Loading...
HomeMy WebLinkAbout042-1027-80-000 o p i p o. ey Oi a) a) 0 0 c *6 04 c L N aLL CL 04 m O CO c a~ a; 0 E v a t o 19 E ~ a? c co ;M o -he N E m p U t0 2-a . N U) Cc) 0 (D m 0 O O Z N Z c `a c C LL 3 LL C O CO O 0) 3 `o N y ~ I o `o c 0 0 Q L+ N a Q L c M o M co W Z £ co « O C 0 Z a m a m o ! c I 0 ca o 2 a c c ~ ~ I o w 0 w o w o d Z rn c rn z U) P _0 ,0 ~ .O N M N N 0 ! N cm 7 CL y d N •N a` m co s o O n 0 ca O Z co z Z co Z 0 w N I z 0 ?1 C14 12 La 4) N W d N ! N = m ay. 0 Cj. O Q a ~I L o G G M L m O 0 N N E N to fn N 3 3 3 3 FL z 3 a z 0 • i aaa aaa ) a ~ li a I o fj) ccoo ccoo ! } fA J V O O) O } N N ! C N N 7 N N O N O a, > o o vv EC4 Q Q O o C 0 0 co y c ✓ O m N O V N N m a O w~l ] 0 ~dpp1 Q} cn O m Q} N p co 7 a~ co co y O 00\ wo V H C ! r !p E N LO >0 o c Y o Y a c a N N l \ y N v O N c6 1- j V N V 0 0 y o n in C M U L o o y Z a~ (D a~ H c a) ° ~ N N N O N O ! dC14 p fn E 0 U • LL N O Z c I- LL N O Z c V ) Cc € a at a li a L: CL • Cd a a+ cI d C d d c y E L c l c 0 ; o 0 A vat 0 0 Oinv 11/15/2007 05 07 PM Parcel 042-1027 - 0 PAGE 1 OF 1 Alt. Parcel 10.29. 8.159 042 - TOWN OF WARREN ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historic ate Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FREDERICK, ROENE L & S&J JOHNSON ROENE L & S&J JOHNSON FREDERICK 1288 100TH AVE ROBERTS WI 54023 =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC / Legal Descri ion: Acres: 40.000 Plat: N/A NOT AVAILABLE SEC 10 T29 R18W SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2003 714473 2182/118 PR 03/25/2003 714472 2182/117 PR 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Last Changed: 07/11/2003 Valuations: Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 6,000 0 6,000 NO UNDEVELOPED G5 1.000 100 - - "0 100 NO OTHER G7 2.000 6,000 ' 85,400 91,400 NO Totals for 2007: General Property 40.000 12,1000 85,400 97,5000 Woodland 0.000 Totals for 2006: General Property 40.000 12,100 85,400 97,5000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: Category Amount User Special Code Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 Parcel 042-1027-90-000 11/19/2007 12:11 PM PAGE 1 OF 1 Alt. Parcel 10.29.18.160 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner ROENE L & S&J JOHNSON FREDERICK O - FREDERICK, ROENE L & S&J JOHNSON 1288 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1288 100TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 10 T29N R18 SE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2003 714473 2182/118 PR 03/25/2003 714472 2182/117 PR 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land I e Total State Reason AGRICULTURAL G4 34.000 5,400 5,400 NO UNDEVELOPED G5 4.000 400 0 400 NO OTHER G7 2.000 15,000 135,000 150,000 NO 0-I Totals for 2007: General Property 40.000 20,800 135,000 155,800 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 20,800 135,000 155,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: OTX Labor and Human Relations INSPECTION REPORT ` Safetfand Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 1AIA1 !7 P TtiliL)ir:1'C8 e: KEN ❑ City ❑ Village R Town of: State Plan No.: WARREN Parcel Tax No.: CST BM Elev.: 1:15 Insp. BM Elev.: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA !Dist Bottom Dosing NA ader/ an. Aeration NA ipe t. System PUMP / SIPHON INFORMATION Final Grade Manufacturer De and Model Number GPM TDH Lift Friction q6' tem TDH Ft Loss cemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTE BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYST M TO P / L BLDG WELL LAKE /STREAM CHAMBER Model Number: INFORMATION TYP O OR UNIT S tem: DISTRIBUTIO SYSTEM Header / Manifol Distribution Pipe(s) x Hole size x Hole Spacing vent To Air Intake Length Dia- Length Dia. Spacing