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HomeMy WebLinkAbout030-2013-50-000 o N O' n co O 3- n d d o _ f C o c R CD (D a 3t c CD (D 3 - M m w o w 0 o m 0 o o ~ ` w° 1-11 • (D 7 O O (D N (O CD 3 Z E to N K (°n O- a a :z Z ro h co 03 N a N co V=i W N r S A O r -V a B- 0 °o CD CD croi v cro a o D o >v O 1 =3 a) 3 CL * CD 3 N go N u 90 7 o O m (fi < D a U> a z CD (o CD cn p Cp CD (D G CD N IW o o l a IW 0 O n N;< cfl rp { cD a o r co m co x° w c on c on N o =1 =I v c d z 000(n o00can- O N D :03 (n 0 ~ v n O N N N =r cn Cl) fA ccn m v 0 a m v Q -0 0 D 3 3 CD rp' CD CD D m o p IN CD o m = CD , O (D c m m rn m :3 Im 3 3 N o cwt (CD z co z z co z N C D CD o D a c CL =3 t-, a rrt n O . -O =r cn CD ( O F. m m ro m CD ro (D CD u !mil (D CD CD a) S~ .0 (a cc -1 r CD (D ro ~o d a a CD U) (D CD L6 ID N C C n n W' W 'a ~ o m m Q z ° 3 C7 I C o " Z O M (r r. 3 3 I N Z7 N z y P CD r I a, CD CD ~ 3 "O f I Lei m ~Q(v a CD 0 No O D CL O 7~ a m o n < a Ul 4, r-n r, CD o'a° - oy7N o _ cc O C 1-0 C -n C!1 '-E (D CND CD N m C 'Np 7 COO =O m C 7 X° s z a rJ rt z a CD To m o m o C-, 0 CD M. (n 6 (2 CD (n sm U OQ~ 3 a (D T~ CD N 'O ON (on :3 5 w- s1 rrt r con M U) 0 . c I o o a roses 3- b 3. 3 o CD (n r ro r 3 CD = a) a o* 60c3 O Q N (n CD Z (C D C ? O N "O O a-- x o m a O O o p 0 N CD Q I o E m o 3 ~ Q (n c CD Q 0 w O 0 O A ~ O CD D p N N y O 0 C N b (D CD o ° Q I o ~ ti 0 Parcel 030-2015-95-000 12/06/2006 03:15 PM PAGE 1 OF 1 Alt. Parcel 36.30.19.417 030 - 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): O = Current Owner, C = Current Co-Owner LEWIS LTD PARTNERSHIP MCKAY O - MCKAY, LEWIS LTD PARTNERSHIP 5600 CLINTON AVE S MINNEAPOLIS MN 55419 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 41.000 Plat: N/A-NOT AVAILABLE SEC 36 T30N R19W NW SE ALSO A PARCEL IN Block/Condo Bldg: THE SW SE BEING LOT 1 CSM 11/3058 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1162/194 WD 07/23/1997 1124/191 QC 2006 SUMMARY Bill Fair Market Value: Assessed with: 169595 Use Value Assessment Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 4,300 0 4,300 NO AGRICULTURAL G4 6.000 1,100 0 1,100 NO MFL BEFORE 2005 OPEN W7 34.000 75,500 0 75,500 NO Totals for 2006: General Property 7.000 5,400 0 5,400 Woodland 34.000 75,500 75,500 Totals for 2005: General Property 7.000 5,400 0 5,400 Woodland 34.000 75,500 75,500 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-2013-90-000 12/06/2006 03:14 PM PAGE 1 OF 1 Alt. Parcel 36.30.19.408 030 - 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): O = Current Owner, C = Current Co-Owner O - MCKAY, LEWIS LTD PARTNERSHIP LEWIS LTD PARTNERSHIP MCKAY 5600 CLINTON AVE S MINNEAPOLIS MN 55419 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 36 T30N R19W NE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1124/191 QC 2006 SUMMARY Bill M Fair Market Value: Assessed with: 169576 Use Value Assessment Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 31.000 4,800 0 4,800 NO AGRICULTURAL FOREST G5M 9.000 12,000 0 12,000 NO Totals for 2006: General Property 40.000 16,800 0 16,800 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 16,800 0 16,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ter' C ' , TOWNSHIP OWNER 7" SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN C, SUBDIVISION LOT LOT SIZE t PLAN VIEW Distances and dimensions