HomeMy WebLinkAbout016-1081-30-000
n cn O 3 v 0 C7 r_
c o 3 co `~1
CD .o A~
,g -O o c
m C
m Q
o N v o N
3 o c o S w x
ID {O^p Z EL m y v ° o
CD 0 11 N c ry co N d O W O
-9 Ci 3 j O N O
O
N O
7 V O 0
(D C)
(n G D a
(D (D N N Q
Q W O O d
CD F~
O N (O
F n r cn m ~r
N W OD O cn O C 1~V1
co ' .9
Z O O O d
o < ZD
c y ~~4
~
v v v o
O m y A
7 +n (D y 'O T
p1 _
N a7 C>
a
Z
N
° z z -a Q
D D
co O N
c !r
O O N
Z7 O
CD a
n ET
c
CO
W CD l0
Z Z d CD
O N I ~ ~ C1
N A z
O
< O m
W
CL Z
O 3 cn
3 m ~
N z
N
Q
O N a.
7 'O - <
G N p -
(D C7 ~ T
O N C
CD n Z a
3 0
v CD
O O N
d
N 7
d ~
O CO
O
y
67 N
N N
N N
(fl O
(D 00
T7 N
N
O
O
a
A
0 N
C=D Q'Z ti
cfl O
o ((D
0 0-
Parcel 016-1081-30-000 07i27i2006 02:36
PAGE 1 OF 1
F 1
Alt. Parcel 36.30.15.552C 016 - TOWN OF GLENWOOD
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 - ANDERSON, KENNETH J
KENNETH J ANDERSON
1214CTYRDW
DOWNING WI 54734
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1214 CTY RD W
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 36 T30N R15W 1A IN SW 1/4 SE 1/4 LOT Block/Condo Bldg:
1 OF CSM V4/1101
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 7,500 151,300 158,800 NO
Totals for 2006:
General Property 1.000 7,500 151,300 158,800
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 7,500 151,300 158,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
o c
7 "0 o
3 et
3
n
CD 1 m # C ':r
O -3 w "
Cl) a Q
w •
n ( C D o v o rn o ~l
CD > j o CD w o ry
o
C.nn (D m 5 G' (D °o cn
o a Q 3 co o cn !
0 w 7• (D d --I N O ~ O
O c A c (D Q l< O W O py ~1
7 N N ~ O C
D1 a w
r"7 lV
v v D m n oo
w a c
c W p
3 0 . °v ° x
U N)
Z W CD a) "*ANA
0
N N
O O
O O p c
N O O O I, 3 S
0 O O (D ry~~1
o,' tin vii tin D yN
N (D cr 'C O _O cn
O = (DD N N -4
m w A 4~-
77 N
w N
N
z N
Z
_ N
D D D O
O
O •
m CD
(D N~l
c
I w m
n 3
z CD cn
A Z CCD
O l Cl)
N A C) 7
O
o Cl)
W V
CL z
3
g m c"
N Z <
(D A
O
I
d C
CD N a G
Q O ~ ~ T
7 CD w C
7
p n OZ a
O (D N CD -
N Z
6u
-u O
n
(D N
A 3 p
O
O 0 ' S
3 m
C0 `
O
~w N
w o ~
7
O_ =r O
(D
A
0 W
O
b •
A N
O t N
ti
~ O
O L
ti
07/24/2006 03:17 PM
Parcel 016-1081-20-000
PAGE 1 OF 1
Alt. Parcel 36.30.15.5528 016 - TOWN OF GLENWOOD
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 - AJER, SANDRA J
SANDRA J AJER C - DANOVSKY TODD C
DANOVSKY TODD C
1208 CTY RD W
DOWNING WI 54734
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1208 CTY RD W
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 19.000 Plat: N/A-NOT AVAILABLE
SEC 36 T30N R15W S 1/2 SW SE EXC PART TO Block/Condo Bldg:
LOT 1 (1A) CSM V4/1101
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/22/2003 740859 2416/151 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,000 185,200 197,200 NO
ENTERED BEFORE'05 CLOSE W8 17.000 34,000 0 34,000 NO
Totals for 2006:
General Property 2.000 12,000 185,200 197,200
Woodland 17.000 34,000 34,000
Totals for 2005:
General Property 2.000 12,000 185,200 197,200
Woodland 17.000 34,000 34,000
I
i
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
• / , 3 FORM NO. 983-A
✓y✓`
,US ~d N= Wu.Gap~y®
CERTIFIED SURVEY NO.
