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HomeMy WebLinkAbout030-2074-60-000 . � � 0 f � : s a ■ � 7 � CD 3 w « ° CD 0- \ \� k /� / §\ k ; G } \ q t 0 0 - 8 w :© J w o o . ` E E 8! § 8 E 2 K V > \ § o 7 a # , e .. u \ ) . = I \ 7 \ § 9 { ( _ƒ ) 2 0 » \ / \� 0 o � o o \ � 9 / (D � \ 000 I; �- o: C:, m / I CO) % 2 �� $ 7 �\ / J �� 0 X72 ; . ; I CD e § / � _ 0 7 & > 0 § / g $ / 7 ƒ } § %( : \ / § o CL 2 _ ■ ° ® c ` ® [ i / z E 0 R cn a M § o CL § k \ § c C D ; > > ) \ \ #E S 4 F A 2/ 0 � ; 0 ƒ Co \ � � �0 . �a * { ¢ _ \ƒ �\ Parcel #: 030 - 2074 -70 -000 02/11/2005 08:31 AM PAGE 1 OF 1 Alt. Parcel #: 26.30.20.632 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner * DAVIS REVOCABLE TRUST DAVIS REVOCABLE TRUST 1362 15TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.410 Plat: 1910 - DRECHSLER HGHTS SEC 26 T30N R20W LOT 7 BLK 1 PLAT Block/Condo Bldg: 1 LOT 7 DRECHSLER HGHTS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 04/26/1999 602031 1421/633 QC 07/23/1997 425/281 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6345 8,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.410 8,300 0 8,300 NO Totals for 2004: General Property 0.410 8,300 0 8,300 Woodland 0.000 0 0 Totals for 2003: General Property 0.410 4,900 0 4,900 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 Parcel #: 030 - 2074 -60 -000 02/11/2005 08:34 AM PAGE 1 OF 1 Alt. Parcel #: 26.30.20.631 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner DAVIS REVOCABLE TRUST DAVIS REVOCABLE TRUST 1362 15TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1362 15TH ST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.410 Plat: 1910 - DRECHSLER HGHTS SEC 26 T30N R20W LOT 6 BLK 1 PLAT Block/Condo Bldg: 1 LOT 6 DRECHSLER HGHTS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 04/26/1999 602031 1421/633 QC 07/23/1997 425/281 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6344 136,600 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.410 39,100 95,300 134,400 NO Totals for 2004: General Property 0.410 39,100 95,300 134,400 Woodland 0.000 0 0 Totals for 2003: General Property 0.410 23,000 81,000 104,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 209 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r -- ' Wisconsin Department of Commerce Safety and Buildings Division "PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363886 Permit Holder's Name: ❑ City ❑ Village ❑ jown of: State Plan ID No.: Jo hn St. Joseph Townshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: L) 4 U o 030- 2074 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l J « � S j� op Benchmark /� q ©S. L /0 f � Alt. BM Aeration Bldg. Sewer Holding 56/ Ht Inlet TANK SETBACK INFORMATION 61 Ht Outlet �, q TANK TO P/ L WELL BLDG. Air I to ntake ROAD Air Septic 7 ��' ��� -! 2 NA NA Header / Man. 25- Aeration NA Dist. Pipe Holding Bot. System �� t e . 