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HomeMy WebLinkAbout020-1122-00-000 0. O C N 00 O 6 0 0= 4 et > x 0 o a~'i LO x€ a C N wO C Q4' C y c p C C Q N d W N = ? a N tr- 0I O f0 CY) 0 ` O E r /_i N 0 -p C IM tM .9 k p w - N Z :y , 'a p m m E C X 2 C Z N 0 U) L) LL -Fu -0 C U. c w N a 3 3 ° N CL 70 a va N a cM M ~ I 3 d• m I N Z rn w E E cn • o I °o I •o d d ~ m w a a m I I c I o I p Z c it r Z O O y (A F- rn c Z Q) 4) a~ E c E -o v m N a N y 7 N N co (D y U) C N N Ny p c a p a U) O Z H Z Z co z O U co Z r m C N p E 03 to .0 -a) CL M CD N L V! d d N d p E U G G a L d W co O _ : w U) tq al 2 v c- D '6 • a a a a a 2 Z a 3 a U) o to J V 0~1 0 N N co r r m } m c r y ~ 2 0 N (D ;35 C O - O E "O m N c J ml (D a co c Q } C d d U) ~i O Y N N L W N OO O I y Y Yl C O O C M n E co - 0Ic- , 3 y M N d 7 O \ N p OE C p d 0 v ~O fV c ~ p C N cc fCp N N r CO 1 LO v ) In O co C M 0- .4 N N p Cl) d N N N O « 'O O • N N N 0 0 Z' N Lo d p C s m ca 0 0 2 N D Z c co O Z c 2 2.- co a da €a ~ E E a = d c d d c tt~~ ~1 A ciao i0aQ OazC> I Parcel 020-1122-00-000 04/12/2005 11:21 AM PAGE 1 OF 1 Alt. Parcel 07.29.19.537 020 - TOWN OF HUDSON 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 * CICHA, JEFFREY A & KRISTIN I JEFFREY A & KRISTIN I CICHA 367 KRATTLEY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 367 KRATTLEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.230 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 8 Block/Condo Bldg: LOT 8 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 10/14/2002 694192 2011/394 QC 02/24/1998 573681 1299/309 QC 07/23/1997 1181/265 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 48625 247,500 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.230 38,800 152,700 191,500 NO Totals for 2004: General Property 2.230 38,800 152,700 191,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.230 38,800 152,700 191,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 304 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 r } TC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER P"&C- 14167T ADDRESS 367 SUBDIVISION / CSM# ~ LOT+ SECTION I,$ T 2-0_N_R W, Town of ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WILTHINI100 FEET OF SYSTEM 1v I r n, ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ T 'y /per esT-- /80 7/'?7--t ioa - d BENCHMARK: s~~~'~V S `sdw.~ ALTERNATE BM: wsev / SEPTIC TANK / 4BER ON 601*e5 /e Liquid Capacity: Manufacturer: Setback from: Well ~O' House Other toy Pump: Manufacturer Al+ Model# Size Float seperation IVA Gallons/cycle: Alarm Location .Ay7:::: 'vExl SOIL ABSORPTION SYSTEM Width: Length ley Number of trenches 79 ~ So . Lc~T- L Distance & Direction to nearest prop. line: Setback from: well: !ZO House &0 Other ELEVATIONS Tim (r- exrs?,N fi A- Building Sewer ST Inlet. t~~ ST outlet 100, PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Gra.de4_ -Y _t Final grade DATE OF INSTALLATION: PLUMBER ON JOB: PoluwT "w"` 1,647- LICENSE NUMBER: A/ if 57 3307 INSPECTOR: j-elo kl*zv5 31/ 9 3:jt ell o ° i c ~~~Z y y~ ~ y ~ y l IN, v~ o~ i v o o ~ ~ w c ~ I w % i T?£N--------Sx~y--- Ilk n cr z N W Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor ary9Human Relations INSPECTION REPORT ST. CROIX 'Safety and Buildings Divisign (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 219 5 Peqjt.ti4l RNan%M & DEBBIE ❑ City ❑ Village © Town of: State Plan ID o.: CST BBMT`Elevv.: l nsp. BM Elev.: BM Description: ~s Parcel Tax No.: -7/00/ /j "v. ct, j /V AQ4nn49;s /Jol TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I?i,XyQ-j Benchmark too Dosing 10 Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 7,oy C(, 3 S~ TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header / Man. 9~~9 Q t log 7 71,517 Aeration NA Dist. Pipe q~; s io~8 9 qa,~g Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade -s 9S Manufacturer Demand 5.7 , 6 A CT/ 97, 7$ Model Number GPM TDH Lift Friction System TDH Ft ead oss Dia. H Dist. To Well Forcemain Length SOIL ABSORPTION SYSTEM BED/TRENCH Width ~-j Lengt II J No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `T