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HomeMy WebLinkAbout008-1093-70-000 o N 0 K-0 0 tz~ O " c m O con 00 v 3 I ~ Q (A -i 2 Z o cn n m w 0 • w o `C ° I" s 3 m ~ M E 3 c N ° w c` CD z a CD N W Q I'.. W o CD 3~ W ~ ~ rn ca ~ 1 N N CO CL tv N 0 C CO -4 i CD -10 CD cn CD C) , CD 0 D o rn 3 c * o O C CD (n VI ~ N O r~ ~I a W N c _ V n 3 _ 0 10 0 (U b W N p n o; C W Q (D b Ci1 C (O (O a L 0 r to cD on 7~ U) a s 7• o c rt 1-1 Q O• W •V "a T 'I rt L-4 • z 0 0 0 L, I In fD C W 0 o< z a 3 N N fn o D O Z T O O O o cD w o m (CD H tQ E H N Ll m (D y N (D H j 7 ZIA. N z w z 0 ~o I - r- 0 O D a r d N 0 ' CD CD III • n j l(y11lVI I c CD N w m a H H cn 1 O N zi~ a 3 w oo (D (n Z c p Z 7 A 00 O JJ a A Z = 4:1 rn r v G1 m n N W G rt W v c t~1 N. O Z CL G7 O a A AH`~N 3 z rn rt H Lo (D K C A v 1 G' CL CL o v c z a O CUD I s I fi y I A, 4 I A I fi A ti O O V ' A (D OAq N f ~o O CD o ti o a C) a- Parcel 008-1093-70-000 01/11/2007 12:59 PM PAGE 1 OF 1 Alt. Parcel 33.28.16.495A 008 - TOWN OF EAU GALLE 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 - ROTH, THOMAS R THOMAS R ROTH 71 230TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R1 6W 5A IN SW NW LOT 1 CSM Block/Condo Bldg: VOL 4/919 Tract(s): (Sec-Twn-Rng 401/4 1601/4) Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1103/296 WD 07/23/1997 802/221 07/23/1997 701/90 07/23/1997 701/89 2006 SUMMARY Bill M Fair Market Value: Assessed with: 171486 172,700 Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 31,400 82,500 113,900 NO 05 Totals for 2006: General Property 5.000 31,400 82,500 113,900 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 31,400 72,800 104,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 192.00 Special Assessments Special Charges Delinquent Charges Total 192.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R / W i ADDRESS ST. CROIX COUNTY, WISCONSIN Ar, SUBDIVISION LOT LOT SIZE, ; PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM JA Ily y i # i /.r i /yam, IL t~ r /r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used i12 is Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used:> Tank manhole cover elevation: Tank Inlet Elevation:/ ; Tank Outlet Elevation: 76'~ Number of feet from nearest Road: Front,O Side, XD Rear, O feet From nearest property line Front, 0Side 0Rear, 0 feet Number of feet from: well j , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ✓ PUMP CHAMBER, Manufacturer: LCapacity: R Pump Model: Pump/Sipho Manufacture ; Pump Size Elevation of inlet: Bottom of ankielevation: Pump off switch elevation: Gallons ~er cycle: Alarm Manufacturer: Alrm S_itch Type: Number of feet from nearest properlt 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: yr-. s Trench: - Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: C Number of feet from nearest property line: Front, O Side, O Rear,O Ft Number of feet from well: Number of feet from building: ?.J (Include distances on plot plan). SEEPAGE PIT 0 % Size: Number of p s: / Diameter: //r Liquid depth: Botz`tom of-seepage pit elevation: Area Built: Has either a drop box O or d'strib' ion b x been used on any of the above soil absorbtion sytems? (Check one . HOLDING TANK Manufacturer: Capacity •(5 r' f Number of rings used: 1evation of bAttom of tank: i t Elevation of inlet: i` Number of feet from nearest ' ro erty li;le/- ront, O Side, O Rear, OFt. Number feet from w 1: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job:!?