SOIL CO ER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Ove 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.) LOCATION: WARREN.10.29.18W. SW. SE. 100TH V-1E az.:~ °O'~ r ctrl Plan revision required? ❑ Yes L -N-o- Use other side for additional information. - Date Inspector's Signature Cert No. SBD-6710 (R 05/91) _ Safety and Buildings Division ~j■■■~ SANITARY PERMIT APPLICATION Bureau Building Water Systems 1 V~■~L„t7f1 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County -56 than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number ,..2 (ate 7 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert y O ner Name Property Location ' T N, R /g E (or >r t. _50/4 ~ 1/4,S Property Owner's Mailing Address Lot Number / Block NPerA City, S to Zip Code Phone Number Subdivision Name orru F~-~ _"o;3 (?Is-) >x9.~t3r~ m~t II. TYPE F -BUILDING: (check one) ❑ State Owned ❑ pityy Nearest Road -k [3jillage Public 21 or 2 Family Dwelling - No. of bedrooms own of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 41.7- 1 ❑ Apartment/ Condo 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 E] New 2. E] Replacement 3. ❑ Replacement of 4. reconnection of 5. C] Repair of an S stem System Tank Only______________ Existing System -_____---Existing System -------y----------------------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pr surized Distribution Pressurized Distribution Experimental Other 11 eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 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 ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 69 g~ 3 Feet ?%'.9 Feet VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Concrete strutted glass APP. Tanks Tanks Septic Tank or Holding Tank /p00 40"Zw ~.X> El 0- Lift Pump Tank /Siphon Chamber ❑ n VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbej's Signature: (No Sta rj) PS) /I A MP/MPRSW No.: Business Phone Number: - S 7r S7-7Y7 - 3 3 Plumb_@r's Address (Street, City, State, Zip Cod IX. COUNTY / DEPARTMENT USE ONLY Disa roved Sanitary Perm;Fee (Includes Groundwater ate Issue Issuig ASignat No St pp Surcharge Fee) Approved ❑ Owner Given InitialAdverse Determination /r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 3 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 maintained. The septic tank(s) must be pumped by a 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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, purnp/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to 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 8 112 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 county; 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. l ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 4, &a residence located at: ~W ; , ; , _5 E Sec. 10 , TZ__~~N, RTown of L.Ij nj NL, , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No Y (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: D O d 4Ae Construction: Pref b Concrete _ Steel Other Manufacturer (if known): Av Age of Tank (if known) : /79-3 /V6 C ( ignat re) (Name) Please Print c~-0Wi✓-5 h ®3a-s8' (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or i licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). h~ Name 0"'C-d Signature gMP/MPRS D 3,_ nt HY 1Y c.k ~1`~~ l'~R~CoNN~"GT~O~ o~ ~X/'ST/~v~- S/~ST, ~CU~P/PE.vf~Ii S~U/vG- 3 . ~{,y•~ ro AI&V 4yV6-'!~-7R 3 13 ~-R,em , 11V, j ~ t fir, -b Ale- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations - Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code Z 72F5 7- ~,~c fl- • COUNTY Sr G~O/' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O ~j'~ -/d 17 - f O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION kEIV j--IREPL5,e / G A GOVT. LOT 51V 1/4 -SE 1/4,S/0 T 2~ N.R /T E (or~ PROPER OWNER':S MAILIN ADDRE~s LOT # BLOCK # SUED. NAME OR CSM # z 8 D0 Tog- P-419 r aP /6o A~ 164RM CITY, STATE ZIP CODE PHONE NUMBER E]CITY VILLAGE N NEAREST ROAD W R0M,FR rs GU/. 