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HomeMy WebLinkAbout020-1103-50-000 0 F o O 3 co CD a y 0 m o 3 o C) 0 10 a) C: =1 5~ 21, CD 3 m o ° N CL F rn rn a m z p ° N N Q 7 ° ° O Oo ai Oo C m = = fll O o U7 N 1 ~ 7 N A O Q N_ N CD .1 O d ID a n CD D a m ~ m v, O. m c C 3 O N a) N cD OD m c (On co co A O c A O rr cn H~ 0 0 0 j A N w ry~ fn t~A fR rn o N v v v o 0 o CD C7 CD ID I CD CD - 23 '0 A 7 ~ ' D lV r► N Ln d i_2 1. N A - A O 3 z n N ° o N O 0 7 'n o ° CD tr j m N si C (D (a O v N CD W (D n 3 7 Z (D p c p E3 Z CD C s _ A Z O v O_ O o A W CD (D a Z 3 A y C z (D 4~ w F o s Q m CD F a T yo m m c - N aim o a Or N 3. O X cn W C ? O =r 'o 0. ~ O F ° > A C S 5-3 A N N r °C 7 aN o m o o ° CD A cn ti p b N (D f A O D y O ti V 0 v, 0 C w 0 C `~1 =CD 30 . t. CD (D -0 K -0 7! o - v `I m (D 3 z O Cf)~ o a C) Q?O k. 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Se"P7,~C iANi~ ; rl , ~ i 1 y Non7iv w e VENT S7AtJN 3 y~ INDICATE NORTH ARROW AID /r BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: / Proposed slope at site: SEPTIC TANK: Manufacturer: tEp ]Liquid Capacity: lz-,/- Number of r_ngs used: Tank manhole cover elevation: Tank Inlet ;Jevation: Tank Outlet Elevation: Numb.,r of f:et from nearest Road: Front, ~Side,Q Rear, O ~d feet From iearest property line Front,0Side,K7ARear,0 feet Numb(r of feet from: well building: (Include this information of Khe above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE a w r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: P,. ..!c;^hnn 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: Length; Number of Lines:^ Area Built: b zs ell Fill depth to top of pipe:' Number of feet from nearest property line: Front, . Side, O Rear, O Ft.,,,3Q Number of feet from well: nn Number of feet from building: c,G (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 0 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 C+` INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 XUCONVENTIONAL ❑ALTERNATIVE State PI.o ID Number: + f assigned) ❑ Holding Tank El In-Ground Pressure El Mound Il NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECT ON DATE John Cahoon 661 Ottawa Ave., St. Paut, MN 55107 - f --.Y L/ ~t BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. EV. NW SW, Section 34, T29N-R19W, Lot #3,Ron StewaAt Addn.,Town of Hud6o Name of Plumber. IMP/MPRSW No 1C,-ly. Sanitary Permit Number. Gan Za a 3300 St. Cno-%x 49500 SEPTIC TANK/HOLDING TA(!K: _ MANUFACTURER. LIQUID CAP ACITV. TANK INLE- ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PRI-O~V IDE D: PROVIDED. Ifs Y E S ❑ N O ❑ Y E S ❑ N O BEDDING: VENT DIA. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILD ING. VENT TO FRESH / ALARM. FEET FROM / O LINE /O , 41 AIR " ❑YES ❑NO C- r ❑YES ❑NO INEAREST-.