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020-1157-70-000
o 3' O o 00 °cn p °En I m I oo ao a~ a> 0 0 c o I i o ~ I I > ca N tl N 0) U tl O f6 N N O Q) ~ ~ II LD w 0 M C N .N., O m O E C z 3 C Z Q L L m r LL C LL O O aL w O N N p -O Q .'C.. Q N (7 M r N z z ;b rnwl'I E E cn O O am am N F- (n C C7 O Z :!t C c (D C> E E N N 'a O N N N N 7 ~ d 7 7 cm C3 (D (~'►,V^r/ l6 N j N O d d N U W N N •^i d L CL U r- O c a O C O O Z 00 Z Z F- Z N - I' ° > LO y - d _ d (D cn > N d N N y d N T boa m b o a a r N a co NO a LL •N Oa a s = a 0a a co N a~ CL 7 O N J J N N fA J V rn Z p 0)0)0)0) 0 -0 LO (D r- m w m N d 0 0 tt: 0 0 0 0 0 0 0 0 0 O N N N N N N N N o v o 0 0 On o0 ccl co co w r o co c o m y c a v v v r~ v v v aN~o cn Lm U (D v Q U) m p _d Q z U) U) a) ~ 3 ~ I ~ U I ICI .s C O O O N C y O U O C C E CO V' f- co O O_ N O C U O C N ~G~+ co 3 N N a C N N Q. O. u a 0) 0 0 0 0 0 0 0 0 1 co 0 U i~ ^ O C O V) E O N E E N N N N N N N Q O) ` .O-. C C Q1 00 N co 00 W f- w D U s U o cO LOw D v v v ch N a) (D C, c q) 7 N O N E O N r O N E E 5 U • O N = o O Z N 47 Z O z 2 "7 Cn E rn A m a y as • a EL a a R) y c y c r A c°) as O D 0 0 vii C) i AS BUILT SANITARY SYSTEM REPORT OWNER 4-~~ TOWNSHIP SECTION T_ 7 N-RZW ADDRESS sG/K~fi• 5/~ax. SYo~~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT:LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM b ~ f ~n 2 XW 9 3, r1, l~ ~~9Yg 3 74 sw ro r K w, U~ INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: fir/! ~S Liquid Cap. Rings used: 0 Manhole cover elev: ~OeFinal grade elev: 2V 8 Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front; Side Rear Ft.~ From nearest prop. line:Front Side , Rear Ft. 160 ~ No. of feet from: Well '9 , Building: 5 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side._, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: L,'~ Seepage Pit: Width: Length 1Y -Number of Lines: Area Built &0 Exist. Grade Elev. ZX.oe Proposed Final Grade Elev. -W-D ` Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear~Ft.)-~ No. feet from well: Al No. feet from building ffaffo y7` HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: ` DATE : PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj LOCATION: HUDSON 26.29.19.884,SW,SE, MEADOW LANE, LOT 24 Wisconsin Ddpartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENb AL INFORMATION - 171440 Permit Holder's Name: ❑ City ❑ Village)] Town of: State Plan ID No.: DELTA CONSTRUCTION CO HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020115770000 TANK INFORMATION ELEVATION DATA A9200205(9165 2_ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark 1,3, 9, ep, !/1> Dosi Aeration Bldg. Sewer 96, ; 73 Holding St/ t Inlet , Q TANK SETBACK INFORMATION St/ Outlet S 03~ 950.3 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic a~l ' -5 ` r1A NA Dt Bottom Do NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade P ~u,~-rte 3. , tTDH Demand 6o,o°s.7.. Number GPM Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Lerig$h i No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 U (0 DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO. P/L BLDG WELL LAKE/STREAM INFORMATION Type O C_on CHAMBER Moe Number: System: eye OR UNIT DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent To Air Intake Header /Manifold ~ Distribution Pipe(s)~ Length Dia Length~~f Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over „ Depth Over 22 i/ xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed / Trench Edges ~ - 3~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) -7.Z(i 8.57 6. 