oZ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE STREAM LEACHING Manufacturer: SETBACK CHAMBER A _77 INFORMATION Type O G' ► I ' a,0 / OR UNIT Model Number: System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I 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: Hudson.7.29,19W, SW, SE, Lot 8, Krattley Lane 13 0t,, j/,)A1,-qua. D4 `7~ ~~U~ a Io gq /D.0 Plan revision required? ❑ Yes ❑ No Use other side for additional information. /7 / F6 To 1?, d SBD-6710 (R 05191) Date ; Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I L fLH 2 SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code TY G/eb/` x iws.s.u,w~w,v~ STATE SANITARY PERMIL# -Attach complete plans (to the county copy only) for the system, on paper not less than tic 19 0 ?J 8% x 11 inches in size. ❑ Check if revision to vious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. !V PROPERTY OWNER PROPERTY LOCATION O~o -4, w Y4 Y4, S T L9 N, R ! E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~SO~ ~i. ~~o~fa o ~3 jr1fy`E;vim II. TYPE OF BUILDINGCheck one CITY NEAREST ROAD ~~r ( ) State Owned LLAGE TOWN QF RCEL TAX NUMBER(S) Public 2 Fam. Dwelling-# of bedrooms '3 111. BUILDING USE: (If building type is public, check all that apply) Z 0 Z Zdd d O Cy 1 ❑ Apt/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 orgy one in line A. Check line B if applicable) A) 1.0 New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - 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 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure , 43 F-1 Vault Privy 14 11 System-In-Fill Z 7RE0e,41 S s-/f eeA, _ / X f o l~n 61 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 (sq. ft.) (Gals/day/sq. ft.) (Min./inch) G ELEVATION 7 / a0 ~do .5- /U Feet 0 Feet VII. TANK CAPACITY Site ' in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks s cted Septic Tank or Holdin Tank Volvo /O dO / Gv /FSF2 Lift Pump Tank/Si hon Chamber 410106t47441 40'. E] 0 El El 1:1 1 El Vlll. RESPONSIBILITY STATEMENT I, 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) IUR/MPRSW No.: Business Phone Number: R0,65e 7- NhPi~4 ~ X~ 33 6 7 7~ 3 F4" Plumber's Address (Street, City, State, Zip Code): IX. OUNTY/DEPARTMENT USE ONLY Disapproved Sstaryit ee (Includes Groundwater Date Issued Issuing Age Sign ~pINo ramps) Approved ❑ Owner Given Initial Surcharge Fee) C 5 Adverse D termInation: X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r, 1. -A sanitary permit is valid for two (2) years. 2. our sanitary permit may be renewed before the expiration date, and at the time o` renev ail 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 6399) to be submitted to the county, prior to installation. 5. Orrsite sewage systems must be properly maintaired. The -_•.-ptic tank(s) mi-ft be p`1rYio-d ' v F. 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 & Buildings Division, 60B-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 r, niber(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms d 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 in 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 in #1.-1. VII. Tank information. Fill in the capacity of every new and/or existing ,ank, 'ist th-3 total ,lallonr -urnber of tanks and manufacturer's name. indicate: prefab or site construr.ted and tank -material. C:r-r-i-! :'e for all septic, pump/siphon and holding tanks for this system. Check ut ape imertal approval or; ` °,3nrns received experimental product approval from DI1_hR. Vlll. Responsibility statement. Installing plumber is to fill in name, license ni~mbe• with appyop#ir-w prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX County/Department Use Only. X. County/Derpartmen' Use Only, Complete pkans and speeification•-1 riot smaller than B'/2 x 11 inches mu!..t b, • ibmitted to 'I ;runty. The Plans must iill i!Ude the followin : plo' plan, drawn to scaif, or wit!, cccanplei- dime 1_lorrs., 'O ~,ition of nolding t tic tank(s; ;Dr c. her treatment tanks; buildi, - well-; wa.'reriPir?E ,w:ater service; streams acrd iaalres; pump or siphon tanks, distribution boxes; see -;ystern• re,, .i"Elment system „ = `ai*as; an *r n