HomeMy WebLinkAbout042-1087-70-100
0NO m T 0
t~
o _ c m o
d
1
~ •O A7 H.
~
CD 3 m ^
CD 3
(n Z z O
O < A •
. N O cn A
0 co
S N N N Imo/ ~C 11
C7 U] Z O1 N (D O D N W Cp CO - =
O W (D N O O ? ~ C 1 0 CO E al _ FF c 10, -4
C z N C2 O (O O O V O
(D ~-d CD O O 7 1 N p~ O
00 (D CD
::3 (D CD
rt t'' O t= CD 0) 3 0
0 7 N O Q
Fl.
o H. H. (A c co
W ~l n cn <DZ- a
I-' V a O CD n CD N a
-D cn
\o C ° =
Z oo ~ 3 O N m
(D w (D N) = ti
0 r-
o (n o c
6
rn (°Dn 0
z O O O cn ~r~
In o 0 O < N Z
r 3 fn In N rn D
M o v
W CD a)
(D
r (7 d
C1. 1 N y y m
00 C
In H H (n N N (n
O N :V:4 cn
N ~ Q W N
z
Ln o ° DWO O
I rh r m' O a tr
oo cn N
(D -b
:3 (D
ri rt a
b r r• CD N
O (D O O O c .0 CC CD N'
$ rt CD
(D ~ w m a
ri N W z (D
~ Z o A Z n
O
C s .Z7
~ > z o
m A
n
o
c cn --I w
CL z
a
3 c
z
CD
A
{{{7777 O D
=r a
X~ CD c)-
0
T
v
o
1 ? z a
CD
P CD
D N
o
o
CD
I v ~
~ A
N ~C
n O
S n
CD O
SL Q
O Z
3 ti
O
O
CD
ti
O
(D
b9 ~ ~ O
O CD a
°o CL
Parcel 042-1087-70-100 10/03/2005 09:03 AM
PAGE 1 OF 1
Alt. Parcel 31.29.18.486D 042 - TOWN OF WARREN
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 - DAHL, DOUGLAS W & NAOMI D
DOUGLAS W & NAOMI D DAHL
618 91ST ST
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 618 91ST STN ( f GI „Q/
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 3.257 Plat: N/A-NOT AVAILABLE
SEC 31 T29N R18W SW SW LOT 2 OF CSM Block/Condo Bldg:
6/1553
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 718/310
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.257 43,300 156,600 199,900 NO
Totals for 2005:
General Property 3.257 43,300 156,600 199,900
Woodland 0.000 0 0
Totals for 2004:
General Property 3.257 43,300 156,600 199,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
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
OWNER TOWNSHIP jjti SEC. T~N-R f4f_W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of UHR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
,5 1 if
- r
Tq(;z ~J
r,
~A
INDICATE NORTH ARROW
tv 2,/_,
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
tl
SEPTIC TANK: Manufacturer:/ ~,~'t~ Liquid Capacity: Number of rings used: Tank manhole cover elevation:
!r)
Tank Inlet Elevation: _Z% ,,qZ Tank Outlet Elevation: l C=
Number of feet from nearest Road: Front,QYSide,O Rear, Q 7 feet
--From nearest property line Front,O Side, Rear, O~ feet
n.1 ".1 /
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
iEE 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: A Trench:
Width: Length: Number of Lines:~ Area Built: Fill depth to top of pipe: "
Number of feet from nearest property line: Front, O Side, O Rear, (7) -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:
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: ,j-
License Number : _ j
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969
MADISOil, WI 53707 BUREAU OF PLUMBING
MCONVENTIONAL ❑ALTERNATIVE SJ State Plan I D Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Up
NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER. INSPECTION ATE.
Doug Dahl 645 E. Lincoln Rd., New Richmond, WI -2 _21 S _1I
BENCH MARK (Pen n anent rete rence point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELE V.. CST REF PT. ELEV
SW SW, Section 31, T29N-R18W, Town of Warren - Lot#2
Narne of Plumber. TP"mPH SW N". Cni~niy Sanitary Permf N,mher.