9S J Z 1 IF ~.s2 3 7,11 1 7. g ' Plan revision required? ❑ Yes' III O Use other side for additional information. (p 5=~~ N d/ SBD-6710 (R 05/91) Date inspector's Signatur Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: . " SANITARY PERMIT APPLICATION A In accord with ILHR 83.05, Wis. Adm. Code couN STATE SAN RY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / ~ 8% X 11 inches in size. Ch f r visio to revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P PERTY OWNE PROPERTY LOCATION T ,N,R / E(or _AeA =54dr_Z:a~ - PROPERTY OWNER'S MAILING A RESS LOT # BLOCK # B MAO CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR CSM N MBER s cv 11. TYPE OF BUILDING: (Check one CITY NEAREST RO ) El A State Owned VILLAGE : f e ❑ Public 1V 1 or 2 Fam. Dwelling of bedrooms Z_ PARCEL TAX NUMBEK(S) III. BUILDING USE: (If building type is public, check all that apply) G 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 40 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 in line A. Check line B if applicable) A) 1. EiINew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 E §eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 1Weepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure / - 43 ❑ Vault Privy 14 ❑ System-in-Fill $t c ~'t~ r ~GS"fY~' J t 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) 2.90 A(~r / 4.2 ELEVATION rD A1719 • S'~O W1. 41 * 3 Feet 509,,V Feet VII. TANK CAPACITY Site INFORMATION in gallons Total of Manufacturer's Prefab. Fiber- Exper. New Fisting Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber F-1 El 1:1 El I [I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. tier's Name (Print): mbe aAP/MPRSW No.: Business Phone Number: ® 3 z A: s6 Plumber's Address ( tr 10;~~ S eZi Cde): ,Mjk / D 01 IX. C U TY/DEPART MENT USE LY ❑ Disapproved Sagjtary Permit Fee (Includes Groundwater [Date Issued Issuing Ag t Signa a (No S ps Approved ❑ Owner Given Initial urcharge Fee) Adverse Determination 2L ZLCf~ X. CONDITIONS OF APPROVAL/REASONS FOR ISAPP OVAL: & ol,~~ SBD-6398 (formerly Pib-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 sanitar* 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 ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SEC) 6399; to be _,submitted.to the county prior to installation. ! 5. bnsite sewage systemSrmusttr6properly'maintained. The septic tank(s) must be'putripedby a'Tidensed r` purnper whenever necessary, usually every 2 to 3 Years. W-1 K, 6. If you have questions concerning your onsite sewage system, contact your local code administrati?r or'tfYe - y State of Wisconsin, Safety & Buildings Division, 606-266-3815. To be complete and accurate this sqnitarx.. ermit 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 in - led. 30 II. Type ~of building `being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Builcing 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 ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Corno ete for all septic, pump' /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber 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% 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), septi6.`tank(s) or other treatmerlt,4.anks;, building sewers; wells; water mainsfwater service; 'strearhs s}hdlakes; pump or siphonlanks; distributlbn 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 performanill~curve; pump model and pump manufacturer; D) cross section of the soil absorption system if ;,-required by t4e_rpunty; E)spijtest data on a'1,154orrn; and F) all st',ing information:, - - - - - - - - - - - - - - - - - - - - - GhOUN OWATEIWSURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through $hese surcharges are used for monitoring groundwater, ground- Wdt(Err contamination investigations and establishment of standards. % SBD-6398 (R.11/88) 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 Location of property SL.cJ 1/4 S 1/4, Section , T 7-7 N-R ~9 W Township, fN / Mailing address Z O Address of site Subdivision name Lot number Previous owner of property Total size of parcel Ley Date parcel was created Are all corners and lot lines identifiable? X_Yes No Is this property being developed for resale (spec house)? -Yes No 77 - Volume Rand 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 warranf- deed recorded in the Office of the County Register of Deeds as Document No^~ 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 the Office of th County egi ter of Deeds, as Document No. SZL:f 42 Signature f wnei Signature of Co-Owner (If Applicable) 7-/a-G?