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HomeMy WebLinkAbout040-1203-20-000 o (4 o 3 -0 n o c m O (D v i ~ o ^ 0 3 ~ ~ ~ \ 1 ~ o w o ti U m o o co cn `C • o o a CD 100, n n n v s N 00 CD W CL C~Do N h w r N ❑ o O CD CD a) (b O A7 O 3 3 m `z o O ~1 N C ~ !r d < A a m Cl) CD o W m-- C C ° ° a CL F; CD 7 C:,l X C) r- C/) z Co < O N N N K t SR c T :a !r !n Nil z N n o C n 7-7 N fin O ° o~ m v v~ v o :T O D - d '6 N O lr O C ~ - y N N 3 m a CD a N o z03 z O A a o. CD !r • CD cn CD N C AD C C (D W CD CL z ' Z C9 O A , n (n - z O CL A a. (n -1 w Oo .o m N cn CD CD _ co z 3 a 0 o _ to 0 3 z w n~ A so a n C TO. pn p G N a - =r 0 < : p fl ((n (D (D C11 d N d C A ti A S CJ =O N N D i a (n ~ j p N N oa o 3 (o 0 0 c7 A N CD D O w <n 0 O (D b O s. s ~ r 3 e5 oq r r~ ~ T C" CL Parcel 040-1203-20-000 12/20/2005 12:49 PM PAGE 1 OF 1 Alt. Parcel 35.28.19.938 040 - TOWN OF TROY 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 BARRY A & LYNNE J BUTENHOFF O - BUTENHOFF, BARRY A & LYNNE J 18 DRY RUN RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 18 DRY RUN RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.010 Plat: 0164-CERNOHOUS ADD SEC 35 T28N R19W 1.01A CERNOHOUS ADD LOT Block/Condo Bldg: LOT 02 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 103623 242,200 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 41,200 191,900 233,100 NO Totals for 2005: General Property 1.000 41,200 191,900 233,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 41,200 191,900 233,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 205 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT ;E.-at._~. , TO;•1NSHIP ell SEC. a - Tom' N R W ADDRESS i lfti - F • , ST. CROI: COJ, %TY, WISCONSIN. -DIVISION LOT LOT SIZE , I PLAN VIEW Distances & dimensions to meet requirements of h62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1~ I t ' I ; I ~ I t~ ~ Imo... I 4 I I ~ rt % j I I _4 i j i I Imo, ? I j I ~ I d/ I is I ' I ~ --t -r $ 1 I ~ ~ i I _ _ ' f i I I F _ I s I t I i I~ I I ! 4 I I -1 L(~_ 1 I II I I I i ~ 3 Yn. I I I ' _ 1 JJ I ~ T___ i I I 0 /4 i 'TIC True: S Indicate NantGc AAtzow C MFR. CONCRETE r- STEEL S cad e NO of rings on cover Depth DRY WEELL "NCHES NO. of- width length area no. Of lines___`. width lengthy" area depth to top of pipe ;::,EGATE w: ROTE AREA PREQUIRED AREA AS BUILT j -claimer: The inspection of this system by St. Croix County does not imply complete .roiiance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for s,om operation. However, if failure is noted the County will make every effort to ':.ermine cause of failure. :41SES AND OILS SHOULD NOT BE DISPOSED THROUGH `:HIS SYSTRM. '-INSPECTOR , DATED PLIPMB ER ON JOB 1 LICENSE MaMER a r . ~~~PoS~ o w~ 11 ok Mo~IE ~ ~~EAS ~ , • ' To `E LpT /~FbN. P~U~OSED 13 uTf~lh~Dfr~ ~1 S~ ~~i-cr.•fr~PN of /S,-v Y I ( Ru 1140400.0 of s ~vocDs - (,y `y r ~ ~ i I I ~.-MESt?E TESTIhtGr,., I i ~fS h I o6S~ ry ~~vrw All V V Pw ~M s R i~f~.