Cal Powers 1563 St. Croix 74983
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. L. IQUID CAPACITY TANK INL ET ELEV TIWARNING LABEL JLOCKING COVER
(000 O / . PRO IDED PROVIDED.
i~cJ~M /cl AYES O EYES 10
BE DDING. VENT DIA.. VENT M- T1 HIGH WATE NUMBER OF ROAD. _PROPE FiT WELL BUILDING NT TO FRESH
] I J
aLAH n FEET FROM NE IAVIER INLET
! NO YENEAREST---~ Q0
DOSING CH MBER:
MANUFACTURER BEDDING JLIQUID CAPA I T Y PUMP M()Df I PII+.~P SiPH/)h Ali A1,00 :1(.I UHF H WAHNING LABEL LOCKING COVER
IPROVIDED PROVIDED.
EYES ENO L DYES I J'NO DYES ENO
GALLONS PER CYCLE: JPLIMP ANDCONTHOLS QPERATI ONAL NUMBER OF PROPERTY WELL BUILDING ~ VENT TO FRESH
(DIFFERENCE BETWEEN _ FEET FROM NE AIR INLET
PUMP ON AND OFF) EYES L_.' O NEAREST
-D
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing, nnu TE f: ^.1AT1 HIAL AND MARKING
or excavation, (If soil can be rolled into a wire, construction shall cease until FOR E
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO OF DIIH PIPE S{'.~ll'~:-E Et INSII;E I)I.1 .PI fS LIQUID
BED/TRENCH Ii nzFNa)ES AL PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH I)ISTH PIPE CISTH PIPE DISTR_ PIPE MATERIAL N I H NUMBER OF PROPER .Y WELL BUILDING VENT TO FRESH
BE LOW PIPES Aj1_ c41ER 11 1V INL I ELEV END PIP(s FEET FROM uN AIRI T
NEAREST-
-
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-
EYES E meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE HMnNfNTr.,+nwKtfvs GPSEHVATIO%wW,IS
_ L YES ENO EYES ENO
DEPTH OVER TRENCH BED DEPTH QVFH THENCHBEU I)C Vin OF 7l)PS(11L SODDED SEEDED M1IULCHED
CENTER EDGES
L___ 'EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH IEN(,T" NO. OF LATERAL SPACING (RAVEL DEPTH BE LOO, PIP F FILL DEPTH ABOVE COVEH
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MAN I F O LU DISTR PIPE IMANI FOLO MATERIAL NO DISTR DISTR PIPF DISTHIBU T ION PIPE MATERIAL&MAHKING
ELEV. ELEV CIA ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHE CI E V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES LJNO OYES ENO
COMMENTS: PERMANENT MARKERS OBSERVATION WELLS. NUMBEROF IPROPERTV WELL BUILDING. FEET FROM
-
CJ YES LINO LjYES El NO NEAREST- LI N E
r T(3
t
Sketch System on
~ Retain in county file for audit.
Reverse Side.
SIGNATURE ' TITLE J~
DILHR SBD 6710 (R. 01/82) ✓✓~v~~`~' C" /
wlsconsln APPLICATION FOR SANITARY PERMIT
'Z~DILHR ' COUNTY
OEPRRTrT1EnT OF
(PLB 67) UNIFORM SANITARY PERMIT #
MMMMOPIM In0U5TRV,LFIB0R&HUMRn RELRTIons
9 93
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS 57 ,I
i"
P PE TY LOCATION CITY: r
VILLAGE:
r
1/ 1/4, l`? N, R E (or TOWN OF
LOT NUMBER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD; LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED / - Qua7e 76-10
1 or 2 Family Number of Bedrooms. J ❑ Public (Specify):
THIS PERMIT IS FOR A:
0 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 Cl Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued-
E-1 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 I "
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: 7
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 installatio oft e private sewage system shown on the attached plans.
