HomeMy WebLinkAbout038-1154-80-000
r ,
o cn 0 v o C7 ~1
0 7 ' O
.Cf
C 3 41 ~ <D A
3 II `G
U) z CD -4
cv c io
3
m CL fb z a ro Vi N N M
ED :D '41 24 a*
Q. 7 O N (D , Oo O
p 0 = Q (D D) p
p C SD CD
3 N O
C] Ul 3 7 N :OE O
O N (D N N co 7 C
N 00
a a w
(o (D 7y m (a CD m U)
rt ki C1 N v :3 N co
O H. H 3 O N N
W r i CD "ftaK
CD
H ~I P H
O N 00 co m ~ p
(D N H Z7
"fti
z o O O 3
O ( c cn c
n n o y
N
Q v
a. CD FD'
cn !I
v ~ ~ s cv
U)
rt N ~ ' f3D ~ J I~ d
o r N
~.O O z O
(D I ct o O
a oo ~ 0 D a z
u, oo m d ,
o C CD
N ro H H CD N
i rj o w
VDC ;
w z c m m
00 w o 7d
rn (D r+ r~ n 3
ro W Cn z CD ~p 1 cn
O (n :E~ (D o o A z
£ N. rt 0 ~ (h c ~ 36 m
(D in. W rt 0 a A z o
n w n Fl- 9 c)
D) N ro 0 o.
i w
pi ca C
N• w r z
o
-
Fl( D a
~D 0 z
H z
(D
W
D
CL
Q
o -
I m c
o CL
N
,a
i ~
b
I m
I ~
0
I ell
JI,
I ti
O
a
A
ti
0 N
~ b
CD bQ V
ffl 0 ti
O
p :E
O CL
Parcel 038-1154-80-000 12/04/2006 12:44
PAGE 1 OF 1
F 1
Alt. Parcel 13.31.18.712 038 - TOWN OF STAR PRAIRIE
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 - WELLS, WILLIAM K & TAMERA J
WILLIAM K_&_TAMERA/J WELLS
218 2ND_S~ 2
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 2182 32ND ST
SC 3962 NEW RICHMOND
SP 1700 WITC 1
Legal Description: Acres: 1.480 Plat: 2348-PRAIRIE RICH ADD
SEC 13 T31N R1 8W 1.48AC PRAIRIE RICH LOT Block/Condo Bldg: LOT 08
8 A 1/15TH INT IN OL 1 HAS BEEN ADDED TO
THS PARCEL 722/352 726/480 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
13-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 726/480
07/23/1997 722/352
03/13/1997 1227/435 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.480 29,100 127,500 156,600 NO
Totals for 2006:
General Property 1.480 29,100 127,500 156,600
Woodland 0.000 0 0
Totals for 2005:
General Property 1.480 29,100 127,500 156,600
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
y Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. Tom, N-R W
ADDRESS
ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ,L~~j/ LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
i
i
:s
+ G
I
I L 2 r
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:/
SEPTIC TANK: Manufacturer:
~t quid Capacity:
Number of rings used: Tank manhole cover elevation:.:'
Tank Inlet Elevation: Tank Outlet Elevation:
I'll Number of feet from nearest- Road.: Front 1<7\ Side, Rear, O j~ feet
From nearest•property line Front,O Side,W Rear, Ofeet
Number of feet from: well building: T
(Include this information of t_.e above plot plan)( 2 reference dimensions to septic tank
SEE REVERSE SIDE
t r
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, a Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width: Lenth: Number of Lines:' Area Built:.
Fill depth to top of pipe:
Number of feet from nearest property line: Front O Side, O Rear, 0ltt.
Number of feet from well: 7
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 O or distribution box O 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: Plumber on job:/.,;
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
P.O. BOX 7969 DIVISION
M'4DISON, WI 53707 BUREAU OF PLUMBING
P4CONVENTIONAL ❑ALTERNATIVE Slate BI-I.D Namber
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assi9nedl
NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER
INSPECTIO DATE.
