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Home My WebLink About020-1284-20-000 (2)/ t d: qJ o*z r Ze.(-a- sTc 10 { AS BUILT SANITARY SYSTEM REPORT 1 (/ ,(//1s 45 O Yi,rtvr-&Ih;v< t.(flbhtnLJ ,- ( /// SIIBDIVf SfON / CSttt# trf tA ,t t.'//a,"t R ; J-."e fo:Zl'Ot # sEcrroN 11 r Uw-tAR I t_W,Town of ,<6. k ta./ tb1+sT. cRorx couNTY, WISCoNSIN Provide setback and elevation information on reverse of this forn. Provide 2 dimensions to center of septic tank manhole cover. PITAIMEIV SHOW EVERYTHTNG WITHIN ].OO FEET OF SYSTEM n -.1 ^-r -.abt(-ry v- 7 l,Sx5 7'Tve*clj ){-.- -od-s.o 3?'i?/rz,:r, 5,1t' < s \\ U\ d IN rCATE NORTH ARROW t*aZ<^ty' BENCIII.IASK:.9.r*-z AS ,/,/{ AIJTERNATE BM: SEPTIC TANX ,/ PUUP CEA!,IBER ,/ EOI,DING TANK INAORUATTON Manufacturet z 2l)u<1t* ) Alarm I-ocation Liquid Capacity: / otherSetback from: wel\Sl ? House Float sepe ration Pump: lilanuf acturer_ Model#_ Size_ callons/cycle: _ 8OII, ABSORPTION SYAITE}{ width: f r*ngEb--f7-Number of trenches - Distance & Direction to neareEt prop. line:4V/o- setback from: weLL: ,42 tv- Pc inlet DATE OF INSTALI,ATION: Hotrse a/ Other i;I.5[imircNE Building sewer_ sT fnlet r sT outlet PC botton Punp Off Header/l,lani f o Id_ Bottom of sys tem Existing crade_ Final g rade PLUMBER ON JOB: LICENSE NUMBER:2zDZ ?P= INSPECTOR: 3/e3 |)t ,h .r LACAf,IqU#"HI}BSqH",aP Labor and Human Relations TlafetV ailJ Eurldrngs Drvision '2e ' lew'ffirfIrFgEulieEB+ttPffi RrDGE E INSPECTION REPORT TTACH T PERMTT)GENERAL INFORMATION So TANK INFORMATION PUMP / SIPHON INFORMATION SOIL ABSORPTION SYSTEM ELEVATION DATA A93 A0367 Permit Holder's Name: ;IAPHF:T.T. . RTT.T.1lou^1.-r \S Town ofI City f] Village HIINsi(lN CST BM Elev i lnsp. BM ElDvf /nt [ lrl /-*; tu"i- 8M Description5 rmit onatY State Plin lD No.: ParcelTax No.: O2O-1 2RA-2O-OOO TYPE MAN U FACTU RE R CAPACITY Septic Ij If-,)lo.vn t l, Loo Dosing Aeration Holding STATION B5 HI F5 ELEV Benchmark /o8,o,l F00 Bldg. Sewer st/ Ht lnlet Q,GL J'/o5 St / Ht Outlet a-8 tr /ot, /L Dt lnlet Dt Bottom Header / Man G,o z f ,/O /o Z.o z /o 2 .?9 Dist. Pipe a32zrz> /6/, zr /6 2.72' Bot. System 7,)Z G30 / oo, ?z 7 o/. ?4 Final Grade 5,ot/),UV Z /o{ {ta-r"t< Ot*r-$, r (4 4 )/,5 at /o 6-s 3 PIL WE LL BLDG.Vent to Arr lntake ROAD Septic >xt >5d /g')Lo'NA Dosing NA Aeration NA Holding Manufacturer Demand GPMModel Number TDH Lafr Friction Loss Svstem Head TDH Ft Forcemain Length Dia Drst To Well BED / TRENCH DIMENSIONS Wrdth ft:L"nstqs,No. of45nches PIT DIMENSIONS No Of Prts lnsrde Dra Liquid Depth SETBACK INFORMATION SYSTEIVI TO PIL BLDG WELL LAKE / STREAM LEACHING CHAMBER OR UNIT Ma n uf actu rer TypeOt f System: ',h )5or (-q,) /obl kJ l4 ModelNumber DISTRIBUTION SYSTEM Header / Manifold Length Dra Distribution Pipe(s) Length x Hole Srze x Hole Spacing Dra Spacrng Vent To Arr lntake SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed /Trench Center Depth Over Bed / Trench Edges xx Depth Of Topsorl xx Seeded / Sodded IYes ENo xx Mulched fl Yes E No COMMENTS: (lnclude code discrepancies, persons present, etc.) .,' LOCATION: HUDSON .29 .29 . L9W, SW, SE , LOT LZL, WILLOW N t"?e 4 J RIDGE E II-2 'hurl H 6*; *c * , t', ,CTH A t g+t ,'r,b - f-,-:+\ f,'toi Plan revisioffIequired? ft Yes D No Use other side for additional information. sBD-6710 (R 05/91) a 4 ()/+/4 (J b oate ,/ l3O o I,t ns r's Srgnature 5E Cert No TANK SETBACK INFORMATION TANK TO t -l H ln accord wlth ILHR 83.05, Wis. Adm. Code 814 x 11 ln 3lze. (to lhe county copy only) lor 6€ system, on paper not loss than -Sae rerorce slde tor lrutructlom lor completlng fib appllcatlon. ttrr-rrs]lxf l?q]Ir5iFlll ffi 'K.. Crrrt-lgil Eit .ppllcatoi STATE PLAI{ I.D. NUI'BER :l E%s A€ r-IFr..'? O'Ir, :uIrfn[E7]T iI] ,lt)OTY, STATE LOTil /2/BLOCK # gJBDlvlslol{ t'aAME On C8r, NUMBER/) i/l,al 2.t./oe E.--7 iaEARESTRO DCrzTl-t (Ched( one)State Orunod 1 or 2 Fam. Du,elllngr# ol bedroofiis tl. BUILDI G UsE: (ltbulldlng typo Ir publlc, ch.d( {lthat appty) I 2 3 4 5 Assombly Hall Campground Churclr/School 6 7 8I Medlcal Faclllty/NuBln0 Home 10 11 12 13 Outdoor R€creatlonal Facllity R6tauranuBar/Dlning Sarvice Stauon/Car Wash Mercfiandlse: Mobll€ Homo U. TYPE OF PEBIIT: (Check only onc h lln A. Chck lln€ B r lpplb.ble) A) 1.New Syltem 2.3.Enephcementol 1.Reconn€ctlonol 5.ol en Tank Only ExBtlng System ng System A Permlt was Oate lssued Y.TY?E OF8Y8trEI: (Chcd( only onc) Experimontal so E Specffy Type other 11 12 13 11 Tronch 21 22 Mound l't{iround 41 12 43 Holdlng Tank Plt Prlvy Vault Privym Systam-ln+lll ffi 1. GALLOI{S PER DAY dad 2. ABSORP. AREA AESORP. AREA 4. LOAOING RATE 5. PERC.6.7. FINAL GRAOE (8q. fi)(!c. ft.)(Galrday/8q.lL)(Mln./inch)t0 EI.EVATION aa I or, €6) ITTI CAPAC]TY ln dellonl F.:Tllift:il"t'tTl]Eltirrrlil|t Llll Pumo T.nkr8lall6.l Ch.l!$.? Total GellolE *d Tank!Manulacirror's Namc ,h ;,, ,)-. - r Pretab. 0oncrete Sita Con- rtructod Sle€l ft ft EEEM Exper. App. K /2do lL' YUI. NESBO SIBILITY STATETETT l. lho undeElCnad, alsume r€sporulblllty br lnrtalladon ot lha onalb aowegB systom on lhe stbched planr. Plumbrr'E Nama (Prln0:Plumbar'. Slemtul!: ( o $lrE)Phom Numbrr: ?C. ! i! ft _l l{t l Flb3r- ela$ ApproEd m Daarp9rolrad Oltl.r Olv.o lnltl.l =.