f&, Ition of the buP <4;ng served; 8) horizontal rti~a! elew -Jo_n reference, Point::_;, C) complete specifications for purnps and controls; close volume, eivvation differences; friel cn 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 numt)er cf regulated practices which can effect groundwater. The 'lionies coi':ected thrOUgh ;ilese surcharges are used for monitoring gto_:rJv,, ,tei r water contamination investigations and establishment of standards. SBD-6398 (R.11/88) LA 0 w U h o 0 I o ~ I ;o ice, ~ ~ ~ ~ - ~ ~ Tr • ~ ~ ' X11 ~Of / 10 SO - - 14; 0 0 O wo o 0 ~ o ~ y, w { Fresh Air Inlets And Observation Pipe tT/' rApproved Vent Cap Minimum 12".Above Final Grade ltJ~?Jt. 3 Above Pipe 4" Cost Iron A Vent fIpe' 'to Final Grade . Synthetic Covering -Min. 2" Aggregate Over Pipe Distribution - Tee Pipe 'L0 0 0 0 0 (o * Aggregate 0 Perfbrated Pipi Below peneoth Pipe 0 Coupling Terminating At Bottom' Ot S.ystorn S. Fresh Air Inlets And Observation Pipe ~0 to IRL~..l clt Approved Vent Cap Minimum 12" Above Final Grade 3 (o "Above Pipe Cast Iron o~ - Vent h;ve lo Final Grade lpLv,Q/L,. Synthetic Covering Min. 2" Aggregate Over Pipe Distribution -Tee Pipe FO 0 0 0 0 co " Aggregate 0 Perforaleed Pipe Below Beneath Pipe 0 Coupling Terminating At 5t/ fTE~y Bottom Of System g 10 1j Cb 416 RECEI Wisconsin Department of Industry, SOIL AND SITE E V A ON V Page 3 Labor and Human Relations TI. 1`QR P of Division of Safety Buildings in accord with ILHR 5, ~dm. Code i S- 1"RCt . UNTY T GiP~ X Attach complete site plan on paper not less than 8 1/2 x 11 inches in si UP 4WkV[y*~ ,ice not limited to vertical and horizontal reference point (BM), direction and f scale or µ PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION 74.E ~ Z)'ea 3/ E /4~TTGzK' GOVT. LOT _Sw 1/4 -!L-- 1/4,S 7 T 2-f N,R 19 E ( yy PROPERTY OWN R':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 36 7 ~G.v • 8 ~/Dac-'e-- CITY, STATE ZIP CODE PHONE NUMBER []CM OVILLAGE OWN NEAREST ROAD }f upso.J 4J/. ~yo~lo (7/.Jf) v6-1,5705F3 tJ pso,t> ",477x4y Lot/ . [ ] New Construction Use [ A-r'Residenfial / Number of bedrooms 3 [ ] Addition to existing building ii,rheplacement [ ] Public or commercial describe Code derived daily flow ysa gpd Recommended design loading rate / bed, gpd1ft2 • Strench, gpd/it2 Absorption area required. _ bed, 112 %00 trench, 112 Maximum design loading rate ~ bed, gpd/ft2 G trench, gpd/ft2 Recommended infiltration surface elevation(s) SSE 3 It (as referred to site plan benchmark) Additional design / site considerations 215-- rr 0 ,61A-e e0 cv . 11 Parent material SGS yy - XWZy i Flood plain elevation, if appli6able y/~- It S = Suitable for system C121S OMO L MOUND IN9-9- -GRUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAW U = Unsuitable for stem ff-S ❑ U ❑ U [a ❑ U O S 3-tr- 0S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tench j o-rr~ 0 3 s '-7 4Y*- s,7 CS /!c , s ~ L S-1 2_1 ~ /a y., y S/ .2 f ,:51 -6< e-5- h~ . s Ground 3 L /l e' S elev. / f7, 72- ft. ).2 Al Yl Ylo~; 51 2, Depth to 1"2 s9.u limiting facto 1-T Remarks: Boring # ; -13 /oriP 313 f sd,.~ ~i, ~,P cs z • y . S 1 -23 -57 Ground /O elev. 7 ft. Depth to limiting Ibl-N factor Remarks: CST Name:-Please Print Phone: Address* CST-y lY~ L Signature: Date: CST Number: 1414 7-,x- r'~v gCt_nc~ / / O r`9 /3g Ar- APO UTEZ) J" 'r c'1'Al /~L. Y y PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z Of -3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou day Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed D 7 is 3 s/ ~►-►f~P - y S Z~ /o Ile 31s~ Z 16~ ,1,,,e ~S s - • S - Ground - /Or ,P y Si~ Z~•-► /M7--- l' elev. S7 Depth to limiting factor Remarks: Boring # Ground elev. it. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 1.31 Ground elev. it. Depth to limiting factor Remarks: COf1 07J/\/O /\G Mf\ 0 M n ~ ~ ~ ~ . O v . W „ Vt m N rv~ ~ ~ v }~C ~ Q ~ o r, N I W ~ N o ~ o y v~ \ k ~ ~ I ~ D Iqt 1 O W ~0 QO -s--- y 1~ l~ ooh w Wisconsin Department Industry, /OI SOIL AND SITE EVALUATION REPORT P>'t 3 p Labor and Human Relations Division of Safety & Buildings In accord with II-HR 83.05, Wis. Adm. Code COUNTY s`TciPO X 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 (SM), direction and % of slope, scale or PARCEL I.D.If dimensioned, north arrow, and location and distance to nearest road. 0 L & it Z-LoL p d APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION TO.