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HomeMy WebLinkAbout030-2080-90-000 0 v, 0 K m n d c o d f d o CD L 1 CD `D ° m v a xt c v 3 m ^ ("D 3 gr O L N O O n eC • C) v N v O CD 7 O t9 v ui p O N ".7 0- (1 c~ (A O O N OD ? CD iu d lT O O CD 0 cr R. 'P O c CD O M ~1 N 3 O p a N o c d ~ cn ~ D (D a w W fl (D U) C d C C) 00 O o o j G LL Ll FD" ((D 000 000 n c N a a cn Q m v Z T- O O n ° O a ° U) D cn vvj 0 o 0 ° O (D y yo cn v' CD o a 0 m 0 rv c CD a co o z co a z N o O a c Z CD a l N • N CD Z m ~ 'n c m can F4 N O N a (D -i w m _ Z O A Z CD o c y ;u - A Z 3 0 M W Ln W (D o a z C z N o m O H z CD w ~ o ~c o c o r. W 13 c z a m d c ~ o a X N O Q S CD CL N O N O O H a o b C(D a w `0 0 fA O N o Z, { 0 0 0 a Form - S T C - 104 AS BUILT SANITARY SYSTEM REPO_R_T_ OWNER T ~ TOWNSHIP SEC. 2 T !10 N-R Z~~ W ADDRESS Z ST. CROIX COUNTY, WISCONSIN T-...~V J SUBDIVISION LOT -~7- J LOT SIZE 1 PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - e I \ \ S fps f w\ V t .36 M 1 u Nou scr tclc~ ~ I I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point :7.30 = -~-=1~ 690.0 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used:, Tank manhole cover elevation: Tank Inlet Elevation:~j~_ Tank Outlet Elevation: 0 Number of feet from nearest Road: Front,0 Side, Rear, ~ feet From nearest property line Front, Side, O Q O Rear, z 5,0 feet Number of feet from: well _Jo . ~ ~ , building: 5.5 ?fcarn (Include this information of the above plot plan)( 2 reference dimensions to septic r~11110 PUMP CHAMBER /]L Liquid Capacity: Manufacturer: Pump Size. Pump Model: Pump/Siphon Manufacturer: Elevation of inlet: Bottom of tank elevation: Gallons per cycle: Pump off switch elevation: Alarm Switch Type: Alarm Manufacturer: Ft . Number of feet from nearest property line: Front, O Side, O Rear, Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed ( Trenchf--- c, _ ,max ~ gth: Z ( Number of Lines: Area Built: Width: Z ~ - Len Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,( Ft• ~C r Number of feet from well: 5 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Number of pits: Diameter: Size: 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 Capacity: Manufacturer: Number of rings used: Elevation of bottom of tank: Elevation of inlet: O Side O Rear, O Ft. Number of feet from nearest property line: Front, Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: /T_, ems. Inspector: Plumber on j ob: Dated: License Number: 3/84:mj V, U) Lit N !rti l ' /0,0 / i d~ o u 5 u_ Z x 3 4' Q _ a t / V• I 171 G~ t LF C ~l C~v Gm, 7Z --4'T P DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING n^" !Sr,,, WI 53707 2PCCONVENTIONAL [--]ALTERNATIVE St ate Plan 1D. Number ❑ Holding Tank ❑ In-Ground Pressure E Mound I If assigned) AV q1W(1W.6_ NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DA TE. Richard J. Jackson RR4~1, Woodland Hills, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SW NE, Section 25, T30N-R20W, Town of St. Joseph,Lot#9,Woodland Hills /1~v Name of Plurn her. MP,MPRSW N... Coumv Sanitary Perron Number: Douglas Strohbeen 5432 St. Croix 54975 SEPTIC TANK/HOLDING TANK: MANUFACTUR LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. IVIARNlNGLAIIFL LOCKING COVER p PROVIDED PROVIDED 7,'ti"1 EYES ENO EYES ENO BEDDING: VENT DIA.: ' VENT MATL HIGH WAT NUMBER OF ROAD: 1PROPERTY WELL. 1BUILDING. VENT TO FRESH YES ENO G r ` ALARM FEET FROM LIN AIR INLET. 