5y0 2 (713) 7fl9- 334/2 XfRRsN /DO 'Ak /I . NN w construction Use [lf Residential / Number of b6drooms 3 Addition to existing building _ [~.l'fieplacement eavHdoWmibe Code derived daily flow gpd Recommended design loading rate '4//e bed, gpolg2 trench, gpd1ft2 Absorption area required bed, ft2 trench, 1112 Maximum design loading rate'V/,',o bed, gpolg2 ' trench, gpdM2 ct 5 i 6 infiltration surface elevation(s) J 3 O ' ft (as referred to site plan benchmark) Additional design / site considerations Parent material 5Gj SZ 5'4 r A,15- , ,bA SOi S Flood plain elevation, if applicable N It S = Suitable for system CONYErR UL M L•_ t~D ❑ U IN-GROUND U ESSURE AT-GFADa U S~YST"-iN FILL HOLOM TANK U = Unsuitable fors stem CI 1/~~ $ LJ S C~ S U p S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed lencti 2,2- /0 VXMI Ground 3 Z 7 f YR y/(.t - : s. 19 s . 7 ele v. C 3 OV S- 41-1 jr4 4-H Depth to 0/ S 4F" t C ,g U .A limiting _ tact 0kUf0 .0 7 t C Remarks: ' !U ctaf"'" 7 l'J 007 BBoring oring # /a ye S1/ 2fsd,~ ,w=-,e fS /f s . Ground elev. y 7•SYX %/O S. p, S /hi~Q tv i ~0 Depth to fB 75 Yk limiting factor q „ 7 ' TT iQ Z ) Remarks: CST Name:-Please Print ROOe p 7- 2Y/hR/GA7.-- phone; Address: CST~t2 y~z~ 9& PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. 0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Bounclary GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Roots Bea Sena, 31K /71i-, Ik If Ground 3 7 s y S elev. 4/ fog. 3P it. Y111 13- Depth to lo xe Y16 C2 _ limiting /7C'S a L/ • Jt facto w - O /0 yX S/ c 3 GL 0,444 UI/ 55.5 Remarks: ,PE~4 Soi7'fi/3/,&- D,vCy ~ /YOU-c~D ry/~~" SyST~•y Boring # . F / D 31 w llsw-4e S / S = , Ground / - %6 Jr/ 17L'Sh~~jP .S- elev. 94~3,0 it. ~o s s. D s c~ _ . Depth to 7 S y ig 'r 10j, 141111 ,PA~vDo.~ b factor s~ Z.FS : Remarks: use e/~' lr~G~ yC.z- -Fop- -=-IeEack¢ S Boring # i Ground elev. _ rt. Depth to limiting factor Remarks: Boring # 'N+k'z F i Ground i elev., r -1 it. a Depth to ` limiting factor i . -1 -I a y VJ ~ p O o 'c In in, ~ o / v a Tl • ~I O ~ C W wi W L -4 -t-p O I-N 0 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~E/v MAILING ADDRESS 9s PROPERTY ADDRESS o rs s3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE & Lff zy'2~_-S S -~o 3 PROPERTY LOCATION S GU 1/4, 1/4, Section / D T l N-R TOWN OF l G~ CAJ,Q ST. CROIX COUNTY, WI SUBDIVISION Tt- LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property L k Location of prope y W 1/4 -S 1/4, Section n T ?N-R S Township / A~ Mailing address Address of site Subdivision name Lot no. Other homes on property? T 1"Yes No Previous owner of property Total size of property n CLe.~ Total size of parcel 1la o rum-+-~ Date parcel was created ( 9 Are all corners and lot lines identifiable? --Yes No Is this property being developed for (spec house) ? Yes ----No Volume 41,9 / and Page Number Ge,/ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the o fice of the County Register of Deeds as Document No. S 4/3,7 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property,-for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. r. Signature of Applicant Co-Applicant Da '@e of Signature Date of Signature e ("1 No. S-1. Warranty Deed-Common Form V C11 L C 4 "F eo-^) (1 (ST IT OY+' W f~COCSI ~ Sec. 235.16. Wis. Statut<ea. Form No. 1 Pu611.th.d h y Eau C1.1,. 