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HomeMy WebLinkAbout032-1054-70-000 • ( f) to o g -0 n _ 3 CC) =Or U) 00 03 o o s (D ~ o (\~4 V cl W a s N O X CD O w'h `A\ (n to cn Q= co N N 0 N =r -4 O Vt, _ 1 ~ 7 N O O O ~1 0 C O O CD m C D _ cfl CD N N co N 10 O N O O 10 O 0. m -4 3 W CD (0 to 0 r- cn t.s"N w w co ~ O N Q C . Q O O O l.r o c rs -i z fn D 0 v C 0 0 CD M 4, \ ` Q 0 .d. N (O ~ 3 V a - ° z N " ° z co z o Dd (D N N CD a) .0 (a CD (D I a o z N = -It(6 :t o c o ° N o z n ~y o X c ,'0 v N a A o # z N err (o Z W m Oa a z Z Y O r: z 0 v~ ' ~l I m m ~ z O W H t a O N C !x oZ d oo m N TJ (n - I z 1 o w rn 4- t~ 77` I O s I o ' o o y C=D o A O a ° : a °o CL 0 m f 0 E f o d F 3 o 3 fD (D CD 7 f9 m 3 m 3 (D CD m d (D 3 (D 3 ` 11 3 - 3 - 3 X c w y z m Cn z O N z m F z v z 2 N z 1 O N' N O "Y ? 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Parcel 21.31.19.272A 032 - TOWN OF SOMERSET 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 JOHN H WILCOX O - WILCOX, JOHN H 490 208TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 490 208TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.930 Plat: N/A-NOT AVAILABLE SEC 21 T31N R19W 3.983A IN N1/2 SE NE Block/Condo Bldg: LOT 1 CSM VOL 4/1170 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-31N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 696/43 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.930 52,600 90,600 143,200 NO Totals for 2006: General Property 3.930 52,600 90,600 143,200 Woodland 0.000 0 0 I Totals for 2005: General Property 3.930 52,600 90,600 143,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-1055-10-000 11/22/2006 10:36 AM PAGE I OF 1 Alt. Parcel 21.31.19.272E 032 - TOWN OF SOMERSET 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 - WILCOX, JOHN H JOHN H WILCOX 490 208TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.727 Plat: N/A-NOT AVAILABLE SEC 21 T31N R1 9W 4.727A IN N1/2 SE NE Block/Condo Bldg: LOT 3 CSM VOL 4/ 1170 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 871/490 07/23/1997 696/44 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.727 56,600 0 56,600 NO Totals for 2006: General Property 4.727 56,600 0 56,600 Woodland 0.000 0 0 Totals for 2005: General Property 4.727 56,600 0 56,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 2P Form - S T AS BUILT SANITARY SYSTEM REPORT / OWNER KJI~LDX TOWNSHIP SGtifS /PSET~ SEC. Z/ T 3/ N-R I W o'`fk ADDRESS Lam, 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 TA A~k i-S VT6 wzgk AEI C; s -S~ Tod ~ cA sl d crx iST~N V. 15 70 A, ~F O 62316 0 FT. S. o I /~,c~ s~~ rF sT 11-13 6 ~s Pi/-e -f du4e ;7/0 APP/E- ~ p z \~l }VowrR PaIE 791 O Y6 --CL INDICATE NORTH ARROW A x 2 PA4i42F,,- z!PzD o~v L v PR-- S of L ~ T orav BENCHMARK: Describe the vertical reference point used /ll l e T / 6y~J0rP Elevation of vertical reference point: 0 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: vs 6~ R u PT-1 C Number of rings used: Tank manhole cover elevation: s'S fA^'K i5 G L F' G ,ter . Tank Inlet Elevation: (2' Tank Outlet Elevation: F0 or Number of feet from nearest Road: Front,@ Side,o Rear, O feet wed ( dab ( , ~As//) From nearest property line Front,OSide,ORear,O feet ~y V/CTI 0 ~ ~ C~~ Number of feet from: well 63 building: 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Li id Capacity: Pump Model: Pump/Si on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: 'Z - Pump off switch elevate n: Gallons per cycle: Alarm Manufacture .7 Alarm Switch Type: Number of fee 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: X Trench: 13/ R Width: 2 Length:^l Number of Lines: Area Built: Fill depth to top of pipe: /-l,+Y iti Number of feet from nearest property line: Front, Side, Rear, O O Ft.