`': 7 r' License Number : J!,tom 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. FOX 7969 BUREAU OF PLUMBING MA' ISON, WI 53707 XXCONVENTIONAL ❑ALTERNATIVE State Planl).D.N„mber (lf assigned ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Jay 0. Cambern Spring Valley, WI 1 - 3o--84 a °:136 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV.. SW NW, Section 33, T28N-R16W, Town of Eau Galle Name of PI-ber_ MP,MPRSW No.. County Sanitary Perron Number Everett Boldt 4489 St. Croix 58913 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL. JLOCKING COVER 4 PROVIDED PROVIDED 4V U;'> [-]YES LINO ❑YES LINO BEDDING. JVVENT MAT L. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH Z. / / ALARM. FEET FROM LINE (AIR INLET'. ❑YES NO ❑YES LINO NEAREST DOSING CHAMBER: MANUFACTURER 7ING L IQUID CAPACITY PUMP MODEL JPUMP'SIPHON MANUFACTURER WARNING LABEL JLOCKING COVER PROVIDEDPROVIDEDES NO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH OPERTV WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES LI NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IL FNGTH DIAMETER MATERIAL 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. ILENCTH:• NO. OF DISTR. PIPE SPACING COVER INSIDE DIA. -PITS LIQUID BED/TRENCH Z TRENCHES MATERIAL PET PT+4 DIMENSIONS 'J y r % - GRAVEL DEPTH FILL. DEPTHISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DIST NUMBER OF PR DPERTY WELL. BUILDING. VENT TO FRESH BFLOW PIPLS ABOVE`COVER EL EV. INLET ELEV. END PIPES ` FEET FROM LINE AIR INLET: Z2 NEAREST- o0 a9:7 -1-0 MOUND STEM: 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. YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES LINO ❑YES LINO DEPTH OVER TRENC=.E VER TRENCH;BED DEPTH OF TOPSOIL . SODDED SEEDED MULCHED CENTER ❑YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. CIA ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING: FEET FROM LINE ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Cr , ~r yam, J Sketch System on _B t"n county file for audit. Reverse Side. SIGNATURE'. TITLE. DILHR SBD 6710 (R. 01/82) z 4z wlsconsln APPLICATION FOR SANITARY PERMIT y~,DILHR 'Co x COUNTY (PLB 67) oevRRr mEnr of UNIFORM SANITARY PERMIT # InOUSTRV, LABOR 6 HUmRn RELRTIOns Je~/ Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 1iinches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS JR Ar+)4e5 R., Yi4/je Lis PROPERTY N C/ TION r~ C TY: -10 :5(A l/4 1/4, S 33, , N, R (or W LI.NA-G ~Q u R /~G LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEA EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER A ~rA ~oVw4 R ~ - I ie~ec-e /✓/4 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. .3 ❑ Public (Specify): THIS PERMIT IS FOR A: IX 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 U 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 /000 O rv, e_ X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: E~j S a N c C 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): f i- Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for inst ration of the private sewage system shown on the attached plans. Name of lumber (Print): Sig ature: MP/MPRSW No.: Phone Number: Ve.►2e.~f P 9 (7/5)6YV-337 Plumber' ddress: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 5~&W Q ffYj / f fx Approved Adverse Determination L/ f' 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 k t 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. o R. A e .e t4.5 4,1 !~O 4 ! 4 Q~ 4 y f Ror+n !~.