13,v, Ht tf uury co, This Indenture rdade this day of bz t4ai~ , , A. D., 19 !?fir . between 1, 0 on part'- of the,3rst part, and CCU MCi£tID: That the said art partl` of the second part p~ of the first part, for and in consideration of the sure of t f One l p r 1 c. to in hand paid by the said part of the second part, the receipt whereof is L:roby ! confessed and acknowledged, ha given, granted, bargained, sold, remised, released, aliezio:!, clu;"<•yerl and confirmed, and by these presents do • give, grant, bargain, sell, remise, r eleaso, alien, come , y rind i , confirm unto the said part of the second part, forever, the following dcscr bed real estate, sit , heirs rind ;rs iF;,zs ited i:7 t_le county of and State of Wisconsin, to-wit; C C i s-•'t . j; 4f a 3J rrrJ, !e } .1 Coffrtb£C with all and singular the hereditaments and appurtenances thereunto belong ing or in any-ivise E` appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part 1 _r + of the first.part, either in law or equity, either in possession or expectancy of, in and to tho above hart;air:r d , s, premises and their hereditaments and appurtenances. I Zo I?ab£ imb to 1)01b, the said premises as above described ivith the hereditaments and appnrtcrvinc, ` . z unto the said part of the second part, rind to heirs and assigns FOREVER. ' i Y. for 1tc SF, 1- ; "i' heirs, executors and administrators, doh:, covenant, grant, bargain anrd agree to and with the said part of the second art, the ensealing and delivery of these presents P heirs and assigns, that at the time of - well seized of the nremises ahnvn ilnc--il,,,,, ~ w A; 1 se('('a;l Part, heirs aa31 ,:;si ns, ag~:inst all and every person or persons, lawfully claiming the f j whole or any part thereof, will forever W['RRANT and DEFEND. UMIIt ,fe;, the sad pc;rt of flue first port l,j„ hereunto set her hand and , w l ! seal this day of r: A. D., 19 N Signed and Scaled in Presence of I / ti fit i t 1;,,, ..(Seal) f. - 3. L. L. - _ _...w . ..................._.........._................_.............._......._._.__...__._..._...........__.._..(Seal) f ~ .(Seal) a T r c, c 1 afr of Wirronoin, r~ l..................... f . ...........County. ss. ` t Persc ,lly C M20 hPfore Me thrr; r , A. D., 19 ~ the abovo named r to me knoara to be the person who exec,vted the r^;trur3crat and acknowledged,thesame. r c, ~ ur"t y, Tisco4tih } n~ .y fs _ ~ (N.B.--Ch. 59 Nix. Statx. pmvI&n that all inxtrumente to be rc-MM nha❑ ha- plainly printwl or typewritten therbn the nnmm of the ! ir-lit-s. witnemen and notary.) ~rnnlmx° t l:}S ~ b 3r . .III ~4 r 1 Y~ O E I v Parcel 042-1027-90-000 07/11/2005 04:47 PM PAGE 1 OF 1 Alt. Parcel 10.29.18.160 042 - TOWN OF WARREN 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 ROENE L & S&J JOHNSON FREDERICK * FREDERICK, ROENE L & S&J JOHNSON 1288 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1288 100TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 10 T29N R1 8W SE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2003 714473 2182/118 PR 03/25/2003 714472 2182/117 PR 2004 SUMMARY Bill M Fair Market Value: Assessed with: 38019 Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 5,400 0 5,400 NO UNDEVELOPED G5 4.000 400 0 400 NO OTHER G7 2.000 15,000 135,000 150,000 NO Totals for 2004: General Property 40.000 20,800 135,000 155,800 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 20,800 135,000 155,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 Parcel 042-1027-80-000 07/19/2005 02:31 PM PAGE 1 OF 1 Alt. Parcel 10.29.18.159 042 - TOWN OF WARREN 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 * FREDERICK, ROENE L & S&J JOHNSON ROENE L & S&J JOHNSON FREDERICK 1288 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 10 T29N R1 8W SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W i Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2003 714473 2182/118 PR 03/25/2003 714472 2182/117 