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HomeMy WebLinkAbout040-1210-10-000 n <n O v n tz 10 j3 V 7! c :7 0 3 # y M`-° \ 1 3. F Cn -1 2 n Z o rn T N o • o m n o CC) m o U o `c 2y 3 j O d z Q N C: -j N W Q N j C cD (A 0 O O p N Q O ?c tD 11 00 -0 0 7 m n v o ° O cn , CD o o 0 O W H. C m c v O C H v? A (D yy Z m cn N W a O tr~ -u CD CD (D C d O O N O E3 O ~_o (\1 r l lot O P. x CD o o rt CD CC 0 r, Ch f- 0*1 CD N m co N o c 00 H o a v • v v m m• 00 E p O O O N FA X7- s Y c -0 v, y - °g Fy E ~n to cn r ;T CAD o LD. d rt' ~ ~ ~ o N x L> •a ID 3 m cn lJ7 V` N S 00 a - N z 00 ~ N o r-.) y co 0 O rt 00 N O Z o C CD ~~y • r~ I = m N N r C o N N N v~ O C/) c coo CD rt 5~' (D ca a n C7 H rt n 3 n N• z o m o ~ o I o cl, M N v a G7 ri x In o n cra o ou - m y m 03 rt G A Z (n N1 .J 00 O a y z CD O C- 91 (O 0 - N Z3 T - Sll C z o (D o fD ~ N m N CD T 0 ` N C' x S N N ' A N O O a ' A O CD bq OO N O o S. C) CL 03/24/2006 07:59 AM Parcel 040-1210-10-000 PAGE 1 OF 1 040 -TOWN OF TROY Alt. Parcel 25.28.20.996 ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Towner(s): O = Current Owner, C =Current Co Owner FERRARO, KENT D KENT D FERRARO WHITNEY SHARON K WHITNEY SHARON K 128 GLEN LA RIVER FALLS WI 54022 * =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description * 128 GLEN LA SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.160 Plat: 2495-ST CROIX HIGHLANDS SEC 25 T28N R20W NE SW LOT 11 OF ST Block/Condo Bldg: LOT 11 CROIX HIGHLANDS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 08/17/1998 585101 1348/525 2005 SUMMARY Bill Fair Market Value: Assessed with: 103681 367,700 Last Changed: 07/22/2004 Valuations: Class Acres Land Improve Total State Reason Description RESIDENTIAL G1 2.160 53,000 300,900 353,900 NO Totals for 2005: General Property 2.160 53,000 300,900 353,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.160 53,000 300,900 353,900 Woodland 0.000 0 0 Batch 211 Lottery Credit: Claim Count: 1 Certification Date: Specials: Amount Category User Special Code Special Assessments Special Charges Delinquent Charges 00 0.00 0.00 Total Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ViD9 SEC. 2 -5 T L~ N-R 2-0W ADDRESS I2ST. CROIX COUNTY, WISCONSIN s~•~~ h' y~~~N~f I a ~ q ~ s SUBDIVISION LOT ! LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 sus f~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 /Zj(1MS~ rr--oo I\ ND or G/ut~ lies 64 tie tovv , r (3S ~13 s. 72, iN~ 54016 tIC PLUS INIS. H~MES~.1l ROP: HUOSO Rj 3 O N R48ER~ ULBRI NO 3307 M•p•R g MASTER PWmBtR6NtR 0C. NO UO~b INDICATE NORTH ARROW w,S 1N9j ALTER & Dig 1NN 7_01P .1 4 16 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 0 Proposed slope at site: 3 ~d SEPTIC TANK: Manufacturer: iquidCapacity: /4aa (l) a Ff. / Fr . Number of rings used: R,*A C Tank manhole cover elevation: T lcD Tank Inlet Elevation: fl • Tank Outlet Elevation: / 3 • 0 13 ~ ~ . Number of feet from nearest Road: Front,@ Side 0 Rear, O feet From nearest property line : Front, 0Side, ORear, 0 F c2- feet Fr. Number of feet from: well G 1 , 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 Manu