HomeMy WebLinkAbout020-1161-40-000
r
O N 0 -0 O
y C
7 A 3 1 7 A 3
7! It
~a m n
_ = a o, o cAO m w n°~ H•
7• A IV O k
O\ A(D 7 (D N O Q
N N v CCD_i O 7 C
C~1 O W
N N a 7 O 0
W O 0 CD O c c (OD 7 707 OA O
V (7( N co N p
3 y 4 ? ° ~ !
c:> 0
`
c oo p
0 Dl A
0 a a
p N (Q N c Q (D
N W
C7 'S N rn N 3 n pV A: N
C.I CD ID ::p N3 N)
c'S t t1 N a O
ko G N n r
o co w o
~o to
~,C rn r 1 I j A co co A0 3 M c
o r- t cn
n I o 000 j `may
p c'S 7C 6.'' 0 c -1 rn N T
Z 0 3 fn ti cn O
x
p' ((DD C <
m
\ 0 CD N `G
3" (D
CL 7 3
Z D
o a
c m Z n
7
7 m o
7
N J 0 Co C c 0 O PK' CL
.3 -P CD
F (
ti.f I 7 ((D (D p 0 7 (cn
r, r Vf ^ 7 O .Z7 C 'i
7 (D
O to c 10. N.
(D 3 (n 3 - a
7 !D ~
Q N rn Z y c 0 7 --I cn
p k O O N= A Z (D
~o d7"O 7 A 2 O
d t~ rn 0 ~~(n a O
~ o (D fl
0) ? m N W
m v (D M m Z
a
o~`1e w°N o - N
N N O fn
A
W N
N I 7
- C~ W
N N (7n CD (nn Q
CD -0 ;u -0 Ln.
o N 0 O O. G
N x 0 j p
<
C77 7
(n O Z 7
p y
G
c ~ o
O m
S 7 3
CD cn
a- Er 3 -0
N (D (p 3
D
j (D
m a a c N
CD tv
I m9 o.f a
Cm: CD 7 V
p d (n N fi
A
=r (U a
N (j 00
0 CD
a :r 0 0-
A O
7' a a- 0)
O (D '0
a .D N
y ' ~ (D °o
(D Cr l< v +a
CD ti
O 0 0
I
(D b
O
o 0
a° C Q'
n Cl) 0-0 n d _ 1
I O m f c o o
(D 0 CD
CD 4t
I CD m CD
n
O
3 ~
o o v p o a 3 c W N C
O
CD= Z N o O CO
N C (b l
~p W (D (D CD - cn :3
O O
g -1 (0
n
O O-0 0 7 7 (D o 0 N O ~ O
7 0
0
cn r) C: (D CD
0 3 a o co 77
0V o O
3 N O
p m r W O
(D (o (D (n Q 3 I
o m N W
0 3 c C:
a o 0
=
C, p iz~ N)
oN (D FP cn
W d
z 0
o co 000 :3 0
a c ~r
v o cn
~
0 o Z 0 0 0 41-
I .P .A o °
0 0 3 N y y o N O
N N 3 3 X
00 00 0. v o v v eO
o m O m y (D
N
D y CO)
Z) :3 CD D N
Z a
a
O
zm z
y (D o O
,p(D. co c cL v O a ~
CD 0 C) CD Cl)
7 O CD 'II
co a3:3 (o CD CD
Q
° v N j. 3 7
Z ( O (D (a (n
Z (D
> O m
-a :3 n a =3 A Z O
m - CD a O
0 3 n (D
a
v ? c N w
o m m
W A (o
a , z
=o No
1 CO
o v 3
m CD
d 3
7 (D
W
s cn rr ~ (n c\ y
v N N (D (n (O (D CL
(D 'II -O ] O CL I
n N n OX n a 0 p• 2
CDix7 zo, 7 N
U) (D c
cn O 7
O A~ C O C L n OZ C
C
N
S 7 N
~G a
CD
QS3 ~o o~
~N (D (p 3 00
(n C m' ° cn
(tena< 0 rm o yy
3 (D Q O
3(O m o N 3 (n :5 S m ,
oCL3yN w
(a &S
s~ CD :
D'
aso a ti
(D S CD 'o (D N
OC '-w-0
N
C CD
CD Cr<
CD N O o,
3 (D ~ A
I p b b
(D
6q
O W
0
* H
O p
CD 0-
Fo rm - S T C -
AS BUILT SANITARY SYSTEM REPORT
OWNER
1 C TOWNSHIPl t Of SEC. 1
N-R
ADDRESS ;.Y ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
7
i
a /0-
44
400 G~ c S~~~r rc EAR 7#
7-4 h`'ja c~ S~ ,`rfi
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used 1 L T '
Elevation of vertical reference point:
i~' , Proposed slope at site:
t
SEPTIC TANK: Manufacturer: (.Cr f- t; ' Li uid Ca acit
q p y IL Number of rings used:_ Tank manhole cover elevation
Tank Inlet Elevation:_I(;, Tank Outlet Elevation:
Number of feet from nearest Road: Front,(V Rear
> e ; feet
From nearest property line I'ront,~Side,0 Rear,O
> feet
Number of feet from: well 1''r7 buildliig:
(Include this information of the above plot plan)( 2 reference dimensions to septic rank)
"t . ; i ,
O~
AMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: - Pump Size T _
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: .-Gallons per cycle:
o
Alarm Manufacturer: Alarm Switch Type:
Ft .
Number of feet from nearest property line: Front, 0 Side, O Rear
