HomeMy WebLinkAbout040-1064-10-000
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STC - 104
AS BUILT SANITARY SYSTEM R T .
OWNER AuLs{ r5-71 LIJVC7
ADDRESS ) 3 P • 62- Z 0c e/,? ~1
SUBDIVISION / CSMJ LOT $
SECTION._j T-RW, Town of
I to. 2R. A-
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
- - -
On
AL& % 410 .
i INDICATE NORTH ARROW
i'rovide setback and elevation i nformat ion on reverse of this form-
Provide d i menu ions to cenLe: o; -apt c Lan; mani,ole cove,
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LQQ&Ws part 4PYf 14,§tTy28 .19 . 240AMIOR fit%ggf iA~tM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division .9T_ CROIX
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 199957
Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.:
IJLA TROY
ev.. Insp. BM Elev.: BM Description: Parcel Tax No.:
040-1064-10-000
TANK INFORMATION ELEVATION DATA A9300360
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Ov Benchmark /0 (0 co ~/OG
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet ,gyp
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD ._D4-.44e+"
Septic /0 f ~p~~ G 3 NA QLZQUIQ~
QD
Dosing / NA Header / Man. 7, f' ~ /
Aeration NA Dist. Pipe 770 93,j0
Holding Bot. System D J 17f a
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction estem TDH Ft
oss
Forcemain Length Dia. Dist. To well
i
SOIL ABSORPTION SYSTEM J . s XSo
BED/TRENCH Width Lengt No. Of n es PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS v DIMEN I NISETBACK
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type O CHAMBER Model Number:
System: ~s0 G l~ OR UNIT
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 Syste 0 ly x ound O ra a Systems Only
Depth Over 7Bed th Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center /Tr ench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 16.28.19.240A, NE,NE,GLOVER RD.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. S G f J
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
f
it *
DILHR SANITARY PERMIT APPLICATION
IIIIIIIIIIIIIC.e.;,,~,,,a.Z ,,o. In accord with ILHR 83.05, Wis. Adm. Code COIF
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El / b
8% x 11 inches in size. Check rlvi ono preous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
L - - '/a EY/4,S T ,N,R / E(or)(a
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
;-3 23 R a
CITY, STATE i ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE ; _rpo
t:
❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX Nu
III. BUILDING USE: (If building type is public, check all that apply)
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. TY~PPEt OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. LCI New 2.E] Replacement 3. ❑ Replacement of 4.0 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 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. A11EA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 96,5-0 ELEVATION
49, o
Feet f p, f-ef Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New listing Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App
Tanks Tanks strutted
X F]
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on hed plans.
Plumber's Name (Print): Plumb Signature: (No Stamps) M MPRSW Business Phone Number:
/r F
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTYIDEPARTME T USE ONLY
p Disapproved Sanit ry Permit Fee (Includes Groundwater Ic e ssue Issuing Agen i )
Approved ❑ Owner Given Initial 4" ` o(f urcharge Fee)
Adverse Determinati n JJjjjj"' JVU - ~ -
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
1. A sanitary permit is valid for two (2) years.
2. 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.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in :;wnership 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 ~tlr't~nk a) must be pun!ped k!yzRi tensed
pumper whenever necessary, usually every 2 to years.
6. If you have questions concerning your onsite sewage syt tern, contact your local-code administrator or the
State of Wisconsin, Safety & 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 Dwell;ng.
III. Building use. It 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, •econnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information request--d In ##1-7.
Vli. Tank nformation. F„i in he rapacity of ev~r,, new and/or exist;-,., !-ik, list the total gallor5 -!urrt:er of
tanks and rnanufacturer's narne. Indicate prefab or site constru.s:ed 4nc3 tank n-talerial. Corni lete- for all
septic, pump/siphon and holding tanks to' the S System. Check ex,:. mental ~,r proval on , if ?anks received
experin-!,_,ntal product approval from DII-h-,"
VIII. Responsibility statement. Installing plunw,s r is to fill in name ~ss;•.- :e -.tuber with appfo,16r-,1e prefix (e.g.
MP, etc.), address and phone number. Phu ber must sign form.
