L 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 4 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; & 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. i Elev. _ /DoO fr. PLB ~7 PLOT and CR 055 SECTION QIANS A G~ 7r'r v 61.4- 1?0 Ed S o 5 B p No'`'r Rs ~ ~ y ~ `fll ' ~ 36'K50 13 ~ P ' OXEs \ 30 y _ Y Pao s,E67- r vG~ X-bw r li aoGD Ld I` # Gv ooDG~c,v~ ~ yS S GA/ED ~ I IO~riESITE SEPTIC PLUMBIPtG GO. Rl. 3 O'NEIL RD. HUDSON, WIS. 54016 ROBERT ULBRICHT m ,ir~,rn oiaFg r yin ~w)7 Y. PR C M:"+'v. -'M! LLER ~ D` Sib . IC NO ')5'=63 Fresh Air Inlets And Observation Pipes so« TE 5T73 y (3y HOMESITE TEST.'NG RT.-3, O'NEYL RO.:v,,) Approved Vent Cap HUDSON, WIS. 4016 Minimum 12" Above Final Grade /,gOSED I'C7 4" Cast Iron 2 'Above Pipe - io Final Grade Vent Pipe Marsh Hay Or Synthetic Covering min. 2" Aggregate fll~ Distribution Over Pipe Di L Tee 5~ S~ Pipe 0 0 0 0 0 "Aggregate ~b~~'`~ ~ Beneath Pipe o Perforated Pipe Below 0 Coupling Terminating At Bottom Of System ' 3 y~ 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 inadequaoies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr,("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 OG Location of Property /V Section Z S , T 30 N - R W Township Mailing Address 5V Subdivision Name l~ 0 U Lot Number / Previous Owner of Property Total Size of Parcel Z Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X No Volume ~1 and Page Number 2 a as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2 Land Contra t 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 Hap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eehtti.6y that a.te 6tatemente on thiA 6o,m cute tn.u.e to the beet o6 my (oun) knowledge; that I (we) am (ahe) the owner (6) o6 the pnopen ty des c4 i.bed in this .in6o4mation 6oAm, by viA tue o6 a waAAanty deed neco4ded in the 06 6ice o6 the County Reg•c6teh o6 Deed6 ae Document No. and that I (we) phew entey own the pn.opo6 ed Aite bon the 6 ewage dizpO.6~-AyStem (on I (we) have obtained an easement, to h.un with the above descAibed pnopenty, bon the eouth.ucti on o6 6aid 6ystem, and the Game ha,s been duty hecoAded in the O66.tee 06 the C Regiz "o as Document No. ) SIGNATURE F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED _A hda z W ST C- 105 r r 9 SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County CD 0 W N E R f B Y-E~- ~t/iQ ~j U13 Z42 y c~ ROUTE/BOX NUMBER Fire Number CITY/ STATE ~SZ IP PROPERTY LOCATION: s~ ~4, Section 2f T30 N, R Z0W, Town of St. Croix County, Subdivision 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, 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 N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- 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. S I G IF< DATE 5, St. Croix County Zoning Office P.O. Box 96 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 3 0 it) ~ cnw~m ;K- Pi -1 3 cn x- l< cCD O O A _ to -p 0 ? cD Q CD cD N 00 C CD Cl) A N (D a A , O (D 00 0 0 O CD a ~ o-o (D (D N Q O CD o ~~v7 ~ N , r 4 (D ~ A O (D 5m OD(D lp A 0 a O ; cc 9 W =3 :3 =r to 0 C- c: Cc Ew 3: 3 'r- 'o< S-3 OL 00 Z~ c~ Q~ W ~ N ~ Al Al Lo o~m o_p:OIL m° ~p N cr ? n Cr < O O O D c fD 0 A AA. O -r °c cpc. W O ~p p' O ~Ha w (AD CO = te a WO N C N o N (D (D W 0 Z D N `cn w co 0 ~o Z mU) w CD?sa 0.CD 0 3 :CA (n - D W c 0 o A m va ..~'?0w0 f Na ac0*CD C m o 3CDD0 v(~w =r ~~0 6/ (D C ~ O Q (D 1 fn • BCD w = CD vw ~ Z O < 0 = c~ ip a i ~ o c ° N «°c~ N vi °C p CD A A~ p A)1 0 a.o N c= aw O m :3 W CD = CD CO :3 ;:w - CL a CL (CD a?vi 0 0 cr :3 Q~~ N ~ (p W ?