7Z � 1 , PUMP / SIPHON INFORMATION Final Grade 6 " a er Demand St cover 3 3 jo L z Model Number r TDH Lift Friction Sy TDH Ft oss ad For ain I Length Dia. H Dist. To we SOIL SORPTION SYSTEM z : `�� BED TREN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM ` V 3 DIMEN I NS SYSTEM TO P/L BLDG WELL LAKE /STREAM ELEAC Manufacturer: SETBACK NG INFORMATION Type O r r Model Number: System: & ? � — o / -7 7S —� T DISTRIBUTION SYSTEM Header / Mani Distribution Pipets) i x Hole Size x Hole Spacing Vent To Air Intake Length g J), Leng z 3 ( L S Dia. Spacing tie I /V SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: & /S' /OD Inspection #2: Location: 1362 15th Street, Houlton, WI 54082 (SE 1/4 NW 114 26 T30N R20W) - 26.30.20.631 -Lot 6 1.) Alt BM Description = 2.) Bldg sewer length = x 7- - amount of cover 3 t « df o h 6ac,E i Plan revision required? ❑ Yes No Use other side for additional infor ation. b b SBD -6710 (R.3/97) Da nspector's S Lure Cert. No. 1( ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I o E € L' , S �s s!. s e k e s e A E ; 3 e e t e � e i O s Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Viscons P 0 Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete Ian t unt e s o the count co only) for th st 'm o than 8 not less p p ( o ) o e e "� y Y copy Y 1�Y � v2 x 11 inches in size. �', °' ,, „�h;� 06 • See reverse side for instructions for completing this application t t e Sanitary Permit Number o f ,,., 3 6 3 9Vo Personal information you provide may be used for secondary purposes heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �:,` x ate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT AL ✓ PQ �TIO Property Owner Name e o AdAl T 30 , N, R A0 E (o W Property Owner's MalliU Address Lot Number Block Number Cit , State Zip Code Phone Number (/ Subdivision Name or CSM Number I. P F BUILDING: (check one) ❑ State Owned � o v a e Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbe (s) a _ a&. t9.3C 1 ❑ Apartment/ Condo dul SO. 2D.1 o.) 0 — 10 1 7 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. g Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an _____System -------- System ------------- Tank Only______________ Existing System ________ ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 [@Seepage Trench 22 I � Gro y nd Pressure 1 42 E] Pit Privy 13 ❑Seepage Pit I$ >^�^�' W aul Privy 14 [] System-In-Fill 3 )Tre w 06 VI. ABSORPTION SYSTEM INFORMATIO :t!)'r w ms's 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) _ Elevation I Y15 0 E r Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic Exper. New Existing Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank ` 29 ❑ ❑ ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber IE3 I ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: (No Stam ) M P Business Phone Number: 7 �_- 5 4 e sl Plumber's Address (Street, City, State, Zip Code): 5 AL 7 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) A roved If S surcharge Fee) pp []Owner Given Initial � � Adverse Determination o� S —ZZ X. CONDITIONS OF APPROVAL / REASONS DISAPPROVAL: b l` A S -6 v (R. 4199) DISTRIBUTION: riginal to County, one copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly rriaintained. The septic tank(s) must be pumped'bya licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. - -- •- - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply- IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber into fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application,form.. IX: County/ Department Use Only. - X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following.' A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the co - unty; E) soil test data on a 115 form; and F)' all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I _ - e I I , � I i _ w I I i ' , i S r - , a -- -,- - -- - - -- � _.