PR 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: /7 Last Changed: 07/11/2003 Description Class Acres Land E85,400 Total State Reason AGRICULTURAL G4 37.000 6,000 6,000 NO UNDEVELOPED G5 1.000 100 100 NO OTHER G7 2.000 6,000 91,400 NO Totals for 2005: General Property 40.000 12,100 85,400 97,500 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 12,100 85,400 97,500 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 . h Parcel 042-1027-60-000 07/19/2005 02:31 PM PAGE 1 OF 1 Alt. Parcel 10.29.18.157 042 - TOWN OF WARREN Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner ROENE L & S&J JOHNSON FREDERICK " FREDERICK, ROENE L & S&J JOHNSON 1288 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 10 T29N R18W NE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2003 714473 2182/118 PR 03/25/2003 714472 2182/117 PR 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 5,900 0 5,900 NO UNDEVELOPED G5 4.000 400 0 400 NO Totals for 2005: General Property 40.000 6,300 0 6,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 6,300 0 6,300 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 t S s T CU~P,PE.vf~ SU~v(,- 3iP,r,, . ~oP /fem. T6 ,v4/ LG' 3 13~'D~M , h7a,Ar&'ffa.rr; -b lge-av.~ CIA, - - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT, page-/, of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code cou ysoi L 7E5 7- ARE A- SST Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P . I.D. dimensioned, north arrow, and location and distance to nearest road. RE D BY UHL~ DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION COUNTY 1 FICt PROPERTY OWNER: PROPERTY LOCATION % (oW l~~N ~R~fR / c GOVT. LOT 5W 1 /4 SE 1/4,S PROPER OWNER':S MAILIN ADDRE LOT # [kom# SUED. NAME OR CSM / z S Do ves . P~,~ r VF /*o CITY, STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE FAMN NEAREST ROAD W Rol3Ere7-5 Av/. 5VO 3 (1i5~ ~y9-33 2 XfRRi5V goo 141"e [ J N ction Use [!f Residential / Number of b6drooms 3 [ J Addition to existing building =ed e ally flo w ~ gpd Recommerided design loading rate '`1V bed, gpd/ft2 4 trench, gpdtft2 Absorption area required. bed, ft2 trench, ft2 Maximum design loading rate /V/,10 bed, gpd/ft2 ' ( trench, gNW c t - 15 ~ infiltration surface elevation(s) 3 D ft (as referred to site plan benchmark) 13 - Additional design / site considerations Parent material 5GS 5L , 54r7/P?~_ X01 7S Flood plain elevation, if applicable N ft S = Suitable for system CONYENTI L M_ yD IN-GR NDD PRESSURE AT-GRADE U SYS N FILL T HOLDING TANK U= Unsuitable for system IRS Q U Q U I US 11 O U 0S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rertctt (9-10 /0.93/3- /e Af z-Fshk,- 44,,f Gs /f . 5 !o .2- (0- 1 z. /0 yle 10+14 '2- f 544e Ground 3 2 " 7.f yR /~e s /hl • 7 elev. p S. d, S,e 9 A* ft. s ~,e yrCo 3 Depth to D/ S S U A limiting factor it © paif 0 /~lr-GlJ ~Q s Q,P~¢~ Remarks: ' IUD Q.f-' 7 C Boring # /Dye j/-7.- Si/ 2~S6iC~ lwiC fS /7G S ~o z fi 4 116- Ground -7 .0 elev. Depth to I ~e R factor „ limiting URIGMA l g•7, Remarks: - CST Name:-Please Print R,919eP7- /~R~GGjT Phone: 7i5-r 3,f 6 Address: y 9~ CSTM2 y~Z n~~o CST Number: PROPERTYOWNER_ ~~N ~~~i /•~iC SOIL DESCRIPTION REPORT Page 2' of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mnch io 36L 2- .r„ J6 c y-/S" ion X31 - Alm 11!3-1k f • Y •S Ground 3 51 4 ! S , Y S elev. 2-4 ,9,0. 3P Depth to 6 -7 /6 Ye Y16 CZ 51 I -f 3 '-r~ a G/ • Jt limiting factor io VX 51 c 3 )9 CL Remarks: S~ / 77M/ dw 4e /W 141(aavp T y/~J~" SyST~~-t . Boring # /Q - j/ ~7C✓``✓.