~3 Number of feet from well: ~Q Fr Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of its: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: - Has either a op box O or distribution box O been used on any of the above soil absorbtian sytems? (Check one). HOLDING TANK Manufacturer: acity: Number of rings used: ~evation of bottom of tank: Elevation of inlet: Number of f 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: 7 Inspector. < V1. Dated: Plumber on job: License Number • RT. 3 O'NEIL RD., HUDSON, WIS. 54016 • ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO, 3307 M.PTSS- MINN. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj A DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOY. 7969 BUREAU OF PLUMBING MADISON, WI 53707 'CONVENTIONAL ❑ALTERNATIVE slate Plan LD. Number. (lf assigned) D Holding Tank 1:1 In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE: John. Witcox Audabon Lane, Hud6on, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NF NF, Section. 21, T31N-R19W, Town o4 Someut,Lot01,Appte Riven Run. Name of Plomber. MP/MPRSW No.. County S rotary Permit Number Robed U2blLich 3307 St. cuix 58896 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIGU14CAPACI 1"Y' v. .TANK INLET ELIOV [ANK'00LET ELE WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. YES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: IPR40PERTY, WELL. BUILDING ENT TO FRESH .i I' ALARM FEET FROLE IVAIR INLET YES ONO" DYES ONO N/DOSING CHAMBER: MANUFACTURER 71 LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. S ONO DYES ONO OYES ONO GALLONS PER CYCLE: 7P MP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL JBUILDING IVENTTOIRISH (DIFFERENCE BETWEEN L:1 FEET FROM NE AIR INLET: PUMP ON AND OFF) DYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing c,n, DIAMETER 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: (J _ WIDTH. LENGTH NO OF DISTR. PIPE SPACING COV ! INSIDE CIA -PITS LIQUID BED/TRENCH / TRENCHE M E ~gL.: PIT DEPTH DIMENSIONS , ~ r ~~,Ef!. GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR PIPE ' DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EL E,1 IN LF7 LEV. E PIPES LINE: AIR INLET E 0 j G" j~ _ND FEET FROM lk / NEAREST -s (`I M 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- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES NO DEPTH OVER TRENCH: BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO OYES ONO DYES ONO 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. D PIPE DISTRIBUTION PIPE MATERIAL & MARKINGFLEVELEVDIAELEVPIPES DA.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS. DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL'. BUILDING'. FEET FROM LINE. DYES ONO OYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. I C.WJTUR TITLE, DILHR SBD 6710 (R. 01/82) ~ Lt U" ja ~ 0 i&Sconsln APPLICATION FOR SANITARY PERMIT DCOUNTY (PLB 67) - CIEPRRTT1lEnTOF UNIFORM SANITARY PERMIT # In OUSTRV, LREIOR 6 HUMRn RELRTIonS / Jy -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 111 inches in Csiize. -See reverse side for instructions for completing this application. PLEASE PRINT PROPE TY OWNER MAILING ADDRESS Ao 7t/so j Lti ~ his s~Glb P OPERTY LOCATION 1'61/4AE1/4, S Z/ , T , N, R ~ E (or W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED N1\ 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: N New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System L-1 Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed El Seepage Trench ❑ Seepage Pit El Holding Tank ❑ 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 Lift 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 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): / (D~S 12-XSL~ (pL Private ❑ Joint ❑ Public I, the undersigne IyE~i 1, it for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): 'ROBERT ULBRICHT Signature: t-ft4l/IVIPFISW No.: Phone Number: WIS. MASTER PLUMBER LIC. NO. 3301 M..R.S. ?30 (7/S) ~l Plumber's Add lame