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Parcel 030-1017-95-000 09/15/2005 08:16 AM
PAGE 1 OF 1
Alt. Parcel 05.29.19.76A 030 - TOWN OF SAINT JOSEPH
Current 1XI ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
WILLIAM A & JUDITH J TALLEY O - TALLEY, WILLIAM A & JUDITH J
1172 ROLLING HILLS TRL
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1172 ROLLING HILLS TR
SC 2611 SCH D OF HUDSON
SP 1700 W ITC
I
I
Legal Description: Acres: 3.220 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R19W PT SW NE BEING LOT 1 OF Block/Condo Bldg:
CSM 8/2297 3.22AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/28/2005 798857 2832/079 WD
07/23/1997 990/600 WD
07/23/1997 901/305
07/23/1997 779/340
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.220 78,200 145,900 224,100 NO
Totals for 2005:
General Property 3.220 78,200 145,900 224,100
Woodland 0.000 0 0
Totals for 2004:
General Property 3.220 78,200 145,900 224,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 119
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
rl
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AS BUILT SA TTARY SYSTEM REPORT
OWNER S a, Hn VW I I a Y" TOWNSHIP Sf. T g c fa
3 /
SECTION S T % --W
ADDRESS f0y .mot 2 ST. CROIX COUNTY, WISCONSIN
#ei 1 4) l l~ x-/o 14,
~l.
SUBDIVISION C-S, /0', LOT -/LOT SIZE 3,22
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
s~ XY9,
~ oft
wo- ~I 39 00 p.p+-YMSv I.-f.~
%6r" 4c fm. D~;
y
ask. p.;,,s wd
• 3,(11, Tmp of 1 ~4.p ~S. o ~ y~
At S, E Cefi Ce r,~ ow `l
E I I Ov, o c~' I
F- A /00, V1
s
I ~0
/I I
I I I
_ N
L, • t'
INDICATE NORTH Low
BENCHMARK: Elevation and description: TnT f I Q; ate- S.E. Lora Qr g/ -/ob, av =10~ 43
Alternate benchmark_Toio 4 ~ewK ftr®!..1op = 3 3 ~
SEPTIC TANK: Manufacturer : W a s w Liquid cap. Rings used:-4-Manhole cover elev: 5'i°® Final grade elev:
Tank inlet elev.: 'Z Tank outlet elev.: Ce.S-S
No. of feet from nearest road:Front Side , Rear X Ft./9a
From nearest prop. line:Front , Side., Rear Ft.((,7
No. of feet from: Well SOS I , Building: dy
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
~t
i
AS BUILT SANITARY SYSTEM REPORT
J
OWNER TOWNSHIP
SECTION T N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
BENCHKARK:Elevation and description:
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap.
Rings used: Manhole cover elev: Final grade-elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
From nearest,prop. line:Front , Side , Rear Ft.
No. of feet from: Well , Building:
(include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP T da^lz,D
SECTION S T_2-Z7_N-R ~ 7 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION G S ~1< LOT1_LOT SIZE 3 ZZ
PLAN VIEW
h
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap.
Rings used: Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
From nearest prop. line:Front , Side , Rear Ft.
No. of feet from: Well , Building:
(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 :Can v4t~ ' "-4/Trench : Seepage Pit:
"-F
Width: Length !d Number of Lines: 3 Area Built ~oBOsy~f
Exist. Grade Elev.
~Z Proposed Final Grade Elev.