'-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
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side Rear,0
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:
? Plumber on job: ,
Dated: ,
License Number: -
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RPiLATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
[~NYCONVENTIONAL ❑ALTERNATIVE State Plan Io Number.
❑ Holding Tank E In-Ground Pressure ❑ Mound assl9neal
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Dick Fmeott 2425 F. LaApentuAe, Maptewood, MN rft~
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV..
F SF, See.23,T29N-R19W,Lot#22, Fox VaP~ey,Town o6 Hud6on
Name of Plumber. IMP/MPRSW No.. IC,,,,Iy. Sanitary Permit Number.
Donavin Sch.m,i tit 3205 St. cuix 49461
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROV IDID . PROVIDED111 .
s I ~'94.I EYES ENO EYES ENO
BEDDING: VENT DIA.. VENT MATL.. 111113H WATER NUMBER OF ROAD: P . BUILDING. JVENT TO FRESH
4, ALARM FEET FROM LINE: AIR INLET.
EYES ENO EYES ENO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMPSIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED
EYES ENO EYES ENO EYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTY JWELL BUILDING IVENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) EYES ENO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. 1 if soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF DISTR. PIPE SPACING INSIDE DIA nPITS LIQUID
12 r/ TRENCHES M ERI L'
DIMENS L PIT IONS Y DEPTH
GRAVEL DEPTH FILL DEPTH ~ISTRPIPE DISTRPIPE DISTR. PIPE MATERIALTNUMBER OF PROPERTY WELLBUI LDINGVENT TO FRESH
BELOW PIPEjS A t B v~cf),VER LEV INICF,T EL v. END PIPE FEET FROM 3l AIR INLET.
"{{L ,I S• / D- 7 Z NEAREST-i
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 NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS Y
EYES ENO EYES ENO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH.BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH 7LENGTH. NO.OF LATERAL SPACING. G RAVEL 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 E LEV.. ELEV.. DIA. ELEV.. PIPES. DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
EYES ENO EYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE:
E YES NO ❑ YES ❑ NO NEAREST
C 4, ID q
j _j
l
~uS IJa
Sketch System one Retain in county file for audit.
Reverse Side.
SIGNATURE. TIT LE.
DILHR SBD 6710 (R. 01/82)
sln APPLICATION FOR SANITARY PERMIT /
I L H R (PLB 67) COUNTY
F::7%EnT OF UNIFORM SANITARY PERMIT #
V,LRBORGHUMRn RELRTI-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
4Z LZ4~1/ 41
PROPERTY LOCATION CITY:
VILLAGZ;,
5Z'1/4 5L-1/4, S __3, TAN, R j % E (or fOWN OF c/ S c
LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME ATM-ST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
14
1 or 2 Family Number of Bedrooms: ❑ Public (Specify): 1
A
THIS PERMIT IS FOR A:
N 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.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑Va`ult Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # A /A issued /VA
❑ 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 Irr ALift 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 Tan s 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.