IX. Countyi Department Use Only.
X. County/'Department Use Only.
Comp'r ps .i, . and specifications not naller than 8Y2 x I ;o_• t be submitted in th- cotmty. The
Plans Hill ' or.l: de the following: A pi .-an. drawn to sc :.;o ;plete d r- cn!:, r 16 ocation of
holding to ;eptic tank(s) or other tt rr, tacks; bU elEs; wate xater service;
streams a)0 i:ikes; pump or siphon tanint,; distribution boxe system
ar ;as. and the- -ocatit,n of the building horizontal arc, Pei It";
C) complete pecl;t€cations for pumps and controls; dose vo!!Vw,;, -.6 differences; friction loss; pump
performance curve; rump model and purnp manufacturer; D) ce oss :sec ':ion of the soil a t sorption system if
required by the county; E) soil test data on a 115 form; and F) ali sizing information.
GROUNDWATER SURCHARGE
1983 Wiscor:sin Act 410 included the creation of surcharges (fees) for a number of
regulated practices wh;ch can effect groundwater.
The monies collected through these surcharges ar=I. used for monltori iu :_1"a =dv,,ater, gra y" j-
water contamination investigations and establishnient-of standards.
SBD-6398 (R.11/88)
?o a,P•l,.r~,~ ,Q&'l-040A 7- ft
t Wiseonsin oapertnent of industry, SOIL AND SITE EVALUATION REPORT Pape ~ of Z'
tabor end Human Relations
DWiWon of Safety 6 e"Idings in accord with IL.HR 83.05, Wis. Adm. Code
COUNTY
T
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference pant (BM), direction and % of slope, scale or PARCEL I.D. ft
dimensioned, north arrow, and location and dlstanoo to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER 6~'STL v-,vQ PROPERTY LOCATION
GOVT. LOT,v % 1/4 NE-114,S 16 T lg N,R I? E (c WW
PROPERTY OWNEFIr S MAILING ADDRESS /..IV LOT fl BLOCK ff UBB. NAME r o,= O Cy'7 i ~ s
6577 i3 Nr Rte-- f~ y
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (N NEAREST ROAD
pSo W/ SYol v ( his) 3,P6 - 60 s'2- IW,9 Gio Pe-R 577-t7,,VA-)
(y'-Nsw Construction Use (rfResidentlal / Number of bedrooms y Addition lo existing building
I I Replacement (1 Public or commercial describe
Code derived daily Dow 6000 gpd Recommended design loading rate i bed, gpW ~ Q' trench, gptt/ft2
Absorption area required 8S7 bed, ft2 7s -O trench, ft2 Ma)dmum design loading rate , 7 bed, gpd* '0' trench, gpdAt2
Recomnw4ed infittration surface elevation(s) Pa Z ft (as referred to site plan bendtmarp
Additional design / site considerations ~'sE 7.~EucuFS ov S/ w~' O,~°vja ~D x OrSTzi °i,~fOT~o.J
Parent material ScS $2 - $v f?k- 4WP7- - IA'rre-P Flood plain elevation, J applicable yam-- 1
S - Suitable for System cONVENnow MOUND NfGROUND PRESSURE TAT-GRADE SYSTM N FILL HOLDING TAN(
U- Unsuit" for tern Ca l~ O U O S 2 04-0 u O S ~T ae-0 u 05 M.J
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Woes Texture Structure GOfNislarm Boundaly Roots GPD
in. Munsell Qu. SZ. Corti Color Gr. Sz. Sh. Bed Iendt
0-7 /o X Y Z-) S/ :2f, sh& .mot fie S Z-~ , S^
7 7 0 s/ Z,~, s~,e s l f. s .
Grotxtd C, 119-2,g 7,57 YR 3y 4 v12 CS • ? , S
p1/ 70 f. cL 1f-yo /O yle y~ - S , s ~r-~ - - . 7 •4
Deo to
limiting
factor
Remarks:
Boring y 2,f 56~ fie s Z,~ . S .