/ Date of Signature Date of Signature i' • i j' DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA i STATE BAR OF WISCONSIN FORM 2 -1982 471576 , ~PA6E 25 - - - REGISTER'S OFFICE ii GLENN and VYCELLA M. WAXON, husband and wife ST. CROIX C04V I I; Recd for Record Grantors, JUL 171991 conveys and warrants to -DELTA. CONSTRUCTION COMPANY-, . of 8: 30 A. M I /J it a..Minnesota..norporation.,... s~ I ~'JC. ~ 11 Grantee...... - ' Regiaterof Deedil RETURN TO i the following described real estate in ._....St. Croix County, State of Wisconsin: ~i Tax Parcel No:.15.2.0 ...~.Z I I Lot 24, High Meadows II, Town of Hudson, St. Croix County, Wisconsin. TOGETHER WITH and SUBJECT TO easements, reservations, restrictions and rights-of-way of record, if any. I Amnum PEE u i,. !j li I~ ~i This ....is not homestead property. (is) (is not) i it I it Dated this . ~5 day of 199.1... (SEAL) ' ---......(SEAL) Waxon 4G ii C~.... (SEAL) (SEAL) ~.LU . . . . . . . Vcella M. Waxon y 'I AUTHENTICATION ACKNOWLEDGMENT i Signature(s) STATE OF WISCONSIN i St. Croix I~ County. authenticated this ........day of 19...... Personally came before me this .T5.,51ca,..day of 7'. 19.91... the above named Glenn Waxon ~nd Vycells M'Waxon husband- and_wife----------------••-•-••--•--•--•.....------_.. TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by § 708.08, Wis. Stats.) s it to me known to be the person who executed the foregoing instrument and acknowledge the some. THIS INSTRUMENT WAS DRAFTED BY j Barry C. Lundeen, Attorney • I Hudson,--Wisconsin.-54016 Notary Public St. Croix - - County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) ''ZA date: .....................D 19.1.5..) -Names of persons signing in any capacity should be typed or printed below their signatures. ~l'4RT14 VTV t1 T•n'1 -rnrc -•nn nc r,. ft SEPTIC TANK MAINTENANCE AGREEtIENT r St. Croix County OWNER/ BUYER / J_ e' /j w /V o NUMBER ' D Fire Number0 ROUTE/BOX r CITY/.STATE ZIP n ~ 09 PROPERTY LOCATION: Section T N , R W Town of 74;~ud6 6) A) St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licens*ed* 's'e' t'ic tank pumper. the system can a ect the Function o, the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents•mn be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whi.c 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 .s s~tems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- 30fdayssludge apthan 1/3 proximatelyfull priordtoc~• essary), the septic~ill kbe ssentless Certification form three year-expiration. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- ment of Natural Reso5~ceC~oixCertification Zoningform Officemust withinm30edays~ a and returned to the of the three year expiration.date. 1 4 SIGNED A DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. ~gPAFiTNY OF REPORT ON SOIL' BORINGS AND SAFETY & BUILDINGS IhDUS'fRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 ON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: R TOWNSHIP/LOT NO.: BLK. NO.: SUBDIVISION NAME: ~lP sJ '/4 '/4 ip /T~9N/R qE (or z~- 17 COUNTY: OWNER'S/BEER-S-PIANf€: MAILING ADD ESS: DATES OBSERVATIONS MADE USE PROFIL D SCRIPTIONS: ER OLATtON TESTS: NO. BEDRMS.: FCOMM'EiFilAL DESCRIPTION: ~esidenca 3 ew ❑Replace ? 2 RATING: S= Site suitable for system U= Site unsuitable for system / r ONVENTIONAL: MOUND: ~ jIN-GROUND-PRESSURE:JS1ITE -INa-FILLHO~LDING T~ : RECOMMEUN/DED SYSTEM: (optional) EOS If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS S - - ~S Pc K BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATIOND OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Sy-/oG hCS'Ulf dc , ~04 ,Opt C ;:1 ~l'- S8'd~'n rhs a~sf-9P !3n M+s• B ? c!