of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial / I J /ill 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 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 developnent'be intended for.resale by owner/contracto;,("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 '1 N - R W Township Mailing Address Subdivision Name Lot Number _ Previous Owner of Property Total Size of Parcel 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 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 . ti wic tr, n the f.ast „l L (OWL) V _ on t. ~V~ t •u t w~ a.c~ 4.1.u;t. U71 e 11-c, U I (we) rQ C elw(.of knowledge; .ghat I (we) am (am) the owne, h) o6 the pn.opehay daut-ibed in this , quo-matc.on i6oam, by v,iQue o6 a wa)La)ity deed neconded in the 066ice o6 the County Re9i ten o6 Deeds as Documcnt No. 3 y~- /yam and that I (we) - pJLu~ert.tXy oun .tile. pnopobed site 6o4 ,the. 4ewagE_ rL{~poba. ~bybtern (un T (we) have obtained an easement, to nun with the abuve descvu.bed pno)9e)lty, box the cujjstt,Lucti.or, o6 laid bysten, and the same has been duty seconded in the 066ice o6 the Country Regiotea o6 Deeds, an Ducumout No. is SIGNATURE OF CO-OWNER (IF APPLICABLE) SIGNATURE CiF OWNLk DATE SIGNED DATE SIGNED -1 1y... W.ir. E T . u_•% Of .a.~: JoU tllt as t t`4 of `he _.j•tl... _l:i }1, ~~''1 ilI . ~ ~ •1 J •'O ~e L:f tt? , Croix ('u-i::i, , :i.- a T-)c:icat: _ y inC.icat z ul.rL A ; rf. 0_ ol~ A. 1 E ,.i7 l;J 1 8 2.00' c a z r, 2501... r+j ? 23 3G - r~ t t: i I fj U K `1 t- t7 co L; z J l' 4 C, p tT N p O 1` l M :c I rt v- J 1 V~ LL; 71 crj :C _ uJ rj ~ • 7 OJ iiJ ~ ~ V k tr _ cli _ _ _ _ _ wl ,y 3 •i 4 G 7 ` ~ fnc~ .1 ~ ~ ~ ~ ~ k •.t " _ I S 00. 25' 3A "E 110.ja' % }I 1 t~'f'rt co c` 2, - ter •J: _n n ul t ! Imo- in c, -j. tJ k-+ Dcl) rn N Q n M ,i l S ~ :71 ~ I e-j - H . ~ y S T C - 105 r r Y H SEPTIC TANK MAINTENANCE A(;i(EEMENT H St. Croix County OWNER / 4 /A - - - - ROUTE/13OX NUMBER Fire Number CITY/STA`L'E syvl✓ Z1Y ft-o/ 11 RO11ERTY L0CAT 10N SCc t iOn 21 I' 31- N , k j W , T 0 W n of St. Croix County, Subdivision LOt oumber i Improper uSe "ud maintenanCe Of your sL-J~Uic System COUld result in its premature failure to }candle wastes. 1'rO1) cr [IlaiIt tCna11CC Curl - sists of pumping out the seictie tank every three years or sooner, it needed, by a Iicults e_d std tiC tauk 1cUIll per. What you put into the system can aIICC t the fun Ctiorc of Lh nrIC tank cis a tr'_at - meat s tage in the waste disposal system. St. Croix County residents uia} tie eligible to reccivu a ;grant lur a maxi.wum of b07 of the Cost of repluceutvut of a failing system, which was in operation prior to July I, IL)78 St. Croix County accepted this prograIli in Aug,LI St Of 1980, WI t It tIt c r(rdui ruuient that Owners Of ell nt'w s~'SLUMS agree to keel their systems 1) r01) r I y ilia intained T I I e pruperty OW It er agrCCS to submit to 5t. Croix CO it it ty it 11, a cerIitiCatiOn torus, signed by the owner Ind by a Ili a:.,ter plit Ili l)er, jourii eyncait plumber, restricted plumber Or a licensed I)It nper veri- tying t hat ( i ) the on - site w astewater disposal sySteIll 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 arid scum. Certification Yuan will be :;cnt approximately 30 days prior to three year expiration. 3 0 I/WE, the undersigned, have read the above requirements and agree c„ to maintain the private sewage disposal System in accordance witsc x the standards set forth, lierein, as set by the Wisconsin llepart - ment of Natural Resources. CerCifiCati011 forIll must be completed ~ arid returned to the St. Croix County Zoning, Office within 30 days of Late tIt ree year expiration date. S I G N Ell St. Cil,,oix C.tunty Zoning Office P.O. I.ox 96 Hanunor d, W1 54015 715-7~ 6-2239 or 715-425-8363 Sign, date and return to above address. r C^ Do --I ~v, w N3 O p C y N 'D c m o a 3 -a (o Sr =lr