17 ❑ YES ❑ NO NEAREST ©O DOSING CHAMBER: MANUFACTURER IBEDDING. LIQUID CAPACITY PUMP MODEL 1PUMPISIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: EYES ENO DYES ENO DYES ENO GALLONS PER CYCLE: PUMPANUCONTROLS OPERATIONAL. NUMBER OF PROPERTY JWELL BUILDING VENT 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 H 1111AMITER IMATIRIAL 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: BED/TRENCH WIDTH LIS NGTHNO OF DISTR PIPE SPACIN(; COVE UE DIA #PITS LIQUID q TREK M ALDEPTH DIMENSIONS K/.~ GRAVEL DEPTH FILL DEPTH R. P PF DISTR. PIPE DISTR. PIPE MA RIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEy, I ET ELEV. END PIPE FEET FROM LINE. / AIR INLET. ri NEAREST-----ow- MOUND SYSTEM: 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- EYES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS 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. LENGTH NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE CIS FRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.' DIA.. ELEV.. PIPES. DIA.'. DISTRIBU11ON INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ENO EYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING FEET FROM LINE ❑ YES 1:1 NO ❑ YES ❑ NO NEAREST I~ Sketch System on Retain in county file for audit. Reverse Side. f Slfi'N T RE. ` ✓ TITLE. .r DILHR SBD 6710 (R. 01/82) wisconsin -7 APPLICATION FOR SANITARY PERMIT . ~ DILHR COUNTY pEPF1RTTT 1EnT OF (PLB 67) UNIFORM SANITARY PERMIT # ~ ~ InpUSTR V,LABOR 6HUmfin RELLiTIOns yr~ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OW ERA MAILING ADDRESS L. piyt p ,c11 r' jc c sw e i © ) PROPERTY LOCATION G+4;-Y- 1C 1/4 E,1/4, S T I N, R`ZO E (o W :y TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED _ O 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 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 D 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 - El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity r, Fs Lift Pump Tank/Siphon Chamber C Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiber G+1U-Is Tr-k, Concrete Constructed Fiberglass Plastic 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): Signature: MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: C Lti 1 G 7/' T t l Vii" ~ C4' COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ~,3 e-~ ❑ Owner Given Initial 7 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 I 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 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 R, c kQ-d- ~ T Location of Property , Section , T CT N - R L L 't'ownship Mailing Address Subdivision Name 1"/vc^r~ f«~~ Lot Number :#~Z Previous Owner of Property r Total Size of Parcel `jc d~✓1 T Date Parcel was Created Are all corners and lot lines identifiable? 