Part of the Southwest 1/4 of the Southeast 1/4 of Section 36, Town 30 North, Range 15 West,
Town of Glenwood, County of St. Croix, State of Wisconsin, described in Volume of
LA Certified Survey Maps, page ---as Certified Survey No. _
I
O
UNPLATTED LANDS
PO.B.
S 89°40' 13"W
SCALE I"=100'
250.00' 33
&0019
I ACRE ! BRG. REF TO THE EAST LINE
.U1 43,560 SO FT NOT INCLUDING R/W s r SE 1/4 SEC.36, T30N, R15W.
49,310 SOFT INCLUDING R/W aj ASSUMED BRG. N00029'15"W
C\j
a IT LOT I - Nto I~ I x
0 O
0 - z L~
z
UNPLATTED LANDS o\2°' 199 N
op 250.00 9ii • o
N 89040'13"E o I
UNPLATTED LANDS
I
0 -3/4"X30" ROUND IRON BAR
WEIGHING 1.502 LB./L. F. _J 1313.64'
s89045'10'"W e rc_R.
SEC. 36,
T30N, R 15 W
2" IRON PIPE
WITH ALUM.
CAP
SURVEYOR'S CERTIFICATE
I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify that I have surveyed,
divided and mapped a part of the SW 1/4 of the SE 1/4 of Section 36, T30N, R15W, Town of
Glenwood, County of St. Croix, State of Wisconsin, more particularly described as follows:
Commencing a~ the Southeast corner of said Section 36;
Thence S. 89 45' 10" W., 1,313.64 feet;
Thence N. 000 32' 36" W., 658.71 feet;
Thence S. 890 40' 13" W8, 33.00 feet, to the point of beginning;
Thence continuing S. 89 40' 13" W., 250.00 feet;
Thence S. 000 32' 36" E., 174.24 feet;
Thence N. 890 40' 13" E., 250.00 feet;
Thence N. 000 32' 36" W., 174.24 feet, to the point of beginning.
Said parcel contains 1.00 acres, more or less.
That I have made such survey, land division and plat by the direction of Kenneth
Anderson. That such plat is a correct representation of all exterior boundaries of the land
surveyed and the subdivision thereof made. That I have fully complied with the provisions
of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of the Town of
Glenwood and the County of St. Croix in surveying, divid'ng and mapping the same.
DATED THIS 5-"' DAY OF~ 1981.
THOMAS G. KUESTER, Registered Land Surveyor
P
vv=
Y
5-1345
s
AS BUILT SANITARY SYSTEM REPORT
OWNER s"1oJJ►~ "rL' A7", y- ~ "TOWNSHIP SEC. <S G T,';~ N-RrzW
ADDRESS L' w Y% NN ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
OWL-E_VE~YTHING WITHIN 100 FEET OF SYSTEM
s
t '
7 'e f s
L
VTA
'J
1J
I di a e oath Arrow I
BENCHMARK: (Permanent reference Point) Describe: S iv ~,7~I1+C~~'/^
Elevation of vertical reference point: Slope at site
SEPTIC TANK: Manufacturer: c;` sc lj Liquid Capacity: l ~yc c1 L
Number of rings on cover : rA+r Tan manhole cover elevation:
Tank Inlet Elevation: - Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: i c= S c 1i,5 Number of gallons 7
Number of gal. pump set or a cycle - gallons; Iota capacity o
distribution lines' gallon: size o pump ,J head;
gallon per minute horsepower 1 rand name of pump
and model number
Type of warning evice f4;t 2 N
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: 1_im er o Pits _eet iametpr_
feet liquid dept~i seepage pit inlet pipe-elevation
bottom of seepage pit e evation feet.
SEEPAGE BED SIZE: number of lines-_:2- wi t IL% leyigth 2,Z ile depth SEEPAGE TRENCH: width length
PERCOLATION RATE A REQUIRED RE S BUILT
INSPECTOR
DATED ,7 PLUMBER ON TOR y
LICENSE NUMBER yc''
REPORT Of INSPECTION INDIVIDUAL S(WAGI SVSIIM
• Sail( f"ahll I'c~lrvi( I
-I. (z t c S c l ) ((c -lGG ZQ 7
n ,1 rowvlbLl irr--AT/-- t. Ctll)~ x cul~vlfil/
seC.tC0n Lo t SubdtiVICA (()n
t I'I IC IANK
akfovu5 Numbers o corrl)ah mentb
l~l)ni(Morn: WePf - 8u4'e,C1-Yl 12`0 6-Yuve.