-IA 8AD6S (bim.rly Plb{tl (R. r r/E} t ISTRIBUIO : Geltlrl b County, O||c Copy To: Slbty a Bufldtnlp Dtvltton, Orillr, Plumb.t 1. 2. 3 4. 6. trEmtrtriltrtrs A sanita.ry permit is valid for two (2) years. ,Your sanitary permit may be renewed before the expiration date. and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. All revisions to this permit must be approved by the permil issuing authority. Changes in ownership or plumber requires a Sanitary Permit Transler/Renewal Form (SBD 6399) to be submitted to the county prior to installalion. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. l, you have questions concerning your onsite sewage system, contact your local code administrator or the State ol Wisconsin, Salety & Buildings Oivision, 60&26&38.15. To be complete and accurate this sanitary permit application must include: l. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) ol where the system is to be installed. ll. Type ol building being served. Check only one and complele # of bedrooms if 1 or 2 Family Owelling. lll. Building use. ll building type is Public, check all apptopriate boxes that apply. lV. Type ol permit. Check only one in line A. Complele line B if permit is lor tank replacement, reconnection, or repair. V. Type ol system. Check appropriate box depending on syslem type. Vl. Absorption system intormation. Provide all inlormation requested in #1-7. Vll. Tank inlormation. Fill in the capacity ol every nevv and/or existing tank, list the total gallons, number of tanks and manufacturer's name. lndicate prelab or site constructed and tank material. Complete tor a// septic, pump/siphon and holding tanks lor this system. Check experimental approval only it tanks received experimental product approval lrom OILHR. Vlll. Responsibility statement. lnstalling plumber is to lill in name, licsnse number with appropriate prefix (e.9. MP, etc.), address and phone number. Plumber must sign application lorm. lX. County/Department Use Only. X. County/Oepartment Use Only. Complgte plans and specifications not smaller lhan 8% x 11 inches must be submitted to the county. The plans must include the rollowing: A) plol plan, drawn to scale or \rith complete dimensions, location ol holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/waler service, streams and lakes; pump or siphon tanks; distribution boxes; soil absorption syslems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation relerence pointsi C) complete specilications lor pumps and controls; dose volume; elevation differences; lriction Ioss; pump performance curve; pump model and pump manutacturer; O) cross section ol the soil absorption system il required by the county; E) soil test data on a 115,orm; and F) all sizing information. til-iI.IrIl.I;ITf fdil:Irf;IdI]Tffi: 1983 Wisconsin Act 410 includod the creation ol surcharges (fees) for a number ot regulated practices which can erfect groundr,aler. The monies collected through these surcharges are used lor monitoring groundwater, ground- water contamination investigations and establishment ol standards. sBD-5398 (8.11/88) tr' -- trI!LHFI SANITARY PERMIT APPLICATION ln accord with ILHR 83.05, Wis. Adm. Code -Attach complete plans (to the county copy only) for the system, on paper not less than 8%x 11 inches in size. -See reverse side for instructions for completing this application. I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ""9 o application STATE PLAN I.D. NUMBER PROPERW OWNER E'// ldon- -// PROPERW LOCATION 5*l Y,SE Y1,s 27 T21 ,N,?14 e@rY6) PROPERW OWNER'S MAILING ADDRESS ta ,€j //4 LOT #/21 BLOCK # CITY, STATE ,(a/o Oa/ t,t,( ZIP CODEs/arc PHONE NUMBER9trl-rrc F/rs SUBDIVISION NAME OR CSM NUMBER b,'l|or,t /?;/.,-t E-s f L ll. TYPE OF BUILDING: (Check one)State Owned NEAREST ROAD trVILLAGE :r ( fJ proti" EJ t o, 2Fam.Dwettingr# or bedroo ^, Z A !ll. BUILDING USE: (lf building type is public, check allthat apply)Oeo-/28?- Ra 1 E AoUCondo 2 Z Assemblv Hall 3 E Campground 4 ll Church/School s E Hotet/Motet 6 7 8 9 trtrtrtr Medical Faci lity/Nursing Home Merchandise: Sales/Repairs Mobile Home Park Otf ice/Factory 1O E Outdoor Recreational Facility 11 E nestauranUBar/Dini ng 12 Service Station/Car Wash 13 Other: Specify lV. TYPE OF PERtllT: (Check only one in line A. Check line B if applicable) A) 1.K ru"*-system 2 Replacement 3 System Replacement of Tank Only 4.Reconnection of Existing System 5.Repair ol an Existing System B) E A Sanitary Permit was previously issued. Permit #Date lssued V. TYPE OF SYSTEiI: (Check only one) Non-Pressurized Distri bution Pressurized Distri bution 21 E uound 22 Z ln-Ground Pressure Experimental 30 E Specity Type Other 11 12 13 14 Seepage Bed Seepage Trench Seepage Pit System-ln-Fill 41 tr 422€E Holding Tank Pit Privy Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 2. ABSORP. AREA REQUIRED (sq.ft.) ,c4a I s. nesonP. AREA I I pnoposED (sq. ft.) Ilzsal 4. LOADING RATE (Gals/day/sq. ft.) , A6 5. PERC. RATE (Min./inch) //1- 6. SYSTEM ELEV. (oa, n " /da,o4 Feqt 7. F!NAL GRADE ELEVA/.1*,{TION Feet VII. TAilK IilFORUATION CAPACITY in gallons Tota! Gallons #ol Tanks Manufacturer's Name Prefab Site Con- structed Steel Fiber- glass Plastic Exper App.New Tanks Existing Tanks Seotic Tank or Holdino Tank x //dc (fu,V-e<T Lift Pump TanUSiphon Chamber VI!I. RESPONSIBILITY STATEMENT l, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans Plumber's Name (Print): /,) ,'//,'o ro g-/, Lr,./,/dr/ Plumber's Signature: (No Stamps) /-/--7 6ffDttleRsw No.: CsFA Business Phone Number: (7 ts | 3Fa -?