~ ~EiC3,(3iE /yET-TG~K° GOVT. LOT SW 1/4 ~ 1/4,S 7 T ~9 N,R E ( W PROPERTY OWN R':S MAILING ADDRESS LOT / BLOCK # SUBD. NAME OR CSM / CITY, STATE ZIP CODE PHONE NUMBER [iCITY ~1IILLAGE raM NEAREST ROAD upso,J e~j/. s'yoelo (-71_f) 3P -f0F UDso.t 7 "477X--y 4t/ . [ ] New Construction Use [ residential I Number of bedrooms 3 [ ] Addition to existing building [411eplacement [ ] Public or commercial describe ' Code derived daily flow yfo gpd Recommended design loading rate / bed, gpd/ft2 . Strench, gp&V Absorption area required bed, ft2 Da trench, ft2 Maximum design loading rate bed, gpolfl I G trench, gpolft2 Recommended infiltration surface elevation(s) SSE ~g • 3 It (as referred to site plan benchmark) Additional design I site considerations 2/SE TiP~-~~ l5 '--LoN Parent material Scf yf - /fyivy Flood plain elevation, if appliEable S =Suitable for system 00W Q U L MOUP IN-GROUND PRESSURE A~T GRADE SYSTEM IN FILL HOLDING TAW U = Unsuitable for stem ld s M O U C ❑ U CAS ❑ U ❑ S 34 J_ ❑ S 134- SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdafy Roots GPD/ft in. Munseil tau. Sz. Cont Color Gr. Sz. Sh. Bed Mench IAII '3 4417~< 11c 4' Z S- ley "41 7-~P e'- 5- 1'7c- . S Ground Ili S 5 elev. f7, 72- It. ME Depth to limiting factor Remarks: Boring # -13 101le 313 s/ ~~`<S~.C,P G'S z • y : S z 2 s3 /off s/ Z 4e w, -//P elS -76 rX .5 Ground `3 3 /O S . s iYy► 7~ elev. ys. G 7 it. Depth to limiting lace Remarks: T Name:-Please Print Phone: 21s- i~~ Address, Signature: Date: CST Number: -2zea1 N07-e- j;ic'6>0 7- /f e405-5 (~1"T rlw C' S~vs TF;-J - ~.rpt1 /~'~l5 TEST /►1PiE ,~I~9// .U~tt Z,2 7o 13e- 1P - APv uT&-,D elo,qE PROPERTY OWNER CGS SOIL DESCRIPTION REPORT Page Z of-3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourXIMY Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rend Ground M1'7ci C' f - • $ - ~y. elev. Depth to Imifing factor Remarks: Boring # Ground elev. it. Depth to 8mifing factor Remarks: Boring # i Ground elev. ft. i Depth to limiting factor Remarks: / Boring # E Ground elev. ft. Depth to Rmiting factor Remarks: Cars 099/110 r1G M91 Im\, O N ~ o a p _ O N o m ~ ~ m tis r0. ' s y r r y ~ r o N o ~ C l~ 3` N , I ~ AS BUILT SANITARY SYSTEM REPORT `O OWNER -S 01 Al I TOWNSHIP-/-f u AV C7 SEC.ZT JN-R/qW ADDRESS Tf' e ' f fi I` b o 4~~ v( ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE Z C{ PLAN VIEW Distances and dimensions to meet requirements of H63 - THING WITHIN 100 FEET OF SYSTEM w h I d--ft-a e o 1i A ro SC LE: '7"d~ l o f c BENCHMARK: (Permanent reference Point) Describe: 00 / a en el Elevation of vertical reference point: j Slope at site: 3 67 y SEPTIC TANK: Manufacturer : (4t/1 <1 s Liquid Capacity: 1 0 Number of rings on cover : L Tank manhole cover elevation: t~, Tank Inlet Elevation: ? Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity of- distribution lines gallon: size o pump head; gallon per minute horsepower ran name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device- SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid dept seepage pit in e pipe-elevation bottom of seepage pit ~1. ev tion feet. SEEPAGE BED SIZE: number of lines wi th length Y -tile depth 34 SEEPAGE TRENCH: width length PERCOLATION RATE A REQUIRED '7..L AREA S BUILT 7 INSPECTOR DATED_ Z PLUMBER ON JOB 18 OCD LICENSE NUMBER 5 Z 0. S G U l 1 ~ I 37" 1 ' ~ I I I I I E ~ 5~ ~ ( I AlJ s~ul~ 1 . ~ / 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 s~ residence locat,d at: 1/9, S 1/9, Sec. ? 