-7).] /V ~C4 {EI 7 DOSING CHAMBER: MANUFACTURER BEDDING: JLIQUIID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PR OPEFITV WELL BUILDING I(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO _ NEAREST ill SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE: MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WI TH LENGTH NO.OF DISTR. PIPE SPACING. COVER INSIDE DIA =PITS LIQUID DIMENSIONS BED/TRENCH TREES MA'rrR IA. PIT DEPTH GRAVEL DEPTH FILI DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO ISTII NUMBER OF PROPERTY WELL. BUILDING. VENTTOFRESH BELOW PIPE ABOVE COVER ELEV. INLET ELE EN P S FEET FROM ALINE 7 AIR INLET /o ZI Z 7 Z 3 3~ 3I Z L Z.. Z7~ 10,2•$0 NEAREST--- f 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 ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH,'BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SOODED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO 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 MANIFOLD MATER AL NO. DISTR ID ISTR. PIPE DIS FRIBUTION PIPE MATERIAL & MARKING. ELEV. ELEV.. DIA. ELEV.' PIPES. DIA.: ELEVATION AND DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY 1COVEF MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE. ❑ YES ❑ NO ❑YES ❑ NO NEAREST t Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE- - TITLE , DILHR SBD 6710 (R. 01/82) - wisc+nsin APPLICATION FOR SANITARY PERMIT C, DILHR COUNTY oEaRRTmenTOV (PLB 67) UNIFORM SANITARY PERMIT # - InDUSTRV, LR©OR 6 HUmRn RELRTions 9So 0 -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 O NER MAILING ADDRESS ~ . _ CA 0.0 ~v &61 6774W+ 4 PROPERTY LOCATION @iT~ p \fi-F-I-:PcfrF: 7~ r N101 /4 S~ 1/4, S 3 , T 2p N, R I? E (or II TOWN OF: HU v J~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, STATE PLAN I.D. NUMBER 3 Ao S 7E_W,-V7" 4DP;7-. G i L 3 E R 1 ti~-- TYPE OF BUILDING OR USE SERVED (JG~U l//D--~~~ 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: S New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System Ll Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank VNO ❑ 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 16UT) Lift Pump Tank/Siphon Chamber A,/y Holding Tank capacity o~Q - Cc~/Ff tJ Manufacturer: ,0g f e,6,VCeXE 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): PR~jOPO D (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): Signature: W/MPRSW No.: Phone Number: &I AX t ; x/144- 336 0 Plumber's Address: Name of Designer: '72,2- Ra'j ~P~ S7/ - 1,',0,4 D fo /S . COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved VI L ala~ . ,6 nJ e-~; q>7 % / . J .-0 7 ❑ Owner Given Initial C l.t- l.(~ (C (p (,7 6? 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 l INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION PLB 67 - SB D 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 SANIT.,RY PERMIT S '1' 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 _ i ill i (1i iCj 1( ;r is (i i Location of Property )~I' 65-~' ' Section T N - R W Township Mailing Address I P Subdivision Name 6CO Lot Number L C?1 C C- ~-)14 l)C?j ~1Ct IV) ~yA 1L c~ 'J14 Vic.) y cl 1 I E Previous Owner of Property r Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? J~ Yes No Is this property being developed for