/3, yx
#Mon
13 aS i Np =N
1- 11 /o Yle S/6 S / f s*-
Gfound
_q /o yip
y 00
$3 . so It.
to
limiting
factor „
Remarks: _
FTNanie.-Plene Print Phone: 7ir 3 Pao SIRS
"I e: Date: CST Number:
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STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER )OAULg 4nC +E ®/1ll ES/ L G1,i 0
ROUTE/BOX NUMBER 3 93 CJ`L(Jaa~e ~ FIRE NO. 393
CITY/STATE LaoD 'D /I( 601" ZIP ,Syal z
PROPERTY LOCATION: 1/9 X1/4, Section %2.? R_-/~?W,
Town of Tko St. Croix County,
Subdivision Lot No. AIA
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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
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 Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
C~~
SIGNED
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
APPLICATION FOR SANITARY PERMIT
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), 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 _ P44FLA- 2 1J~ lrC~le 5 &AI-1-7
Location of property _Q 1/9 1/9, Section , T ~N-R 9 W
Township
Mailing address 39/3 Gz-DUt=f.~z2
r
SQ N Cf~o ,5
Address of site 303 Z, ale2
Subdivision name XIA
J
Lot number X
Previous owner of property ~QirLL- 11A,1-J, 0A/
Total size of parcel,
~_'i4C/lE S
Date parcel was created
Are all corners and lot lines identifiable? x_Yes No
Is this property being developed for resale (spec house)? Yes _N0
Volume 9.2et 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 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 Office of
the County Register of Deeds as Document No. '-1967T-1 ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in he Office
of the County Register of ds, as Document No.
Sig ature of Owner Sign t re of Co-Owner able)
Date of Signature Date of Signature
TFIIS SPACE RESERVED FOR RECORDING DATA
DOCUMENT NO. WARRANTY DEED
STATE BAR OF WISCONSIN FORM 2 - 1982
4907`2
CO., REGISTER'S OPFICE
~
Myrtle A. Hanson a/k/a Myrtle Augusta sr. cCROiX ROIX
Hanson, a single person
0 G T 2for Rocord
91992
.
I _ - - . at 10.0 A.
C011VU S and warrants to -.-Paula J. Estlund and Gregory
_ - -.......Est.lun.d,,._.hu-sband___and_wif.h--------- _
- - - - - - - Reyisterof Deeds
RETURN l"O
_
the following described real estate in St..-_.Cr_Q1X .............County,
State of Wisconsin:
Tax Parcel No:
A parcel of land located in part of the SE1/4 of the SE 1/4
and part of the SW1/4 of the SE1/4 of Section 9 and in part of the
NE1/4 of the NE1/4 and part of the NW1/4 of the NE1/4 of Section
16, all in Township 28 North, Range 19 West, Town of Troy, St.
Croix County, Wisconsin; further described as follows: Beginning
at the SE corner of said Section 9; thence N89'41'59"W, along the
south line of the SE1/4 of the SE1/4 of said Section 9, 600.00
feet; thence SO1' 16'25"W, along the west line of Certified Survey
Map recorded in Volume 11711, Page 2084 at the St. Croix County
!i Register of Deeds Office, 1299.76 feet; thence N48'46140"W, along
the northeasterly line of Certified Survey Map recorded in Volume
"3", Page 796 at said office, 1304.30 feet to a point on a 1253.00
foot radius curve concave southwesterly, whose central angle
measures 4'40'3711, whose chord bears N40'21139.5"W and measures
I' 102.25 feet, said point also being on the northerly right-of-way of
I!, a town road (Glover Road); thence northwesterly along the arc of
li said curve and said right-of-way 102.28 feet; thence N49'45'58"E,
~I along the east line of a parcel of land recorded in Volume "840",
Page 27 at said office, 45.67 feet; thence N23'1711811E, along the
li east line of said parcel, 367.12 feet; thence N5515715111E, along
~I the east line of said parcel, 218.66 feet; thence N29'14148"E, along
the east line of said parcel 383.30 feet; thence N0102011811E, along
east line ofho e: ~rcel, 845.58 feet; thence 589'37118"E, along
d it perty.