2. y SOnJ ~ T N, R-W~ Town of 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 L Did flow back occur from absorption system? Yes" No (1E no, skip Approximate volume or length of time: ? next line) gallons minutes Capacity: /&Vv (lax Construction: Prefab Concrete St ' eel Other Manufacurer (if known) : 4>/&--S 7!C . Age of Tank ( i f known) (Signature) (Name) Please Print (Title) (License Number) (Date) ORIGINAL Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) o r-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). Name po'4"j- ?,e,6X4/ A7Si nature g M~MPRS 3367 A0 5/88 t S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER yo -3 ADDRESS 3 6 7 G-'~ • FIRE NUMBS 3 4 7 CITY/STATE ZIP Sl~cx~ PROPERTY LOCiTION:fC 1/4,`~- 1/4, SECTION 7 2L / TOWN OF St. Croix county, SUBDIVISION 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 a 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 Co. Zoning officer within 30 days of the three year expiration date. SIGNED:- DATE:- St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 i STC-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), thenta 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 ~ ~f-G, saLocation of, property SW1/4 l/4 , Section , T ZfN-R /f W Township lfyf~.So.J Mailing address 3 7 k~~4'TTzy L-~ ~I7~SD-~ 4y / . s yG! Address of site -S~ subdivision name_ 6!< /~O, Lot no. Other homes on property? yes No Previous owner of property •s /~'f/ll Total size of parcel Date parcel-was created 1 ~l Are all corners and lot lines identifiable? ~s _No Is this property ?being developed for (spec house)? Yes r Volume `/and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGF NUMBER & 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 n the office of the County Register o'. Deeds as Document No. Ply 1 , 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 County Register of deeds as Document No. J , Signature of applicant C ap lic nt Date of Signature Da'e of S tune ~1 -01-11kli-~,T No WARRANTY DEED ,~T%TE 13AR 0F Wi;CO\SIN FORS( -1982 s~,9 1654 -.118 SAM E. MILLER, a single man ,I ! 1'i; 29th r Oct A. J. i 82 .-rrv's to THOMAS J. METTLER and DEBRA S ~ t?:-l~~ ,1. METTLER, husband and wife as joint tenants i r±aaWr vd Daed~ in consideration of the sum of $68,400.00 1C+ftli,ed real t•,I.,,e in St. Croix Lot 8, in Eagle Ridge, a rural subdivision located in the rax Parcel No:.-. SE of Section 7, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. TO=£R WITH and SUHT TO a non-exclusive easement for ingress and egress and utilities over the following parts of Lots 7 and 8 in said Eaqle Ridge: Beginning at the NW corner of said Lot 8, being the point of intersection of the common boundary line between said Lots 7 and 8 with the SEly right-of-way line of Krattley Lane; thence N 56°02'30" E along said right-of-way line 60.0 feet to the NE corner of said Lot 8; thence S 33°57'30" E 191.68 feet; thence S 00°38'02" W 105.68 feet to the Sally line of said Lot 8; thence S 33057130" E along said Sally line of said Lot 8, 265.40 feet to the SW corner of said Lot 8; thence S 89004150" W 71.57 feet to the SE corner of Lot 6 in said Eagle Ridge; thence N 33°57'30" W along the NEly line of said Lot 6, 245.06 feet; thence N 00038'02" E 105.68 feet to the SWly line of said Lot 8; thence N 33057'30" W along the Sally line of said Lot 8, 173.0 feet to the point of beginning. This easement to serve Lots 7 and 8. SUIDJ to an erosion control structure on said Lot 8 as described in a certain Affidavit dated March 1, 1976, recorded July 23, 1979, in Vol. 597, page 621, Doc. #358518, in the office of the Register of Deeds for St. Croix County, Wisconsin, which shall be maintained and repaired as necessary by the owners of said Lot 8. 'I 711ER WITH and SUBJECT TO any other easements, covenants, reserval-ions or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encum- brances beyond the term established by law therefor. T, is not hnme~G•ad pro~ert:. iisl Is not) - F''o !"I w .%arranties: 0~. O aa> W, October 82 IJ (SE:AL) Sam E. Miller i F.ALI I~4EAI.1 AUTHENTICATION A C K N 0 W L E D G rA E N T Signature(s) /A STATE OF WISCONSIN _ -------St. Croix ss. ----(-ounty. authenticated this day of----------- , 19.--.