resale (spec house) Yes No Volume and Page Number 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 1 (We) eeAt%6y that aU statements on this 6oAm ane tAue to the best ob my (ou"d h.now.Eedge; Vat I (we) am (a)Le) the owneA(a) o6 the pnopuuty deg cAibed in .this in~oAmati.on 6oAm, by vi4tue o6 a wwLAanty deed Aeeon.ded in the O~6iae of the County Reg-i~steA o6 Deeds as Document No. 3 I`t~fl , ; and that 1 (we) pAe,sentty own the pnoposed site ~oA the sewage dispo~ system (on 1 (we) have obtained an eaAemer~, do Aun desnibed pAorJeAtil; 4oA the con,5t&uction o6 said system, and the same has bcc,~ Aeconded in the 066,ice o6 tJte Cougy RegE6ten o4 Deeds, as Document No. ~o-Lt~C:~c~ ,'IGNATURE CF OWNE1. SIGNATURE OF CO-OWNER (IF APPLICABLE) (c• i l -"7 DATE SIGNED DATE SIGNED H H ST C- 105 r y ti SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d OWNER/BUYER ROUTE/BOX NUMBER i,,~ Fire Number CITY/STATE j_ ) L- I P SS / cj -7 - PROPERTY LOCATION: t:, Section__,?) L, T___ N, RIq W, Town of St. Croix County, SubdivisionADO(J'f A AAPLot 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 F, I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- lu 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 llATE ~e - J 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. Form - S T C - 102 ONE AND TWO FAMILY The existing system must be inspected for compliance to bedrock and high groundwater requirements of the code. This, in many instances, will require a soil test to be conducted by a Certified Soil Tester or an on site by this office. If the existing system does meet minimum requirements for groundwater and bedrock depths and if it is functioning, an addition can be added in most instances without updating the existing system. If the existing system is utilized for the addition, every attempt should be made to locate and reserve an area which is suitable for a code complying replacement system for when the system fails. If the addition will substantially increase the wastewater discharge, the existing system shall be replaced with a code complying private sewage system. 1/4 1/4 (Subdivision & Lot Section Township Rural Route It Address Post Office Zip Code i (I) (We) J-) IC IC') C'0~ 1cyi') plan to (build an addition to, remodel) the building at the above named location. The present private sewage system has been working satisfactorily as far as disposing of wastes. If the present private sewage system does fail, it will be replaced with one that is code complying. (1) C t . ham-~f a. (2) (Owner's Signature) Date Subscribed and sworn to before me this day of 19 Notary Public County, Wisconsin My Commission Expires ST. CROIX COUNTY (County Authority) Plot plan attached (show location of building addition to drainfield and septic tank). Include soil testers report form. STEWART'S ADDITION LOCATED IN THE NW 1/4 OF THE SW 1/4 OF SECTION 34,T29N, R19W, TOWN OF HUDSON , ST. CROIX COUNTY WISCONSIN. WEST 1/4 CORNER SECTION 34 T29N,R19W y/ NORTH LINE OF SW 1/4 6 6j UNPL AT TED LANDS NE CORDER OF Q ~8335000.'E N 89°56'40"E 200 p NWI/4 OF SW 1/4 O 1280.94 N 400.00' 494194 111-1 66. 