Name of Plumber (Print): Signatu M /MPRSW o.: Phone Number:
Plumb 's Address: .,t Name of Designer:
1 -
( //C I✓fY( /il/ -h / .
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
0 d ~ O ❑ Owner Given Initial
4 e/1 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 SANITAkY PN.KMIT
S C - 100
Lhis LIJ)pIication lurm is Lo bu completed i.. full and si8uud 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
~iul.d and submitted to this office with the appropriat,~ dead recording.
- - - - - - - - - - - - - - - - - - - - - - -
f f
l_)wnc• r 0I 1 rope rty
~cj
Lut_,,itiuii of Property Sj i4, Section PU , T p - N - R IV W
't'ownship `5 7-_ 7 -SO A/
M.i i ]ing Address f ~L= JL t n~
/ !C S0/l/ /r, -
Subd i vis ion Name
Lot Number
Previous Owner of Property V Z::: IV6N c~Al
Total Size of ParcelG
DDItParcel wa>, CI,llted ~ ~ 991~D--- -
Arc ;III corners uui tot i i.nes identifiable? Yes ~ No /
Is th_Ls property being developed for r~,sale (spec house) ? Yes No
Vol ume and Page Number s as recorded w LLh the kr~r ist or :,1 Out_,&,
INCLUDE WITH THIS APPLICATION ONE OF THE: FOL.LOWIN(~ -
il Warranty Deed
2. Land Contr_„ct
__i. Other recordirll;s fI_Led with LL,' Kt_-gJster ui ~)Ced: Ut i ice
In addition, a certified survey, if available, would be hot-pful so as to avoid delays
0I the reviewing; process. If the deed description ri,l L rs Ct'rL i_1 i e<! Survey
Mah, the Lhe Cartilicd Survey Map sha11 also be required.
PROPtRTV OWNER CRTIFICAI SON
1 (W(!-) eent i t y that. a-f'.Y. statements on this Aonm cute -titue. ~v the befit o~ my ( out.)
hnowXedge; tLat 1 (we) am (ane) the owner (,s) o6 the pnopotty de,6CAibed in tbu~t
cn6otwiation ~ orcm, by v(ntue o6 a wa Aan.-ty deed neeogded -61 the 066ice o6 the
County Regis4 eh o6 1 dAe.ds " Document No. and that I (we)
p~te/sentfy owri the pnopoaed 4ite 6on the .sewage. cut.6posaP /system (on I (we) have
obtained an casement' to nun witbt the above de/sen.ibed pnopeh-ty, bon the
cou.VLuction o6 said s y.6tem, and the same has been d4,y necorcded in the 066ice
u6 the Countt. Regi,6ten o6 Deeds, a6 Doet rient No.
SIGNATURE Of OWNEk SIGNATURE OF CO-OWNER (IF APPLICABLE)
Lc_
DATE SIGNET) DATE SIGNED
S T C - 105
SEPTIC TANK MAINTENANCE ACI:LLMENI o
St. Croix County
d
OWNER/BUYER %'Cz/ ✓YIL c~ i/ -1i,r~~ < L
ROUTE/BOX NUMBER AdCiVi-_ Fire Number
~ r 1
_Z 1P--
CITY/STATE
PROPERTY LUCA`I'ION: ``-4, =4, Section- hN, R_ W,
Town of ,L-~ r f/eL-) CSt. Croix County,
Subdivision 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 pumher. 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, 197£3. 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 "D-:. to St. Vounty 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 nee-
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. o
~ I
I/WE, the undersigned, have read the above requirements and agree U
to maintain the private sewage disposal system in accordance with
H
the standards set forth, herein, as set by the Wisconsin Depart- 0
meat 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.
S 1CNED
_ _•C~
1) ATE
St. Croix Ciuuty Zoaiag Uftice
P.O. lux 98.
Hammor d, WI 54015
715-756-223) or 715-425-8365
Sign, date and return to above address.