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 'Z: Land Contract 3. Other recordings filed with the l~e~ i:;t.et of Oeeds 01 rice 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) een-t.6y that al statements on this {ohm ane thue to the best o~ my (oun) hnowtedge; that 1 (we) am (ane) the ownesc (s) of the pnopelity dese~Libed in thin in6onmati.on ~o.,m, by viAtue o~ a waAAanty deed neconded in the 066ice o~ the County Reg-i~ste,, o6 Deedh as Document No. .3 and that I (we) pAmentty own the puposed 4ite boa the sewagedizj7oiaf-,system (on I (we) have obtained an easement, to &an with the above daehibed pn.opeAty, bon the con,sth.uct%on ob said system, and the same has been duty neeonded in the 06~ice o6 the County RegisteA o~ Deeds, as Document No. SIGNATURE OF OCW'NER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H y S T C - 105 r r y ti SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County r OWNER/BUYER G' ROUTE/BOX NUMBER 1, c L~f =t Fire Number CITY/STATE ZIP P. PROPERTY LOCATION: ~4, Section T 3 e.N, R '2 Town of f "TP S4.IP St. Croix County, Subdivision tJ,'t1JJ,,J [J; (Is 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 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 mdY 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. ti 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v 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 DATE T- St. Croix County Zoning Office P.O. Box 9$• Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. SELGi 1<' : /Q TR+~k DAN Dc , /y/6 rA=T Ai'~. Al, L~q,~=s%'qc c ?~1z'. 5 i /rl DEPARTMENT OF REPORT ON SOIL BORINGS A D SAFETY & BUILDINGS INDUSTRY, ' DIVISION LABOR ANC' PERCOLATION TESTS (115 ,AA&OS~UBDIV P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT N :BLK. NO.N NAME: su> '/a a /T 3L'N/w yi%s saAd. COUNTY:,. OWNER'S/BUYER'S NAME: MAILING ADDRESS: _ )10iP,fi SeiC1~P 7A-11L ;k/ SAC` V-u USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace L I L~ ~J T 3 3 721 13, t RATING: S= Site suitable for system U= Site unsuitable for system 13 L) CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) osou Zs❑u ❑s©u asou ❑sou Movx)~oti~Z If Percolation Tests are NOT required DESIGN RATE: LFIoodplain, 'n y portion of the tested area is in the unders.H63.09(5)Ib), indicate: indicate Floodplain elevation: F PROF Fr_ ILE DESCRIPTIONS .57CS L~j SHoruy r,UCC,P,NE~l~% X15 C/S`~?E,~ BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-I7T6"ZS CHARACTER OF SOIL WI HICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ITV, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- j y(,l 1.3'AV-&y.5z-, /,&7',dv,s .y'o,P.sz-, .&7 sic, A83 ~'Zff - y 0 '1cr&,141,03 A,4ye;AS o-P o~P. 5L ScL ) , f4,Z4 Ok-6y Mots o-1 qf- fo 71;? c, B CciUE el-V S/'LT C6'4 + G- w a y ^+p 7'0 G /r~J'IlA.L5,-2,7,j ' Zk&)709e. ~w,e :t7yCL 3..2 s'L~Q B- z l9, f6Y.,' Si [ T -5,wv col P. om Aj e,* OP. -G . M p ,-S -V 0 ~ S O.P-av j SgJO~' Czgy Gogrl B_ 3 B ,V, SL, 17' l !3N. SiL /,,j ' •Af1X7VQe OF 6A;. Se-,L ~ 13 e .04 sz_ 4u; fF Q -Q ..4er A a, 1~1. B- / 7 ' Al, Y. 13A;, e5 Z i.,G) ,S L. Mo t,+XoeQ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATE LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PE OD 2 PERIOD 3 PER INCH P- P- P- No q ` C Zee P- ) ) 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 C 0,41 D .~POCk' rv r f /iV ft: P - ?~~.e 5 ct, S/ l T~ 9rar~~' ~hieGl3 Sf N f L C Uvr Z " G'4 V ' FT, Zlk ~e I . . 