-. Personally came be;,re me this ' dac of N/A October 1982 the above uamui Sam E . Miller TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized b - - y § 706.06, Wis. Stats.) - to me known to be the person who c1MC"uted the Foregoing instrument and acknowled,e the.?ame.' 7-1',3 INSTRUMENT WAS DRAFTED BY William J. Gilbert, Attorney - - - ' - , Hudson, Wisconsin 54016 - Nota-%- Public) St. Croix 7 (Signatures may be authenticated or acknowled>red. Both SIC Cnmmi~;sion is nerman ernt. i li not, stsfe 'ext, r:ifiort are not necessary.) _ date: J u 1y - to 3 .1 'Naazes of Persons miruin¢ in any capacity should be tyne•( 1 t nb,d h, 1-, rh, m {CGa Cd h'a. WARRAM'T DEED STATE BAR OF WISCO%SIV :CI. , r•in L,i[xi 1 FORM No. 2 - 1,y2" tt ` n cn p 3 m n r~ 0 c d 0 C7 ~1 2'a 3 CD (D m cn a: E O N O O D - C ~4 N O m p Pb =T .4 CD 3 0 CD N li O CNO O rC1 L1 C) _ `Al W CD gy O d CD N St a N 0- O 3 W O 0, CAD N OWi 1 ~ v 0 e~T o v O H y O O ~ cn ~ D tp a m F ~ CD Cn m U) a CD U) c co d V M~ 3 0 o CO CD N O CD ~V W C CL w CD (D co o rtn CA co co 0 ch 0 a lei d "a T z 0 0 0 M N~• p O !r (n :2 00 m 0 ca 0) 0 CT 0- v v CD CD CD u M _ m M a m ~ ~°1! y CD 7 ~ ~ III. z M N z w z o O D a 7 CD y (C (D N C CD N CD W (D C1 z CD t0 co ~ p Z m C) a 3 o. 0o v m co M CD C z 00 3 c 0 3 I m co H z CD A W F ~ CDD C d CL C) n CD - O T U) O 7 z a O C CD d O N @ O 9. cc :3 01) O co C S < A. C ~ A 0 8 X N C) J A O ~ b CD dQ N A .0 o g o 00 i_ Parcel 020-1122-00-000 03/28/2005 11:37 AM r PAGE IOF1 Alt. Parcel 07.29.19.537 020 - TOWN OF HUDSON 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 JEFFREY A & KRISTIN I CICHA 'CICHA, JEFFREY A & KRISTIN I 367 KRATTLEY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 367 KRATTLEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.230 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 8 Block/Condo Bldg: LOT 8 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 10/14/2002 694192 2011/394 QC 02/24/1998 573681 1299/309 QC 07/23/1997 1181/265 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48625 247,500 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.230 38,800 152,700 191,500 NO Totals for 2004: General Property 2.230 38,800 152,700 191,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.230 38,800 152,700 191,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 304 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Y rs c AS BUILT SANITARY SYSTEM REPORT `O OWNER 01 TOWNSHIP li Af h SEC.ZTaN-Rf fW ADDRESS D'04 fi t b o r r \ ST. CROIX COUNTY, WISCONSIN. ~Psdh V' 1`S r SUBDIVISION LOT 6LOT SIZE x ' Ct PLAN VIEW Y Distances and dimensions to meet requirements of H63 THING WITHIN 100 FEET OF SYSTEM I di a e o th A rv SC L : BENCHMARK: (Permanent reference Point) Describe: Sw. C or ~~r Elevation of vertical reference point: % 0 d Slope at site: 3 S y' SEPTIC TANK: Manufacturer: L411 se Liquid Capacity: j G O 4 ~ Number of rings on cover : .L, Tank manhole cover elevation: r-j / Tank Inlet Elevation: 77- Tank Outlet Elevation: qf!' ' PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc e_ gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device- SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid dept ► seepage pit in e-t pipe-elevation bottom of seepage -e evation feet. SEEPAGE BED SIZE: number of lines width length 5f-tile depth SEEPAGE TRENCH: width length _Z2- AREA/AS PERCOLATION, RATE O A REQUIRED BUILT 7,7- INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER M - g 1 Z Ell ft5V5f(Im w _y r~Ve loco <L 37' f f I I I f f i f I I I ► I I ~ ( I I I NU $ to~A NC; Scc~4 Ty oe f of pi rc (r r~G- s ; DEPpuRTMENT OFE INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ;'LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING M^.DISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: El Holding Tank ❑ In-Ground Pressure El Mound [If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DAT SarrL (biller f : z - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. T n- II ~i moo Name M Plumber: MP/MPRSW No.. County: Sanitary Permit Number SEPTIC T K/HOLDING TANK: , MANUFA URER. s LIQUID CAPACITY: TA K INLET ELEV.. T NK OUTLET ELEV.: WA NING LABEL LOCKING COVER / • PRO IDED: PROVIDED: YES ONO DYES ONO BEDDING: VENT DIA.. VENT MATL HIGH WATER ry{}M-PER OF R( D: PROPERT WELL BUILDING. VENT TO FRESH ALARM FEET FROM i LINE: AIR INLET. YES ONO DYES NO NEAREST DOSING