1A 11/~R I MI N I OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSS I IiY, DIVISION
LABOR AND P.O. BOX 7969
11U,MAN.H1 LATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION SECTION IOWN'HII'IMUIK1+tALITY LOTNO. :dLK.NO.: SUBDIVISIONNA E:
,t a r, 2_ ~z r~~ ~o l ~
,)L '/4' 1_/a 2 /T2.`1 N/R 1 ~ two W_ L_
COUNTY OWNER'SI'FC-r1'S NAME: 1i, 4112 -MAILING ADDRESS:
~ _0 q2
5 . r r I wr r q,21,-~030z , #)A I u) cad rn I n rl.
USE DATES OBSERVATIONS MADE 6/O 19
-
NO BLDIZNIS COMMERCIAL M1CRCIAL DESCRIPTION _ PROFILE DESCRIPTIONS PER OLATION TESTS:
IAReside We IKNew ❑neplace
RATING. S= Site suitable for system U- Site unsuitable for system
(ONVLNIIONAI. MOUND
S IN-GROUNDPHEc~°URE SYSTEM IN-1-11L L.. IiOLDIN, w< ECOMMENDEDSYSI EM:(optional)
[]U S ou [ AS EIU EIS A EIS ZU I1(
If I, icol, uwi Lests ate NOT tecfuired DESIGN RA 1 E' If any portion of the tested area is in the
under s_Hb3_09(b)(b)_indicate:
- Floodplain, indicate Floodplain elevation:
LLL PROFILE DESCRIPTIONS J
11F :tmNl' 6HIf4_ES'-S, x IiO HIND 1OIAt_ P H TO GROUNDWATER ICHES CHARACTER OF SOIL WITH COLOR, TEXTURE, AND DEPTH
NUMISI_H UCYffi-FW, ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBHV. ON BACK.)
r7 f I C `J5 i '7 ob O 00
/ Q 111 0 A)
93 } oB z5
C z5
B 1 109 _ 10 l ZS.
.3 f 1 J i 3 3 ' ~j CO ~I OLJ 7S Z J
B- ~ 7 1 o1 !
/17 o fU 7
3 f13
o L9 41,Z
B <11 r
~Olo~~ /~d fuEs, } (c?off ~l3n.5, l3 5.L't
00 on ri ell
B I Flt 3- H C)Cc~e} r
S~il I f'~,1t7_b ~t9 ~tcr+~sr~ J~~ ~ratvt•d vr~t~'
- - - - - - ' - ' - - . o I "
t,ntr(, PERCOLATION TESTS
1~) E•S
TFST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBEN INChtL AFTER SWELLING INTERVAL-MIN. PERIOD PER.IOD2 PERIOD PER INCH
j j Y ~ - z- - 'd r 2
v
- 3 -
P-
I'
PLOT PLAN: Show locations of percolation tests, soil borings and the dunensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
•ontal 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 lond slopu.
SYSTEM ELEVATION / 0 s
+A, v
i
i l
I
"h ,f' 3 I~ I )08
s
"t 0-il
3 y~ v 3q 3 f3' 13 -
N
yyg SZ, lo' 0-3 /0
Or 8 3
wA 3~ I o
I ~vow3~,l 0 C
I
I, 1110 undurSigned, hereby certify that the soil tests reported on this torm were made by me in accord with the procedures and methods specified in the Wisconsin
Admmisttmive Code, and thin[ the data iecorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (p mt): / TESTS WERE COMPLETED ON:
ADDI-I ES CERTIFICATION NUMBER. PHONE NUMBER (optional):
CST SIGN E:
"l
DISl R[B ,11ION: Urnlin.tl mid mw col)y u, LUC,II AUIn,)I ~~v, I'i nlnn iy U",Ic, ,Ind :;mi Tetitdi.
DIL I11i-SBD 639b_IH. 02/821 UVEH
O AoLC-y
TeP A/
w`
F
Al
_r
j
~J
O
c~
R ~t
- ~t
C- L /C, y
C P, AP"
3
j, '/,l A-11V r
0
E I~ l ~ki.t 1 /~tc- j
I~;ci~ L1` L:z"TT
7 Sc kip ~2s' T