~ , 7 ~dN t s 0 IS/ w c - .ns w z- "G ssr'~ B- A,////11 e > n m B- W/>1 C > //O - O S B - D ' in B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER P- / 9 c 3yn° , 5- P- 2 D o P_ Z ~n P- r P- P- 'An 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. f'3, y W -3 yz,9' =Si SYSTEM ELEVATION E E E Ica / ` _ _ - yo s ~~r 4ls a~ e©d. f1 _ _ / _ r _ r, , n r I " ~Sav sac _z~ P 17-3 E 13 N r ~ E , Lei r sL u iS._ l ocu'117 lo.~:l. AIP, _ . .{2 toC' p P ING G/H n ~K<7 t/ . Ca • %Ja j~~ ~f>'~ o~ T' i n~hs~s, d/ lu ~ n~ n, r c~ q I, the undersigned, hereby certify t45at the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: DAVE FOGERTY PLUMBING 5 s rL at PIUM,00F ADDRESS: License ar es CERTIFICATION UMBER: PHONE NUMBER (optional): #3233 #3289 R0j S, WISCONSIN 54023 CST SI NATURE~_ Phone 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - r t s rt. E t TO THE i O 4 M a 3 ~ ~ M ~ - 2 3 k N dG Ai ° # J.OMNtoo d. - -V a IL Ozm ul. 1 LL. r i ~4 1 Lin 3 h n y r v w ~ F a za iR N s i j I REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 4 06/64/9.2 16:27 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 5/92 AREA: JT Activity: A9200205 6/ 5/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 26.29.19.884,SW,SE, MEADOW LANE, LOT 24 Parcel: 020-1157-70-000 Occ: Use: Description: 171440 Applicant: DELTA CONSTRUCTION CO Phone: Owner: DELTA CONSTRUCTION CO Phone: Contractor: FOGERTY, DAVID Phone: 715-749-3656 Inspection Request Information..... Requestor: DAVE FOGERTY Phone: Req Time: 15:06 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION 0 -.0 00 co~ 1 c 3 h. > > o • s ~ to 0 5 3 3 - r1 C t~D 01 N j ~ ^ a m CD to o o j ai o o N o ao m a_ m d 3 3 m 0 3 3 v 0 ao 's N N N ' -4 Q 'O 'p N 10 . O - 00 v O O O CO C1 N M CD p f7 ~C A' O A7 co °g a a) m>> o a o C) N p 3 fA p O N N M -4 1 J m u)~D m a° v~z> ' 4°I. m co y co a m D m CD CD CD M 3 rn rn o O o A m cp0 co m o co m N 0 Cl) N N N 3 O• C !\i C z 000 0 000000 0 -n ca N cc ul N CD A co cc CO) CA h ~p N CD lD W O CD a m 1 3 M = N o I D m° D a 0 0 CD CD CD CD Cl) Cl) I CD c v CD C CD CD a N 1 CD `(D N. C fD cc a a W fD fD I ° 3 m -1 tN o a n A G j (p N A ~ co U) m CD vii Z tan Z CD (D A W CO I 1 CD a E N a 1 rt o o Q 1 Cb z a y f o a (D N N y ] N II o 1 ~ c Co y y N a O CD 4 CCD D y G v n s ON I ~ N O j a o 1 m 1 ct ~Fuq O <n O r I o ~ ° f o °o o. °o Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ay and Buildings Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Lot 24 Sanitary Permit No.: 149121 Permit Holder's Name: City ❑ Villag KI Town of: a State Plan ID No.: Delta Construction Hudson CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 884 TANK INFORMATION ELEVATION DATA Aq (p0 2.9$ 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. vent to ROAD Dt Inlet Airlntake Septic NA Dt Bottom Dosing Header / Man. Aeration Holding PUMP/ SIPHON INFORMATION Manufacturer Model Number TDH Lift Loss 3yste0 I I Forcemain Length SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt its Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO CHING Manu acturer. SETBACK INFORMATION Type O 4MBER Mo a umber: System: 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 Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t SANITARY PERMIT APPLICATION , 121103 s,HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY CEO X - aawm~ns - aesr,we.A,a.awnna~,..vat • STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ,(~IQ' J 8% x 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. C, 0 PROPERTY LOCATION Q PROPS TY O N R ~ )6/J w %4J~- Y4,S~ T~. IN,R E(0 PROPERTY OWNER'S MAILING ADDRESS LOT # , ` BLOCK # U 5ec_ 6 S~ y CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION,NAME OR CSM NUMBER t~kk S 61 eA 0 r_j :j II. TYPE OF BUILDING: (Check one) CITY NEAR ST ROAD r] State Owned VILLAGE : ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PA E AX MB III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo F94 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.-aNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E1 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,USeepage Bed 21 ❑ Mound 300 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 INFORMATI I. 1. GALLONS PER DAY 2. ABSORP. AR h~R-p►RFA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq Oq. ft.) (Gals/day/sq. ft.) (Min./inch) 4 ELEVATION YS 0S 05 ~3 1 a Feet Feet VII. TANK CAPACITY Site Fiber- Exper. in allons Total # of refab. INFORMATION New istin Gallons Tanks Manufacturer's Name P oncret Con- Steel glass Plastic App structed I Tanks Tanks Septic Tank or Holdin Tank _ b Q U K) 77- F1 --m- I D El Lift Pump Tank/Si hon Chamber Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: eesf,k /)'V-. &5u 6 I 38t~-9o~a Plumber's Address (Street, City, Stat , Zip Code): 108 ,l61,eA15-6 N St )oX ~bSvti )Sc 0 Cn IX. COUNTY/DEPARTMENT USE ONLY Issuing A nt Signature (No Stam ) ❑ Disapproved S itary Permit Fee (Includes Groundwater ate Issue rcharge Fee) Q Approved ❑ Owner Given Initial 7 Adverse Determination 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; umber INSTRUCTIONS 1. A_sanitary, permit is valid for two (2) years. + 2. Yc ur 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 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 & 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 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 ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber 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% 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 tankks; 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R. 11/88) < DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN„ RELATIONS N WI 53707 - (ILHR 83.09(1) & Chapter 145) V ION: SECT)ON: LOT NO.:BLK. NO.: SUB (VISION NAM /a /Tzq N/R 10(or a y CO TY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ~r~ e a c~ 1j'5 2 ; o - ~S 5o42 167 - 510/6 74 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI 'E DESCRIPTIONS: IPERCOLMT19N TESTS: XNesidence ;RN.w ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S DU ❑ S U LAS ❑U ❑ S C9U ❑ S illd.y If Percolation Tests are NOT required DESIGN RATE: J If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C:: Floodplain, indicate Floodplain elevation: /v PROFILE DESCRIPTIONS BORING TOTAL t DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKN'SS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVE (SEE A BRV. ON BACK.) B- `7, SYl /✓~nc. 8 Q"g ' o B~. y2 Q., 1~ S. b7 ' ~S B- 5' 6. 6 Fr B- 5 75 [ Z. 7r° b. 7s Sf ~r~ 37 i 7 • ~~n S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER laP@"&S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH /L 3 o > P- o' /0 9 3 P- 3, 33 P_ P- P- 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. SYSTEM ELEVATIO 3 ~ 3 . E f w- a F a E r 1! SL9 rC i'"or ' N j 41 6,k 3 sal . q. F I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS ERE OMPLETED ON: d-11 ADDRESS. f/i U CE IFIC TION NUMBER: PHONE NUMBER (optional): /L~y ~cce S~ tiPS~ S/°/< Boris ~8`r 6 ~3j CST SIG DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - T INSTRUCTIONS FOR COMPLETING FORM 115 - RD - 5335 To be a complete and accurate sail test:, your report must include. 