3 E E I E e E A ! /q ) E t ~ r ) t 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. A ""T NAME (print): WERE COMPLETED ON: A/)A'r'L b / yF3 ADDRESS: s' CERTIFICATION NUMBER: PHONE NUMBER (optional): WIc. 54016 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER us R t_ r a E.. y a C %.[19i ,iryl ~c,b d°vi a f sty- c.,in wk .od vol ,u ,ili(s .t= a itrtiui: ~ 3t{E=~ ~r 1 E;..itlf ' "r cat €EC r y,tlf rr~ >s € 4 ~ I.t o yy Ar r 1. E v t tnt~ ` r Iv r t~zt < 4 eE ~x kll PC =tt.l a it, e ?46,i~_ f ~ S DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, . P.O. BOX 7969 1ABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECT ON: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: ~/4 ~ i /T 70 N/R 22,61E (o~ sT JosctO& G/] ir~aUv~A~v COUN/ Y~: OWNER'S/BUYER'S NAME: MAILING ADDRESS:: IX 141~~ USE DATES OBSERVATIONS MADE INO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑New ❑Replace ❑Residence RATING: S= Site suitable for system U= Site unsuitable for system ffj~_EALMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) S ❑u E S au aS ❑u oS ❑u EIS ❑u % If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the .09(5))(b), indicate: - Floodplain indicate Floodplain elevation: under s.-163.0 FF PROFILE DESCRIPTIONS Fr' BORING TOTAL DEPTH TO GROUNDWATER-TTVeI-FRS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH$W, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) G j ~5, . 4p 7 ' F4-e ,loll. SL, RV, S'C/- w; B- 9, 3,0 04-6 - "yo T5' y 3 ' {v~.e S i CL 6,,,A D/S?, .yoT 13"V. 6 Y, 0,9 5:"4 0 C'S dlr.c~. IBV • C ~ B- C1~ 4,,'~G1 p&M. titers. y/ ; ot,G2 9.P? B- c L M 5ce 4 r (Ma .3,14" /1 01 leg - 15 B- B PERCOLATION TESTS _5 daZ lJd DROP IN WATER LEVEL-INCHES RATE MINUTES FTEST DEPTH WATER IN HOLE TEST TIME PER INCH INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 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 j - i i t : I- i y i I I ' TN 3 t t r r 3 l I { I 3 ~ a t ; r - 3 i 3 ( 3 i 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 o my knowledge and belief. NAME (print): '9 _ TESfiS WERE COMPLETED ON: If ~ei ADDRESS: ~TIFICATION NUMBER: PHONE NUMBER (optional): E a Z 3 6 T Y' CSTSIGNATUR :'~%'(/"v( . 110ZJ!3 1 ;:t jr % M . 54016 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/32) OVER i -kit r ~ T 1'.S .it Pt d F 1 iS 1 1 ~ s L': i2 7!€.~ Lt,7TT}(. ~t 1 { ~'t E3 gt Dt to ul a, r ~ x x t a. a s al t= t r v~v r r) I ° 1 C t > x r, r ni its ul, t;h? tUiSt ti r'"rf3-7r. F~-a E_16€C f,; i.3C Fri I'll! ..x MtE4tl-i r xBt G` E fP'[:liC co 1'ti r3; F. gtE.,4 (b t 3 q r, r ` ti - I, rJ'9j z ~'a rr~ cc b J1 r 1 a f ,E 'y~ y yt~, ~g Lrf i,. t _ , : 4?r _ F-me S ° , 4 r c - ate t P .3€ r i E sic i . a r r r,J, tt t REPORT ON SOIL E30RIN&S o PERCOLATIot TEST5 PLOT PLAM DArF" =%h HOMESiTE TESTING CO. . IS S 3, O'ME3L R 0 A D BOB 5,4016 057- 5.5- 02 Yf2 . PROP05ED mwsE Mosr Cie zr' Fr. aa~ MD.PE ",O cl A,tL rx7-5r j oe.45, PROPOSED WELL MVSr LIE- 5O Fr I49er F~POt-/ ,gc~ T~'sT ~q,PE,9S, • = Q~t.~fy'o£ Pir,S O =EXIST/.~1(,- Gt~~L~ X = AtV6 10C47-144Y = 1IANP RV9E~e,0 ®,~e 5,44dEL BovE5 c = f/A,tiz . B 4 LEGEND 45/444 iev OA 11a to 'fe !G 0 , 0 i ~0 r op I 1 Y L 07- 033 4- 57 /0 Bo UEzi;c/i/ ,P~-/ Pl- ~I I .