��.1_ ��-- ._at�sc _, ��'sor2�Y,�.�._.- �u- R�•��touer� �4= ��r�_..Z__�.Y------ T-- >-- - -- — � I I ON- ' CAA M 1 I I ! I - • - Al I � ' I I - : E i j 4 A44 I ; I +t` 1 + + — + -- ZA ��. -- - - -- - I �� 1 - i I � 4 p I ` ' 9 F e � i c • i 1 ! I i 1 i r ° - 3 I i P 1 , I I I I I � 1 F _. f f_ , ° f 1 � , I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, a tic n and distance to nearest road. Parcel I.D.# 1 030 - 2074 -60 -000 APPLICANT INFORMATION - p`►r��t all infol� Personal information you provide may be u J ndary rposes (Privacy`�aw, s. 15.04 (1) (m)). viewed B Date Z � Property Owner f ro'; L Property Location Davis, John And Janice .. t Govt. Lot NA SE 1/4 NW 1/4 S 26 T 30 N,R 20 W Property Owner's Mailing Address _ MAY 1 7 2000 Lot # Block # Subd. Name or CSM# 1362 15th St. r r, 6 &7 NA NA City S ip Code member ❑ City ❑ Village ❑ Town Nearest Road Saint Joseph 08XrtNGOFROE St.Joseph 15Th St. ❑ New Construction Use: e d i" tdU "rpae' edrooms 3 []Addition to existing building ❑ Replacement ❑ Pub lal describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 643 bed, ft 562 trench, ft' Maximum design loading rate •7 bed, gpd /ftZ .8 tr ench, gpd /ft Recommended infiltration surface elevation(s) 95.50 ft (as referred to site plan benchmarl Additional design / site consideration NA Parent material OUTWASH Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system S ❑ U ®S ❑ U ® S El M S El EIS ®U ❑ S ® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench 1 1 0 -7 10YR4 /2 NONE SL 2MGR MFR CS 2F .5 .6 2 7 -17 10YR4 /4 NONE GRSL 2MSBK MFR GW 2F .5 .6 Ground 3 1743 I0YR4 /4 NONE GRLS OSG ML CS 2F .7 .8 elev _ 98.06' ft 4 43 -93 10YR5 /6 NONE MS OSG ML - - -- - - - - -- .7 .8 Depth to limiting factor Q5 , SD 1 , 30.72 &( 1 ? Z 2 , Remarks: s+ 2 1 0 -7 10YR3/2 NONE SL 2FSBK MFR CS 2F .5 .6 4 � 2 7 -15 10YR4/4 NONE GRSL 2MSBK MFR GW 2F .5 .6 Ground 3 15 -37 10YR4/6 NONE GRSL 2MSBK MFR CS - - - - -- .5 .6 elev 99.5' ft 4 37 -94 10YR5 /6 NONE MS OSG ML - - -- - - - -- .7 .8 Depth to limiting factor >94" H Remarks: CST Name (Please Print) Signature: ,� 'J Telephone No. Thomas J. Schmitt 715 -549 -6651 Address Tom Schmitt Date CST Number Ref # 586 Valley View Trail, Somerset, WI 54025 4/25/00 227429 1002 r PROPERTY OWNER: Davis John And Janice SOIL DESCRIPTION REPORT ,00z Page 2 of 3 PARCEL I.D.# 030 - 2074 - 60-000 Tom Schmitt Horizon Depth Dominant Color Mottles Texture Structure � onsist nce Boundary Roots GPD /ft2 in. Q Co Munsell u. Sz. Cont. for G r. Sz. Sh. Bed Trench f.s I, 'Sp 3 1 0 -8 10YR3/2 NONE SL 2MSBK MFR CS 2F .5 .6 Y 2 8 -13 10YR4 /4 NONE GRSL 2MSBK MFR GW 2F .5 .6 Ground elev 3 13 -38 7.5YR4/4 NONE GRLS OSG ML GW - - - - -- .7 .8 99.44 ft 4 43 -93 10YR5 /6 NONE MS OSG ML - - -- - - - - -- .7 .8 Depth to limiting factor >93" g3• z $ S _3 Z p ti Remarks: � 4 4 Ground elev Depth to limiting factor Remarks: ;fu x, r J Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: I -�� I I � - I _ N i I I I I i i I I I I I , I ! I I I ! I I -_ I ! I I I I I I , I I � j - -- I I I I , I I ly I I c I� -- -moo - - -- -- — — —.00 I I i I I I : I I pppppI7, 1 , 1 1 L . : I : I i L : s I _ J I I I I : i I I I I I I i I I L i I i I I L J i 4. d 1 L �d no :;I-- I i j : I i 1 I I ' I I I I : : I � i I I ! I I t ; ; : 1 j , I I I I I I I i I : i S CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERS[ IP CERTIFICATION FORM Owner/Buyer Mailing Addrecc i G Z Property Address 13 62 (Verification required from Planning Department for new construction) City/State IOU ro,y Parce Identification Number A 30 -10 29 a3 o - ao 7y -70 -©vo 1JEGAL DESCRIP�TON Property Location :5 ;, — ' /,, Sec. T N-R � W, Town of S�, piE=rr�.! �t Subdivision Lot # 6 ve 7 . Certffled Survey # ^� w e3' P Volume 7 . Page # Warranty Deed Volume . Page # Spec house ❑ yes 0 no Lot lines identifiable I$I es ❑ no Y r SYSTEM. UMTENANCE Impropause and mandcnawcof your septic could result is its pccmatmr failure to handle wastes. Properai kenance consists of pumping out the septic teak every three or sooner, if needed by a Licensed pumper. What you put into thq;sy -dem can affect.the function of the septic twk hcatmenu Up in true waste disposaivstem. MW P M=W owner ag= to submit to St. ix Zcniag Depa t meat a certification form, signed by the owner. to by a MA*:rP joUMCy=aPl rcstrictodphmtber alicensedpumperveriffyingth at( 1) the on- eitewastewaterdisposatsgstem is in P� operating condition and/or (2) after' and pumping (if necessary), the septic-tank is less .than 1/3 full of Mudge. Yvm, the undersigned have read the above roquiremuds agree to maintain the private sewage disposal system with the stet fork herein, as set by the Department of Commerce die Department of hfatttal Resource; State of Wisconsin.. cation ttatntg Y septic has been maintained must completed and returned to the St. Croix.County Zoning Office ' 30 f dle three lion date. APPLWAM v 'CURB tJF OWNER. CERTIFICATION t . I (we) certify t all statemcnts on this form hue to the best of my (our) knowledge. I (we) am (arc) the owns) of descn OAP a ve, by virtue of a warranty d recorded in Register of Deeds Office. S /97 as Any information that is mis- represented tray t in the sanitary permit being revoked by the Zoning Department. PP tamped warranty d from the Register of Deeds office * « « «« «« Include with this a lication: a s t` a copy of the certified survey ma if reference is made in the c warren ty deed I 19tl. Warranty Deed— Statutory Form W S tatutes, Sec. ' 36.06. (Turin of No. 20) - . 2UQ5 43 WARRANTY DEED FRANCES ROSE DRECHSLER, a widow and now single person grantor of St. Croix County, Wisconsin, hereby conbtg s anb Maiants to • JOHN C. DAVIS and JANICE L. DAVIS, husband and wife as joint tenants* Minnesota - grante s , of Washington CountyMimcovskK for the sumof One dollar and no /100 and other good and fraluable consideraf W. the following tract of land in St. Croix County, State of 19i.sconsin to -wit: Lots Six (6), Seven ( and Fifteen (15) all in Block One (1) Drechsler Heights, Township Thirty (30) North, Range Twenty (20) West, St. Croix County, Wisconsin, together with a driveway easement across the North Twenty (20) feet of Lot Fourteen (14), Block ne (1), Drechsler Heights, Township Thirty (30) North, Ra ge Twenty (20) West, St. Croix County, Wisconsin. Le (� 03 - 1C) 7 -oar cd� 7 �,3d. �a7y 'e . oa9 Possession to be Augu t 8, 1966. � 1S d,�J- za 7S' S"7J -Oars REGISTE" OFFICE ' ST. CROIX CO.. WIS. d; Recd for Record this- 2.2nd t, day of ... duly ----- A.D.1 %6 L•. at - - - 11 ��� - - -��. , M. _ David Hopq---- - - - -.. e Ister of Deeds dzliiitntog the hand and seal of said gra ntor , this '?1st day f J y , 196,6 In Presence of :.1_`i-� ' ` r= - 4—r- Frances Rose Drechs er John E Walsh � ...._-...._... ....._.