(D co 3 01W A c (Di A C G) cc n f/1 A (D 0 C, 0 7 O f0 C (D C CD c I Q) CD p M V o Aa p j O j (D O 3 p) d a O 0 3 V i 0 , ~s uyEiV : ,rU,p/- No DEPARTMENT OF ' IND'J TR", REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS LABOR AND PERCOLATION TESTS 115l P.O. HUMAN RELAT.IDNS ( / . BOX 7969 ME- (H63.090) & Chapter 145.045) / MADISON, WI 53707 EO SECTION: 4TOWNSTOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 25 /T 3o N/Rlo E o sY. Tos~pOWNER'S/~'S NAME: MAILING ADDRESS: 3a NN 7v~('~ fo 3 G~ U~P Q ft~e . U1~so~ W/S USE NO, BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE Residence PR FILE DESCRIPTIONS: PERCOLATION TESTS: 3 f~- ~~+New ❑ Replace /C-~/~ ^ RATING: S= Site suitable for system U= Site unsuitable for system JCS J CONVENTIONIAIL: MOUND: ZU IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDI(N~G TANK: ~'CVOG~°D ©S DU J UcJ/'iPfSfU,PF) ZS EJU EIS Zu ~J EU S/o F ~XCESJ'i uE- ot~ U uTio yt I'VC-41W J, - f Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: [Floodplain, indicate Floodplain elevation: r `tom /w 'Tvc M 6-Q FT'• PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH I NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 9/ ? > ',S1 , /33'1~(3N. )Ili ~S^ RAP-B,J. B Z fO' > (f' 0 ' ~f ' . s N RAP- Q S . B_3 /G s. /0).6 aN . s .,?3 N. i7 . . 4?'0 !a By . S/, F3 v. /s, 8~1, 1hu~0. U . y 7 -1. 7 33'- e. /3N P3 ' S/, / 7f ' _/7-N . - o,e. 5; , 7",~-~- ~a S'/ wry, h.~P•S. Pac/~zfs 75_' 11,¢SS"Pe- (3.). , co T w,'dt. • `D"S7/.1c,-/- LB- _OR - G-X-Mv/S A7- 5.o . 4 teeS Ao" y ~j S • SW46-1/Ep Z PERCOLATION TESTS y ~,~s. ~Gw sEEP.,~ r TEST DEPTH WATER IN HOLE Tt DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING DI PER np2 PERIOD3 PER INCH P- 3 ' C2 P- P 2- . U 2 2- P_ P 3Z A, r ~ / r P--- * s,4N T- A-w 3 S 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' 5 pEC4Z_ NO 7- ST~TEZGr-1~~~,~~y 00AES 7 r:l ~ 5` U Tft (S~2 S v i ,z2o,y D~> ~-~',v,¢-~. l ~//~~Il~~ Fo /E' CD.cJVF~EJT%D,U,yL SoiG -~l"~foc~j~TiO,v TN /~"N" _ ~.v~,~2ovv11) ~i►-es~z s/~s{-e~.,... ~~T~~'it/~}Tv~- S s~'~i . ,g- ~l ,vi vim, y S0/T4 R <e_ so, t! . Zi4i S f7_01e j r~ 4-ee-ls Cdr Ile 3 /02-) a Ito Lk) I,J ZfS~ CD,tIU N>~io h~ SyS Pwt~ ~'S 1041f~o l/ERy c~v STioU~9/~/~ 4AI IN OVIVP Fitt S'yOX)1'ZE, 0 S 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 O : ADDRESS: - CERTIFIC TION NUMBER: P ONE NUMBER (optional): VED SITE EV U TI 1`+1S P ST S S =d L 4/~L MI:v ESOTA LICENSE NO. 00663 C SIGNATU E: WISCONSIN LICENSE I40.55-02482 RTt, 3, Q=L JW., BUDSON, W154016 DIST RiMSWWaa-Grig~ina and one copy to Local Authority, Property Owner and Soil Tester. DII_HR-SBD-6395 (R. 02/82) - OVER - pp "AYLL v N6 k Use `13EkJ. AX? `p it` '-1 i.€E3:P F (30 6, ii } a s t o 1 ; l € f rn i a y U € ! 1 I t rg;~F t 1 v~5 ~t!_3 9 xk #I r.~1;,t yf,x ..tes e.k3k3rr°c F.E~u ib r" £t, ka} VV k, 'VIAK 5.: T f _ U , ~Irz c lrls -3Io m rxflti are CSC PS S f€ j _ - i 1 ,y rk -r, b G. ld ~~d .rC 5~ ~s~ ~a; x. z at r [ rr 3~~~?-r?x,31 , po €,ni'.3kFion l£,{ £ nt.£ et i a ar1,a r ;v;~l ure'.,i1, k , ~E ,t i.9,;:; , t.<£ ll'1 x a,zrG4 NA, ri the ai?p1 opri~te box; s. v si. E7 ci Md; 1 , r r ;:ii;~ rt?r ez g, Tai ~ Bera 7 .a, LS i nI 3 9 x r- i}t f=: 3jax y E jF t5 ~ €`,`x24 n~~ a ~y }t',. c=tit ~ tr31 f tk,€'£'=I' .S t,'S{.'.liEs" r UlxiEyr pei .r_. ~t Ut 3-i.tt'f€u rlt trtIC",,GI£;S A ,~E 1. i.E r 7 .SCi, k ti', ktl?t€r x g trr.E (J4'1 ',W I r . ` REP097 ON SOIL aoRi,, C&S PERCOLATION TESTS J1S P' Lo PLOT PLAM ROSEC 1' D. HOP~ESiTE TESTING CO. X.2 o~ VI 3, o'sN EiZ ROAD BOB Ulxj~c,.;. ri ;UX)N, MS.- 54016 C57- -T PROPoS D H s Mo7' We r of mote 4,~i- nr5r Pgo Pos1E p WELL M vyT Li E- 50-r o~ IOI?r FfeM 111.4 T£ST ~•P~'~S, 8,46i fla,F PIT3 O = EXIST1A) 6- ZOEI-4 X = - /oC,}7-110A f = //,#A/,P 1409 E~PED 050 54erJE4 1-3tw s z . ~3 U£ ricAl- REF6RZAM, ° Po;~)r° -oIO ~ cVIVIISI-C J2 4P~661, P .Sgc Cv` VA CE~'rER ,~i.vE Ui~ 7/1fF iL-- A 9s 6 /3 31 36 3o DoT ` ~ pE /kox✓ yo' ~y Pie~v /3ox e ys 1 oR M°~~ \ z ~ A