/z r Zircod-): - - / Oa a 9z-n€ ,e/ .1v-. JCa-J 2.,(/' -9q dl 6 IX. COUNW'DEPARTMENT USE ONLY f, ooorou"o EE Disapproved Ownar Given lnitial Adverse Determination Sanitary Pprmit Fee (lncludes Groundwaterf /fa surcharse Fee) Date lssued /e-/7 43 lssuing Agent Signature (No Starqps) 1hn*^d(hofiru) X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:v-v-v SBD-6{198 (formerly Plb67) (R. 11/8S) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber tr PERM IT loif tr IEL-l tr INSTRUCTIONS 1 2 4. 5. 6. A sanitary permit is valid for two (2) years. Your sanitary permit may be renewed belore the expiration date. and at tlre time ol renewal any new criteria in the Wisconsin Administrative Code will be applicable. All revisions to this pernrit must be approved by the permit issuing authority. Changes in ownership or plumber requires a Sanitiry Permit Transter/Flenewal Form (SBD 6399) to be submitted to the county prior to installation. Onsite sewage systems must be properly maintained. The seplic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. ll you have questions concerning your onsite sewage system, contact your local code administrator or the - State ot Wisconsin, Salety & Buildings Division, 608-26G3815. To be complete and accurate this sanitary permit application must include: l. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type ol building being served. Check only one and complete # ot bedrooms if 1 or 2 Family Durelling. lll. Building use. ll building type is Public, check all appropriate boxes that apply. lV. Type of permit. Check only one in line A. Complete line B it permit is for tank replacement, reconnection, or repair. V. Type o, system. Check appropriate box depending on systcm type. Vl. Absorption system intormation. Provide all intormation requested in #1-7. Vll. Tank inlormation. Fill in lhe capacity o, every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. lndicate prelab or site constructed and tank material. Complele for a// septic, pump/siphon and holding lanks for this system. Check experimental approval only if tanks received experimental product approval lrom DILHR. Vlll. Responsibility statement. lnstalling plumber is to fill in name, license number with appropriate prelix (e.9. MP, etc.), address and phone number. Plumber must sign application lorm. lX. County/Department Use Only- X. County/Department Use Only. Complete plans and specitications not smaller than 8% 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 ol 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 absorptron systems; replacement system areas: and the location of the building served; B) horizontal and vertical elevation reference poinls: C) complete specilications tor pumps and controls; dose volume; elevation dilferences: friction loss; pump performance curvd; pump model and pump manutacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 rorm: and F) all sizing inlormation. 1983 wisconsin Act 410 included the crealion of surcharges (rees) lor a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used tor monitoring groundwater, ground- water contamination investigations and eslablishmenl of standards. sBD-6398 (8.11/88) r03 56986 SO FT r 308 AC. m?t A ul o u) o u) oo a to2sffi-e so Fr t 368 AC 00 ao .ioo t22 i-t 7.,8,s 8 47590 SO FT. r. 093 AC.123 r5' I 13' rt n!t a ctt il U) 67211 SQ. FT r 543 AC. I / / a / t2 t '!, !, o 5_o 752 SO FT r 165 AC No Z t a roroo a 2662,34' .o 120 63498 SQ FT 1 458 AC. 949.31' tll a N !u to ?l oo a N O)() (v trj o P @ u') oo a l04 sz ilsz so. Fr r.317 AC ,31 r05 5464 I sQ. r .254 AC. r5 oo -g'-..-o, ,,{ 1co t1 ilo 53 7O8 SQ, FT r 233 AC. N I 247 . '01 ' 01 'H 41 .83', t' 40 l{ 1 -8 oo s89 ,a N 89' 43 ', 37'E t.07 o o\t!t o2,. ? A !l I / 47 26U- so FT I o85 AC S 17 ' 07.E?,3.3 4 |? N I;o a; ro .l il9 66739 SO. FT. 1.332 AC. i oi r) n C) ]t ov oo c;q) ?r I I ro: o ? u)to C) S as-oil 27-"Vl r3 56076 SO FT 1 287 AC 45699 so FT I o49 AC o s J SOUTH LINE OF THE, SE I/ 4 OF sEc t7 1.\Y 2t f 4 It E 0 ;TION I7 , AND 29 N,r R l9 W. J,J\R rt uEw- Egu\LEg- F I ilts- AD!!f P!r{ : 'l N 89'09'.2?'E qg. ol d I ao P @n aoo z N !9o oltol" E 89 L Iton on Ioo z _/ 7 i SBD€398 (formerly Plffi7) (R. 11/SS) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber tr' -- trIILHFI SANITARY PERMIT APPLICATION ln accord with ILHR 83.05, Wis. Adm. Code -Attabh complete plans (to the county copy only) for the system, on paper not less than 81Ax 11 inches in size. -See reverse side for instructions for completing this application. !. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. GOUNTY STATE SANITARY PERMIT # Check if revision to previous application STATE PLAN I.O. NUMBER PROPERW OWNER PROPERW LOCATION % Yl,S T ,N,R E(or) W PROPERW OWNER'S MAILING ADDRESS LOT#BLOCK # CITY, STATE ZIP CODE PHONE NUMBER ()SUBDIVISION NAME OR CSM NUMBER ll. TYPE OF BUILDING: (Check one) E S,"," Owned E pruti. E t or, ZFam.Dwellingr-fl of bedrooms - NEAREST ROAD VILLAGE lll. BUILDING USE: (lf building type is public, check allthat apply) 1 2 3 4 5 tr ApUcondo Assembly Hall Campground Church/School Hotel/Motel 6 7 8 I trtrtrtr Medica! Faci !ity/Nursing Home Merchandise: Sales/Repairs Mobile Home Park Otfice/Factory 10 E Outdoor Recreational Facility 11 12 RestauranUBar/Dining Service Station/Car Wash 13 E Other: Specity lV. TYPE OF PERilIT: (Check only one in line A. Check line B if applicable) A) 1.E n"*2 E neptacement 3. E Replacement of 4. E Reconnection of Existing System 5 Repair of an Existing System B) System System Tank Only A Sanitary Permit was previously issued. Permit # - Date lssued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental 30 E Specity Type Other 41 E noloing Tank 42 l) Pit Priw € E Vault Pilry 11 12 13 14 trn Seepage Bed Seepage Trench Seepage Pit System-ln-Fill 21 E uouno 22 A ln-Ground Pressure V!. ABSORPTION SYSTEM INFORMATION: 2. ABSORP. AREA REQUIRED (sq.ft.) 3. ABSORP. AREA FhoposeD (sq. ft.) 4. LOADING RATE (Gals/day/sq. ft.) 5. PERC. RATE (Min./inch) 6. SYSTEM ELEV 7. FINAL GRADE ELEVATION Feet Feet VII. TANK INFORTIATION CAPAClTY in oallons Total Gallons #ol Tanks Manufacturer's Name Prefab Site Con- structed Steel Fiber- glass Plastic Exper. App.New Tanks Existing Tanks Seotic Tank or Holdino Tank Lift Pump TanUSiphon Chamber V!!I. RESPONSIBILITY STATEMENT l, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans Plumber's Name (Print):Plumber's Signature: (No Stamps)MP/MPRSW NO Business Phone Number: () Plum s ress p e IX. COUNW/DEPARTMENT USE ONLY ! lpproveo EE Disapproved Owner Given lnitial Adverse Determination sanitary Permit F"" (8"1,:flffS'F::f'"".Date lssued lssuing Agent Signature (No Stamps) X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: RI tt ft INSTRUCTIONS h sanitary permit is valid for two (2) years. . Your sanitary permit may be renewed belor€ the expiration date, and at the time ol renewal any new criteria in thg Wisconsin Adminislrative Code will be applicable. All revisionsio this permit must be approved by the psrmit issuing authority. Changes in ownersliip or plumber requires a Sanitary Parmit Transfsr/Renewal Form (SBD 6399) to b9 submitted to the county prior to installation. Onsite sewage systems must be properly maintained. The septic tank(s) must bs pumped by a licensed pumper whenever necessary, usually evsry 2 to 3 ysars. ll you hav€ questions concernlng yout onsitt 3ewage system, contac-t your local code administrator or the Stale of Wisconsin, Salety & Buildings Division, 60&26G3815. To be compl€t€ and accurat€ this sanitary permit application must include: l:,l. Property owner's name and mailing addre$. Provids the legal doscrlption and parcel tax number(s) ol wher€ the systsm is to be install€d, ll. Type ol building b€ing served. Chock only ono and complets # ol bedrooms i, 1 or 2 Family Owelling. lll. Building use. ll building typ.€ is Public, chock all appropriate box68 that apply. lV. Typ6 of p€rmit. Check only one in line A. Compl€te line B it'p€rmit is tor tank rBplac6m6nt, reconn€clion, or repair. V. Type ol syst€m. Check appropriate box depending on sy8tem tyFp. Vl. Absorptlon system inlormation. Provide all intormatlon roquested in #l-7. Vll. Tank intormation. Fill in ths capacity ol ev€ry new and/or existing tank, list the lotal gallons, number o, tanks and manutacturer's namo. lndicate prefab or site constructed and tank material. Completg lor a/ septic, pumpisiphon and holding tenks lor this syst€m. Check oxperimental approval only it tanks recsived experimental product approval lrom DILHR. Vlll. Responsibility statement. lnstalling ilumber is to fill in nam6, licens€ number with appropriate prelix (6.9. MP, etc.), address and phone number. Plumber must sign application form. lX. County/D€partment Use Only. X. County/Department Us€ Only. Complete plans and spscirications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the tollowing: A) plot plan, drawn to scale orwith complete dimensions, locallon of holding tank(s), septic tank(s) or other treatment tanks: building sewers; wells; water mains/water service; str€ams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location ol the building served; B) horizonlal and vertlcal elovation referencs poinls: C) complete'specificatiohs for pumps and controls; dose volum€; elevalion dilferences; friction lo$; pump perrormance curvs; pump model and pump manutacturer: D) cross section ol the soll absorption system il requir€d by the counly; E) soil test data on a 115 form; and F) all sizing information. GNOUNDWATER SURCHABGE 1983 Wisconsin Act 410 included the creation of surcharges (lees) lor a numbsr of regulated practicss ri/hich can effect groundwater. The monies collectod lhrough these surcharges are used lor monitoring groundwater, ground- water contaminalion investigations and establishmenl ol standards. '1. 