Fill depth to top of pipe: ~
No. feet from nearest prop. line:Front , Side , Rear,~Ft.L7'
No. feet from well:,// No. feet from building 7S
HOLDING TANK
Manufacturer: /4 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:G'~~i'~
6/90:cj
T
LQjQ&T;Q#;rtrgtQ PXjt;,• 29.19, SW
Labor and Human Relations ~y ATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
186524
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
R ST, JOSEPH
B E ev.: Insp. BM Elev.: , BM Description: Parcel Tax No.:
vo . 'S", , az &~2 1
TANK INFORMATION ELEVATION DATA A9200408
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 60 t 4,2,- Benchmark /duo
Dosing Q 3,3 D7. ZS
Aeration Bldg. Sewer
Holding St/J(t Inlet
TANK SETBACK INFORMATION St/>t Outlet SSr o v, TANK TO P/ L WELL BLDG. Ventto ROAD
Air Intake
Septic >LdJ~/ }Gr® a9' NA
Dosi NA Header /
Aeration NA Dist. Pipe a , d f
Holding Bot. System v0- .37 r
PUMP/ SIPHON INFORMATION Final Grade r
d , G.3
MiLoss Demand S G~' / S
GPM
Friction System DH Ft
Forcemain Length Dia. Fi Dist. To weu
SOIL ABSORPTION SYSTEM
BED /TRENCH Width IT 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
0/ -7
D 0 IMEN I N
DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM L HING Manufacturer:
SETBACK CHA
INFORMATION Type Of V' f / r CHA -MorlVM um be r:
System: Jt)eC 604. 7M6 ~ OR
SYSTEM
Header4Z4aoA54+ r1 Distribution Pipe(s) A~ 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.)
LOCATION: HUDSON,5.29.19,SW,NE, LOT 1, 48TH ST.
4
, c>( 4- los~8z (Zi p t
411an revision required? Yes o~
❑ ItJ~
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspe or's Signatur Cert No.
ADDITIONAL COMMENTS AND SKETCH fi
SANITARY PERMIT NUMBER:
I
i
l -
DILL-IR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITA RMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. Ch i e o pr iousapplication
-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
vE- SQ~fy/,//~✓ ,54,)Y4 /VE %,S S T Z%, N, R / E (o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
/!o~/t®h wL o~Z Sy GGD/ 1_15 ,
N. TYPE OF BUILDING: (Check one) F-1 State Owned 0 VILLAGE : NEARES_AROAD
:5f Toss Pit 8
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms:;!-- PAR ELTAXNUMBER(b)
III. BUILDING USE: (If building type is public, check all that apply) 30 - /O
1 ❑ Apt/Condo I /
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 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 ® 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. 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) ELEVATION
YSD O 5-0s7f?- /,0 SD s fT 2 V /60.5/3 Feet /O of Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks .T nks structed
Septic Tank or Holding Tank 010 a %5
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT 71 - - 7
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) MP/MPRSW No.: Business Phone Number:
0 "u j l4 0 5 .56 n(I ti k . - ~-f 32- 2 7 3z3~
Plumber's Address (Street, City, State, Zip Code): 441
IX. COUNTY/DEPARTMENT USE ONLY
4 1 ❑ Disapproved nitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Sta )
Approved ❑ Owner Given Initial LMDO. Surcharge Fee)
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, Plumber
INSTRUCTIONS
1. -,A sanitary permit is valid for two (2) years. `
2. .Ydar-santarypermit 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 adrninistrator-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 tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information. _
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
I
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ AV,W "Alld r$- IS-,W /yl•~/~~
ADDRESS ~9F1 /4•'u~r FIRE NUMBER
CITY/STATE_~aa/7Far► ZIP S%08Z-
PROPERTY LOCATION:X1/4,1/4, SECTION S- , T ! `!N-R /f
TOWN OF ~f Tosc~h St. Croix County,
i
SUBDIVISION-4-e5.5, oln 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.
J
SIGNED ✓ &0
DATE:
_
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
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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), thenla 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_Sz-+/1/4 NE 1/4, Section S , T a9 N-R
Township _ :57;
So s ,P/~
Mailing address 3f 8 IEj,'✓~ r ~°0~,,4
ow/to Gyz ; sV499 2-
Address of site
Subdivision name G. S, FYI Lot no.