~t,~~~ RR y r Y ci _ fem..' °'~r~~:'Zi t! DE'1ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. c'OX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE state Plan 1,D, Number [if assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE'. BENCH MARK (Per ent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF PT. ELEV ~l. Nanur of Plumber L I 1 -T P 0 y - MP/MPRSW N,, C.-ly Sanitary Permit Number. SEPTIC TANK/HOLDING TANK: .0 MANUFACTURER LIQUID CAPACITY. TANK INLET LEY. TANK OUTL T LEY. WARNING LABEL LOCKING VE O r C P O DED PROVIDE S41 r/7 6/ 7, S RYES ❑ NO 1:1 NO BEDDING VENT CIA VENT -MATE IT IH W ;E~ H / NUMBER. OF OAD. PR O PERTY WELL. IBUIL TO FRESH ~.r JALAHM/LINE f AIR INLET FEE" FROM . C IVENT EYES ENO / ~N NEAREST-- ~-l~~ L_ DOSING CHAMBER: MANUFACTURE H 'BE DDING ri)In CAPACITY P APMODEL PUMP,SIPHON MANUFACTURER WARNING LABEL LOCKING COVER I J PROVIDED PROVIDED. EYES LINO /A EYES ENO EYES ENO GALLONS PER CYCLE: P AND CONTROLS OPERATIONAL NUMBER OF PE HTV PIE U- BUILDING VENr ro FRESH (DIFFERENCE BETWEEN J FEET FROM aIR~ PUMP ON AND OFF) E NEAREST - YES ENO NEA SOIL ABSORPTION SYSTEM. G eck hVsoil eist re at the depth of plowing I. - - ,I.,Lrr 11 H MATE-RIAL AND MARKING or excavation. (lf soil can be r led t,6 a wire, co struction shall cease until FORCE the soil is dry enough to conti e.) 111 MAIN r CONVENTIONAL SYSTEM: BED/TRENCH ' WIDTH LFNC,rH NO OF DISTH PIPE SPACIN( rravE ¢ IDE DIA s uou[D TRENCHES Mn)E PIT DePn+ DIMENSIONS r `f"~E 11 ..I DFPTH DISTH FII F DISTH PIPE DISTR. PIPE MATERIAL NO R NUMBER OF HOPE RTV WELL BUILDING VENT TO FRESH t- I{ E ~,1;()VE GOVEIt F V INLE I ELEV NU PIP t 3 7 ~ I 2 7 FEET FROM L[ AIR INLET 1 C-- NEAREST _--~s- ~ MOUND SYSTEM: ~p, rpq 7 G Mound site plowed perpendicular to slope eck the texture f the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: and systems o make certain that it ON REVERSE SIDE. SHOW ELEVA- 'm ets the crite a for medium sand. TIONS MEASURED. EYES ENO SOIL COVER TEXTOHf JPERMANENT MAHKERS 111111E11VA111111*1`111 _ _ _ EYES LINO E YES ENO DEPTH f)VFH THE N(,H BED DEPTH OVE -R1 HE NC11 BE LI I EPTH OF TOP_ )IL jS[DFI1 SEEDED MULCHED I,ENI li ED(;ES ❑ ,X<LINO EYES CJ NO EYES ❑.NO PRESSURIZED DISTRIBUTION SYSTEM: Jr WIDTH L--IN O. OF L EHAL SPA NG. G V EL DEPTH BE LOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH THEN {ES DIMENSIONS J Ml1N I FO LD PUMP MANI OLD DISTR. PIP MAN[ LD MATERIAL NO DISTH DISTH PIPE DISTRIBUTION PIPE MATERIAL F, MARKIN(, ELEVATION ANDI FI FV. FLEV.. DIA ELEV. PIPES IDI A. (I I DISTRIBUTION INFORMATION OLE SIZE HOL PACINC, UHII U:CILY COV ER ATERIAL VERTICALLIFT CORRESPONDS TO APPROVED _ NO EYES NO COMMENTS: PERMANENT t•.AARKERS'. OBSER ATION WELLS. NUMBER OF PROPERTY WELL'. BUILDING. FEET FROM LINE 4 . D (p I ❑ YES 11 NO ❑ YES ❑ NO NEAR EST- 1o4.o`~ 7.57 ~eA 3.7g . S7 1 Sketch System on Retajxf in county file for audit. Reverse Side. - s[cNAruRE ~r'"~ nrLE