2. 3. 4. 5. 6. sBD{ggE (R.r1l8E) ,z STC 105 SEPTIC TANK MAINTENANCE AGREEMENT'St. Croix County ol,IN ER/BUY E ADDRESS o 1- t't IRE NUMB CTTY /STATE IP t7o/6 PRoPERTY LocATroN:-fa/L/4,9 {t/4, SECTIoNEg_, %N_nJiL w TOWN OF , SE. crolx 'County, S UBDIVIS ION '// att r LOT NUMBER/&/L . rmproper use and maintenance of your septic system courdresult in its premature fairure to 'handl. '*i"tei. propermqintenance consists of- pumping out the sept,ic tanx every threeyears or =?"t:.5, if needed by a licensed =.pli" tanX p,.r*p"i. whatyou puE into the system can af fect, the function of -the septic tankas a treatment stage in the waste disposal =yst"m. !st' croix county residents may bd eligi-dre to-.""eive a grant,ror a maximum or 60* of the .oit of reptac"*"nf-;;^; ;"iringsystem, which was in. operation prior l"-Jury 1, 19?8. st. croixcounty accepted this program in August of 1980, with therequirement that owners of all new =-yJt,..r agree to keep theirsyst.T properly maintained . ' The property owner agrrees to submit to se. croix zoning acertification 'form, si9t"d.uy the owner and by a mater prumber,jo'rneyman prumber, rLstrict.ed prurnber or a ricensed pumperverif ying that ( 1). tlre on-site wastewater disposal system is inproper operating condition and (2) a f ter in=p."tll-n and pumping ( i fnecessary), the septic tank is iess than l/l ful1 of srudge andSCUM. r/l'le ' tlte undersigned have read the above requirements andagree to mainLain the private sewage disfosar sysC"* in accordancewiLh the standards seL forth, he."inr ds set by the wisconsin DNR.certification stating that your septic has been rnaintained must becompreted and returned to tne st. crolx co. Zoning offLcer within30 days of the three year explratlon date. -- S IGNED :C St. Croix co. Zoni.g Office911 4th St. Hudson, l.ll 54016 DATE: 'b7 /4,2 tl ',This apprication f,orm ls to b.e .completecl in fulr and signed byIthe owner ( s ) of tlte property ^ neln! 'd'.r.ropeo , Any inadequaci es 1111 -only result ln &qrqv* tr th;"pJimit i..uan.n. , should rhlsdevelopment be intended for resaie by gwn er/cohtractor, (specItouse ) , then I a second f orm shonro 't " idtuined- lna completed whenthe propgrty-' is sold and submitted to this office with theappropriate deed recording. sTC 100 Owner of property Location of 'properly$rtL/4 9ft/a, Section Z I , 'f R./n_R4u Town sh i p S O-,,r- Maillng address Z Address of slte Subdivlsion name Other homes on property? PrevLoue owner of property {z .l-ra--r/ =( N o t no. at Total s tze of parcel /"7{4-.',17a, q Date parcel .waE created L 4< rs thls property pelng deveLoped f or ( spec house ) ?_yes ,y No :;,32Z#andPageNumber7aarecordedw1ththeRegister INCLUDE WITI{ THIS APPLICATION THE FOLLOWING:A WARRANTY DE'trD which incrudes a DocuuENT NITHBtrR, voLUHE AND pAGEHUHBER & TIIE SEAL OTI THE REGISTER OF DEEDS. ,ID AdditiON, Acertified survey, 1f avairabre, would be herpful so as to avoidderays of the revi.e.w_i.ng proceBs. rf th; deed, descriptionreferences to a certl fled Survey Map, the certifled s"i""v Mapshall also be required. PROPERTY OVTNtrR CERTIFICATION I(we)certify that a1I statements on thls form are true to thebest o f my ( our ) knowled ge that I ( we ) am ( are ) the owner ( s ) ofthe property dbscrLbed I n thls lnf ormatlon form by vLrtu eofawarranty deed recorded n the offLce of the Co unty Register ofDeeds as Document No., and that I (we) presentlyown the proposed slte for the sewa ge dlsposal system or I (we)obtdined an easement to run the above descrlbed property, forthe construction o sald system,and the Bame h as been dulyfrecorded ln the off lc e of County R egLster of deed B as DocumentNo. ..".'/./ 4 Ll zlrba-n-z 4/e- S1 gnature of applicant Co-appI icant Date of Slgnature ,r1g) Date of Signature rft 4,-./.r*- I 8.a rHsqflfll 'tu. 0$lro {S I l,,Lrl.\ r_()., Wl+ lor'* ,or Rccord nf 4!rl doy ol_firr_ _Ao. lgltt\2 CGTIACI G]I rtrlrca vclolrant, fac. , ,tUY.D Cotrrct, bt rod brtrrcn Arnold l. lrrtckcu t 1l. A. l.Yir3ille A. Bertctrco, utirbena and rifr., fcrrdor, end !. r H.e Uircoortn corporrtloo, purcharcr, . ;,.1 i ' vludor rellr rod r3rcrr to corrvey to hrrch..Gr, up6 th. prryt rDd fullPrrfcrrDu. of thlr cmtrect by rurcf,...r, rhc roriorioa;;;i;; rogcthcr rlththe rratr, profitr Gd oGhar rppurtr-orat tt"r.rt (.ir "rit.i tb.