>'a t' l>1• K r. iw iwi d Yi ~i• / \ ~'rY~ ,y` as _ 41 I a].tn'cS SOLD t ♦ l sj 0/ i- d 20 i)•.oca - _Ij C>O = r SOLD - F , t J I E C'- 19 rr ~ alf A 1 w .Ot> t1Jr . ° r; r a: _ 4. 4-i SOLD - 8 2. KK3 ~ M1 ,r - w V (17) 1P J ; w r ec~ s 4,-1 a. All KERi OTT AGEI\ICY b 600 3rd Strcet Hudson, Wisconsin 54016 } Phone 386-5151 - 436.5755 - - UNPLATTED LANDS ` - :.cv,r. aw•t or ac w as +.t w t~ 1 t x b ~ •~`C`• ~ to ar .07 is j 1/. sao 00 / ~ 1 Isu.eo' T. w ♦}s SOLD 14 16 a>~ cYrf ]a].cYtt ~ • ~ x 1] cYft ~ 9 ~ ) t is R! 3 _ _ _ ! SOLD so ~fs J. V cL SOLD \ l 8 - - \ rrli •tT 1.' t1' s ~t't _ 'cow :?OLD a ti (7) b ] zn-c 1S •o J. Y S F C: n~= 2 s• s Z. J .rte. 12 -ts ~Af wi w SOLD • t ~r. c Ibli :S. V) ]a•.02f ; "r,a•O.°,t' . ; ^ 1r w►!ba'V•[ ]>..M' qy.Y r 4 v 00 s't'a°u ° 61~ tir I's c, rr o iQ ~ I /i " ~A ~ ^ a04 TM[iY ~W MT-(Y•-.r.1 1_rC - _J' ~J i 'n4 Q-a rnott a o6 -.j art. 64 - . ~ 0 li a •raiaz'+ sssti .a 9 - ~ . - * - , -----------------------AN - a.rod as r. :e►.••i / -77 UNPl1~TTED . p DEPARTMENT OF REPORT ON SOIL BORINGS AND SAF 'Y. BUILDINGS `iN,GUFTRY,, Q^ ! DIVISION AND PERCOLATION TESTS 115 P:O., OX 7969 HUMAN RELATIONS h-) TVf/~~SOn~ 153707 (H63.090) & Chapter 145.045) ki- LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. SUBD N E: S e~ % 1/ 1/ 2 5~ /T3e) N/R z61(o s COUNTY: 9NtlAfEf}'S/BUYER'S NAME: MAILING ADDRESS: I-11X 7A,4 USE DATES OBSERVATIO NE SCRIPTION: PROFILE DESCRPTIONSPERCOLATION TESTS: %Residence New ❑Re lace 1 ~ RATING: S= Site suitable for system U= Site unsuitable for system _'17 (Z 7 r0l NTIONAL: M-GROUNaPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) s ❑u 0s ❑u ❑s QU❑s Dlr%rE /~'EL C(,7 If Percolation Tests are NOT required DESIGN RATE: I If an ~I y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INr"ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHTAI, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9,v, -6y 4n4i_SiI1_ I-S /3A) B-2- Q13 . /0 y/0 s ' / 7 '13A1-6/ L sj 3, o ' 64). DRY, i-oos~e- -Wee s _ j3 . or ro~ 3 L5 R. 57. B-_3 ~o. 013 > / `13 ,6/ LSD 1X4. S "Aix AA). 4 s A). /7`YJ'Cj~ G~y RA)-GB- Vol, SA Jam' ~tQ. Sy I `/L ?.61 , 1-5 Ad'. S ' 457 to SETS a F B / 7s Gy. S~ cv/ -fey ArO rs a B S~ /Gll~. ( ~or~ ' o '6N. ts, //1 0e. , X. 43 T. PERCOLATION TESTS 'Z) f~, ~t0 rs TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I11EN,ES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ i L P- P- L% i P- P ~ i 77/6 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. )607701-1 OF fiEP 9XE.4Urfl"io..t) S-e q 7 Fr SYSTEM ELEVATION l~ LOUD 0"r1efl- gEFE,~E-~« poivi, ~r /~U r o 3Q ~r /V eel //STS ~~(~F'T/Uclg L ,T~PAic) F1c`LL~ --/j ^ St>. F7_ l~1 x 7-0 101,,0-5 Aee- N _ 4... E Al C, 047C i/` ~f !A"E- SSE Q ~ G~~ Ao, I , rW6 0C 4€S 4,7- 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): -02 Yge 2__ CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER t + 'sra' =3°.... mss. fc, u, se r 7r. rl, a [f'`,`t _,t ,t2"! n iaL ,~to h, X, a ih Ea ta;ta1.f, ,xqt t.l... m t, Tc, t; ra c 11 ttt.}'y-„[ ~ Etf~C s ~S E-~g~t r ~t Et.~ ~ r €t f>' f i~ F E ~yt 3 ~ s=` - fi f REPORT ON SOIL (30R1NGS ; PERCOLATION TESTS I!S PLOT PLAM PR0TEC T D. 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