HomeMy WebLinkAbout032-1052-10-000
r
n N O 3 v n r~
0 a Ct 0 rD `+1
to = v
CD (D
o' M
d C ^
3 # K.
\ 1
3
O
C ~
0 O W 0 O z (m cn N)
O I O O oW •
:7 3 (0 3
00 a 7 Z o. N CT N (D j O
N C (D CD (O O
N
D y Cn pWj cn N fD N N
i13 CL 0 0 :3
3 5 u 0 o
g- o O
m r CD 0
m v> D m 4 c°o
CD (Cl CD U)
(n a] d OD
CD C O Q p
C
75
H fD j
C, Ll
c ` cQ
(D c co rn m co co N 0 c
d _ N cn Ln0
O O O
r-~ G n N N fn O
p ay v sT u v %J " O~y
o rt1 0 G) ~R " a y ~ rn
o S
a CD - (n
N
z O
2 z-~o
D CD ~y
CrT1 m 0 ~ N
•
d o ? U) "WA
v CD c
00 `O v m
a
i w (a
N oc CD
CD C6
Q W fti OZ O A Z CD
OO m C - p 0~
l1i Z rn 7 A Z
v CL
Z w No
oo m
CD M Z
0 m CD
~ ~ v w F
1J o
ZI N~ ~ o a
s0~ j N o
CD m O T
N N a M 0 N C
cn°CD O - 7
X 1 N y 0G O CL
C~
CD m
O O_ Cn ty,
?
(D Cp
C S n
C V =
(D y 0 N yy
~ CD CD G
N d
Cn
CD _CD a C Z
~•7vam
CL z z
0 =r
C N
N
3 ~ (n ti
O'CD ~.C CD
a
N, a C)
O 0. O O
CD DO Op
W
O w
o * C
°o a
' Parcel 032-1052-10-000 04/21/2006 03:19 PM
PAGE 1 OF 1
Alt. Parcel M 20.31.19.257A 032 - TOWN OF SOMERSET
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 - WICHELMAN, ROBERT C & JEAN
ROBERT C & JEAN WICHELMAN
2098 40TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2098 40TH ST
SC 4165 SCH D OF OSCEOLA
SP 1700 WITC
Legal Description: Acres: 14.070 Plat: N/A-NOT AVAILABLE
SEC 20 T31 N R1 9W NE NE EXC WILY 175' OF S Block/Condo Bldg:
375' AND EXC LOT 1 C.S.M.6/1545 AND EXC
PT AS DECS IN VOL 948/48 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
20-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Pagi Type
07/23/1997 948/4
07/23/1997 7171105 LOT
~0~n hl'='rr
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 14.070 129,100 133,800 262,900 NO
Totals for 2006:
General Property 14.070 129,100 133,800 262,900
Woodland 0.000 0 0
Totals for 2005:
General Property 14.070 129,100 133,800 262,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 032-1050-30-000 11/22/2006 09:23 AM
PAGE 1 OF 1
Alt. Parcel 17.31.19.252 032 - TOWN OF SOMERSET
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 - WICHELMAN, ROBERT C & JEAN
ROBERT C & JEAN WICHELMAN
2098 40TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 4165 OSCEOLA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 17 T31 N R1 9W 40A SE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 979/379 TI
07/23/1997 555/353
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANDS G6 40.000 200,000 0 200,000 NO
Totals for 2006:
General Property 40.000 200,000 0 200,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 200,000 0 200,000
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-STC- 104
AS BUILT SANITARY SYSTEM REPORT 0 N
_ TOWNSHIP zh y Je,~s SEC. ! T 3~ N-R C W
OWNER C1 ti ~C tu&f,
a-jc
i ST. CROIX COUNTY WISCONSIN
ADDRESS c <
SUBDIVISION 1,4 LOT R LOT SIZE arPLAN VIEW
Distances and dimensions to meet requirements of ILH,R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I l
l 3
6V
fld
I
i
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site C
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: L/) Tank manhole cover elevation: l
i,
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,t?\ Side10 Rear, O L-,2 r3n feet
From nearest property line Front,O Side, Rear, O //'~q feet
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
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, O Side, O Rear, 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:
~C~cs f
y, !
Fill depth to top of pipe: z Z
r
Number of feet from nearest property line: Front, Side, Rear,O Ft '
Number of feet from well:
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:
H/eit a drop box O or distribution box O been used on any of the above soil
asytems? (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:
l;
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on j(,: !'71
License Number:
/~/1~ ,5 s
3/84:mj
DEPARTMENT.OF INDUSTRY, INSPECTION REPORT FOR : ,r=`Y & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIOr,I
P.O BOX 7969 BUREAU OF PLUMBING
P11A{IISON, WI 53707
UtONVENTIONAL ❑ALTERNATIVE ~slacPpla~lD-N~mner-
;nf ass~4~~1
Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT OLDER. s iADDR FSS :-:F PERMIT HOLDER. INSPECT N DATE.