CHAMBER: MANUFACTURER =IQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUF ACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDDYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF ROPERTV WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN , FEET FROM~'INE AIR INLET PUMP ON AND OFF) DYES ONO -NEAREST-- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of Plowing ui AMETEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until LFORCE the soil is dry enough to continue.) IN I CONVENTIONAL SYSTEM: rNTH LENGTH NO. OF IDISTR PIPE.SP ACING. COVER INSIDE DIA -PITS LIQUID BED/TRENCH rRE Es r MAr L: PIT DEPTH: DIMENSIONS n FILL DEPTH UISTH PIPE DISTR PI E OISTFi. PIPE MATERIAL. NO. DI TR NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH BELOW PIPE ` ABOVE COVER EI F F j ELEV N PIPE LINE: FEET FROM AIR INLET: NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE. JPERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BF.U DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: RED/TRENCH NIDTH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL [NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV. DIA. ELEV.' PIPES DIA.: ELEVATION AND; DISTRIBUTION INFORMATION TOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1 OYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM INE: DYES ONO DYES ONO NEAREST - Sketch System on Re in in county file f audit. Reverse Side. SIG U E. TITLE. DILHR SBD 6710 (R. 01/82) 1 , *PL V '6 7 State and County State Permit # r Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: S M 114 111 T-4901` ffrook Not H&4sm W1 ;'ILot G B. LOCATION: Section ~ T N, R li (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village ~aq~o R~~g e Township soh C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family tf"- Duplex No. of Bedrooms .3 No. of Persons D. SEPTIC TANK CAPACITY /DOU Total gallons No. of tanks 1 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete t"'- Poured-in-Place Steel Fiberglass Other (specify) New Installation L~ Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New f~ Replacement Alternate (Specify) Seepage Trench: No. of Line Ft. yllidth 'D~pth Tile depth (to~ No. of Trenches Seepage Bed: Length. 7` Width~_Depth ~Tile depth (top) 3 G No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- 17, Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the C rtified Soil Tester, / NAM E 4 04 A I', to e X 1^ ! f fcAlr '1454 4 C.S.T. # Jr (r and other information obtained from a,+1 All , life- (owner/builder). Plumber's Signature MP/MPRSW# Ad jR - 3 2- Phone 17- 31 3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E ; 3 e~ ~a z q ~ m 1 F Do Not Write in Space Below FOR COUNTY AND ST TE ARTMENT USE ONLY Date of Application Fees Paid: State it Count ate Permit IssuedIRMIMTed (date) q" --K~ Issuing Agent Name , , EA ) Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 REPORT Off, L BORINGS A-NO A8 AND, VISION HU I~ RELATIONS " w;;..STS IA. BC 9 MADISON, WI 63707 N liC.iVQ. SU i iSl NA E CO TY: OWNER'StBUYER'S NAME: AlLllqn AD IM RESS: 0( vrx S,4' /~T life r .,c+ USE DATES ORSERVA 1 ]RI ION FI MOESCRI ION esidenCe - New• ,,Qftplem 170 RATING: S= Site. suitable for systamt U- the insuitable`fo CONY NAL: UN !N-- l:E N TANK : RECOMMENDEX SYST :lopti-641 q If P " tion testsare NOT required IJ SIGN .RAT If anyportion_of the lot is intha Imo: T [~!M: : under s.H63,U9(5)1b}, ittdicara: ~ " • Floodplain> indicate Floodpleinetleyetion: PROF" 4ES6RIPTLON9 H (Pi, ELEVAT40 iIKRAATfR OF IL WI Q _T WRqW 08 sg"&Q LQF-B OCKIF. ERVED'( E .ON:9i# a O t3 ~l ' 3i. ~ ~oZ ✓d ~ • l~ir'Yi 7 S~ /C Bi". r 'I,Ui t) ~ S"• _ ~ 3 Y4P f, V, ll'4 !r-rlGitf ~,/I / t1 ' /S-^ J C's A 05h -S B_ -3 Aln, Aa m, ~ `'~"•S~ ,4 PPEl3~OL'ION TESTS DE TA WATEFUN ML I - MC NES AFF'ER.SWEtLING INTERVAL-MM. ' C P- r.7 P. ' ra L . P_ P 4 PWM1 VWW: Show IoMions of "percoiatlon-tests; soil borin>se 0W ties iManl~ns.61f suitasle won. Indicate seals ilrf:d ,,0 the`ht+N zer" and verticaE`:elevatian--reference "pcilt*4s':and show zheir}Ybbatfnn on tta'plot ptan brow surface aWmdon"tirtlit bori~•and t wand ►3atasht of land Slop: hat~ 