- ..- _- ...- m.- __..- ...�._ ..__._...�....- _ -... -- _(Seal) ....................... __ .... _......__... Judith A McNeil fatatt of antom Minnesota ss. County of Washington On this the 21st day of July , 1966 , before me, Joyce Labore , the undersigned officer, personally appearel FRANCES ROSE DRECHSLER known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that s he e xecuted the same for the purposes therein contained. 3tt Witneo'o I hereunto set my hand and official seal. Joyce&LaBore Notary Public Washington County, Minnesota �` January 5 •• 1 ommi on i Tres �. p «. (7b be 1111ad i If signed M . Notary ) VOL 425 PACE 281 ` (;.B.—Ch. 69 Wis. State. provides that all instruments to be recorded shall have plainly printed or typewritten the the names of the grantors. grantees, witnesses and notary.) EH 115 Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 30'3,MADISON,WISCONSIN 53701 LOCATION: s�v.,NwY.,Section 26 ,T N,R WE (or)W,Township or Municipality S74' To sE/p ii- Lot No. , Block No. , DRES0Is 1£4 NE'GHT5 County .5 . C'-4' — s rAN HAN iS Subdivision Name Owner's/Buyers Nam Mailing • 1,Er • 2 hiVD.SOA./ TYP IMPAIR C' ‘ idenoe No.of Bedrooms COMMERCIAL EF � iY NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES O.ViR P)ONS Mt • r: SOIL BORINGS SEP r /0 PERCOLATION TESTS y/ SO APSH= - `�: C 4,4 Sh NAME OF SOIL MAP UNIT f VbbA•EI — iv I. PERCOLATION TESTS iiy TEST/� HOURS WATER IN TEST TIME 1.^11r+ CHARACTER OF SOIL DROP IN WATER LEVEL,INCHES RATE NUM- INCNa. THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 .P— LOTS t /O, 9, e', 7, (a , S i i e ISO EE - TES TEG . P— AS ShtoWN Rrt.OMJ. E44c1,1 13o4' N14 % 70 P- /4 pA R T fRom -4-t OMe, . Ali L?oA°E Ro/Ei WAD P— S/PEwhU `t1 O(' UD SEeEAcoE SEE pttSREP cOLti, #v') - P- AMP AI36LiE -,tt- - zo,uE-f of IRo.M/A/E. r Co ',no.V P— MOTTLING- • • - 136R E SOIL BORING TESTS la ` E/EV/-no". ,PEF PT. TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B— / 7z 5z 52. 3/"8N Is, c':,,,.X. s, G "Scl(o;5y Mo+Y).22" c B— 2 72 z y2 20"/1I,,. Is, 13" R Is , 9 " R sl (o- ay Mots) m B- 3 72. YG 96 SSG "/S o 2( '' G y-6.vy C (PROM. Co r+M . 0 mots) B- Sv SG yZ i/Z- 4/2" is, /y" Gy c wil,w I Rn,-t. Comps R ',of o B- 5 36 2 q 2G /q fiv s( I 11' R. sl(e,u-6y Mots) 4"Gy. c (R.Mo B- 4_ 4 k 33 / 6) 23"13., S I (R-Plots) /0" /c,/S"c Ce-6N Moir ,t PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.P Indicate number of square feet of absorption a'ea needed for buildin/type and orrupancy Indicate scale or distances., , Give horizo tal and vertical reference points. I idicate slope. 6-7 _Si' 1 I 3� - � 5 17"6/v./S(W;s4 o-Rn ots) 3/ 'r e (REo-o Mo6) r I I1 40'' . . oo)r to' ._i- to - 90 r 9o't _ to' • O 1g • s C 40-�- -- • I- . - , . a, ei ► �1 8-- --- s- Q. . a n �, e � -- 0 r �[ , - It I la I . ♦ • frit /0 9 . �'° A' 7 G s V v ' t tail ivC/D ' . • 1 io z /30,,wi_ Es '0v4 rfp f1©' lion 4,44i2 (Wt't r) . LoT G/wE MI CdjjTEA of .&A , LpT. - _ l Soe 7 (fo RTE1p 9o ' -Awl Xo.?OJ ON E.inf /� ur%cnL TO �Jooe; 4T A ' R a1evfi/ic.v. _ _ , i _� -�-�-�._- - t' - _-.' I y I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. Name (print) Rob r Z//6gich r Certification No. sync,1-ve2- Address tr. 1 H(JDSOAJ WI S. s Yo/' Name of installer if known [�,,/� �- �j�. Copy A—Local Authority CST Signature ,`O+�� /Mite