) the north line of the SE1/4 of the SE1/4 f
(i~)S (ip - ~ . ~l - -
said Section 9, 1132.19 feet; thence
II, Exception to warranties: SOl' 04' 02"W, along the east line of the
easements, restrictions, SE1/4 of the SE1/4 of said Section 9,
and rights-of-way of 1302.77 feet to the point of beginning.
cord, if any. October I9__
Dated trll p day of
- - (LA)
----.-(SEAL)
rtle A. Hanson a/k/a Myrtle
ugusta Hanson '
--------------------(SEAL) "--(SEAL) 'FEE
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
SS.
- - St . CrO1X County.
authenticated this day of___________________________ 19 Pers nall carne before' 1J the above named
October
My ---rtle
M y _r-7E_1_& -•A -
: Manson a/k a
-
~liigizsta--Hanson
TIT ITLE: MEMBER STATE BAR OF WISCONSIN
(fnot, - - - - - - - -
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
f x•c •oi Ig instrun ,n and ackn wle lge the same.
I
I ~
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland
I ttorney at i,aw Alice Joy on rs
-
ro1.x
St-. - County, Wis.
Notary Public -
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (ky9t, ftcbon
are not necessary.) date July 1-2 )Votary --pu6ji?3-.)
I
_ - Wisconsin-
Starlelvf -
'Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE , nAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
ri`rt 1Vt N<, 2 - I:ist Milwaukee, Wisconsin
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S U I C-AND---SITE -E VA Cq ATT O N REPORT Page of 3
- Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
if'0~.~
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST e
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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION6- REVIEWED BY DATE
r
s1; PROPERTY OWNER: PROPERTY LOCATION
p,9lJG~ ~S j"L (/,r, v GOVT. LOT N 114 NE 1/4,S 14 T 1( N,R E (or) W
PROPERgTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
CAS 13,q A-, -,4 .4 4v ,P a 4r7 -'r- 4e-teS
CITY, STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE MOWN NEAREST ROAD
r uQ.So •v G~J/S . l7rS)3~l - ~aD.~L T.~o ~rioot7P rT7Tio.~[~'] New Construction Use [ ] Residential / Number of bedrooms 3 7~) Addition to existing
building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate / bed, gpolft2 trench, gpdA1-
Absorption area required X' bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2-ftertch, gpolft2
Recommended infiltration surface elevation(s) 511 P 3 It (as referred to site plan benchmark)
Additional design / site considerations i- Slo S
Parent material x5 b~Z - ~UR~ti~,rvT S - /~'ITEy ov~,,f~, Flood plain elevation, if applicable it
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
' U = Unsuitable fors stem o s ❑ U ❑ S ®U 2S ❑ U as 0 U ❑ S MU ❑ S aU
~~'e4!15v'vF SIO^S SOIL DESCRIPTION REPORT -5 OAe5
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed rerxil
1% O- oY~ z 371 3 ,m ~ S
.4~
Ground G " 7,5 Y~ L n,~ , Q S U f , ? .
elev.
jtv la le
17
Depth to
limiting
factor n r Th S teSt I
ysterr 14
y -
Remarks:
Boring #
2- y io ye Ys-
-5 4/
Ground
elev
Depth to
limiting
l fact
Remarks:
CST Name: Please Print Phone: 7/s-7-
-
HOMESITE SEPTIC PLUMBING CO.
Address: 655 O'NEIL RD., HUDSON, WIS. 54016
CSZNumber:
Signature: VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
f Date: l y f2-
~f~Z
i0PERTYOWNER 571-16uO SOIL DESCRIPTION REPORT -
PARCEL I.D. ~/7.9GilS - G/OUP S~- Page _'of
a
Boring # Horizon Depth Dominant Color Mottles Structure
in. Munsell Qu. Sz. Cont. Color Texture Consistence GPD/ft
Gr. Sz. Sh. Y Roots
0 /o y,~ y 2- s~ s~C Bed Trench C,57 2
30 /0 YIV
si f 5
2
6,~
Ground /J 30-,~(P ~v yR S/21-1
elev. ~S 0/,", ~y ft. C d /id Io/le s/ s- p
II Depth to '
i limiting
factor ,r
Remarks:
Boring #
sd,CS Gs 3 f
Ground Sk< ~yrl-f * eS 2f S
elev. G z/ •
y l~• ft
Depth to
limiting - i
factor N
' Remarks: i
Boring #
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