-
Htig6lwa to n
I'lIMVIN(i CHAM6ER
S( zer' gdEQavlb Pump Manu~aetuile~l Mudek Numbeit
HOLDING TANK
St Ze gc(efun,5 Numbest. o(I Compan tmenLs
Pumper Aea~irn Sya -tern
D A to n c e. .6 ,11 oy,uW a{ e~ 61t t f d.c n y 12 n f o p e
Hi(jitwate.n.
ABSORPTION SITE
a
Bell " Tscench
( t(4 ncc ~ho m• Woof Ul~~ (utiny I'L'i) bk'upe
Hi git wa.teh
At,'~,(4'1'1ION SITE DIMENSIONS
(u~ Ilh 0 tnencit Kvyu~ pled area
I~nigth of eae61 Yivle ~,t Depth „A rlocle bveow t.iXe
Nurnbell oo- e4i(l.e's - Depth of noch oven tlike tvl
To taY fcengtll oA k.i.nvs ~I Depth oh ti ee below q,lu-de (n
.0 4tit(inee between Y4neA Sf of 01,vneit (n. pe"l 100 (~t
Total ab! ah.pfic.on ahea (t Tl/pe ~11 coVC'h Papc ~l 'u l e t~IaU)
I'll DIMENSIONS
N(i rn1)c t o~ p( tb G1l(4 1v lit Oll.n'd r,t5 if cb
Ollisi(Ic d<c*im)tctl t D- be ow 4nect (t
Iloll' II)A 1.)tion aIt ca t-
A)fc tlc)Ili(rled fit
I N':I'I CTE R_ 6V
TLTI_f h
1I'!'ROVI D DATE 19 a
i,i II CI 1 0 VATI 19 n
I'1 A2 ON I OR REJECTION
I
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BULIDINGS 1
LABOR &*HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION
P.O. BOX 7969• . SEWAGE SYSTEMS BUREAU OF PLUMBING
MADISON, WI 53707 ❑ Mound ❑ Pressure Distribution
NAME OF PERMIT HOLDER: T DDRESS OF PERMIT HOLDER: INSPECTION DATE: PLAN ID NUMBER:
'3c --o~5'i 1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SEPTIC TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: IlII) :.F✓f'.' ]PROPERTY LINE: WELL. BUILDING:
ICI ( ST
DOSING CHAMBER:
MANUFACTURER. LIQUID CAPACITY: PUMP MODEL PUMP MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
❑ YES ❑ NO ❑ YES ❑ NO
GALLON PER CYCLE PUMP AND CONTR OLS OPERATIONAL: ~FEU L~PROPERTY WELL: BUILDING VENT TO FRESH
L'"E AIR INLET
T FIRIw
DIFFERENCE BETWEEN E ~
PUMP ON AND OFF YES El NO AS57»w..'I
SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction
shall cease until the soil is dry enough to continue.)
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM
and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW
El YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF SPACING CENTER ~+t LENGTH: DIAMETER. MATERIAL AND MARKING.
D ~:D! t nlN y TRENCHES: TO CENTER:~r"'Twvl"'j
C?1M NSt NS„ MAIN
MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
DIA.: PIPES: DIA.:
HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
❑ YES ❑ NO ❑ YES ❑ NO
SOIL COVER:
TEXTURE.
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED.
CENTER EDGES
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
COMMENTS:
SIGNATURE: I I I "LE:
DILHR-SBD-6227 (R. 05/81)
State and County State Permit #
PLB 6 7 Permit Application County Permit #
r
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #J
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: La.+ '/4 '/4, Section , T?o N, R / (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family X_ Duplex No. of Bedrooms, -No. of Persons
D. SEPTIC TANK CAPACITY 100 iC~ Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber 040 Total gallons Prefab concreteX_Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area'' sq. ft.
New_ & Replacement Alternate (Specify)- , /y » ~J aN t~IQNSS r~ IS~~
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- I Distance from critical slope
WATER SUPPLY: Private ~9 Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester, j
NAME ,16;-,41- C, SM b' lift C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# 40 Phone #,-~"~P.~~
Plumber's Address G=L.,C 1Y4r d d i Ll
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
1
3
F ,
E
i
.
:
r
i-
E
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application i Fees Paid: Stated ~y County Zl Date
.n 7 01 Permit Issued/P.44@@, a (date) Issuing Agent Name -~G
Inspection Yes X No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
state (pink copy) 4. plumber (canary copy)
- - Revised Date 7/1 /iA
251
Smith Plumbing PHONE (715) 265-4838
GLENWOOD CITY, WISCONSIN 54013
i
I ~
J'31412. 19g i
~ ~icto~ GU.Y[b~erw'
it
/L
ri
11
11~
f
a P j
fiELATIONS
State of Wisconsin ` Department of Industry, Labor and Human Relations
ro 7
SAF ILDIN ION
B of Plu ~t~yj9 tt' Il Protection
P ox 796
T0: on,,~,°
Plan Identification No.