DI LHR SBD 6710 (R. 01 /82) f ~ 1 Slate and County State Perrnit zt B 67 f J Permit Application County P r n tr for Private Domestic Sewage Systems County ULN0 I LS S I A I E APPROVAL REOUIRED ,ate Approval Heceived from State it Reywred State Plan I.U. # OWNER Of- PROPERTY 42A Mailing Address. LOCATION Secttpn j~ T .17 N, RIVE (ur) „Al Lot# Z City _ Subdivuuni Name nearest iuad, lake or landmark Blk# Village 'E4)A/vh,4 uS 40j)17_10A1 C7(~ /w Township T O~_ TYPE OF OCCUPANCY-rCanrtwrcial `Industrial 'Other (specify) Variance Single family XDuplex No. of Bedrooms 3 No. of Persons Z SEPIIC IANK CAPACITY /01'D Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prelab concrete Poured-in-Place Steel - Fiberglass Other (specify) New Installation x Replacement Lilt Pump Tank or Siphon Chamber Total pal Ions Pretab concrete Poured-in-Plact: Other (Specify) L I FLULNI DISPOSAL SYSTEM: Percolation Rate ~~Total Absorb Area sq. h. New---.L Replacement Alternate (Specify) Seepage Trench:.No. ofI meal Ft. Width Depth Tile depth /sn(top) No. of Tienches Seepage Bed:~_Length_ I~7z__Width Depth .7' -Tile depth (tup~_s_Q_ No. of Lines -3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope No.V 2._ I L_R SUPPLY: Private Joint D Community 1T1 Municipal ❑ jiwirs name as listed un EH 115 if other than present owner: ` nu: undersigned, do hereby certify that the intormatiun I have repoited is in accord with Section H62-20 di.r.unsin Adrmnisuauve Code, and that I have sited the effluent disposal system from the EH-115 prepared r rife Ccrtihcd Soil Pester .AML ~p64,P/- C.S.T. # J3 01-7 0Z and other intuirnatiun iauicU hwri (owner/builder) _ _ wnlx r 's 5ttpialu' . MP/AAtnia` "1110 t Phone # )15 5'Z3 C0-3 ~ J ffber's P.dchess S L-- V li1/A)7~rf sj. l(JE~ ~~s ~U~S VA 3,1, A~ PLAN VIEW Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tron shall be included on file sketch. Indicate or dimension location of all wells on the property or neighbors prupe(ty. If well has riot been drilled please indicate. - - - - ~r-r --r- - r r cn i~. ~ t ( i~ M BEN r- f t I ~N~4"kid( l~AP6~ / }'~0 !q 5,~0~4~ ~ MrNrfIUN ~ A/~E i i i C) 4' ~~r of ~f 10 NAY I I I ~ - ifr 1 Iii hqy~ ,P o _ i 1 14- 4-4 i ( ~ I ~ ~ wNrrwM ~ p~ ~,PE~iI'lE uN Or"R o /E Q Nut Write in Space beloww_ R COUNTY AND STATE DEPARTMENT USE ONLY of Apphcatiun r -Vl -Fees Paid: StateZ,/"j"/`J__0 Co ni Y G~~ Ddtc cur tysund/Nelected (data)~Issuing Agent Name i fluff Yta A- No State Valid# Date Recd ...filly (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 3U9, MADISON, WI b3YOl (puck ,opy) 4. plumber (canary copy) E t'AH I M` N Of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ,J!)U ;711Y DIVISION P.O. BOX 7969 1ivIvIAN It ANtU t_Ar toNs PERCOLATION TESTS (115) MADISON, WI 5307 ATIfIfV ° F~71 N - TO N`HIP/MUNICIPALITY: OTNO.:BLK.NO.:SUEIDIVISIONNAME: t~ ~ , 3' /T 1~ N/a ~y (u), l w a C'~P~volf~0u nNl Y -_._-OWNER'S/BUYER'S NAME: _ MAILI-NZi AJ~ - f 4111)( .9,PR E3vTESffof` ~T / ~ y'_ - ~i s. Sy0/~ L ES OBSERVATIONS MADE - Nq. HEDRMS. ZOMMEI~f IAL bESCR1P710N: ~ / i'~LE I)SCRIPT1bfVS PEACOLA7fOTl'TESTS: 13 pljl~ IONiNGt~ oT W,Vvy W I IN(: S- Situ sudabie for system U• Site unsuitable too system OFFr X, s vl.fv(ION!