04 6 -4- - .R f t j • ~t i e 1 r s Y s y' + 10419 l t a a 4 q~, 44 i5 r P~ f I, r undersigned, hereby -Certify. thllt the -it tests reported:on this form were made`bV me 16 socor'd with the protleduras methods specified in ilia VlFiseorlsi[// Admkvfttrative Code) and-t~•the'~.records f4 and-the;Icleatiorrof the amsts we correct to the bestjof: my knowledge and belief." TESTS . i» . ' : WERE r f COMPLEUD AMM' / TIFI£ATION R: NE R?PV y 1t ofS`~ss„r BE / f 1c f~Gr rt? > r76~2 r T`,glt_;N U >11 ftHti> . O rigfnal4aA el Amthortt ;2nd papaureau of"fllur»binff3rd poge-Property Owner, 4th page-Soil Tester. $BD-095 (N.0"1) y af" r q~.rwc s 1 ~i c wn , ' t i t - M - t T - 2 r ' e+~ 41 Ad~ ABBREU►TION1F*D SOIL. TE~r ; Sei~eparates-a~'=F~xkares ' r.r''^-= ~{~ther 9'4r►►'~ _ . ~a+ f r +tS&' e Y a8R - Bedre~€tc ,4 ar-.; ` - # !a L ~ $t ~~..7#On@ SS Sam -eob Cobble (3 W-1 grk "G LS ravel (und 'fr Urnest~~i$ 11111 A~..•~, _ i a`rse Santt~ w=" - Mes"611 Rai , med s Medium Sand tit Well t]rsited { 1 r #s Fine~iland Moderatdyx,We nod f : ~ at PO n t ~t SPD 'Se~et Is - Loamy Sand ecl~~. _ s lY.• t ry ! -s z - 0-- Loam, P door n ~T Sandy,-,Loam *i Loam :1gAf Well3: t ! i Building y f - sr _Silt ' - Grr Than Los~ Then My: scl Sandy ~ Lrl " 13n 'Brown std 4` silty.Glay. - Sandy Clay der Gy troy a _l>~y-Clay . Y v. e t o r c Clay 3 t rr` i~ " Ott~@3 s} r A i t j' y W r, s t . efine, faint `u medtturi"~ 'il i~xtu[es h . < inert , - ~ ~ waterlevel, _ ES ~~5~ _+P~zYr#`. rg ~'Vlfiat..St ;ri{t 't. { O ~ ~ pp11~~11 yp:~, •rrs t",; 'TAM t.Y+i}'T ..}b dt'Tw r ~ plYi .~R+~F'~lY1Ark s ~ " 2= .a V RP Yettlrol Refer t+i# v < : - ~ o, yy lie T. y* la-yrr~ _ ~ # ~ - e - r , . ua~9{~_~Y^ a.., + f r,i :l tx !c+ Y,zhl; e7: , t,. 4•+x2'9 Y ir`I. Y"s1'I li .2a,t 4ria".~ a_l',-:• rJ~Pt3.` i.... + . - i -'F'!r1 57RjJ.^.:yat i. n f tlj ! t ~s't`T ttFdt.,wW:. ,411 t , Je t bil rr4'a:Ck "3rtt r Lafi a~ley fit Wye G ct ( n p r eve V✓.` ~aSQMpn~ 1660 ire( u C 601^0 0 f$' opt D Lot L sae ro ~ ~ ~BnG to 0~~ ~ ~ ~~~.F !'ten c e sr> fo fQ/ n ~o I B o lie a t / / o o~ c Tv rDEP.AfRITMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION STRY, I A OR AND CC P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (1~J) MADISON, WI 53707 LOCATION: SECTION: TOWNSHIPY: OTT NO.:BLK. NO.: SU`BBDIVISION NAME: sr- '/4'/ /T N/R/7&1 s0 CW COU,,[[NTY: OWNER'S BUYER'S NA/ME: LING ADDRESS: S/'r l X t~`~P / ~'Cx~ / ~/ieEt SOrt/ r .~L dl USE DATES OBSERVA IONS MADE NO. BEDRMS.: !COMMERCIAL ES RIPTION: rS~~ PROFILE NS: PEFfCOLATION TESTS: esidence 1-3 / - /^Y New ❑ Replace I d- /1 F 42 so,. -0Qa- y~ RATING: S= Site suitable for system U= Site unsuitable for system p al g+d 9 ` Q CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYST M:loptiona ®S ❑U Z.S ❑U MS ❑U ❑S CCU ❑S ®U c6w veu. `0,_4 If Percolation Tests are NOT required DESIGN RATE: S ST M L I If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH- NUMBER DEPTH IN. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /e ` ~a of /fe %s s` Vol, 91h CAS B-.2- ,21` 03`-~lrr ,tlQ if B,,tS~ B-~ ~ ~ /Dar a a B,q .2 4 45, At c S n Bh / S ~O " !I Si J /12 " /t s B- 05 = o'' /IOa.~r 7 ~E " s a Y'• B C -S Y!2 A e" B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERiOD3 PER INCH P_ / s1" o /a .2 .2- P- S.- z " O Q ' L ' 8 P- 3'/" o o /o P- P- P_ PLAN VIEW: Show locations of percolation tests, soil borings and the dimen kn s of s it soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plan. ow the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION t p I _7 VL 'N E ,p Q E . _y.S.__.G4S _0-~T . yJ~SYGk +a 14 11 1 s fir! ee Posr _ _._n. _ _ _ Q '0 p~c ~ B/''t EL. = /aa • ToP .Cow 1, the undersigned, hereby certify that the soil tests reported on t i~ rm were male by me i accord with the procedures methods specified-in the Wisconsin Admimistrative Code, and that the data recorded and the location of th t~ s are correct to a b t of my knowledge and belief. 9 NAME (print): TESTS WERE COMPLETED ON: 70~ J92-- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 1,44, ee-1 I've-, S7, S70 CST TUBE: r DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) c 4L 1 f`t 11 i t