~ C5" If- 26 Yl? Ground elev. - /0 5 S. D S CLlJ ? it. YK Y141 /A*Akp,/`.R Depth to limiting ,PA~uDa~► factor 3 Lf s vfi~ S ~o ~P Remarks: IJ rMiA*-100 4r,6- o~ ~r lr~d~ f'~ •z" f0 P- T (2Eac lam. S Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. r ft. Depth to limiting factor 0 lD (p 1 -1 a -4C,- w N - c • ~ ~ c~ `C N o L ~ n o~ tai ~ Z tj i C a - Tal b r a I t I w Z 1 y I ~ ~I I lei ~ 7 0 1 O -k N -tp 0 I 4IN m -i o o AM 1 0 RI Z ID p y AS BUILT SANITARY SYSTLM KLNUKT "EC 10'1:27N-108~0 UWNLIt Fol TOWNSHIP Q ST. CROIX COUNTY. W1 SCUNS IN . ADUR.LSS SUBDIVISION LU'1 LU'l' PLAN V I EW DidLaneea and dimenaionti to weer reyuiretatc:taLL, ut H63 Yr;ByTHING I'1' ti IN 1 O S S'1 EM = 1+14 L3 A// I'VA - 2 6J- 17.. 19 3 ` lot'- T/ AI di a Ie `o1th Arrow I 1 SC Lk h A~v BENCHMARK: (Perulanent reference Point) Describe: Elevation of vortical,, reference poinL : S Io1) : at S i Le . / SEPTIC TANK: Manufacturer._JA) __CZ_,,~ _ LLCIUld Cai),AuILy / a~O dutgber of ringa on cover :1=,,V ~ _ Tank wanhole cover- u levut ion Tank Inlet Elevation: Tank UuL Lt L._ _L1cvrat tun PUMP CHAMBER Manufacturer: Number ul ~;,a11un:, Number of gal- pump oat for u cycle! gaI Lonti total calanc it y u distribution lineta balIon. size of puutp licad, gallon per minute , hursopuwer brand name of pump and modal number T Type of warning ddv ce HOLDING TANK: Manutacturer Numbut of gallons Elevation of manhole cover_-- - fMENT OF INDUSTRY, INSPECTION REPORT FOR S03110 SAFETY & BUILDINGS R & HLIMAN RELATIONS PRIVATE SEWAGE SYSTEMS _ ^i2b OO DIVISION P.u BOX 796 BUREAU OF PLUMBING MADISON, WI 53707 Ob [Xate ❑ALTERNATIVE Sfassiganl.D.Number: (l assigned) El Holding Tank ❑ In-Ground Pressure El Mound A4 1 -1 NAME OF PERMIT HOLDER: DDRESS OF PERMIT OLDER: INSPECTION DATE: I A BENCH MARK (Permanent reference poinH DE CRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: IMP/)MP.R.SW No.. C7(y County: Sanitary Permit Number: SEPTIC TA /HOLDING TANK: + MANUFACTURER: LIQUID CAPACITY: TA K INLET ELEV.: TANK OUT T ELEV. ARNING LABEL LOCKING COV Li I f-~~ Lh E~I W W vY ES ❑NO PROVID O BEDDING: VENT DIA.. VENT MAT L: IHH I GH WAT NUMBER OF DROPERT WELLBUILD G: VENFRESH LARM j' FEET FROM LI E: lAI I ET: YES ❑NO ❑ 'E C LNJ NEAREST (a Z !1 T/ I OSING CHAMBER: MANUFACTURER. JBEDDING: LIQUID CAP ITV PUMP ODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP CO y7 OL ATIONAL: UMBER OF ROPERTV WELL BUILDING JVENT TO FRESH (DIFFERENCE BETWEEN 7FEET FROM~'I"E AIR INLET. PUMP ON AND OFF) YES ❑NO NEAREST-~ SOIL ABSORPTION SYSTEM. Check a soil m ure at t e depth f plowing H DIAMETER MATERIAL AND MARKING ORCE r or excavation. (If soil can be rolled i to a wire, construction shal cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING. COV R INSIUE DIA.. #P S. LIQUID BED/TRENCH /I ` 1 TRENCHES: M Z RIAL: IT DEPTH: DIMENSIONS v Qi L ,6'_ _ALr .II FILL DEPTH JDISTR. P I P F DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR.✓ NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BEL FS ABOV CO ER ELE V.IINLET . ELEV. END. PIPES FEET FROM LINE AIR IN T: NEAREST-- w- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill m lal for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound.-tyy1ems to Wake ce ain hat it ON REVERSE SIDE. SHOW ELEVA- meets the 4riteria for mediufn san TIONS MEASURED. DYES ❑NO f SOIL COVER. TEXTURE - jA "P MANENT MARKERS: OBSERVATION WELLS. J ff A DYES ❑NO DYES ❑NO DEPTH OVER TRENCHBED 7PTH OVER TRENCH/BED DEPTH O TOP IL. ' FSODDED SEEDED: MULCHED. CENTER GES. DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO. OF LATERAL SPACjNG: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DIST PIP MANI ED MATERIAJL ISTR! DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV. DIA. ELEV.. - PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY j OV MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ft PLAN: DYES NO : DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSER ATION WE LS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM - LINE' DYES ❑NO ❑Y S ❑NO NEAREST I-SO l C, 3 161 :p t~ 1 s 3 I o-5. ft ' 7.yI Sketch System on W~JRet Ili ri county file or audit. Reverse Side. i L q~ 'ql TITLE Ii✓64 TORE: 1 DILHR SBD 6710 P0178f21t ' °'Le !5 W ' DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 ,i•iUMAN RELATIONS (PL13 67) 00 MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: C IT Property Location: City, Village or To nship: County: 6V '/a j 1/4S /Q /T NCR i 6 E (or)& a 1 Lot Number: Blk o. Subdivision Na Nearest Road, Lake or Landmark: State Plan I.D. Number: N IvQ 5- (If assigned) TYPE OF BUILDING 47 U Number of ❑ ublic* ❑ Variance* ❑ Other (specify)* Bedrooms: L!1 7 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: f.E u~ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental epage Bed ❑ Seepage Pit 6 /_5 ❑ Alternative (specify) ❑ Seepage Trench Water SS ply: Owner's Name as Listed on Soil Test Report (If other than present owner): LLJ'Private ❑ Joint ❑ Public lfE Al te_-- I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of Plumber: Signature: MP/MPRSW No.: Phone Number: eV -51 55 2 (715- 7-'9- a Z = Plumber's Address: Name of Designer: Z6_1 i;L9 5;" *111t~ COUNTY/DEPARTMENT USE ONLY i tary Permit Number. Si ature of Issuing Age t: Fee: ~j Date: ❑ APPROVED T DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) NGS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B DILDI VISION INDUSTRI4, LABOR AIVD P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 p Q (H63.090) & Chapter 145.045) LOCATION:- 1/ SECTION;TI9N/RI E (or)w TOWNSHIP/MUNICIPALITY: ~OnNO:BLKDN`O.: SUBDIVISOION NAME: e~ COUNTY: OWNER'IBUYER'S NAME: MAILING ADDRESS: 3Y.CROA EA/ ~it~E %C T ~Nv S-/ - A v,6E.PT5 l01s . USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: K;~ce 1 .2- ,1/~ 26New ❑Replace oC / • U 9fZ ~T l/Oj ~V ~~e ;wAl 1radi/{ hh yF s~, 4MAWy -c,do, f wj;_/1 RATING: S= Site suitable for system U= Site unsuitable for system Z.. Sig Ulf sob _ S TRv7} NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: optional)(w sQ fT R- ✓ RS ❑U 10S ❑U $ ❑U ❑S a] U O,vwfWAV.) Rd It 2(3 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: / V - 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 6 1* 16V _61. 1-1 , 66 96 Y6 Ao,- /onk_ • L 4,)4k ROC, C 9,18,0 -6y. 54 S4, .5 0~0 B- 2-9o g7 ST > 9o s W tee. s . B- ! Z 50 7 3 ~J~ ~3a1, 5 L, 02 h ~3~J . 5 w r $L L4 f3,v . s4 7 zr B- _ s ,v ,0 •5"L. B- ~Abj f~ET PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 0 he S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 P R PER INCH P_ , P- P- 2 3,00 ~91&_ P-_ P- . O LLP- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 1361.1-em 4F ~t` '~i L ~i4T/0~11 Oa 11~r "9LTz/ F7-. &4w By , Ar SYSTEM ELEVATION L'%ZIPoA~ rr. 5-,Y,,' UST )E',)(• Po~aT. !-S _s D 0, irP I X - f~C 5 /3o~~s 11 aa~osio~'"t „ z i ~ ~ - yea E E i ) u tN _-_F ._..r..._ o _ E t y'C r ~ 77 m 16\I TRUCTIONS COMPLETING FORM 116 - SRD - 6596 To be a corny accurate soil test, your report mast iM 1. Compl !e nn; 2. The use se, irly Indic = r this is a residence or commercial project; 1 MAXIMUM nL . Idrooms c- cial use planner's; 4. Is this a rr nt system; 5. Con ing boxes. I'- IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OT'- ?LED OU, ON SOIL CONDITIONS; 6. ~or-s shown writing profile descriptioi co p:. clot plan; m accurat y test locatior rr°d. A riesirpfi; . ire t a point arc s to 4 `.esses, flood a, per, ~ ~mp- 10 n) does not a- l_ K; 11. - , your rertif,rat ibule ALL SOIL T TH THE LOCAL „N 30 D WPLETION. --NIATION, , ERTIFIED SOIL TESTERS nd Textures 01 10") BR 10r,s c--, LS HGVV - rl roc Bay ~j7, J ss P, yy,'5 B :A y. <s+~n duo°i°,~ ° J-~4'4, V lo f. r-7 Is, li 1 4' 2-5- P2 r Z it u= ~i/'~ S r i`I N - ow