\l. MOI1fVD: IN-GHOUN(}PHL:,:iURE:SYSrlMIN-F ULDIN TANK FiMENDED SYSIE_M:Iuptiondl) M5[A_IZSClU _TIS❑U~ ❑S~__ - 1 w,:uldu, n I acls aca NOT tn4wted 2tSi_JfN_kXfC SYSTEM ELEV. If any pu, lion ut ilia lot is in the ln, ..i1bl oyi ,IIb) tndicdta: J Floudpluln, u,dlcntn Floodplain ulavntion: PROFILE DESCRIPTIONS t~lHiNC, I(ll_-Al 'IH' ('R UNDWATEH INt'HL CHARACTER OF SOIL WITH THICKNESS CO E_OH TEXTURE, AND DEPTH 1M1fr11 UEf'It1IN ELEVATION EST. HIC4ltE5C TO BEDROCK IF OB &IiVED I -L ABBHV ON BACK.) ti 6I.-t- > ? a ~s z 9 9 ti 7, „1-)A,-6y 6i'i, l(p v. 4, 7"~ - p - _ 9AI Ij ~s 9 y Novi- 71 yz ,vo,v~ 7y"QA) -6y. S, Z-/,3N Ole, are, s~'" ^a - - - PERCOLATION TESTS I I :I D(N I It WAl Fft IN HOI E TEST TIME DROP WATER LE=VEL-INHES RATE MINUTES fvL M ll It INI Iit'S AF1 F H ,WELLIN INTERVAL MIN, , - ( PER INCH . _w o- _ _ _ - - - r ti _ _ Z - --1 , IAN VIEW :,now locations ul percolation [acts, soil borings and ilia dnnunwunb ul suddbla soil urads. Indicate s(;dlu u, distuncns DascG,be what ara ilia ho,i- .,ntdl dad vulLlcal nlavauon roterenca points and show thalr location on thu plot plan. Show the surtdcu elavation at all bunngs and the dtracllor. and puleent ld„d alul, g,-,o do/TAM T?) L-ice S7„ P&Poseo wz// SYSTEM ELEVATION &iolo E/E v. 4~4 i ooh NQ r.~v \jtA j ) ~~~,Yn E A I Q LOA %v,e dL ~'0~'I a S sf~ I .N ~b i IOU .4 0 7- 1 do l • '-rt---i---t-- l Tqp F! ihN~ t i u e; ~,t TN { ~ ja v Z lrJ V41 T~ 4) - I, the under►ignud, hereby certify that the wii tutti reported on this form warn made by ma in accord with the procedures mathods spaeiflad in the Wisconsin Adnumutretive Code, and that the dote rpcrprdod and the ItIca{ion of the taste are correct to the bust of my knowladya and belief. ~I TESTS WERE COMPLETED ON: NAME IPllltl} obf,Q C r _ - - - - AI]DRESS: CERTIFICATION NUMBER: PHONE NUMBER- upti, nil) ~T 3 1101.5a10 NAT ]NE: Z~rC I -0y. 211 pa(W Iwiaau of Plumbing, -lid p.agu-Properly Ownul, 4th pagu-Suil I dsta,. p c ° ~ offs< z 0C -4 '0 Z mD m m c ID E n C) i y x m D „ ~ y mzm 1zz mC-M-Mx.-- D cDzm o m N m Z w m m 7o D m C.0 O -n -n ° z < r D oo C O -n 70 D 0 cn CD Z En Z =r CD CD CD O m m D m c cn co o ff d O a O J h. f r -1 CD m v CD a 0 \\L * - m on 1 z a F < Z m m p C cn 7l m O D A co ::y O CD m _ z m < 0 M O D \ H' - _ 1 O cn h m O D D~ H m m Z h n 0 Ch W fn m p ° M y r 0 m °z z z r h D G1 V ~ m m CD o ~ r > 13 V < < m m D r y m 'C m z ~1 m (n c ~ ~ to ' 7~0 U ~ v m m 0 O~m C c c CD ~ ~o D z W yl m m 00 03 m to -I D - rn W N D ~m 1. C c D z Z~0 D -i 0 D m -n m z 0 a K 3 m r m z m m 3 m"Z vNi -n G m G c) 3: E F D 0 0 m 2 z m C D a~ can z m 3~m %~o m O m c E ° < < J. z 00 0..) cn c D 3 y z D m s W z -v c: p -I : m g S _ cn -O ~ o 0 W O O R° VI m Z w 0m0 z ~~0 C o ;0 c _X<r o cnT co wvcp CD m -j cDFD Z o "i co Z m CEPT hAUS RpDITION MAY 23, . y s y Secr. 3 5 i Z~? ► 9 w S r c dot Co~,.