turer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation- Gallons per cycle: Alarm Manufacturer- Alarm Switch-Type: Number of fe from nearest property 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: X Trench: Width: ~a- Length: J~ 2-- Number of Lines: Area Built: Fill depth to top of pipe: fT . Number of feet from nearest property line: Front, O Side, Rear, OF t.cps Number of feet from well: DUE// f-f Number of feet from building: /0 V (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid dept h. Bottom of seepage pit elevation: Area Built: Has either a op box O or distribution box O been u ed'-on-_any of the above soil absorb on s terns? (Check one). y HOLDING TANK Manufactur~-r,_ Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest prop ~y'ne: Front, O Side, O Rear, O Ft. Number cyf feet from well: Numbe,r.-"of feet from building: Numb of feet from nearest road: m., Alarm Manufacturer: Inspector: Dated: / ~C ✓ Plumber on job: RT. 3 O'NEIL RD., HUDSON, WIS. 5401£ License Number: ROBERT IJ6SRICHT WS, MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN, INSTALLER & DESIGNER LIC. NU 00663 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WJ 53707 BUREAU OF PLUMBING )bb CONVENTIONAL ❑ALTERNATIVE ET7771 ❑ Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE. Jim Kleinbrook 1289 Fefield PI., St. Paul, MN 30 BENCH MARK .Perm.... . reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NE SW, Section 25, T28N-R20W, Town of Troy,Lot#ll ,St.Croix Highlands Name of Plumber. MP/MPRSW N<,. [1L1111V. Sanitary Permit Number_ Robert Ulbricht 3307 St. Croix 64878 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER - P,RE D: PROVIDED eEDOING / / DYES ❑ NO ❑ YES ❑ NO VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PR O PE RTV WELL. BUILDING. ETO FRESH ALARM. FEET FROM ` LINE: IVENT ❑YES ❑NO CYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIOU10 CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER ❑YES ❑NO J PROVIDED PROVIDED GALLONS PER CYCLE: PUMP AND CONTROLS OF An ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PHOPERTY WELL BUILDING JVENTTOFRESH FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILFN(,TH DIAMETER MATERIAL AND MAHKING or excavation. (If soil can be rolled into a wire, construction shall cease until [:FORCE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH . NO. OF DISTR. PIPE SPACING COVEN INSIDE CIA -PITS LIQUID .5-- C TRENCHES RI PIT DEPTH. DIMENSIONS AL GRAVEL DEPTH FILL DEPTH DISTR PF DISTR PIPE DISTR. PIPE MATERIAL : NO. D TH f! BELOW PIPE, ABOVE COVER El EV. INLET EL AN NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH Z ( 1 ~ 2 2 PIPE FEET FROM LI"E G AIR INLET x NEAREST--► 2~ / c7ro ~J 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER ❑YES ❑NO ❑YES ❑NO TRENCH BED SEEDED DEPTH OVER TRENCH :=BEDDEPTH SODDED S CENTER EDGES IMULCHID ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH ENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE UIS 7RIBU TION PIPE MATERIAL & ^.1AHKING ELEVATION AND ELev ELEV CIA ELEV. PIPES Dln DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRFSPON DS TO APPROVED PLANS ❑ COMMENTS: PERMANENT MARKERS DYES FIND YES ❑NO OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING iii. J [ FEET FROM a"E' ❑YES ❑NO ❑YES ❑NO NEAREST 0 u c Sketch System on Retain in county file for audit. Reverse Side. rSINATURE - TIT LE. DILHR SBD 6710 (R. 01/82) ' r udis~onsin APPLICATION FOR SANITARY PERMIT c ,Z~DILHR COUNTY oeaaannenr ov (PLB 67) UNIFORM SANITARY PERMIT # Ir1OUSTRV, LF1BOFl 6 HUTRn RELGITIOns / } 4 -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 j~ 1 M /C GE/iV /6A° D 0/0(~ /L Frf PROPERTY LOCATION C1T'Y: Vim: 7-At' Q ~ 1/4501/4, S 15 , T N, R 1QE (or W TOWN OF: LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L K STATE PLAN I.D. NUMBER /1 S~ Gtoi X r' GN ~~,vps G G E~~ o A) N,¢ TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System l~ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. LN 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 Lift Pump Tank/Siphon Chamber 444 Holding Tank capacity 0 Manufacturer: 1'A6~ S A) 7;F- 16-41 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 ( /z X f.Z 6 2 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): Signature: W/MPRSW No.: Phone Number: ~~j HOMESITE SEPTIC PLUMBING 0. -330 7 1 ?If 1 M6 Aef' IRT .101101 RD, HUDSON, WIS. 4016 Plumber's Address: ROBERT ULBRICHT Name of Designer: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: ~Dte a : ❑ Disapproved z 1 8 (3 ❑ Owner Given Initial Approved Adverse Determination eason 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 vvill 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 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)V6 4 -50),, Section T N - R ~ W Township Mailing Address 04:p F& Subdivision Name X Lot Number Previous Owner of Property ell. AI &;e-s Pt 7AfC7 •y° Total Size of Parcel Z 'r •`ICi f' f Date Parcel was Created Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes_ No Z/ 01 Volume C© and Page Number j as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: C.1 Warranty Deed 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 1 (We) eeh ti.6 y that att e tatementa on this 6onm ane true to the but o6 my (oun ) know.ete.dge; that I (we) am (are) the owner (b ) o6 the pro pent y dee CA i.bed in t UA in6onmati,on 6onm, by viAtue o6 a warranty deed %econded in the 066ice o6 the County Reg.ieteh o6 Deede a6 Document No. 3 ~ p- ;and that I (we) pneeentty own the pnopob ed .6ite on the aewa a oe ayatem (on I (we) have obtained an eaz ement, to nun with the above deAcA bed pnopeaty, bon the conethucti.on o6 eaid bydtem, and the bame had been duty recorded in the 066ice o6 the County RegiAten o6 Deedb, a6 Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r f-1 L H 9 ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER / ~&1 /~~~c Q C~/~ tH ROUTE/BOX NUMBER Fire Number CITY/STATE ~7U'~~ ~~<S ✓ ~d ZIP PROPERTY LOCATION: G 14, Section 2-~ T -2-P N, R _W, 2,0 Town of St. Croix County, Subdivisionf/ael/'r 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. yo E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H 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. SIGNED c~ DATE 5 A //x 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. 