0' 320.00' w~ p° POINT OF 894._4' m R=80 •y' s' z N BEGINNING A v 131.16 14" g0 -I m. TEMPORARY TURN > J• w RADIUS' ~'n 1 oln' AROUND TO BE AUTO- 't 3 w 8 80.00' oo 616' 0,1 MATICALLY VACATED UPON w "o 2.22 ACRES =131°16'14' \ 0 1 0 STREET EXTENSION 0 O pI \170°54'33 8 89°0527' •o x O NO 0 0 2.75 ACRES ° o z O i 19g~~W 2,61 ACRES n N: l a O I I _ m a w / 10 N N 89°56'40" E 170°54' 33 ~189°05'27 9 a N J. oN N 400.00' \ 2.05 ACRES 6/6 m~ 0 1, s 89°56'40E 10 z 68°02' 354.27' 0 q45 ?9 F o / ~ I m '09'x\ N O, P V w I W D n N ti 3 m p v \ O > n M p Q I J tT 12 z N /y N/ h n N Z N 2.45 ACRES N o ti M 10 2 ti CL_ _N 76°E W 616 a a ao 50.00 o-~ 2.08 ACRES o v Q3 ip s' -•N N 'L 1N N Oy O A wT o N W 1011 0 3 ~oO 59'S2•.w o v 6 0 1 LL ~ ? O OO ~O~ m O 4 2 TRUE 3.95 ACRES a; BEARING -I° 17 16 S21°59.~4E 6/ h 2 N893aU. 33. Of7 5~ 0 ~~582° 54.85 --7 ~6' > 89° 34 24 E e - 3m°s 2 X59 • \ 6 13 ° 6 6' X2.4 r9i, /9 /q?T •e 6~.. ZZ1°00 n I ~~O° m W a~, j p'h OI O p~ 1 I IN BT OF' 14 2.02 ACRES 03' of °O z 1 M w BEGINNING 138°59.47` 3qOg I I o SHEDS -SZD~ 6 1I 20 N 89° 56'40 E 479.54 1 0 228°51'13` 9 1° - - i z \_2 05'13" C, O" 4go 5~ -10.19 vgOP05ED - I 164°24'42` ~Do l•y`TOa /2j 03 y'a - 3' / .3q ~,r\ _ -WATER STJR AGE TANK P-1 ✓ EASTERLY 3 -o QI I "N RIGHT-OF-WAY LINE 2'52 ACRES JI O - i tiff G zl u. w Ig19 vein 2 65 ACRES INCLUDING N ~I c F 6 ~9 o 108.0 a 5 IN EASEMENT 9/° x 1 p, ♦ m P WATER STORAGEN ?6' f \ ~'~j , 3 O'~ w 00 TANK EASEMENT S 89-55'47"W y2, 3 2164°24'42'• ZB 2 O0 204,82 64nc. 380.1 ~g 6• 585.00 / 1.73 ACRES iS OO 0 - - UNPL ATTED LANDS RKC\1YY`~~ a°'9° MFR v ro N m SCALE IN FEET 186 28.30 \ 3 Ki 0 yo ; z. 2.58 ACRES 4 3 200' 100' 0' 100' 200' 2 .70 ACRES r. 0 v ya^ d m oN LEGEND 6, 9sA 0A / N r. to Of \G 9 N NF w m ma b COUNTY SECTION CORNER MONUMENT FOUND,BERNTSEN CAP ~y"o x0 • I"IRON PIPEWEIGHING 1.6871/LINEAL FT. FOUND CEDAR 3 j o 2"X30" IRON PIPE WEIGHING 3.659!/LINEAL FT. SET 6 IX 24 IRON PIPE O ALL OTHER LOT CORNERS STAKED WITH v1~ \ N cS N 0 h : a '~3 WEIGHING 1.68=1/LINEAL FT. h \ ti V I•• X 24 IRON PIPE WEIGHING 1.6891/LINEAL FT. SET ON LINE 'A 6 2 0 NW -SW x FENCE -a TRUE SW-SW wo BEARING \ yo \ N _ ~N \\a~ 111 173° 38'45 0 m I f W NOTE: A BUILDING SETBACK OF 100' FROM THE CENTERLINE OF ALL \ O: a PUBLIC ROADS IS ESTABLISHED FOR ALL LOTS IN THIS SUBDIVISION. y L 9t Lo[s 2, 4 m ro s° by Cert fied Survey 9yO \ a~ S9ly I-P C. m p O I55°40'50" m .08' O 9J° S85°32W \ \ be? b' 128.74 N 88-08 1 04 W ~ ` y 73.96 UNPLATTED- IL0(_A'.,UN:J SECTION: fUWJSHIPIwiUPJiCINALIIY: Of NO. LK.NU.:SU,DI~ISIU`dr"iA~1" 57 1/4 11+ 3~ 7 Ico"j i 1 l: ONINER'S%FiUYcH 5 NAME: MAILING ADDRESS: Gh/~ C~ CD -_1 (W, u.L l~D- c t-L+'t to J O 1^'. t7:~ 1 FJ ~l ,`~F1~VAT10^Il rit ,ADC . %U. f r_Dyoiw.: C5C b11 RCIAL UcSCF,,! IOi~vi _ i' 0 ~ t D ~C;r31P: f~)i.)S: t RGOLA rION TES i S' ii E `1 'Residence At~ IV New l ~fl pl ce - c P3 I J.