~ T~ It' A .Well ' N ° S Y ~ F,PvM ,SEAS Tp S,i' L o r /.,PAN . PeW ycD SuT h,06a s~ ~%~i1TioN of Top o~ big ,.v I at r 9 f Ru f r_/o.,j of ~ ~ ~o 11 ~voeDs G y ' : ~ /aov yAI v /o w ~'/~U.yjbN ' 2 SjP r,~ 1. ~ I I I w I I I ! I IME51TE TESTING CO. :tT-3, O"NEIL ROAM 1 ; ' ' W I aUSON, WIS. S~W►Ia ' I ~ I I W I I ~ I Y 3 F~w~I~S ~~hTlo►I ~ All DLJ T 1 I j 04 W J) A-0A J) S1-4 lailrl I'v I(m4 -f slrtte f C ~1 1 T o w n e h p St. C ii u i x C u u n ,t i " e c ti o (1 1. M 7_._.... S u b d i 1i' l ANK hti'a ,gat to►t,1-' Numb e.A o A curnpan.tme.nxb ;,rrir r -arum: we8u.itd.i..n.9 N.tghwaten. ~r-i II N~; ('IIAMRER~=r t 4n,&ar " p Manu6ac:tµhenModet Numbe-n._ I11NG FANK xs ~rUP144 u 1 e4 06 CompaAtme.nte aAm 'S yA -tem % t.,Yrr c Anomr 4Ve~ Qu.itd.tng_ -12% 6f.ope_--- - Highwa,te,t A ~rl'I ION SITE I;rJ T'hownh':.. c (nom: We~I' Bu i.edin g 121 e4upe 114 ghwa.te n CI'I ION S/IE DIMENSIONS tUr dth o~ tn.eneh At Re u.ned anea Icooth o6 each ti ne.- At Depth o6 n.ock. beNow #iYe in NIrm1,elr o6 X4nee Depth u6 n.ock oven. .t.ii'e.• i.n Iit 1a4' feng,th o6 t..i.nee r.~ ~6t Depth o6 .t.ite below grade 0i 6 dance betweer4 tine4 "t 6 a 6t ~ 9~.vpe o A .t~e,neh t.n . peh 100 t Ir,trri' abeo4p.tt.on ane.a .t Type o6 Coven: Pape& on ednaw 19.,Iw ~11 1'1 MINti1ON.:~- M ~J V,,;rl ,,n u( YJCte Ohavef an.ound pi.-tb yeA n r., r dv di,amete.K 6-t Depth below .inXet a1,Aonp.t~.on an,ea 11~ 6t A,re,r nr'qud,ked 6t I'1 I' I 1 U 8V TI TLI- DATE 19 DATE 19 A'' ON 101" REJECTION 'PLB 67 State and County State Permit # 7 _ Permit Application County P r it # y 11- ' for Private Domestic Sewage Systems County ("folx *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY ,g4,fy /3 uTEAJ y®tCl Mailing Address: B. LOCATION: Section JIE35T L N, R19' E (or) ,W Loi# 2- City Subdivision Name, nearest road, lake or landmark Blk# Village eFRi10A,4JJ 4A%P%T/04/ e/y /1 Township T Uy C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family A Duplex No. of Bedrooms 3 No. of Persons 2- D. SEPTIC TANK CAPACITY /MM Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate L y Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X_Length iWidth / " Depth 3'7' Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land-/ ?J Distance from critical slope •V041•0- WATER SUPPLY: Private Ste-' 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 Testerr, NAME 6b6;'r /Ch/_ C.S.T. # 53-02-7'0'-' and other information obtained from (owner/builder). t Plumber's Signatur ` MP/~$diL# .5 9 Phone #,17 - 7~3 -3 ~J Plumber's Address ~ MAYOU' %Z-4~)A&Nd- -536, N. 01AJMe ST. Uf 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. 