R. R. 1 Box 101B, Sameuet, W1
Rvbent Wich.e&an `
BENCH MARK (Permanent re fe re nee F OE HIRE IF DIFFERENT FHGM PLAN REF. PT. ELEV.'. CST REF. PT'- ELEV
SE% SF%, Secti 'n 17, T31N-R19W, Town any Samizuet
N,~,- of PI uin ber. MP/MPRSW No. IC"""" iS--r, P-- Numne~ I
Gan L. Steed. 3254 St. CAOtix 64935
SEPTIC TANK/HOLDING TANK:
MANUFACTURER / ~,OUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER
C,;9-& / YES ONO ONO
BEDDING'. VENT DI A.. VENT M L. HIGH ATER NUMBER OF ROAD'. PROPERT WELL. BUILDING VENT TO FRESH
ALARM LINE. AIR INLET.
IFEET FROM
OYES O OYES ONO NEAREST_
DOSING CHAMBER:
MANUFACTURER. JBEDDING. 11_111111D CAPACITY PUMP MODEL PUMPSIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
OYES ONO ❑Y S ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY ELL BUILDING I VENT TO FRESH
LINE' AIR INLET.
{DIFFERENCE BETWEEN D' FEET FROM
PUMP ON AND OFF) OYES NO NEAREST 30
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNI;Tl 01 TER MAT RIAL AND MARKING
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:
WIDTH LENGTH NO OF DISTR. PIPE SPACING; COVER INSIDE DIA. UPITS LIQUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH'.
DIMENSIONS
FRESH
GFAVFL DF_PTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPF. MAT ERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO
IHELOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPES LINE. AIR INLET-
FEET FROM
M
NEAREST
MOUND SYSTEM:
t 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.
OYES ONO -
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
OYES ONO DYES NO
DEPTH OVER TRENCH. BED DEPTH OVER TRENCH. BE[) DEPTH OF TOPSOIL 7iy SE EDEDJMULCHED
CENTER JEDGES
ES ONO DYES DNO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LEND TH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. 1110. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV. DIA.. ELEV.' PIPES. DIA.:
ELEVATION AND
DISTRIBUTION vERncAL LIFT CORRESPONDS To APPROVED
g INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS
I
OYES ONO OYES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDIN
-
l% ❑ YES 1-1 NO ❑ YES El NO NEET FROM - LINE
EAREST-
y~c
yf
Sketch System on tain in county file for audit.
Reverse Side. SIGNATURE TITLE
DILHR SBD 6710 (R. 01/82) l
wl5cons,n APPLICATION FOR SANITARY PERMIT
DILH OLu COUNTY
= oEPRRTTT1EnTOF UNIFORM SANITARY PERMIT #
InOU5TRV,LRBOR 6 HUR1Rn RELRTIOn5
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROF', Y OWNER MAILING ADDRESS
RBI I t / , (S 1
PROP RTY LOCATION C1~Y:
ir; 'z-~rcvt:
1/4 /4, S T-3 (N, R (or) W TOWN OF: S O m,' es& r
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK T TATE PLAN I.D. NUMBER
,S 7y 4-
A) r 4 4- j/
TYPE OF BUILDING OR USE SERVED . 03 /off
L~Z 1 or 2 Family Number of Bedrooms. ~ Public (Specify): CJ CJ
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.
❑ 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
Septic Tank Capacity ve,~ Lam"
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 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):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na e~ , of Plumber (Print): Signature: /MPRSW No. Phone Number:
_CC'
Plumber's A dress: / Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signatu of Issuing Agent: e: Date: ❑ Disapproved
J~_ ' ~ ❑ Owner Given Initial
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
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 inadequaQies 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 a~. VL,..
\N\ k- t
\4 lam.
Location of Property s ell Section , T N- R W
Township
Mailing Address ~oc
e
Subdivision Name
Lot Number
Previous Owner of Property X 1%4.1 a 1_)
r--
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? "K Yes No
Is this property being developed for resale (spec house) ? Yes _X- No
Volume 4~C r and Page Number 7X` as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
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) cuLti6y that att statemen.t6 on .this 4oh.m are -tAue to the beat o6 my (ouA)
knowledge; that I (we) am (aAe) the owner (6) o6 the property dacAi.bed in .thi,6
in6oAmation 4o4m, by vi&tue o6 a wa4Aawty deed tecoAded in the 066i.ee of the
County RegiA teh o j Deeds " Document No. `7) 2-%,1. `r • L.--- ; and that 1 (we)
pimentte.y own the pnapobed bite ioh the 6ewage po6 6y6tem (an I (we) have
obtained an easement, to n.un with the above de cAibed pnopeAty, 6o& the
con.6.tAucti,on o6 6aid 6ystem, and the tame has been,duty necoicded in the 06jice
of the County Regizten o6 Deed6, as Document No. '9/< cr
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
0`
DATE SIGNED DATE SIGNED
H
z
.a
a
ST C- 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
OWNER/BUYER 'y\4 1`ye 1\
r
ROUTE/BOX NUMBER G.~.~"rc Fire Number
CITY/STATE ,-•1`` ~ t'v'l 14 Z I P i C,
~
PROPERTY LOCATION: >C-. 4, ter` 4, Section 1~f T J1 N, R Iri W,
Town of /r''hAiYot 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
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- rd
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning; ffice within 30 days
of the three year expiration date.