to meet requirements of ILHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r~ 5 f ' 1 v I 5~ ` G`/~~ G, c l3C/ 4 7> ~I R V 1 I V l (7 ~ /J L' U ~ f ~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used % Elevation of vertical reference point: Proposed slope at site:,-, SEPTIC TANK: Manufacturer: Liquid Capacity: & fL Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: / / Tank Outlet Elevation: .f Number of feet from nearest Road: Front 10 Side,W Rear, O i'FC/-;(-' feet From nearest property line Front, 0Side, 0Rear, 0 feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PAP CHAMBER Manu€ar,turer: 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: Fr21n,t, 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: Width: Length: Number of Lines: Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ® Rear,0 Vt. Number of feet from well: Number of feet from building: ~y (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 distr4bution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottoiir•,,of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Sidej,,.0 Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Plumber on job: Dated: License Number: J.~ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS '.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION 1ADISON, WI 53707 BUREAU OF PLUMBING XXCONVENTIONAL ❑ ALTERNATIVE State Plan I ,D Nunnr ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If asiignedl NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPEC ON CAT Gerald Me Kay 560 Clinton, Ave Mpls., MN BENCH MARK (Permanent ---11 ~r~v p-1- DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: JCST REF. P7. ELEV SW NE, Section 36, T30N-R19W, Town of St. Joseph Nainr= of Plumber MP,'MPRSW N,> Cnu,iy S3nrtary Per -Number. Donavin Schmitt 3205 St. Croix 74992 SEPTIC TANK/HOLDING TANK: MANUFACTURER. - /T y LIQUID CAPACITY TANK INLET ELEV TANK OUTLET E' EV WARNING LABEL LOCKING COVER -7 Z P :OVIDED PROVIDED. IBE D INGVENT DIAVENT MnTHIGWATER YES L--]NO ❑YES LINO ALM NUMBER OF ROAPROPERTY WELL BUILDINGJVENTTOFRESH YES LINO 1 FEET FROM LINE , AIR INLET YES ENO NEAREST C G~ -L- DOSING CHAMBER: IMANUFnCTUREH BEDDING P LIQUID APA(:I FY PUMP M()Uf l PUP.~P. SIP,i()N \9ANUh nc7- I I _IHFI+ WARVNING LASE! LOCKING COVER ❑YES LINO ROIDED PROVIDED GALLONS PER CYCLE: PuMPANOCO neoLSOPeRAnoNnL ❑YES LINO DYES LINO (DIFFERENCE BETWEEN NUMBER OF HOPEHrY WELL suILDwG VE LET FRESH PUMP ON AND OFF) - FEET FROM NE I AIR INLET L YES i INO NEAREST SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthedepth of plowing ~ti,r„ ;In.,rrEH Ar[H~AIANDMAHKINU 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: wIDTEi hL =L~ BED/TRENCH ulsrH IIP[ s7nn;L I:In DIMENSIONS r - pIT DEPTH GRAVEL DFPTH FILL DEPTH DISTH PIPE DISTRPIPE MATEIALNo (DISTH BELOW PIPES Aar LEV I ND NUMBER OF PHOPEHrv WELL BUILDING vENrro FRESH s FEET FROM uNF AR INLET NEAREST MOUND SYSTEM: ec j Mound site plowed owed 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- meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE EiMnnih Nl 41,'1HKf I ORSEHVAn(,N WELLS DEPTH OVER rRENai BED DEPnTOVFH TRENCH ELI) i jYES _ LINO _❑YES LINO CENTER IIF PTH /)F 1()VSfIIL Sc1UDfU SFE OF f) EDGES MULCHED EYES L'_] NO DYES ONO YES DNO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH wIDrH LENGTH No of