``~o~~ T'c 0~! To be /T bG ~~aA~a~~ oFf ~7RAEly ~eLd t e Av,~ ~O lop weld- GaS,v l-d.l8 ! a a 13 ' h ! ! ~ - z 7 s' 9 ~ .34' P3 ~r- 7~ 9S AReA. ; 13- 5 73, 4" gPP~oYe~ a' Foe eA, FouR " o .ScA~ l A4 ~irlQS x 044 t-, f fif °DI ~1t Oven ~t ! Q OR A w v G R -4 L TQ a ;i 7/,9 s`°, 1 ''ma`r FALL v Pcit FAI Cf?G!S S Sc,G~lO,v p c~RAdN lGLOI /1'o7- TD :i C,AA- c" APPLICATION FOR SANITARY PE'RMIl' S T C - 100 't'hin application lorm is to be completed in lull 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/contras tar, ("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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ow"wr of Prop(.rLy t; 01 cog beam location of Property Section 3 3 7'~, N - R 1~1~ W A ~lfe. Township r=Q v '01 Mailing Address Subdivision Name.=,. ImL Number.- A1 lC~ Prev ious Owner of Property UC e -K A Le{ Total Size of Parcel Date Parcel was Created 0-21- Are all corners and lot lines identifiable? X Yeti No Ls this property being developed for resale (spec house) Y Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF fill'. FOLLOWINC : 1. Warranty Deed 2. Land Contract 3. Other recordings l i led with rhW KgiSMr of De•etin Ol fice In addition, a certified survey, if available, would be helpful so as to avoid delays V the reviewing process. If the deed descr iation rPFerVHW, Y to a Certified Survey Map, the the Certified Survey Map Aha l I A I SW it rvq" i r~. d~ VROPLKI y OWNER CLU f 1 C'A7 ! ON [We) cent, "Y that aft 5Crz.{~~rnc°_rt.t5 an aGua ~unr~i ane ,r`icuc io t{t(! - beS-r o~ my ~uu~t) tznowi'edge; t6mt I (we) am lane) the ownen(.S) o6 the pnopon y dezat bed tin ChIs tn6owation 6on.m, by v.cq,tue oA a wa&kanty deed !cecyAded kn the 066tice o6 the County Kegiotn oA Weals a6 Voeumen,t No. and that I (we) pnebentty owr the p:topose.d -64t.e; bon the sewage {.~powx 6yuem (on I (we) havc obtained an E asemen.t, to nun w.i.-th the above, de. w bcd pnopenty, Am the t,-on.s..Vcuct~on of .5a,i4 byStem, and the name hay been duty necotcded tin the OfAW, u the Count; Re-gig ten u~jDee.d Document No. ) . IN y 'IGNAVURE OV OWNER SIGNATURE OF CO-OWNER (I1 APPLICABLE) ----~_-N-P DAM: SIGNED DATE SIGNED H _ Y S T C - 105 C~ Y H ~ SEPTLC TANK MAINTENANCE AGREEMENT 0 St. Croix County 0 OWNER/BUYER ~A Q Arh ~et le nJ rrr ROUTE/BOX NUMBER Fire Number 7-- PROPERTY LOCATION:5w oluj a4, Section 33 , T N, K W, ~ 't'own of G~1v (z'n1le St. Croix County, Subdiv is_io" t~A 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, I t needed , by a - i ccr std s_~latfc tank laumher. What you put into the system can affect the function of the septic tank a 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 acuepted this program In August of 1980, with the requirement that owners of all new •gstems 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 norm will be sent approximately 30 days prior to three year expiration. ~ 0 1/WE, the undersigned, have read the above requirements and agree ~ to maintain the private sewage disposal system in accordance with x r1 the standards set forth, herein, as set by the Wisconsfu Depart- w 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. SLCNED DA'1 E St. Croix County Zoning Office P.O. Box 95 Hammond, W.. 54015 715-796-2219 or 715-425-8363 Sign, date and return to above_ address. v N r m N W •a F (gyp '-I W? N N N c y v;w~c ~ID A A cD A_ mw fO ~ o owc~o 5 = c c `c 0 o v 0 N a m o A Cl. A w O CD :3 co ~ ~ v W M =r °:D? ~owot° ~-4 > o c~tc 300 .