w n p S (D p m m S p as N a 0mNa~NN~ y n - o a n N o co G, V, co S n (D O ig- ID CD =L 0 (p - m = (p CD C o °0cDw 03a o m o 0 o p Soo ,<~c y 3 Zs cr f c • c w m o ~p a~ 3 D C40 ; '20- 79 < CD c y co cr o N w o D c (D _ o n- pj n n o m 0~~dovaoCD (o i a y uoi-~N ~o~ z D ~m0 3~N~Na D V. co (D ° n m o a CL C0 "a Imo NCA%D0Ei. C 171 mc? o°=6 =r m m o = C W (a N n C E Qa, Z - 0 CL < ID ((D (D 0= CO 3 in. a m o (n c ~ asu o 0) (D m ca CL 0, cr -N (an ~ c . ~~w=r (D ca 0 CD c _ 3 m n c ~(p ~O N W A N p (1.0 7 o ca n C CD -i N CCD c 3 0 CL =r 2) ;z 0 a CD o (D CD z o 0 - DEPARTMENT OF REPORT ON SOIL BORINGS AND ) & BUILDINGS INDUSTRY, r DIVISION LABOR AND PERCOLATION TESTS (1151.GBOx 7969 HUMAN RELATIONS \ / _ r t f S Q'NWI 53707 (H63.09(1) & Chapter 145.045) P ~(.v LOCATION: SECTION.. TOWNSHIPHb414' - 1461RAl-I LOT NO.: BLK. SUBD NE 1/ / Z /T 3/ N/R E (o So,~ E,~s~7 COUNTY: OWN ER'S/•Bt11'ER'S NAME: MAILING ADDRESS: 51 CI-0 TO H A) (0 Y, USE DATES OBSERVATIONS NF_D N NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIP € LATION TESTS: Residence 2 New ❑ Replace 7 _S> L C rd%- RATING: S= Site suitable for system U= Site unsuitable for system 4; CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) , ©S❑U 0S❑U ©S❑U ❑SCCU ❑SDU OavvE.vT/ev./ 0.2 7iE'E"v~ e S . If Percolation Tests are NOT required DESIGN RATE: 2-o 3- If an any portion of the tested area is in the i `7J under s.H63.09(5)(b), indicate: 54. /d~G[/VNj . Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) " ` " 'N•ce S/ 1.4,7 G • f3a. caun~ 6. 04. > . AV. /S' . a. /3,J . 15 b?v O.P. h.~ S ,v ' . /00.22 y~ /.15' /3N. IS, /.08' L N , C6-t-y-e . 67 G/. B- 3 J ,;to_ , 4 -15"z/. flo -6y IS) ~X67 '13N .67 ' .7 5 y. S° w I. s' k B-~ r0C PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD3 PER INCH ~ 3 • ~O P- P_ Z P- 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 fT P`~ ~ a y _ 1'3,+Ck'16 E" /3 o,PF'S 0 60 ,ke 36 s GOr~e~• r6V4 nip" - y goo-o' 7-6P ss it ee"'44 a k -y~ kit, rk Apt It t ~b P64 Ol 501'~x 2, p y0 " 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): NUMtSITE SEPTIC PLUMHINb CO. TESTS WE E COMPLETED ON: AT. 3O'NEIL RD., HUDSON: WIS. 54016 JC • ADDRESS: ROBERT ULBR1161 if CERTIPCATION NUMBE : PHONE NUMBER(option VMS MASTER PLUMBER LIC NO. 3307 M.P R.S 33 _0) - Z ANN INSTALLER &-DFSIPNF R I IC. NO, 00663 CST S NATURF~~k~ / `V A 'UTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -)-6395 (R.-02/82) -OVER - a anu descr cool „ ,7a! ,.zE':1f?',C`i; S this ~ r) v,_ or £ sd c:,n't t„ 9E.tif N, itV at , J(.x;s- l 1i i r=.: 1S U1T;A iF FO ~'OLD€Nk~ .l', N€ t~N%'r' 1F: ~':A_L. 6T~, 3I l S F?4 31;1 f ` (JT ? A 't C ( i :4 i1 r'E_E ASF-l. use ih1; ;2i7b€evi a lh,% l,,7 r-n all I €orlp)iCting the plot p!ar); N,Ir4 ~.E A L6 GiLE it1GE.p't1n YF:7i#f• fr;Sp ?(JG-tc.,Jll'> aluo.v;,lt{ bo is, (Jic',ft;;7L'd. tr; a .E d c.r p; s.~C: F ,axa~.~ P}z,r 4)g~l i~3~~ . .J x a as =E; `FG m1,.,, p doc) S [l t iJC:lvl r 1 s~:E; T(, l€ a 7l t` olace, vou,_ curly n, aJ(CS v aut nr~; P Wit., -£.lr >t E n i.t'y Bec 01 SS s ~ .r3 Cy e,~, ;f t' a v" In ;I"'£ «f c•C 1'. ieporg 10 t , • lE:~ PLB ~7 T cLnd CR,055 y 0 r~pr^ SEcTjoN PIANS S T~ ~~LO - o0 0 o w /vno z - ~,Y/-C I ,3KSZ C'~y.~ y s-D Fr. I ~ , R, ~r 3 V, " 3/7 feet- SDi 7-6 f s A J"56 7- 0. c 01;4 /6 IVED __~G HOMESITE SEPTIC PLUMBING CO. ~j ROBERT ULBRICHT / ~/'p' CENT• T~~T~ WIS. MASTER PLUMUR I IC. No. 3M71,1_P, Pc~ MIN N. i NSIALLER & DESIGNER LIC. NO. 00663 7/' 7 So / x X 2 Fresh Air Inlets And Observation Pipe -SOIL TE5TI>3g ay HOMESITE TES-I"NG Approved Vent Cap RT.3, O'WEiL RC+,') I4UDSON, WIS. 1114C.16 Minimum 12" Above Final Grade l 1w I'M 01" /fib s c~2- Above Pipe 4" Cast Iron 1 - -ro Final Grade Vent Pipe Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe L0000 bbl I 14i P: ~P Aggregate a Perforated Pipe Below Beneath Pipe O Coupling Terminating At Bottom Of System