Name of Pfumber (Pri t): Sre: MP/MPRSW No.: Phone Number:
Plumb is Address: ; Name of Designers
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
a 1 ❑ Owner Given Initial
1 5C 0 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
STC - 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 Section T,- N - R 'Jay W
a
Township 'rZ,4-k :TJ
Mailing Address
5- y-
Subdivision Name
Lot Number `
Previous Owner of Property 1~c 1~ Q n2L
Total Size of Parcel
Date Parcel was Created U2
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume D and Page Number V6as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
C1. 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) ceAt16y that aU d-tatementa on .thiA 6onm ahe txue to the best o4 my (oun )
know-edge; that I (we) am (oAe ) the owner (d) o6 the pnopeA.ty da cA i.bed in .th i b
in6o4ma ion 6onm, by v. Atue o6 a wa4.a.nty deed recorded in the 066ice o6 the
County Reg.ib.teA o6 Deed6 az Document No. ; and that I (we)
pneaentty own the pnopoeed &ite bon the sewage dZ4pod byb,tem (on. I (we) have
obtained an easement, to nun with the above ducn,ibed pnopen.ty, bon the
conet.uation o6 baLd dye.tem, and the aame hab been duty neconded in the 066.ice
o j the County RegiA ten o6 Deed. 6, ad Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
/C, - 13-10 - ~S
DATE SIGNED DATE SIGNED
v~
A
S T C - 105 r
SEPTIC TANK MAINTENANCE AGREEMENT
.0
St`. Croix County 12-1
tz)
9
OWNER/BUYER ,
ROUTE/BOX NUMBER -Fire Number
i
C I'1'Y /STATES✓--„ 11'0j -
PROPERTY LOCATION:,_,) '4 ' S e c t i u n i 1---_ N > 1Z _-J'_ -W >
Town St. Croix County,
Subdivision Lot number
I
Improper use and ma iucucin"C, -our septic -t-m could result in
its premature"tailure to handle waste. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed seRtic tank p-uTker. 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 grunt 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 a-1-1 ye, 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 veii-
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 lank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
r-i
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.
l`
' S I G N E D
u ATE- - /d 3 - S - -
St. Croix Touaty Zoning Office
P.O. Box 93
Hammond, W~. 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
- v N
r
x m
x ~
~ j w gc'n n,3 0
V v cn w_ s M m o
m 7C' A A
0~ m °-3
C,- c:90
c~ww~~~
~
~ co co
2' 3 a
~ m
is -p ° =r m m m ow
o ,
m
" o aao0 X0)0-(D
CD CCD CL
0 CD
CD 0 =:z -
CD In , :3 =r co
w = CD
cn -
o3n o~om mw
0 CD - c o w o
=r
o
3°c° `<c_c=:3ci
%
wcEr m -~m
•
w m o= ~oa m f
m CO 'a D
Cr :0- CD C
< CD (a a-
c 0 A -5)-o 0 o
I CL - -1 p~ n a- :3 W O
`m p to Co
0 N U w W N Z >
o New N~ w m*Ej• v D
m ~coCD ~CD Z
a(ADA 3CDI CD CD ~a D
CD N CA D o to
CD =r * -1 0
°-~'a mw~°acow
CL
c y
m
\m 3CDs BCD .J;
NR =k cr m mm v°>>~ N' n _ic
o o- f° w ~ CD CD _ -1
(A 0 c &a CD
+ A
w ° °cf9'
Qo CD c c aw o m
w ? w aaam v, M
CL 0 m C7
C7~~ `n ,~co w =r m 3 n
m.0c -4 =3 00 0m0 g
C, o o ca c C
0 CL
CL 3 ° m O ° m
ar w9L 3' nm ~o
cn n ° m °a
o Z
O
3
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON, WI 7969
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ktb'MeiRAttT_y_ LOT NO.:BL . NO.: SUBDIVJ_SI N NAME:
1/S~ /T2~ N/R I (or) W W Q ~t// 7` A.
COUNTY: OWN R'S/BU E~ NAME: MAILING ADDRESS; /
! ~ r 1
7
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: CDESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
( Residence New ❑Replace -9-S , ~ _
RATING: S= Site suitable for system U= Site unsuitable for system CNVENTIO❑NAL: MIN-G~ND-PR❑ESSURE:SY❑STEM-I N- ILLHO~LDING~NK:REC JMENDEDSYSTEM:(ogtional)
If Percolation Tests are NOT re uire DESIGN RATE: '~f
q If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: N /a Sj Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS T
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER QB -ua, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
cl nit-
7.
o -r.Z 6 s./1,2- -3;/(3ns~ -y.2do .5 ;y,Z-Ss6n 5
i0st 0 In 13 15 7, S- 6/7 6- _r I
B- , D 101, L or) e-- 7 G' 19, - 2, tD
1 -
B- ) 1 n (3 T1 R-2, L/bas, 2, Ll .