William Wells R. R. 2, New Richmond, WI 54017 `
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN -
FREE .PT.ELEV. JCSTHIF IT ELEV
NW NW, Section 13, T31N-R18W, Town of Star Prairie,Lot#8, Prairie Ridge
Na,-of Plumt~er _
M P!MPRSW N,, Cnu,ty Sar~l~ry Perm.; Numhe-.
Cal Powers 1563 St. Croix 75012
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. _
LIQUID CAPACITY TANK)NLE ELEV TANK QU TLE T. ELEV WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
3 7 _ _ J' ❑YES ❑NO ❑YES ❑NO
BEDDING : FIN IA. VENT MnTI HI(;H WTEH NUMBER OF RO~
AD PRNPR ELL BUILDING VERNT TO FRESH
A LA ` HM EET FROM LIgI INLET
❑YES ❑NO
YES L_~NO NEAREST-
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CnPnCI TV PUMP M(%t)Et Vti `.iP Sl nfl(IN MnM1UI Al !I~P
1P TWFARNING LABEL LOCKING COVER
i IDED PROVIDEDYES ❑NO YES I 1NO ❑YES ❑NO
[PC ALLONS PER CYCLE: SOPERATIONAL NUMBER OF BUILDING VENT TO FRESH
DIFFERENCE BETWEEN FEET FIAIR INLET
UMP ON AND OFF) ❑YES ❑NO NEAREST-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing
1ri n",1f TE H HATE Rlnl AND MAHKINC,
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
BED/TRENCH DISTR PIES SI .c.IN: veR Dln - -FIN LIQUID
'7 TfrrL Hlnl P17 DEPTH
DIMENSIONS Sz- /
GRAVEL DEPTH FILL DEPTH DISTR PIPE
R DISTH PIPE DISTR-PIPE MATERIAL NO DI i PROPER V WELL BUIL INC; VENTTOFRESH
ELOw s AE( cov R E FV INI F T ELEV I ND NUMBER OF
PIPES AIR 7
If C e FEET FROM
1 i t l J 7 2- 2'-__ NEAREST_i v
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 TExTURF Ptf4MAN(NTMAf?KfHS OHSEHVA'IGINwfLts
_ LIYES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH BE(7 DEPTH OVFH TH FNC;H HED IIE PiEI OF il)VSf IIE tiOIODF) ~EEDE II MULCHED
C'EN7 ER EDGES
❑ YES LINO ❑YES L_JNO _ ❑YES FIND
PRESSURIZED DISTRIBUTION SYSTEM:
I BED/TRENCH WIDTH LENGTH NO. OF LATERAL SPACING GHAVEL DEPTH HE II l~iv PAP( - FILL DEPTH ABOVE COVER
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLDMATERIAL N
DISTR PIPE I7ISTTIBU 11ON PIPE MnTEHIAL&MARKING
ELEVATION AND ELEV. ELEV. DIA ELEV. PIPES DIA
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING; ORILLEDCOHHFCit-v COVET MATLHIAL VERTICAL LIFT CORRESPONDS TO APPROV ED
PLANS
❑YES ❑NO _ ❑YES ❑NO
COMMENTS. PERMANENT MAR KER S. OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING.
LINE
YES ❑NO ❑YES FEET FROM
❑
_'N O NEAREST
A-LA
s
Sketch System on Reta in county file for audit.
Reverse Side.
SIGNATURE TITLE
DILHR SBD 6710 (R. 01/82)
-7 wlsconsln APPLICATION FOR SANITARY PERMIT
DILHR (PLB 67) COUNTY
- OEPggTTEnT OF UNIFORM SANITARY PERMIT #
- InOUSTRV,LRF30R6 HUmgn RELRTIOnS
-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
PROpE Y OWNER" MAIIII NP ADDRESS 7
PROPERTY LOCATION C4T-Y:
41114) 1/4, S%' , TJ.', N, R VILLAGE:
!p~ ~ (Or)(U~ TOWN OF:
LOT NUMBER BLOCK NUMBER JSUBDIVISION NAMFr NEAREST ROAD,/LACI-E OR LA-NDRAARK STATE PLAN I.D. NUMBER
TYP
Z~l E OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify): , v
A. 7
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.