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM ncr-b, ri' t,==droorTis or comrrrercial use plarirred; 4. Is this a new --mt system; S, Complete fl ~ ng boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTIAL:i RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE u, ~ abbreviations sh£ . re for writing profile descriptions and completing the plot plan; 7, MAKE A L "TLE diagram i,:: !y locating your test locations. Drawing to scale is preferred. A separ<, n ry be used if 6 8. Make sun z=enchrirark and it elevation reference point are clearly shown, and are permanent; 9. Complete appropriate boxes as :o dates, names, addresses, flood plain data, percolation test exemp- tion, it appropriate; 10, If the information (such as flood hl„in, elevation) does not apply, place N,A. it) the appropriate box; 11- Sign the form and place your cu; t address and your certification number; 12- Make lec"1, copies and di ° as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL ~ "'BIT"Y WITHIN DAYS OF COMPLETI-ON- A, .-VIATIONS FOR CERTI SOIL TESTERS Soil S -id Textures Oth(-- Symbols st - m ~r 1B"1 B - ;k 3 1011) dstone gr J (under 3") L ; Limestone F1' High Ground;seater )d Percolation Rate sand Well Btn BI y y" I F sic! _ YrClt ttles sr., w with sic - S.. Clay ff l _ few, fine, fai, .k£: - C.., ai cc common, { pt F' . nirn Many, mec, r m IM", r, (I - distinct p prorninent. fAWL High water' u €aene it textu surfs -e sp BM - Bench Mar VRP Vertical € eference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. J f? Q.L. 67PL OTA N 1) I~~ 0 SS5 _..I ON N AM E_ 0-,, MA Co NAM L Er.//.7117 OCAT ION )0 DATF • l Ad,AczN f lot, ArLt f44 y ale, No's-e ' (fie 11 /15 r~~ la pN ' 6cor►, ecWt,,, of 5 ~ 1411 Stec) Rare '1114 d g ~ X - Ra c O1 s z - _i • ev 10 Sec~Na7zrt o lay 6r'1 ! P3►c 03 3 pa !9 Slcpe L3 3cn2ooM ~ t1 or+~x FRESH AI1: INLETSrAND OBSERVATION PIKE C1t0SS SECTION ..Approved Vent Cap Minimum 12" Above Final _._Gr~Cr' _ 7 a 4" Cast Iron Above Pipe Vent Pipe To Final Grade Marsh flay Or Synthetic Coveri. ng Min. 2" Aggr_cgIl-il Over Pipe -,I Distribution Tee Pipe Aggregate ~n Per•f.orated' Pipe Below Bencath Pipe mot- Coupling Terminating P Bottom of System t by Wisconsin Department o Regulation an 'tensing wisconsm'.eKa.--in -'(optional use date) 3-1-88 (mandatory use date) I Milwaukee. Wis. WB-13 VACANT LAND OFFER TQ PUR HASE 1 t✓AJ Wisconsin . 19.1. ' 2 THE BROKER DRAFTING THIS OFFER IS THE AGENT OF (SELLER) (fffzJXFdtUS.trike as applicable).' 3 IF ACCEPTED, THIS OFFER CAN CREATE A LEGALLY ENFORCEABLE CONTRACT. BOTH PARTIES 4 SHOULD READ THIS DOCUMENT CAREFULLY AND UNDERSTAND IT BEFORE SIGNING. 5 The undersigned Buyer, ba:m v~. ,S~" .G-T'►. l!aF,~.... jl l`1.. , 6 hereby offers to p rchase the pro erty known as (Street Address) /~.T• : / ~~vN~ ' ' ' ' ' 7 in the' ! -}a of I.?'..........: , County of ........~`T...: t . 1 } Wisconsin, 8 more particularly described as: 9 PC 10 11 at the price of: S,LJ4 ."T!"?}li1~l: }J.. )jf:~kx ..Itl.t~:•.AL.I~n4 Dollars ($•ro~~r• :X.Q...) 12 and on the terms and conditions as follows: 13 Earnest money of $ t.- TPO........ in the form of . ~r,~ i. . . • • • • • • • • tendered with this offer. Additional earnest 14 money of $ in the form of to be paid within . days of acceptance of this offer or 15 , • • • , , • and the balance in cash at closing. 16 Failure of Buyer to make earnest money payments as provided voids.offer at Seller's option. Earnesl_money, if held by broker, 17 shall be held in selling broker's trust account prior to acceptance of offer and thereafter in listi>hg broker's trust account or until 18 applied to the purchase price at closing or disbursed as provided herein or permitted by law. 19 TIME IS OF THE ESSENCE AS TO: ADDITIONAL EARNEST MONEY PAYMENT, ACCEPTANCE, LEGAL POSSESSION, 20 OCCUPANCY, DATE OF CLOSING AND AS TO ALL. DATES INSERTED IN THIS OFFER XCEPT: , . 22 THE BUYER'S OBLIGATION TO CONCLUDE THIS TRANSACTION IS CONDITIONED UPON THE CONSUMMATION 23 OF THE FOLLOWING: 24 (If this offer is subject to financing, survey, percolation test, specific zoning or use, approval of recorded building and use 25 restrictions and covena Is, or any other contingency, it must be stated here. If none, so state.) 