2 O O " ` > O _C fA a? ~D E 0 co a0 oc c p 0 cof t Z` U co L i 0 p C C (D p C O y U i U) O C 01 L- = U m U y` N = C U' O CO w . c0 ` to C •L 3 C. 0 O 0 m W oal 'aC: 0aca -3=0M:3 3 c O U. L- ~~w v' d .C = ~ L- N = RJ M C Co cm o V N L O U o N c 5i W = Lc~C~CL o - c0 w N O O Q _OZ'L fC a C N p)~L. O ~w U O (D N O C m Z d L t U CU - m U. 01 U 3 U) FL- N N CLrc~ Cvio 3 CD t5 O O. L U _ U O= ` O ' = Q O ~ N ~ C = > "Cr 0.0 cm U) 7 U d a a) .0 0 co cr c Q L w tT N ca c _C O M O O p fA tC ` IX ; C c0 N '0 O E 75 O = cu c L cu o .r c ~oco0°) ~cc C6 0) - r% ~ CD 0 r tt:: a. U 0) c fn fn N L O a m 00 W M (D -6 a) a) 4) 0- a) O O N (DC(D c - LO = o c 0 0 ~ a .Y o ~ E - - c L 5 z ,13 ~ cc cu cu p = 0-0 H o, - a o ~c 0 >1 cv`°)Y 0Ecv==0 v~iw0 Z oC a x N c XPA6-WV141. 71V o~Plbi vim/ Soi/ Oc7e. 3 Q -8y - IZ'lf rOa : RO77I4v - sysrt--y DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR ANb PERCOLATION TESTS P.O. BOX 7969 rU'f•11AN RELATIONS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHI~{}ft}ty.TY: LOT NO.: BLK. O.: SUBDIVISION NAME: N6 1/ Z5 IPVNIRIoE(o 7;eO/V COUf'T~Y+ OWNER'S/8tH`'S NAME: MAILING ADDRESS: D / S Y ° old%x /M USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL :D:SCRIPTION: PROFILE DESCRIPTpION PERCOLATION TESTS: Residence L' ,TNew ❑Replace ('G 30 Q f f~ S" L9 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK~lz'x RECOMMENDED SYSTEM:(optional) as❑u ©s au ®s❑u ❑s©u ❑sau r -2-" 41e' If Percolation Tests are NOT required DESIGN RATE: I an f y portion of the tested area is in the under s.H63.09(5)(b), indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER . CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~•o f7.0y B- 2-f S terl-ooie B- B- A464CE Af,_'C ",rioa s PERCOLATION TESTS 1-9 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN. AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH g P- P- G.2 < L < P_ " P- 76.3 76, 1 < L 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 A3 NO or Zw, n 'Oez~c 72- l/3 Loo °P rAo,,( 9X To 1S ' - p Fig cO' k 13 70 70 I 3 3 , 1 , -35 &c 3 I SCq~E- : = 30 a •-o I, the undersigned, hereby certify that the so I 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 record d and the location of the tests are correct to the best of my knowledge and belief. HomisiM SEPTIC PLUMBMI "A NAME (print): j RT. 3 O'NEIL RD.; HUDSON, WIS.5401fi TESTS WERE COMPLETED ON: S D ROBERT ULBRICHT ADDRESS: LI O. 3307MARA CERTIFICATION NUMBER: PHONE NUMBER (optional): . ASTER MINN. INSTALLER & DESIGNER LIC. NO. 00663 pS f ^ a i Y~ 2 d't- CST SIGNATURE- -177 ~ I3•M. ~aw.c,, s © 7 Tx_ &2- & y DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 1rlaa :r str€Esul n! so 3~ hest, yoll, fl. c? t~ p€ icot ,.O- lst € ftX 1 "i~tptstr€LIii;I3te,li„'~+~rc9)al;','~~+;>tMC, `Ets €l al 0 atf eC;-;f ,w°£T€3..'Es ti , 'F£'~ a Y6 E' ut i,ePs:f -z,?',.. rr4 1 ! I'FE tc£'v w „E.a2 f,s€,`3t71.3f.„s7s aPiC3 €CbYT24:,lh'tit3 €Y 1C £J€"t; F-s €t',a,, irn t'X ratc;p1 lucati3,{; f:wr ? tst € tc c tlonC , Dl .,v€l` g o scal §,r 3..r i i rcal a ",L- S Cil cl ,r Cl p cr .3`€ 1~.. i t t 'n [i R Ei, r. f tea` IL!, IB! e Jo, r € - F 0 1il .