Gentlemen:
Re:
The Bureau of Plumbing, Platting and Fire Protection has reviewed plans,
site survey information and installation details for the construction of
an alternative private sewage system to be installed at the above-mentioned
location. The plans and specifications were prepared by
and received for approval on
The soil and site evaluation was conducted by
The site meets the soil
an site requirements specified in c h. H 3, Wis. Adm. Code, for the use
of
The proposed system is for a
Wastes from the building will discharge to a
gallon capacity septic tank which will discharge to a gallon capacity
pump chamber from which a pump having a capacity of gallons per minute
against a total dynamic head of feet will discharge through a inch
diameter pipe to the soil absorptooonn rsystem.
It is of utmost importance that the system be installed in complete accord
with the plans and installation details and the conditions of approval con-
tained in this letter. The licensed plumber responsible for the installation
shall notify the county inspector when the installation of the system will
commence so that the county inspector shall be able to inspect this instal-
lation. The installer shall not deviate from this approval and shall follow
the directions or orders issued by the appropriate local or state authorities.
I I / / -
DILRH-SBD-6159 (N.7/80)
in accord with cis. 145, tats, and c h. , Wis. Adm. Code, the plans and
specifications are approved contingent upon compliance with the stipulations
indicated on the plans. Please review your cede for the requirements of
each code section noted.
The architect, professional engineer, registered designer, owner or plumbing
contractor shall keep one set of plans bearing the stamp of approval of this
department at the construction site.
if the installation of this system has not commenced within t years from
the date of this letter, this approval shall become void and new application
shall be made for approval of these plans before work may commence.
In granting this approval, the [division of Safety and Buildings does not
l itself liable for any defects i plans or specifications, plan omissions,
examination oversight, construction or any damage that may result in or after
installation and reserves the right to order changes or additions should con-
ditions arise making this necessary.
This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall
be necessary to obtain and fulfill the permit requirements of the county in
which this installation is to be constructed. Failure to obtain county
permits will automatically void this acceptance.
Sincerely,
Ja s Sargent
Bureau Director
JS:Jp-. s
enclosures
cc: OWS
County
Plb 100a 1`2/78
• v of Wisconsin
Detach-And Return Upper State o
~ DIVISON OF HEALTH
Portion Of This Form With SECTION OF PLUMBING
AND FIRE PROTECTION SYSTEMS
Any Return Correspondence MAIL ADDRESS: P.O. BOX 309
MADISON, WISCONSIN 53701
608-266-3815
DATE: PROJECT:
en dt,
,max
PLAN ID. # '
DETACH HERE
PLAN IC
This !J to r7:I'Cil! vvledgg , rest q i Or the : . _
Preliminary review indicates the plan review fee required is $
❑ Plan accepted for review. Fee received is $
Fee is being returned because of ❑ Overpayment ❑ Underpayment.
Providing one of the two catagories above is checked, remit correct fee in one payment.
❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance.
❑ Plans being returned.
❑ Additional information required. SEE BELOW.
1. Plan Submission
❑ Additional information shall be submitted in triplicate unless specifically noted.
❑ Plans not clear, legible or permanent.
❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code.
❑ Affidavit enclosed.
I~
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY- • DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON W 7969
HUMAN RELATIONS
.LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME:
Sew '/45 '/a /T ®N/RL: E (or) W
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
Std 0/ RAYMakd o. NZ C10a N ,0ic7KS
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R ONS: ER LA ON TESTS:
Residence XNew ❑Replace I«^~~
l(RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
IKS ❑U QJS ❑U NS ❑U ❑S ❑U ❑S ❑U
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
'7
Am& la, 24?
B- :Z 7-Z 10.2
B- 6 s2. /00 M10 13 :'S4 Ned S. ,r .
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER( D PER INCH
P C
P- -l
P'-
A--
-
-
F -
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION p 1 e~ ' J? pa & A-w t
1S
/
+ 17-
E
Z
3 z
sere 5?2; -
3 ~ r
.
W
E E ~ 'j,Q ~ 1
LNG H IDs
YRe - .
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative 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:
6-7 A
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
CST SIGNATURE-
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 IN. 03/81)
Ebb,