~r
V PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
UMBER AFTER WELLING INTERVAL-MIN. PERIOD 1 PERI 2 PERIOD 3 PER INCH
J ~ ~ sv ` ✓
P- 1
A10MC _3
P_ 3 S
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 10 3- j
0-<-Oc. v7\ rnck-- nv -
I I _
-44
~cz~ t3o rn~~ _ ; ~C' _ 74
pe-(,\ C_ Tcs t-
'2\
I rP4<_ i
~N
~ F
E i
_ X52 I _ k
e I
I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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:
ca- i I e W C c~JI I` L L
AD ESS: r~ J CERTIFICATION NUMER: PHONE NUMBER (optional):
ii I G y 6 1 C` C 4 f c r F. - t~U ry.
CS SI UIjDISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
I"N T sn= § .a ,ea f .off N1 FL a HE; FU
1. 0_0Ime how cm r
2, -T'hO i€dP .,P.C k!ln VTR M M
Et. MAX!i v` (,J1rv1 # urni~be.t L;r, o yierf i'; pt!O,.M"(~ „
4. 1 h a ne° or t`a'r [ cern n ° r';;"..'m;
5. 0fir,).,>,c he ,.?'f;-_: ~=t? ~ ~ ir~~fia: q boxes. SITE ? r ,."t . it i°'€ ~ .F°_f . ° i~Ui b„e - a
t - FABLE - A!,..~
O'l HEIR~ SYSTFi~,,,,IS ARE RULED OUT BASE) ON SOT COMMONS;
6. PLEASE use die t=ratNrwiW,, s `own hue 53, i nr Oe SsscafmOns and idompleung w VA low,.
1. A Li..,, >L,_' 31at1twr z£Ct. a i y hCmin mq WS1 located.;: ° Drawing to scaly, j,
s t ,_e sheet my re usyl it desired:
a1, ._.r.. , fi
aH yaw"
t , ~ zas~E r,E r .
of
t.tii°" a a - 1 W 1 SS `'i i ,=era€'
.
kaa=t 0reW'31" ~i T} ' LS ra:etvi'C
,r.<fl:,a-: `r-,sr:'a Pon , _ rg t:€~;~: rr1 ,.r,:i
Rani
NI'darn £ I
Fm Swo EW Won
a r;` :at7cr t r a-'er I hail
SmAy Loun Les That,,
i
r
Gy MY
My L£ aa";l P Y a .
sir 3
z/ E
Np L F.ms mot - it o ,ar
S-KN Coy 1h,
Sky
MY cc (nmunoiy coam,
t fmoi nenl
€,"r h v,,. yr z.
kn!
r
PAGE OF
~ 11 Ct
CrU S S ~ zc' 1 u 11 G " y~t ~~ri~ JyS 0 0-
17s
f ! J Fr*ch Air InIeU And Obcervotlon Pipe
Approved Vent Cop
Mlnlrn m 12° Abov•
Final Grade
20- 42° Above Pipe _ 4° Coat Iron
To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
min 2° Aggregoie
Over Pipe
OietllbatIon
Pipe 0 0 0 0 ~e•
6° Aggregate 0 Perforated Pipe Below
8ene a.h Plpe
o -Coapling Terminating At
Bottom Of System
P, 9
~~tJn7 ton \7
SOIL FILL
DISTRIBUTIOVI PIPE
gPPR,OVED S4NT'HETIC COVER
° -MATERIAL- OR ? OF STRAW
2u01FA61 Gj REG. ATI- OR MARSH HAy
A oFAGGREGATE.
ELEV. OF FEET
u
DIS-T-RIHJTIOIJ PIPE T(j BV- AT LEAST lKiCHE5 BELOW ORIGIUAL GRADE
AMU AT LEASTZO IUCHES BUT 1.10 MORE THA\K1 HL INCHES BELOW FINAL GRADE
MAXIMUM ®EPTVJ OF EXCAVATioij FROM OKI& JAL 6KAOE WILL BE G INCHES
IAIIN1MUM ®EPT-H OF FACAVAT100 FROM. 01KI61NAL C3RAOE WILL 6E ~ INCHES
SIG►JED:
LIGF-U5C QUMBER: Z
DATE'
>>o
uU Z2%
f
i
i
'i
I
~ll 4
j(L ~1
1'