`S t 3 p r y e ~ od ( S rE'pcy! is tale fli-s, slzup ,I t;cut q c sa€Ilans net rni! Pw coin ty o tho [.:4=Paitt uint 1nay t"P.C"uest u:'}# }?b Ee?: P1, c .[31 ~k'i €,`JE9> ,v, j (:`i"i t3'a t£; k€ t} ?..t1 ~t,e pr>Vat 1"'!%)k3 Of this ,a511 12st .l ow -.a r,1 i'i"~~1. -e Stl -€`_t €9 xu :P-'i appi pt we i2-wal 2ut1` olity in ctler'to >>.='~`tti.Ie t hd p osied 1s3 for Lta the Start Of ufly COll'SN'UCziM, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUS :R Y; , c DIVISION L AOR AND PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPM blh4etPA~Y: LOT NO.: BLK. NO.: SUBDI VISIO/N ,NAME: N, 1/ 1/ ZS /T29 N/R E :(o,77 x y( (I ~7 1i/~~ o~ COUNTY:. OWNER'SIBUYE 'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIO S: PER A ION TESTS: Residence 3 N~ CqNew ❑Replace QGf. 3 oC,7(• 30-Py RATING: S= Site suitable for system U= Site unsuitable for system TANK: R CONVENTIOaNAL: IMc:fD. IN G©~ P❑ V RE: S❑ J II IU L Hn SGI/~ Iu e-'0V M1 MENDED d~ /STEM: oPti~~l ~(ISS UU S ❑U - - If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /4fj PROFILE DESCRIPTIONS /,tJ ~2G j tt a~Q F'f. BORING TOTAL DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED ESTT HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) , Z-1 R,)• eh-~ • S yS V,t3 v- c s ~ Gee . B O ' S / y > j~ / D8 Si • 92 ' ,13n~. si/, s- ' RiQ. g J , , s. 0 B A,' G G UE/e C S G,~~ v B 3 / ! y' > /-17 ' /31k. 5, . 7 S /3,v . A S~ ' R Q P- a 0 • , , f" f3,j. CS G-e . Zl o ' ka,P- (3 • S; Z ' 2` ' /.1.S' /3/e. Si/, .'F2 06n)• Si'/, 4 -'fee- r_W'- S." , (1`3 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER D PER INCH P- / - Z /~~iPCD,~rETA 7-U/,~ES ' N P- P- 2_ 356- Z !v CO v ✓ ;v ~L~ P- 4 /,V TIfy Lt /'V Ii CS 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 ~I A~ GOB Q I1 y _ _ i - - _"f T. REF PT o 7 _ -S- , 3 i ` 407 i y p 3 ! 1 ( i uL i /00.0 x 00 TN ! ! I 1 F • ~`rs - S Pow~2 ~0%i ~ t I ! .2oo 3 _ ! I l 1 I_ I ENS G ~p 1, 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: HOMESITE SEPTIC PLUMBINU CO. 2 _ _ L 3 Q'NFIL RD HUDSON WIS 54016 _ ~G~' J Q ADDRESS: ROBERT ULBRICHT CER IFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. j MI NN. INSTALLER CF!- SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester DILHR-SBD-6395 (R. 02/82) - OVER - / 0C'4 to ~ aF 0 SEU w E o ~J _ No . r 6i~E PLB 7 PLOT anc3 CR 0,7.7 5ECT1 O N FIANS ~z !l5 so;~ r~sr) is f z° ~L ~p n Sa r Tyr ~ - XSZ 9~ ~ Glop-q1 , /Ell/t Tio,) Z /00.0 sT,+~~- ~~r,PavED S fiC 5 3 .13 ZN T~~K . 3 96 A- /3 /o S,F--GT- 5'0 Z 7- 21 /Y U'~ESI1E SEPTIC PLUMBING CO. 15 R1. 3 O NEIL RD. HUDSON, WIS. 54016 ' O S 1 &,VED ROBER 1 ULBRICHT Wig MASILH LU Gt L1C. NO. 3307 N1.P.R.S. "NN IN?IALLER a DESIGNER L IC. NO 00663 Cv2~Gy Fresh Air Inlets And Observation Pipe SOIL TE57'03g By HOMESITE TEST"'NG -Approved Vent Cap RT..3, v'NEiL RC)-'';) HUDSON, WIS. ;-14&16 Minimum 12" Above n Final Grade M~~iM vr~ o 4" Cast Iron 5/2- Above Pipe - To Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 1070 0 0 0 Sri L CP Aggregate P CST Beneath Pipe o Perforated Pipe Below 0 Coupling Terminating At 9~. j Bottom Of System