SIGNED C"if C/
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.
Z
- c~ 3 ra
E o C E
m~Oa Eoo p Ec~
c O N H :3 X 0 0 j v m
'O ewe ° (D N N c~ o U)
U Ul E
) ca i'O 0 0 .0
3 - (D
w -0 0 m c co
ccna)c - ca
W 00.0 , U) 3: 010
~R =3=0.0 = vEC h
ca 0 y C O) O. 7 O N
O to 0--
5, Y U L'o O
Nt~U:n~cco ovoiC ~r1l,
!n ~ 0 O t_ O O
cc cc W = ~03ca=Mn OWN
IL N 3 0)"o cn p N~
cu c c U
O L O L co i C N
W c U 3 o ~ m
Q - m cn U o 10 i
:E (D a) E i
C U ~ O L as
fd
Z p g'3~~3N Ll
L
N Z N~LC v)~° ~
CO C O U «1
O 3.06a c~
O_ U V co O N
~ - O Q con O CD >
0.0 O a
` :3 N
~ CC c
O_ a - N
cd C
Q
O T p a) p !
0
-0 0-0 TO O)Z C E 75 > 0 O R) c 0 C c
C,5 m O) . p E U
co 0 0 0 U- o- O)
u rns Cam- (D ^v^``"0t c
T Tcn a) L W a•V Y
- cy) r: ~ i Qol Q jog
T3 3y cno c
N o- a) N C D p a c Z
TY o 0) 0' E C T O` W U) L- E -0
0 0 co
a ~ ` p a N
ca C L O)
O
O? N C i cb w m D
0Ecvcnc'n 0 co
m
N G
t
DEPARTMENT OF 'y REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,* DIVISION
LABOR
HUMAN REDLATIONSPERCOLATION TESTS (115) MADP.O.ISONBOX
WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/Mt tte~T Y: LOT NO.:BL"K.~NO.: SUBDIVISION NAME:
2o /T CO Y NArPOE: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
,Residence JJ ~ q ~ ,~Vew ❑ Replace
z V f c~ [l ~ 'T' c~ CJ
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-INN-~-FIILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) A
[AS ❑ U JL~U S Z]U ~tJ
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: /l) Floodplain, indicate Floodplain elevation: /(J
6SlYYlF~1 PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER Dff.FH4V, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
-50
B- .27 P
7/1 -
B -3 r/ cyg
00 N p, .
B- 35 /'L7a
fu p
B-
~S~mal / PERCOLATION TESTS
TEST DEPT~~j WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCAE~ AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P_ /Un
P- z ~3<~
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
^=~E
7_ _
I.
~ g I
P
E
4
t
aan~
5 I I
.
T- r
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 ON:
-z - s
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
c~,itJ• ~G~ f /1zOY Zvi`. z z 1C__ 9- G-6zvo
CST SIGN f0j R
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DI LHR-SBD-6395 (R. 02/82) - OVER -
s lK S NO . L 0 no! W s, , is, !no a two, 01 TATY-nent i y -t SIT.; K I T A
PLEASE W. 3 (lock. m t , sn, , „ l , onnny FO le desct a do .s and *nniAn c the , A,t pl
. J19~. r': Lit- it..i4 aC< .,.,.F, ti_. .<Vfp, E'3 £..fY , i,?,- 7d u., -r's z, t(s SUM ?.;ptP .a.
,at shop! n t s€ desited;
:z. sma roc b . i oa ; and £?,F.., E ..o i rein enc[Mint d7,. ,:;9r.wl s£"F r, _d , ~E , e
-..aa .1 i,. ,?ts n an .,,-Yac4 as in i e? Int "WY L awt, s, 17C"f €t X do. a at €?w
,,urn a v s 10e,
SR via Ln<
3") ,
Gavel Ax-Am " _.°a `wAlo:e
P
A*Abyn Son; "-V VV i? 1!
1 .1, r HMO""
On Loom BI Wwk
oil C~ My
sono ca:, "q
s "E fi e v,
poll
flam him k,
, " r~ h Y =ii sE ,i - o ;n a r; a a a n ' r {e r A v, n i r.,n , .K _ , a z iai r j e} t a as
j'A 0-mil hs sa o. - , .,a . for 11w ,,i t..:£tf~
i ~
4ds3
lCl-
!3 -s
33
S
`7a
~r
Vol 7