~~Jr -Z RATING: S= Site suitable for system U= Site unsuitaole for system (CCINIVIENTION A~L: MOUND: IN-GROUND-PRFSttS,,URE: SYST_EMI N-FFI~-L HOLDIING((TANK: RECOMMENDED SYSTEM: (optional) CAS ❑a~ ®S ❑U S ❑U ❑S [ill CIS TA~ L'7U e'aJUEU7iOtl,~~- f3>L, to/S' s4. r % ~b If Percolation Tests are NOT required DESIGN RATE: ? D If any portion of the tested area is in the ~un,,2r s-H63,09(5)(b), indicate: St~• ,Q©~ . Floodplain, indicate Floodplain elevation: - J -O,- TiEL b ' PROFILE DESCRIPTIONS jB0RIPIG ITOTAL DEPTH TO GROUNDWATER-IN -r. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH IP:U1"BER DEPTH r ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK,) r- / , - - r 15 '£~,e/3J.SL? SL,, /.•?f" G~f3AJ- a Z %yo Il ! !~U- }~yO s,4 AJ a _ 7 B_3 / .o //-z . y ~'4 v cS /U~~ ' .c~• /3 . Zf.a~. S C S r'X o~ Ila •~o > .75 Av-6/ -2,o9' 3,j. OR-13.x. 54, L 4W4 SG C.. W D¢ G~. Ao TS Q, L f, s- ' A/-- /3 N . .3 , ' T q,o 5; S o ' T~3 U S PERCOLATION TESTS 1 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES `:NUV5ER IN AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH 1 P_ ` (r 2- " FR P C 5 1 r.•. l7,0 iJ /,J L ~T ! v- ~ t Ti D L i L i 1-r----~--- 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- f. ontal and vertical elevation reference points/hand show their location on ,the the plot plan. Show the surface elevation at all boriing~s and the direction and percent V of land slope. , !J Q r 1 OJ~1 D/` /P Cf} t4 7-10,() Q~~ A-Y Z }iAC T L• y SYSTEM ELEVATION 70 Fr /f',10 Tic - - -T- - D l , ' t 1 r I ; I i I ~ I I r - , I r : /~U S l/•P/I !.~>v _ 6~~~ T~ S .T__. 13 -',-104 71 "d I C'u T7-/,,1-_~ _-?GPI _ fo- - FTiPd M -F}-- a t t t ~ I i I j t I { i t I ( 1 i I i i I Fj_ J-1 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 : t~~Q t C~~~ TESTING E TESTS WERE COMPLETED ON: 3 O' EIS. y s) ~ D S~~T ;:LDaESS: CERTIFICATION NUMBER: PHONE INUMBER(optional): +VDS Nj 'visa 54016 A 9LBRl , T CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -11_NR-S3D-n.^.95 (R. 07_%>i''I --OVER _ _ L_ - i PLoT- Pi-AM PPoa Ec i k 6-k, C,4 1710 JIV YESTING CO. P s . 3, O' NE-IL ROAD BOB Al WIS,__. 54016 C57- 02 y~Z PROPOSED HovsE mosr LIE Z,~ Fr p~ Motr ),Qoov A.44 7-.,5-sr PlZoPOSED_ WELL MVSr LIE So 'OR o0Lf0.Pz- FXoH ALL TES'- ~9,P~'~}s, X ~ ~E~G /oCgTiov~ p` = HA~~ v y E~~O o`Q S~evEL /j®,tE S C #,*,eiz . 13 M 1,~, -e- S lJ X, c~-AA j, OtF 2-/c~ D.cJ 4 S~ 7- -67 - LEGEND ~ P 7 OA 1/a1;' leek lor, ~ o~ o Fi J3 ~v o r~3 400 vo 09- 4# v fir,, ~ y►~ G J r ~ ands e) 4) 14A . ~J r mod' r p ~o e • e 6 5 F-(eUA`1-10 3 0 0 Tar P'P zy P~P6 7j6 7- C,- ob o.u 10 3 60 - tiw/ Sw/ S 3 - ~•~E~s~ # 3 yoR z . .D~4 TE- p Zyz-33 Fresh Air Inlets And Observation Pipe Soil TeSTIP,15 By f OMESITE TES-y G f-("• rte- Approved Vent Cap RT- 3, O'NkiL RO HUDSON, W' ',,4 16 Minimum 12 Above ••4 Final Grade /d 4 ~(v" Above Pipe 4" Cast Iron Vent Pipe To Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee )n I L5~ Pipe 0 0 0 0 0 6 Aggregate Fr Beneath Pipe ° Perforated Pipe Below 0 Coupling Terminating At Bottom Of System