-xproprrtrr),lo st. Ctoh Canaty, Btrro "f ii;;-tl"; South 53 l/3 rodr of 8truth n rf le ronturrrt Qurrtrr (sfgyt).Dd 8-,t! tl ll3 rodr of sotrthrp;q g'rter of lo.rboutQurrtrt (rt8lt) of scctloo 17,'fo'gi, nlgr. rh:t prt of iorthrGrt Qurrtrr of f,orthcert Qurrtor (mrtrEt) end of f,orther.t Qurrtrr of rorthvcrt euerter (ilBtwt) of .8rc.1* ZO, T2(il, Itg{r, lylog ltorthcrly of thccGqccrllo. of Bt. crgl. couoty-rrunr-nlghvry ,ir' (forrncrlyLnwn rr Hudroo-Ncv llchoood itljhrry), TRANSTNSJfrA 0 BTCBPT cho folloring pertr of thr ebwo dcrcrLbrd trrctr: All trod iocludod vithla thr plrt of ttill,ov lidge sccondAdditi.oo to thc Tovn of lfudrm er darcribcd in iol. 4 ofPlrtr, prtG 25i Prrcel drcdcd to Dderlin o, hdrht rnd Buth L. rrd.hr r.dcrcrlbod [a vol. 517, p.gG 26, Docrcnt tfo. 32t36s; Percol drodod to logcr E. Hctchlrr u dcrcrlbrd ln vol,, sl7,prgr I 14, Docrnar tr,nbcr 32b43O. ToGETrun vltb en eercunt for rtrcot purpo.er oyer thc Eertrrly33 foct of lrid peretl dodrd to togcr E. Hetchler rr dcrcribcdln Vol. 517, Pegc ll4, Docrnnt frnbor 324430. tota I ing not lee s than $ , i0,00 (a) ilo intereBt slral I acerue under the ternre of. thie I,aragr FEE 8tru;fi m thc r[3ht-of*ty of rrid 8t. crolx Corrnty rrunt, El3hvry?r1rt end to tolcphonc Gr.cEGnt edjeccnt to aeid highvry er rccordrdiD thc officc of reid leglrter of Deedr. h'rrchrrcr rtrcca to purcherc thr Propcrty end to pey to veodor rt: st. croirHeigttr, Erdrm, rfircotrrin, thc Bue hrrchrrc price oi gloorooo.oo, togctber vithrddltioarl pr]runt. pGr lot, Ir folloua: I. Berc hrrcherc pricc. Drc brre prrchare pr ce of glooroo0.oo folloring'*r.n.r: gl5rOOO.0O .t theGrGcutioo of thir contract, end the balence of $gs,oog.ogtoSothor vtth intercat on ruch portionr thereof er rhallraurin fro tinc to tinc uoprid, rt thc rrte of lol perrlurrr, until peid in fullr rr folloryr: (e) Por cech individuel lot dcvcloped and rold by thc purchrrer,hrrchaacr rheil pay to Vcndor e $2,OOO.OO principrl peyocnt, tobc applied to the 985,OOO.00 bere contract bel.encc o.rt"tandirrg. (b) A ninim.rn annual prlent of $151000.00 prioeipal rhalt bep"id eech year, cxcluding the yeer oi rare. Each per lotprinc ipel paymnt required above, ahal I be :red ited torrardthir 915,0O0.00 annual payroent. (c) on December l, 1985, and on Decernber lat of each yearthereafter, Purchaeer ehatl pay to vendor the differentialbetneen the required uinimum principar payrent of $15,000.00end the totet $e,0OO.00 per lot paymente made during thepreceding tvelve (12) monthr, until the Bage Purchaae price hasbeen paid in full. (d ) [ntereet on rhe pri.ncipal balance of s85,00u.0o ehal I accruefrou the date of cloeing, nith ennual payrnente of intereat due o.the I r t dry of. December, each year, coflrnenc ing Decembr:r r , r9g4 . 2. Mditional per Lot pa yrnente.ln addition to tlre foregoing Base purchase I pry to Vendor additionat por lot payments0.00, as f o[ [c',ws: on the principal Bums paid to Vendor .Ph. Pr rce payments, Purchaeer ehal Yu.t}Hl'r lfi (b) hrchrrer rhrll pry to Vmdc thr rtr of ltr00O,0o g* tot oo rll rrrldcntiel lotr drvrtopod rnd rold by hrrehurrt rubjoct to tho conditio{l thrt thc rlnhn mtrnt of prynot! to bc rrdc to Berteltcn undrr thir Prrrjrrph rhell totrl rt loert C150,000.00. (c) Drrrin3 och yorr of thlt Contrrct thrt thorc ir .o ont.C.[dlng cootrrcc btlrnet of tho Berc hrchmr Prlcr(Prregrtph l(o)) thcrr rhrll br no ninirn eoourl principrt P.yr.ott uodcr thfu prrrgreph. Cmenclng ylth thG y.rr folloriu3 ccplotion of pryront of thc Bero hrrchrrc Prlcc, hrrcharor rhrll pry to Vrndor r rlnirln rnnurl rur of SlSr(XX).00 pcr rTcrr. (d) Oo thc lrt dey of Doccrbcr of cach yGrr, Pt:rchuer rhell pry to Vcndor thc dlffrrootirl bGteGGn the uiniu,n emurl pryuent of 9151000.00 rr provided io thir Paregraph, rod th. totrl l3r000.@ pcr lot pryrcnt. rrdr during the prccediug tnlvo aonthr, uatll thr cotire 9150r000.00rinirl rrrl her bcco prid. firlrcrftor, lf Purchrrcr rcllr rny lotr in arccrr of ,O lotr, Purchrrcr rhelt pey to Vandor the rrn of $3r0UO.00 for rny tuch additionel lot rold, up to e total of 53 lotr. ($l59r0OO.0O totel hcreuoder) Purchercr ehell not bc rrquirod to pry roathly p.yuntr to Vendor rufficicnt to pay rearonably anticipatcd ennuel trr.. rnd rprcirl r.tcrla ntr. fuiy emount may be prepaid without prclitur or for uprln principrl et rny tir. Ln the event of any prepryuent, thk Contrrct rbell not bc trcrtcd lt in default uith rerpect to payrmnt 30 lont l. the entire brlrnce of princlpel, and interest yhere required, ir lere then tho ruount thet rrid lndcbtednctt vould hrvc been had the monthly payurentr been nede tr rct forth lboY:. Purchaaer states that Purclrercr ir rrtirficd vlth thc titlc et rhoryn by thc Abstract of Titte eubmitted to Purcherer for crenlneClon, txccpt: Real eetate mortgaSe to San E. Hiller, detcd Pebruery l, 1980, recorded in Volurc rt508rr, Page 152, DocucnB lturuber 362685. Thie mortgage rhell reoein the obligetion of Vendor, vho chall keep a.rid rcrtgegc currlnt rad in 8od rtanding. In the event Vandor fail.r to pry rny rrquired mortgage payrent, Purchercr rhell hrvc thc right to anke such payment, and to deduct ruy peyrncnt ro nedc frm the sLlrna due under the termr of thir ConBrrct. Purchaeer egrees to pay the cort of futurc title cvidcncc. Purchaeer ehall be entitted to