<C A _ ~Z~ °c= 0 ,w.. N (~D w N w co o p~po a~ 0 (o w T @ c-, n ~J o ODSQW j L) 1 _ o A= 0 A A C 000w o°amoF 0 o Nc° v cv ca N C N d ° ID a Z o m F~ a N W CD W M c? a cD ° -0 to N I, ID m• 3 o a a ~w so =r $ m ?c°n'c9 D ° - n > > - CL CD 6i- aco w N v ICD m0~- C 1*1 CD c ? ° 0. CD 4 (ND (D 0 - CD N« N 0 = ri caf° w mamCD -i ° 0.0 - _ tG D cc° v a, w w o c F 0 Q0F a ccncCawo m w w cD C N a$m aa a a.. c c C) 0 S_ w? C N N< o S. CD CD 3 m A c o N 1 A CD o 0.0 7 o ca a c N CD CL c w m BCD C C3 0 3 ° ° 03 °oV 0 w a cD o 3 aR co CCD s o Z O , our year , a i. e. ■~~r ~a SCHU LT u i! 4 k, W N i SANTA F 3 e FLOOR PLANS Y 1 ti t~• 1 Y; i ' £ s 7 Ill R e .,11' W SCHULT HOMES CORPORATION ` P.O. Box 399 REDWOOD FALLS, MINNESOTA 56283 Phone 507/637-3555 ` HOMES OF HARMONY ` 5220 Hwy. 63 N. ` Schuit Homes Rochester, Minnesota 55901 Phone (507) 232-'9833 an Inland Steel company "TNE' DOUBU-WIDE EXPERr$" arr'. k R , q. RIVERVIEW - f J 44x24-35 • 3 BEDROOM • 2 BATHS 4hi a WvH J AN '(1 - P DINING UTILITY 3RD Q LINEN ROOM KITCHEN ROOM " BEDROOM AT 8' 6"x11' 6' z 7'-9"x11'-6" 112 cc ~ t I SENT BATH CL 111 WARD - - - - - - - - 1".. dl LIVING ROOM i i 17'-1"x11'-6" ! 2ND CATHEDRALS CEILING 1$T BEDROOM 'l w- 4r I°q~l BEDROOM WITH BEAMS 12 II .91 13, 9 6 'x11'-6' z- ~ 6 r - 44' SPRING VALLEY 48x24-13 • 3 BEDROOM • 2 BATHS UTILITY : I I - - - OPT. 1 p G7 ROOM FIREPLACE 1 - x„ I - ' 1ST KITCHEN BEDROOM BAT z ( 1 4f 10"-2"x11'-6" O #2 z ' 3) LL GREAT 1 I ROOM d0 13'-9"x23.-O'" ~j y PAN 1 ENT. Q BATH WARD WARD CL. ! I X1 I I (CATHEDRAL CEILING I :DINING WITH BEAMS) 1 ROOM 2ND BEDROOM BEDR 3RD OOM i , 10' 3"x11' 6" 8'-11 "x9'-5" 81-5"x9'-5" I I r 1 OPT. HUTCH l 1 48' 1 - z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, - DIVISION LABOR, P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:N SECTION: / OWNSHIP MUNICIPALI Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: ~w ~/a 3 3 /1 ~N/R (o 4_R u /V A I I e HA Ir' A A COUNNTY- OWNER'S BUYER'S NAME:•/.-~~ MAILING ADDRESS: egAL USE Ulf c.I/)11-/)i e- ,Q DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS PERCOLATION TESTS: XResidence YNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONNV(ENTIONAL: MOUND: rIN-GROUND-PRIIIRE:ISYSTErVi-IN-FILLIHOLDING TANK: RECD ENDED SYSTEM: (optional) l/_'J~ ❑U ❑S ®U ❑S ©U ❑S ®U ❑S ©UON~+;n~~'/QnIA 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: ~Floodplain, indicate Floodplain elevation: F~. PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3.8 t~SEr~ B- 1 7,S" 75:95 " > 7. ,67,6..Sj. r91V B- a, 7. to 75', /11 7t 5' f . 5'R.6 1 s L '.2-0 B- 3 e ~ 3 9, eel B-4-76' 73.9 > 7. o + t~o/~Ls ~ ~ ~t ~-{t?1,rsc. ~ S:3'R.Bw e s B- (,o# 7e,Io' 17 G 1516e4.SL It 0 1gNsL h-, 5` R ~NC_ . B- r+ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ROOMS AFTERAS'WELLING INTERVAL-MIN. PERIOD 1 PERT 2 PER D PER INCH ~ N N et P- t 0 Q P_ I 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 7l • 9S~ I i '5e l " 4 c->f jc~ , Ua~ U E 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) r~ TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ?V-33 7Y' ST SI TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER V a2 s ~I Vf~G /'t Amrne~. q..5 r I ~ o r iyI~ A r, ,gY` yep t r C_ T'k i IN 3~o d Y t I ! f ,----~2^O To Tea b C f4~ .f+' raE c~ arF F", e-LA 7"~ Kam, , 5 t~~p.++a 1 o r` V V`~- ets /p w~R1 ~',oPi:f - g f3-! CAS,l' lt /0010 Gi 75,95r oil 3~ AReA. 73,10 VI7 64 [i 195 0 aAd m q - 7 q PP ~eA Y ~l ve,a ' F F O Ifs s° A o v R pRt~w P.l fJ I~ v at oveQ P~ c I 4 = t". f Cw + I l - / - F ` . / yc"` f~ R FQ -F d P V c. _ P, rn e C R S c r a n F c_1 R A! N i e Lc/ ,Mo7- ?o Z;C 1/A ,.e