LATE' AT SPAaNt; GI AVEL DEPTIi P'_' viPl FILL DEPTH ABOVE COVER TRENCHES ~ DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIP E MANIFOLD MATERIAL NO DISTH DISTR PIPf I)ISTHIET ION PIPE MATERIAL & MARKING ELEVATION AND ELEV ELEV DIA ELEV PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING, DRILLEUCOHRECTL Y COVEH MAT TRIAL VFHTICnl. LIFT COHHESPON DS TO APPROVED PLANS COMMENTS: PERMANENTMARKERS❑YES LINO ❑YES LINO s oaER VAT IO N WELL S V~ PROPERTY WELL'. BUILDING. NUMBER OF y FEET FROM LINE `LJYES LINO OYES NO NEAREST II , . Sketch System on Sketch Retain incounty file for audit. Side. CSI NATTITLE - hk6710 (R. 01/82)A''/f/- Wisconsin APPLICATION FOR SANITARY PERMIT DILHR COUNTY oEaaaTmenT OF (PLB 67) inousrav,~aaoasHUmanae~aTions 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'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS jc A Y PROPERTY LOCATION CITY: VI _)t&1//44 ` &1/41 S ...fit , TN, R E .(or) j OWN OF"` LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ST ROAD, LAKE OR LAN MARK STATE PLAN I.D. NUMBER r /V A L 4'. TYPE OF BUILDING OR USE SERVED ,n2~-aUl ~5 . 1 or 2 Family Number of Bedrooms: ,~7 Public Specify): THIS PERMIT IS FOR A: X 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. 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 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 Gallons Tanks ncr e Constructed Steel I I Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber i 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. Name of Plumber (Print): Signatur MPRSW No.; Phone Number: ~ 4- Plumber's Address: Name of Designer: r ' .d; COUNTY/ DEPARTMENT USE ONLY Signature ofjssuing : Fee: - Date: ❑ Disapproved J r! S pproved Owner Given Initial Adverse Determination Reason for Disapproval; Alternate course(s) of Action Available: 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 percola ,fi -17_1!•,~ a h V awl 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. A99A 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/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 (rt=/,%# ~~I IVA Location of Property fV'i= It, Section, T N - R W Township Mailing Address.( F l V Subdivision Name !v /h Lot Numberr Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable?Yes No Is this property being developed for resale (spec house) ? Yes f~,( No Volume and Page Number k!@ i 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. PROPERTV OWNER CERTIFICATION I (We) eeAti6y that att s.ta.tementb on Chid 6oAin cute .tAu.e to the bat o6 my (oun) knowtedge; that I (we) am (aAe) the owneh(s) o6 the pAope4ty de.6ctbed in .this in6o4mati,on 6o4m, by viAtue o6 a wavmnty deed Aeeo4ded in the 066ice o6 the County RegiA teA o6 Deeds " Document No. - and that I (we) pneden.tey own the p4oposed 6 to bon the sewage di4posat system (oA I (we) have obtained an eadement, to Aun with the above descA bed pnopexty, bon the eon4thuetion o6 said system, and the same had been duty teco4ded in the 066ice o6 the County Reg.id.teA o6 Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H z U) H a ST C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER H ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION: 14, 't, Section t T N, R W, Town of 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 i 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. ti 