trkc potrer.ion of tho propcrty on Cloring. Purcheeer pronieeE to pay vtren due rtt Geret end ellertuotr levicd on tha Property or upon Vendor's interert in it end to detivcr to Vcndor on derand rccclptr ehoving euch paprent. Purchater ssysn.aota not to coit rrtat€ nor ellow velto to bc cmittcd on the Property, Eo keep the Property in Bod tenanteble coodition and repeir, to keep the Proprcrty free froo lienr :uperior to the ticn of thir Contrect, end to compl y wirh al l laws , ord inancet arrd reSulat iont af fecting the Property. Vendor agree. that in caae the purchere price nith intcrect end other tloney. shell be ful.ly peid and alt conditone rhall be full performed at Ehe timc and in the manner above specified, Vendor tlill on dernand, execute and deliver to the Purchaeer, a Warranty Deed, in fee eimple, of the Property, free and clcar of all liens end encumbranuee, except any liena or encumbrancea created by the act or default of Purchaeer, end except, rubject to utility eaeemente and covenante and res tr ic t iona of record . Bertelaen etrall have the right tc purcltaee one (l) lot frcm B & H tlre sum of q5,000.0C. Bertelaen may select his lot after B & H picks ite f ive I ot e for first -1 - I ,,ffin .'"': 'a{ :.1: ,, ', .t lr.8&Irn';S i i, :'. ,i Liaor .3ra.rt to tt tLttl,Ea ol th. F-lta.brrer al Hc drft Dr ro{rr I oDl t3rttc Co a!Diot.,ghtr 1r9r:d d .ut lti.a Dy hrcbr..t. llto rol{eclil i to CL U.rrrtt Drrl rhiob v.!ac .t ll dpllrrr rt ctr. ot' r .l3t-t atall oaolr!.ra d.lh.3 co ftsrD.a.rr l dtldu.td'r;ErrILi lta a.parr!. Hafd.ltl.l lotr rhlctr hrcher.t rry r .l l,rrga prynt of Ch t G lot gryrltr ..t tosth rbovr. lll cort, ol plettrtE mdfxra lr prrprrr:lc ct tlalvi&rt dodr rtrll bl ltrcbrrr'r .rForo. fHrers rg:ol. lt t tl- la ot tta ..r.nc. .!a (r) h thr .r.!t of . dal-ltb tb t trrc oi oy gallclpl or lrtrrot nilch cc,lthru tot r pcrlod of 6O &yrftllrfla rrtr rgrcllLl dtx drtr or (D) l! th. .r.!t of . .t.t.ult l! portorrocr ct eql ocbrr otuattlo of ?urchi..! rfilclr coltlanrr tor r pc rlod ol 50 dryr tol fab3 '..clttro rtlcr 3hrrrot by frodor (drllvmd prnorlly or llbd by c.rtltLa..1l ) ,,. ! ''l: ,,tto tta -tlta ataG.ldlaj brhncr udor thtr c6tr.ct rhtll brcc lrdl.t.l, iilr" $tqD, nfr.), a! Iordor rbdl rlrc t i th. lollalq rlthtr .dlha d pryrDb b tull .t Y.rdor tr opltoo rd vltbqr3 ootlc. (talcL araclaaatrcdlor (rdJrct Co.qi llrlt.tlor Fovldod by t:v) h .ddltlo to tbo.. grovldrd by l.v or Ir a{!tc,rllDtr i (1, ldo' rr, .t tlr ogtla.Carrh.t. tifu Cotr.ct .d *t8ct ..l ra , tlCl. oa hlrrrrt h tb. lsop.rt,.od r.corrr th. ProFrt, brct thrc4l atrlca for.clcEr rlti ray eqully of rrdqt lo Co ). coaltlo.d upo turcb.taa ra tull prprct ol tha .rtln out.trndlEa brhocr,,lth lltarrat th.r.oo frc th. aata ol a.tdt rC tL r.t. h effuct or arrch drt.0a otbar Euatr duo bcrcrriel(b ilch .Eoa .tl mt. prr.lrlourly pld by hrct ..r rbrll br lorrfritd offulirr^.l .rjrr tot frl lurr to tlltill thl.Cootaact od er rotrl' fc thr lrc?Gt, ll yrcteror frlle to ro{rer); or (lt ) Y.ndor .at ru. lor tprelllc pr(crer of tblr Gotrrct to cq.l bcrli rtc ..d full p.F.ul ol tb. .!tlr. -CrtaaaLa La[-ca, rltb lotrrcrt tb.r.oo .t t h. nt. ir .fl.ct oo tb. data of aalalS d o6ar rrrrt. dra ta3.r!aar, ln drt ch.v.ot th. taop.rtt rbell bo r.tlo.a r3 ,l'{lolrl relc .od trsci...3 .h.ll b. lirDh lor eay drflclency; c(tli) iroaot r.t toa .C l.u tor tb. ..tls. unprld purcher prlco or ray porClo tlrrrol; or (lv) Vdor rry dcclrrr l'U. Catr.ct .C .o rnd rnd rrrr thir t.r. clqrd o titl. lo.lut f-tltl. rctl6 ll th.rqnltrbtr i!t.s..! ol rlootr luljdltcrat;ed (v) Vrdor r., hrv. hrrch...t .t.ct.d laa ?oaa.t'it lffit a.a lar. r rrcalrtr rpgobtr d to collact E, aatla r 1..r.. c gtot Itr tb frraercf ol .nt .ctloo rodrt (1)' 0D or (1v) rbor. lotdth.t dh3t rL'iEf c idton rtrtrlte or .ctloat ol Y.ulor . o.l.ctlo of roy o lcrflq s-al. .t ll ol, be bloilq upoo Vrodor lt ed rL! Frrlrd h lltljrt ion d etl coaCt .ra cDao... lncludlo3 r..roneblc .ttora.r.l..r of Yrador bcrstaa to ny scly trrrodrr (rb.th.r .b.t.d os oo!) to th..rt..t lot protlbltrd Lr d ct rr.. o! tltl.rvlrhrr .h.ll b. rdd.d to rlnclPrt rod prld Dy , er leurtrd, rad rhrll bc lncludcd io eny jrdjrent. li',r ltc Gba ccrc-r[t ot durlnj tha P.ndcnc, of eny rctloo of forrclorurr ct tltr Ca3tac3. htchmrr cca..!!. to tb. .PPohtrrnt of . rccrhrr ol th t!o?.rt. tBfdflS ha.t..d l8t.r..t. to coll.ct thG a.ott. lrrtrcr, rrrd profltr d -f ftogorty drrlq th. Frdanc, of rucb ection, ead ruch r.nt., ittu..r rad .tcttltt rto ri coll.ct.d rtrtt te brld end epplird er thG cqrrt rhrll dlr:ct. l\rctr..rr aball not ta.otf.r, rlll or coavcy lay tagel or cquitrbla lat.r..t tr tla troFrGy (by ..rl!Olt of ray of Purchlrr't ri3htr rndrr thit Coltr.Gi ot It oDGla. lol-trrr huc or in.oy othar urr) vithont thG Prlor rrltt.n cotr .ot Oi Vilc-nafri: oithcr thc out.t.!dln3 brhocc pryrbh undcr thir Contr.et lr llrrt iff f" ftill r tbr lnt.rc.t convcycd L r plcdgi or e:rijcnt of Purchercrrr irtrtrrt ni.r Clfu Cotrrct eohly er eccurity for an lndobtodocrr of Purchrrcr. L tia aratG of ray ruch traDtfar' rrlc or conveyloca rithout Vcndor'r vrittea cda.ot, tha otira antrtmdln3 bttrocc peyeblc undcr thfu cootr.ct thlll b.cqD lrdt.tal, dr,. ud pryrbtc in full, et Vcndorrr oPtion vithoqt notice. Yeodor rry veivc rny dafrutt eithout vlivin8 .ny other lubtequent o: prior &fanlt of hrch...r. r.! ir .' iili B't:gi -:l- ,l $ r]. .; .;.], 'l' ' ' ' ltlu', . - in'j.r'IJ.,. *-H&iq'"'l*$t'il ,4it Yi.. I . lir'ri.:. ffii,. r' ffi*** i:1.".: iii {t vt.!,.tr {.; + . alt 3.sr ct, ttl. cotr.ct .i.ol th blrr. le;rl rr;mrat.tl!....