26 27 ~:.~`r..j.t:..~:`14`Jir~ . : ' 28 _ 29 `t~...,f~/. ! f ":•!A, l+.i tom. Ji t )it~ jl.°71~.r ',1 ^ Cx:L~"" 30 n Cc `i }r~.. 1C.`~' / r7f`~... C`~.'.1.,~... a4~C!1 r. ~r?.~ -?..1(7'".~►1i`1i:f`~.Gr.../`IJ.:~r /t ~.t.g.,T 31 /.R ....\.~n l'? .t.1.... _s. [.t....I. ?4a ....~.fK`?~./.r.:,°i ...r>.1 . 32 33 34 35 36 37 . I........: 38 . 39 ......................................................................:.....................:t;..................... 40 41' . 42 43 . 44 45 . 47 Buyer agrees that unless otherwise specified, Buyer will, in good faith, pay all costs of securing any' financing to the extent 48 permitted by law, and will perform all acts necessary to expedite such financing. 49 Included in the purchase price are such of the following items as may be on the property on the date of this'offer, which will be 50 delivered free and clear of encumbrances: all fixtures; and all garden bulbs, plants, shrubs and trees. ail ADDITIONAL ITEMS INCLUDED IN THE SALE: .L. . 52 53 , 54 ITEMS NOT INCLUDED IN THE SALE:....... fJra~.t~ . 55 57 Seller shall, upon payment of the purchase price, convey the property by warranty deed, or other conveyance provided herein, 58 free and clear of all liens and eneumbrances, excepting: municipal and zoning ordinances, recorded easements for public utilities 59 serving tho property, recording building and use restrictions and covenants, general taxes levied in the year of closing and' . . . 1 and Seller shall complete and execute the Provided none of the foregoing prohibit present use, documents necessary to record the conveyance. (WARNING: Recorded building an use 60 62 restrictions and covenants can have material impact on the use of or improvements to the property.) 63 This offer is binding upon both parties only if a copy of the accepted offer is deposited, postage or fees prepaid, in the U.S. mail 64 or a commercial delivery system; addressed to Buyer at I. AlJ t S).. A • • • • V\ :-40,x!_ A • • • • • , • • • or by personal 65 delivery of the accepted offer to Buyer on or before A0.7.N Otherwise, this offer 66 is void and all earnest money shall be promptly returned to Buyer. 67 This transaction is to be closed at the office of Buyer's gee or at the office of . 68 on or before C~A..S?.}.1.;. 19~ or at such other time and place as maybe agreed in writing. 69 Legal possession of property shall be delivered to Buyer on date of closing. 70. It is understood the property is now, occupied by + F1C .t:........... . . 71 under (oral lease) (written lease), which terms are: 72 shall be given to Buyer on :>C~1 Y/t 1t~: t :.~y > d~~: [7~ V 73 Occupancy of ~`~I PIC 74 If Seller is permit0d to occupy property after clb5ing; Seller shall prepay occupancy charge of $ per day, which 75 (shall) (shall not) be refundable based on actual odcupancy. 76 The sum of $ shall be withheld from the purchase price to be escrowed with 77 . 78 to guarantee delivery of occupancy to Buyer AND FOR NO OTHER PURPOSE, which sum upon Seller's failure to deliver 79 occupancy shall be paid to Buyer as liquidated damages or returned to Seller if occupancy is delivered to Buyer on the agreed date. g 691 i • 61 FIST •aa33o anogn aqI 30 P utl lad se ,tauom'Iseuaea IC17'Im 3o Id" ia3aa sa~pa(mou p xaitoag` 991 M133311 AHNONi isHNHVH r i 991 ~B ; ...61 uo , . , . Scl aallaS of paluasaad seen II 69T j vwlftgpt7........A . ~ ..''111 (wat3 pule aasuaat-1) Aq pal3eap seen aa33o suq L E5T l 'ON AltanaaS lstaoS s,aai[aS Z91 (aallaS) L~. /i~ ~C + ! 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T "Im I :3o aatoga s,aallaS 'Putsola aao3aq sgep ssauisnq (E) aaagl lseal l-easuadxa s aallag lr aa~Sng of aptnoad llegs aallaS 901 (•palplddwaluoa aap sluawssassr uotletaossr g0T ,saaumoawog ao sluawssassp raap 3i luawaaa9r lutaods 73 aaptsuoO :uOpnrO) •aa,Sng ,Sq pied aq llrtis sluawssassp lrtaads aatilo Vol lid •aallaS rSq ptrd oq lings aa33o stgl3o alep of aotad patnal ao paauawwo;) XIIenlae alts uo >jaom aoj ,Auu3i'sluawssasse letaadS POT xpl irnuuu palewtlsa ......................