0 I/WE, the undersigned, have read the above requirements and agree z 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 N E D/ail 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. > O C O C a) 0 C «f oo~a~~t Z• U= ca L O O C i C O O O f- O j fC O U O c 'a C 0 cn U i N 0 C O O U T U v°f O O a) ` mt~ 3 c~ 0 0~ C7~~ o u) 'a "a (D C= v c-= C a~ cc c ca 0 ~r3~oa~ ~E 0 0 00 V U) HE- 4)a E cc m 3~» co co o d N 3 O 'D AS C c U N _N N A cc _ - Ca W O C O co c v U a) IM a) w E Q Z y }i 3 w (n F-- c m V) = cn - ca a t C a vi O ; Ate O 0 v V-NI 0 3: .0 'o - O m 7 O U cd - O U 00 O (n 0 j 0O~ NstA N~ C Q aa~ao m a) c 2 c or- o a) o 10 (n ca ~ w 0 3 c(D ~cZ.c N '0 O E O ~I C O 0 p E O = c 0 :3 CU C L c M OOi-- O O co N O O a U i a) - i O d c_4-- .A.. U" 0 C N 0 to N i a) a Ca - cu _c odoCa cvCDY(i oa)3m m m e a) o t U r O 13 ~ r3cn cn ,..3o ct 0 ° a) CD O. a) ~ o a o ca w m 0 a A` O a 0 ~~0Li00) Evo3 o OE>'oC Lm~ m o c,4 cn cn H 3 vO°i W Q CC s in DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, PERCOLATION TESTS DIVISION LABOR AND (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP ITY: LOT 0.:BLK. O.: SUBDIVIS 0 NAME: '/a -~/a /T-?,o N/R ~ &(or) W CO N Y: OVWWS4-9~ NAME: MAILING ADDRESS: y~ USE ~ DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: I ERCOLATION TESTS: Residence ` New ❑Replace '4A I /io CJR~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND- IN-GROUNDPREESSURi SYSTEM-IN-FILLHOLpING : RECOMMEN E SYSTEM: (optional) ~ S ~ S DU S ❑U I NS ❑ U ii [lf Pe rcolation Tests are NOT required DESIGN RAT : If an y portion of the tested area is in the 35) der s.H63.09(5)(b), indicate: j ` Floodplain, indicate Floodplain elevation: C?JaG J PROFILE DESCRIPTIONS _ BORING TOTAL NUMBER [ {zTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 77~ ~S 7 5 > s. 43n 11~n 00 J 1519, 75; B- k)O A) 03 0a _V_ 67 Z r° PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P- Pi P- P . O PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suita it ar tr di cae istances. Describe what are the hon zontal and vertical elevation reference points and show their location on the plot plan. Shoup sulevZAon at orings and the direction and percent of land slope. A SYSTEM ELEVATION i-~ /L4~ I - V E E 3, I 1 30 T _-T i I, the undersigned, hereby certify that the soil tests reported on this form were m de 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 WERCRE COMP©LETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN U DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DIL HR-SRD-6395 (R.02/82) OVER - 0"' ~ T:__ s ° P° : 63 p_.~ s~A' Ss r ra oil t:a , 1?+%?.~ i r,i I:} e , ones v, ue a, Ol i L € I `'Y e l . iLJ i 33 ,U ( B A!SPri F lieu .~01L C DI i 10 i~" J 'Lft a,. fit i~ _ PE_Er` SE the ~i t5t,t....;C. -.t~aaEi,.7s ,arsi r x ' t s 3' ivA ?'c t,n ~(y;a rtr r^; :.1'uc ; ;.tok,' Ivs„,.t.~3Ut' 1...,. 10, N, c 9 v .t E.,, U.wp :?e Fitt hoxes < l a, es, C? l" ~'S. ~d .<#a ..~~s u~$ :,F .~17.~ttfsa"= d£a4 .t.'HOO d f .lift, Ed „wean j doc€ no atw)ly.. ed ;N,A to tho del , ,,I,:at, kta 1o) m al'.C3 CE' ~.EE cu-, .;c wd yt"ul E - ~ , ,E„~ .e s ~ c^E B '7, 1 l' , L p iL o a Q. < ..J~ 2~ ? ~g rte - E tali - n'..i?, if t.. - ;tE pys 'Pe i 79" ;1 i r r 10/0 i ~ r ♦ , '51 -e A~v q, f-i • ~ti~ i'`s rte" w 13 9 r`r Fob DR~1c~ i. r ~l-/CTy S0i V4 --032 I. ~