V 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: ~Q! r 1
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
1, the undersigned, hereby assume responsibility for installation private sewage system shown on the attached plans.
Narr~of Rlumber (Print): ign ur , i MP/MPRSW No.: Phone Number:
Plumb 's Address: r' Name of Desigher:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
T~7~ ~p ❑ 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
f
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 he 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 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 f14kJ 14 Section /3 T N - R W
Township S~'A j41 i Q
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property lf~ l a.tcr.~ /3~•
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 No
Volume and Page Number 18o 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) eentiL y that a.QY Statements on this bonm an.e t ue to the best ob my (ouA)
knowledge; that I (we) am ( cute) the owneh W o6 the pn.opeh ty de c&ibed in thus
,itnbonmation borun, by vi tue ob a wcmanty deed n.eeonded in the Obbiee ob the
County RegizteA ob Deeds as Document No. KJ and that I (we)
p4esent.2y own the phoposed bite bm the sewage dispo.6a. system (on I (we) have
obtained an easement, to tun with the above de6c i.bed pn.opehty, bon the
eo"V uct i.on o b z aid .d y.6 tem, and the same has been duty n eon.ded in the O b biee
1.
ob the County Reg.ius.teh ob Deed6, as Document No. J0-?1(,9
SIGNATURE OF OWNER SIGNATURE OF CO-O~NER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
a
z
H
a
ST C- 105
r
a
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
a
OWNER/BUYER I' A J' H
ROUTE/BOX NUMBER Fire Number
CITY/STATE ZIP
PROPERTY LOCATION: GV' !V~,J_ Section l j T-7 N, R W,
Town of ~4~ f~rcae,2i~i St. Croix County,
Subdivision-, ,','7 OU 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.
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- b
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.
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~
r Cl)
2
a)
m
w a c
=r c-DT c: 3
m d fD X -:3 o
n 0 m
co, O 3 °'sw
z ` ? (a Q j c c w w ~c
N w
N
o ' -0 c m" 'a a CD c D D ° o -A,
N D O 0 (n CD V1 i
to O 1 p
m lD C 0 O O (D O CD N
- CD CL
(D CD 0) 9)
a ° C-
o 3 c 1 n O=? cD P
a c m ~
?M~ c o 0 w ow
o
3 ° ° c lc C-c (n'
c n
+v =r c Q c o
w w w
w CD O p C CD
(n _ ~ - D
(D Co -p -p
(c p- O
CD Co C: En (n O -1 O D C cD ~ ^
L
c C 0, w n 0 C)
CL W n w ^ 0 (D cD O"
CD O a > w O
m O cn o w (n
c
m =3 (n (n (D - w (n V
N? w y nco CD z
v D
. co
o n0 w0'-x z
CL CD 0 o 3 CD CD a
D
(D co
v, C CD co ? D
QN; -W =•c = 0 5*
o m CD F) * a (D N• - = 7 W
=r Cl cc cn
3 CD -0 C
CD C =T v, O_
° p n
Q o acQ _
N0 0 0) o0CD
cu O lD " a W
a o °
w3w ~
m Mawo" R1
CL CL ID In m
CL 0 CD CL
0 c ~c (o w 3• CD
(D ° C •CDcD 3 co n
cn
. n M O 01
O
CL o O 0(a a o
_ 1 C
(p a ° wa c CD
(D cD C (D m
VD CD 3
a p ° 3
CC) - CD
o
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTR~i', c DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) h MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME:
/a - 3 /T I N/R i~ (or) W 'rte
COUNTY: OWNER'S/BUYER'S NAME: AILING ADDRESS:
n
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence q ('plew Replace
RATING: S= Site suitable for system U= Site unsuitable for system Z
MSf IONOffi : I LLHOLDING TANK: R COMM ED YS EM:(optional)
❑❑U S❑U ❑S,'"]U ❑S. U LG u ic)rnQ+'-,
[under Percolation Tests are NOT required DESIGN RATE: If an
y portion of the tested area is in the
s.H63.09(5)(b), indicate: ~cLi'P' Floodplain, indicate Floodplain elevation:
P QL ESCRIPTIONS
IBORING TOTAL DEPTH TO GROUNDWATER-rNf ZfS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r
B- j 11 t_~ i
B-Z 5- cl i! ICJ ? c-t, 31x1 z.,z ' z Z- r
B- S L U U 6 1 i 2, 4 9 - dn5r{ l-' y
2
L/
i B° ? U W '-_i U-, L i=i us is ' - 1, L3r7s Z Z: ~u n
B-
~t:7 PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 44W++ E-S AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH
p- Ll L1. I K" 0 A)
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
o e'rJ AW 6 to #4 1- I'n r"'V_
tZI SoF
z ~
_Te
q
E
r
2
1
_ v
Z.01
o
3
t7- ~r r
I, he undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified n 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:
A- t1l
AD RESS: f CERTIFICATION NUMBER: PHONE NUMBER (optional):
i
CS S.GN TUBE
rJ
_J
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
i
A
Fo o 3 cf ,I J!E to and te~tz YO UV I;`:
wc tie !-i~ tat Pa -;ce mo}c {;.e hdt v".