(If .oc .r erl ot L tro;rtty Gtr lc&r fmh Co t.l.... Lcetma rl . r.lr lr. b oo*lr ot tli. a..a G. 82 c6ht ilued. U Lr Ltlrtfrg rl{d. arrGaaroaa rd orlgr 4c1r of Yidct*.. h tL. f,oJ.c5 gt ll ftrilr tor r rlldttt tfi'p.rC, ..4lrlt t r.ot., Dt raf, Sll: 4.3 ..! 1:r{ Lt a ttL ;]!$ f.y ot xrr.r9ta. lm! (.IIC I ii' " 1 &lota f. t,/ca.L.a a/V e A.R. E rtalt n D6rld l. Uorort , Pr.rld.ot &,ryi F!:L Lrtal..r &rthc!!lc.t16: 8 ignrturc( r )6f Arrl6t d f,rr ll- Pr..id.!t rrrtr g.a?.trF lu t c ryo Illlilr J. R.do.cvich lLcbcr Strtc lar of llitcolrln. lfll8t! rtbr,ill c. U.tull. !!.cr.t.rt Vi'girrir l- r--r.t..i- hir slf.- ad nir.ld E- liorr.trd md llillio C. ir r i't f.r.-. ' .iev' -;.t 'q,\'; l-'"is*: ... r.g 1rt.y' JFc,rlt Ihi. inrtruD.nt drrftcd by: tlit lilt! J. n do..vich Attorncy lt L.Y lludron, girconrin 54016. -4- Il ,,.1* 1i. r{i^rI{ r, '] trF", \, Wisconsin'Department of lndustry,. Labor emd Human Relations'Division of Satety & Buildings SOIL AND SITE EVALUATION BEPORT in accord with ILHR 83.05, Wis. Adm. Code lor3Page Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM); direction and"/" ol slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION CQo,x PARCEL I.D. # REVIEWED BY DATE PROPERW OWNER: B* A/ lsxc ' PROPERTY LOCATION cow. LoT sdJ uq6E uq,s T 29 ,N,R /g E(or)w PROPERW OWNER':S MAILING ADDRESS'7q3 /rrer{A- CrPccC LOT #tzl BLOCK #SUBD NAME OR LJ icrat*r 'f,iluo fxsr CITY^TSTATE ffi,rASonl dt s13Te, PHONE NUMBER()E0ITY EV|LJ,NGE E[owN HU NSo c.,r NEAREST ROAD .,ttCTFI P( tlew Construction Use ffi Residential/ Number of bedrooms I I Replacement Code derived daily flow 4SO gpd Absorption area required Recommended infi ltration surface elevation I ] Addition to existing building i Recommended design loading ,ate 0 ,S bed, gpdm2Q!-trench, gpd/ft2 bed, tt2 trench, ft2(3 tvlaxinfgm(t95 design loading rate O-7 bed,gpdttl} Z fiench, gpd/fr2 ft (as referred to site plan benchmark) I I Public or commercial describe S = Suitable for svstem U = Unsuitable fo? system CONV 4s ENIIONALnu MOUNO4s tru IN.GROUND PRESSURE{s tru AT.GRADEqs !u SYSTEM IN FILLtss tru HL8'*offi* SOIL DESCRIPTION REPORT Boring # Ground elev.to-]{fi. Depth to limiting ,'s$E Remarks Horizon Depth in. Dominant Color Munsell MotUes Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bol.dary Roots GPD/ftz Bed Trendr /)o-ll tale\/ I 5c O,n ^9r ?{v1t b o z D.4 OT tt tl-21 lc.Yf. zlz.At I , n,shB ,,,G J Y t 64 o.5 R,z1 -44 7.sve >J,s L '2, n Sbk ,rr{".l n I o:;d6 8.44 -tr\/o\tR-3/ +{5 C.^,9 r ^l I I 07 lo8 Boring # Ground elev. ,45,11t. Depth to limiting,W A o-(I ovR"3l I "sc |,n.s[(? th tr C 2.o.4iaS I (ao ro\Q.+|4 s O,,.1r n, I c I o ?io,B' g,2o-4(ra\gz/z St I , *, s lo,(n, [r q I 5AA< 8r 4(.1 3 t 6,tp.+/:I . n.9r ,rrfY q I o4ios 8a 73-t?t6v <3r3 Sq , ,l I ,14,sb R (- hln I C.I o+o< 8<69-ll ?tavri3/4 S O mtlc nj I I c7 bs I Remarks: A ts(3tc- 4o&dO N^J 56 Phone,NY oASo^lress:o I 3I CST N r+t2DateSignature: Additional design / site considerations Parent material Flood plajn elevation, if applicable_ tl I Name:-Please Print PROPERTY OWNER PARCEL I.O.LtZ, 'rrrkjr,/'A(t( Boring # SOIL DESCRIPTION REPORT Page Z or 3 +:i.!s\r$aa1:*! Ground elev./c{firr Depth to limiting factor > /o.08 Remarks: Horizon Depth in. Dominant Color Munsell. Mofies Qu. Sz. ConL Color Texture Structure Gr. Sz. Sh.Consistence Bordary Roots G P D/ftz Bed Trendr ^ O-ts to\e7/Z 3L l,p".er hl f z OA a,s 8,/s-s6 /oYe.S/z-t_2, ra.$bR h{-c I o.5 0.6 8.'.S7:70 /oYR.q ll O,^,1n Ir\L z c.7 OS 8r 7o-tz1 )oYP +l+4J O,nd.tLl )ol ios I Boring # Ground elev. /O(s ztt Deph to limiting facto Remar]<s: A o-tz lc.I$e" s/e Sr.I ,"ehk ,\*C z i/ a.4 iai 8,rZSo t oyA+/3 S O ,u.Q?tul L I a.)ot 8z 30.-/23 toYe4 /4 J o. rt", 9 r n-l I I O,7 o3 Boring # Ground elev. iil ,6^-tL Deph to limiting facts >,c.t3 Remarks A c>4 toY*,s/:<)or\I ^.q6k ,n{.C b 6.4 io.f B 44,4 t oY?+lS J O r*.Q r tr1 |C I o,7 OB &(4-r3c i oY€-4 / d S I9rJn IIt,I :o) io8 Boring # elev Ground fr Deph to limiting factor : Remarks: sBD€330(R.05/92) I y !:.i1trtt , I !:.:+ 7 k\b r\ WD. \o("\*! \o .r) Srerr 3 og3 '5 \ p6la**laAr 'l " I Lt- Co*^\q - QoJ A,Pr- 4T 3:"rr(aS; E,rCV ' /oo.oO B> \*l \'- b rx \-- \* \ V^ 5\l ,t: 3 fhr..h b _(o L. : -od r\.VU .aD rrrFYl/r !'jitFO.D-fi Crl Z rB cD9 Wbre(> t,z'crX+K,5Q. \-/u ,il tr \ \ I 4s \ / -2- B-t .5 o(5d\ ) - v v 1 Isx, dz \ Z_ - -- - \ (Iu \ t) .!: ScrL-- I')3a$ -- si i /oas < 5.'f€-q )/eaa 5ala7; c- ^\It\ \ N nI tB-. St'l- -<> { .l \' .\ \ \ () yv I 5:, //;k- tfr,'Pz /?P 5/s//?/ 2, I I