0P CRS ,~crlQ-u ~3~~Lu vAnO Z 90 -5716 E' M~N~MUN @I~Sa G ~P Orr 21 Cg Cf o L14 Al NAY eoCt -f, 14 C ~ 0 off 51 K X000 0 oO ~tivj,MVM Of A~~PE~iFTE lluDEJQ o i AE o Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application c ~-~C/ Fees Paid: State/y" Count vL Date / Permit Issued/Rejected (date) S'- 9-e Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 L 4 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'INDUS'TRY, CC DIVISION BOX HUM N REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: /f /a 3s /T N/R19 E (or) W T~Poy z- P,vol,~rw .5 ,9oa///e,~ COUNTY: OWNER'S BUYER'S NAME: MAILING AP S~;U CAOOIX T USE (G). ES OBSERVATIONS MADE NO. BEDRMS.: JCOMMERCIAL DESCRIPTION: / ONS: PERCOLATION TESTS: $Residence 3 { ep ce~ 1 I ! /9('~ R'4 /CI 1<f1 J T/5i/t Lcc~~a.9il~J 7s11 S~/N<Dy/ RATING: S= Site suitable for system U= Site unsuitable for system 5,7x,47"5 Q CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-F OLDIN TANK: R MENDED SYSTEM:(optional) ©S 5 7AA ❑ U ©S ❑ U ©S ❑ ❑ S ] X ~P AP~3%~Il~i~[ e~° SA A0 Z [under Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the 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.) 3:t -V B I QI it ~Q+ - Al B-2-1,P7 >P7 (f - 0 .s B- L k6 72, AIM c > t> ,y",dam-~y. 1-/.l3N. °,p. SZ B ✓ A10rtl.L ?g(~~ ~~-C;y B- P~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERT D PER INCH P_ 1 '/o !U 2- P_ p- L ~py.,Q_ ✓ P- p_ cTY~~ 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 ,/thesurface elevation/ at all borings and the direction and percent of land slop. .V /30r'QM It) LIB .S7 , (/f P/(OYOsp wt# SYSTEM ELEVATION &«e'' E/Ey.4M l P,2opasc'd AD `v /f° lAl c'~~-/ = TAP oft S , 60 1-67 a ..A..._.. E tN 30 (6 /N QLl-l9 rl,6N r s ~~srev o 0 RZ E~R~ i~f• ~v T ~ iti - . ~LT~Rr~~tlE ~'E9(= _13•-1a~'/3 &0 , 1-5; /jam ~~cr~ y R04D 1, 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): Rob{~r w/~~/~ ~r TESTS WERE COMPLETED ON: 4 ` 6 4 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): /L/.1V C -a 7IP2-- 3les CS SI NAT RE: t l C44- DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) t , ~v~ f31N a PLB 7 I?~~stR FAll5 c~~S . y~zL GAPRy BUTT J NQFF CEpNohAus- I j)D1'Fi0j~ MAY z3, ~q~~l S-! S cam' . St~CT. 3 ~ T.2 ~ toe 1, /y ®S D~E ~~UM R~~~S ~,~flpoSE ~d oR ~ ~r~c TtS ~ Rio Osi5t~ Su TA11106C ,~,,f --1EV fT/ON of 10P Of Mow 10116~F iS /00 7`a- /'~*m i J of- p .lc ' ~En s + ffv ~~~v~tr~o~ of W oeas - ~y _ /Oro 6,41 /o %u~T~ow s ~rl 1. i ~ I I I I HOMESITE TESTING CO, RT•3, O'NEIL ROAD HUDSON, WIS. 54016 IF~~ I ~ ~ ~ I I W I ~ ► I v I 1 -011 Ff oily EQ~p~lo g'~. fth l pb5 ~f P4V V AMD .S+~e~~oc.K ~~UMf3~~1(s-, trAw~Iw Fot ► &xcAuAJ-0~6- 13 PPP BUTDJ HOFF ~~utR FAlls c~►5 . S Yo2L_ CEkNohAuS HPflITJW , MAY 23 1 ~ y 5~ ~ 5ec?'. 35 iz? k I9 Y y5,r ci?ol x ° Oe~~os~° ~~oR Mol L ~tsr ~~EAy SEP~ ys ~'p~ SE! lot/,pd,U. PkOpOSE~ /3uTE,vfi~~iF Sf ~/FvrtlioN of ~s boo 7`i- 4*w ai~,v 1 nt ( ~ r R.v F/.s vet anti of ~D ~vo,eDs G y ' , ;f, pp ` ~ I I ~ w )MESITE TESTING CO. ' I I I ,tT-3, O'NEIL ROAD 1 I ~ I I I JOSON, WIS. 34014 I 1 ; I ~J I ~ i I' 1 ° a I ~ I 3s,v~ p~► ~ 065 o~ ~ Q P~