$3o stspq agl uo aq ZOT llrtis uotlpaoad xul'Butpuad ao palaldwoa st luawssassraa ao'sasodand xpl ao3 passasse Al[n3 uaaq IOU seq ,Slaadoad 3I :NOI.Lf1H0 101 UPON Rutpaaaad aql ao3 saxrl lpaau92 IOU atil tto 001 asimaaglo'umouN 3t'araA luaaana atil ao3 saxel lnaau92 Iau atil uo paspq Buisola3o auttlagl lu palu.toad aq lletls saxel lpaauaO 66 aallaS of anaaar dutsolo 30 .top aul g2noatil sasuadXa ao 'saxul 'awoaut'Sud 136' ' ' ' ' ' ' Puu `Ian3`sluawssasse notIetaossu G6 ,saaumoawog 'sa.2iega asn aamos pur aairm `sluaa'saxel lraaua2 :2utso a3'o Anp agl3o sip palraoad aq [lugs swap 2utmollo3 aq,t 913 96 66 .1 E716. • • • • • • • • ' • _ :06 01 08 SHNI'I NI QH.LVIS SNOI.LH.LNHSHHdHH QNN SHI.LNVHHVM OIL SNOLLdHOXH 16 Claadoad atil 2u1l3a33p suotltpuoa ao slutaaluw atxol ao snoaa.Rupp Kue 3o aatzasaad atil pup sjurl a2paols putioa2aapun(p) 06 -91ladoad atil 2utlaa3373 suotlrln2aa asn puel lumads ao pup[aaotis(a) 69 11 uotltpuoa Butlstxa Auu 3o uotiaaaaoa ao 'uotluaallp 'atsdaa Butatnbaa aapao Ianoa ao rSauaRu luawuaanoN(q) •6laadoad 88 aql 1aa33r 9110 aalum astmaaglo ao sluawssasse lrtoads ut Ilnsa:z Sew gattlM sluewanoadwt atlgnd paouaWwoa .to pauueld(p) 98 ~ :,Sue 3o a2palmou3l ao aatlou ou suq aallaS Ietil aagng of sluasaadaa pup slueaaem aallaS 98 ~ ('t..t~.~~ ~ • • • • pauoz st Slaadoad aqI lrgl sluasaadaa aallaS 68 (alquagddr £8 su 931talS) purllam a ut palraol st Spadoad atil 3o.(~ed) (auou) (sawainut a_;srlayi) (slupaapM aallaS) Z8 •(algeatlddp T8 sp ajtalS) utrld pooT3 r ut paaraol st dlaadoad atil 3o4iy&4'+ri) (auou) (s ) (slu73aanm aallaS) 08 REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DEPARTMENT OF DIVISION VDUSTRY, P.O. BOX 7969 .ABOR AND PERCOLATION TESTS (115) 'RADISON, WI 53707 IUMAN., RELATIONS (ILHR 83.09(1) & Chapter 145) OT NO.: BLK. NO.: SUB (VISION NAM 7c / 1/4 2 /Tzq N/R lq&y(r 2- ~Q w pCI /WTY:, OWNER' Y R'S AME: ,~')j;e e as R 1 U CJ DATES OBSERVATIONS MADE JSE T 0 - S 0 rc~ ~esidence New ❑Replace L 9~ 2ATING: S= Site suitable for system u- Site unsuitable for system :ONVENTIO AL: MOUND: IN-G YSTEW FILL OLDINRECOMMENDED SVSTEM:(optional) I TE]s Ism y portion of the tested area is in the 00, DESIGN RATE: II Percolation Tests are NOT required r0loo under s. ILHR 83.091511b1, indicate: ~~M55 dpla in, Indicate Floodplain elevation: - 3 3 PROFILE DESCRIPTIONS A. WITH ICKN.-SS, col-OR, TEXTURE, AND DEPTH HA. I orJn~e;~; TnrrnL , FPT+.f T •Rf)1)NDIs T_R-INCH S TO B MOCK IF OBSERVE (SEE ABBRV. ON BACK,) NUMBER DEPTH W, ELEVATION OBSERVED HIQHEST ow ~ /.47 B/ 1. tit 5: 467 B- / `l, B- L 7'o 9 ~ yz g X47 TICS e 7, . s • 06" /j~/, /y: 4i z: •,9" lies, r . '.d a s , 20e 4. A B- PERCOLATION TESTS let WHES RATE MINUTES LEST DEPTH WATER IN HOLE TEST TIME DROP V • -PERIOD 2 NUMBER 196"S AFTER SWELLING INTERVAL-MIN: PER INCH P. L , O' / d ' a to P. P- Ix; 1 PLOT PLAN: Show locations of percolation tests, toil borings and the dimensiont of Suitable edit atAttfl'iHt~l~ te~fle'ol ditMrldla Describe whih ire the hors ; :ontal and vertical elevation reference points and show their location on the plot Olen. Show the surfttdi 4164616n at ill borings and the idireetlon and percant of land slope. k SYSTEM ELEVATIO J~~ • loe~ ~t ~ Al a i Orr( Irl 1. Z r .T.. 4,; 1, the undersigned, hereby certify that the soil tests reported on this form were made by me In accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. NA print), ~ T ~ L TEO ON: r r~61~iC h 3 I J ADDRE CE IFIC TION NUMBER: HONE NUMBER optional L ~y / .~B't 6 rr~ S'f ~ Sri w. 5yd/< Do ~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD-639S (R• 10!83) -OVER -