I Xi'v?tJPVl b r o t it i ,o ;l or [aa usl
Is th:s a n n m r ~s r .f.r., mar= ,
Col iF1?r,, AvF,s_.cSr'tBL3
0 EJ `F 3 ,.,M_> ARE Rl.,UED EJ'_J? ASF,L_ DN C)II, (NI-111 T1":)NS:
hest, fo, ~,vntklg ~'a~ t ids: dom,i[mo ns and cc~n,JrCc?i,rr rht; ~?Ic~t ~Izr;~;
( r f ,-,,;D0 E D€'13 t3,~Ccl z7 6.;i~,i.2 ~a1'}f lC)_.~- :YC[ Yo Ur ? ~t sf3GC~don . Lai wing 1, scpflo is q~rellf,'?~reci,
MAKE
$c'pGt.ar9 „ i ..W is£ i a .,t
§".~~p. .tat f i. y~t, i r
;f airy
r"
. ?
s
1ci f~ - P It Cjt
Lo rtt ~ ti t to { r
sandy i .;tars
od,
r
AQAI, Ml,
ff fw-,'
CIY-ly
S1 Ida.
0 E V t z 11 ! Co It'st v `-gr tYl' F 'tt°wway Yfiques"¢
Ji .,3i.; z.3 t.f - , ..,C'.. j ,t i. ;4;n. EI j.)i;sE ~i~ tx=.it, f•;.
C
~.AfC~C.J tau); =,F' E 714, f
I
( f
Al~
5 4
3
g y.
r f Yr _ f'.1\
y
J
PAGE OF
1 1t ~
r u S S z c' 1 v r~ p 1~i ~J r ~l S r' l
i
fresA Air iniete And Observation Pipe
L - Approved Vent Cap
Minimum 12" Above
flnol Grada
1V - 42° Above Pipe _ 4° Cost Iron
To Final Grade Vent Pipe
Marlin Noy Or Synlnellc Covering
min 2° Aggregate
Over Pipe
Olelrlbullon _
0 0 0 0 0 - Tse
Plp•
Aa
Be
b" gragol
ne0th Pi Plp : o Perfaraled Pipe Below
_
o Caupllna Terminating At
Bottom Of Syefem
it
I
SOIL FILL
DISTKIBuTIOi-1 PIPE
APPROVED SJMTl-IETIC COVER
2" ° ""~MATIri~I/~X OP q" pF STGtAW
oF AG GR~GA~~ ~ OR /+,ARSN HAS
o pF 2 P AGGREGATE.
'ELEV. QF' fEET_,..
DISTRiA~ T1:J11 PIPE TO BE AT LEAST li\1CHE5 RELOW ORtGI1JAL GRADE
A~ILAT LEASTZO IUCHE~ BUT AIO MORE THAI! Ha IUCHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVAT100 FKoM 0Ki6 Jgl hKAIDF- WILL RE I"CHES
MINIMUM Drprtt of EACOATIOM MOrN. 1*161WAL GRAPE WILL P,E ~ INCHf.S
SIGLIED:
L_IGEkISE NUMBER: . l~
rub
DATE:
tto