Other homes on property? yes No
Previous owner of property e.y4 ()Ja&o/
Total size of parcel 3.Z z a~v~ 3
Date parcel -was created Y~1Q u l
'Are all corners and lot lines identifiable? -2--yes No
Is this property being developed for (spec house)?,Yes No
Volume 0) 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 & 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 . , gD (lK , 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
Signature of applicant Co-applicant
Date of Signature Date of Signature
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OUENTIN WEINZIERL JANICE DAVIS
Chairman 549-6739 TOWN OF ST: JOSEPH Treasurer 549.6458
CAROLYN BARRETTE JIMMIE TUMA
1st Supervisor 549.6438 Constnbto 549.6404
ROBERT ORF JANE BROWN
2nd Supervisor 386-2244 St. Croix County, Wisconsin Zoning Admin. 549-6470
CAMILLE GRANT DEAN ALBERT
Clerk 549-6261 $t, Joseph, WI 54082 Bldg. Inspector 425-7907
TOWN HALL
Phone 549-6235
[)R T V SWAY PERM T T
I have inspected the proposed driveway location for:
Name: '....0`t.. rl .3..' G
Address:
.
.Gr..C.><....3.....r.... .:......._5..._.... .......................c7 p......_
'f Qc
Phone:
_
The driveway is located at R.a...... . r!..:; ................:r.'.~..1...'...... ....1.....¢.~............ v f /
_..F ..0.4- Lfk ft. L..d _.,:c.r...._j........ ....b~..-....D..c...✓................ g'.. 'V-r
3
h..0... ....................w_..._..-..._....
I have found the location satisfactory.
Culvert: ~J 4K
. ....................................................................._........__e te'r. _
J A1-4 Remarks r r=....'f ....._,C is„rvc, r r.Svc d.J x .........t.k 3...t.__..
WAY. . 0.'1. L 4 `s
Number Town B and t
r
Fee:
0..
A
'-0 . M •..x......................
Date: Town Subdivision ordinance driveway requirement
Section 6 D.7.q. All driveways from the edge of the lot to the
buildings shall have a width clearance of at least 14 feet, with
a height clearance of at least 14 feet, and shall be maintained
in such a way so as to allow for easy emergency vehicle access.
Please notify NSP, St. Croix Electric Co-op, Wisc. Bell and Telo-
Communications when digging in any road right of way.
Diggers hotline number 1-800-242-8511
I)Lv,kti I MLly[ 0 REPORT' ON SOIL BORI~1 ► AND ~>~~~~Y ~ ~~l1t
INDUSTRY, - UIV ISiON 796
LABOR AND PERC LATION TESTS (115) MADISO 1 W~ 3707
HUMAN XR~L~A ONS
(ILHR 83.0911) & Chapter 145)
LOCATIO SE TION: TOWNSHIP/NAY: OT NO.: BLK. NO.: SUBDIVISION NAME:
S[J ~ NE 5 ~T 29N~ 19~or►w St, Joseph 1 n/a n/a
COUNTY: 1i~8/BUYER'S NAME: MAILING ADDRESS:
St. Croix Dan Brown 1174 Rolling Hills, Hudson, Wi. 54016
DATES OBSERVATIONS MADE
USE
IND. EDRMS.: COMMER AL DESCRIPTION: ~R0FILE DE3CP~PPTMt: ~~CA TION TESTS:
Residence n a Iew ❑Replace I 10-24-90 n/a
RATING: S- Site suitable for system U- Site unsuitable for system
;OIVVEIV fIONAI_: MOUND: IN-GROUND PRESSOR : S S EM IN FILL OLDING TANK: R ECOMMENDED SYSTEM:{optional►
S ❑U ® S ❑U ns ❑U S ®U S EU conventional
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
uicder s. ILHR 83.09(5)(b), indicate: Class 2 Floodplain, indicate Floodplain elevation n/a ,
decimal' PROFILE DESCRIPTIONS page 49 CoC2
BORING TOTAL DEPTH O GROUND ATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPII-i ELEVATION _ OBSERVED HE TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) L r- 8.1 7.08 104.51 none >7108 1.00bl.1. 2.08bn.sil. 4.00bn.l.s.
B_2 7.00 103.70 none >7.00 1.17bl.1. 2.00bn.sil. 3.83bn.l.s.
3 7.08 103,97 none >7.08 1.08b1}l. 1.75bn.sil. 4.25bn. l.s.
B-
4 6.66 102.81 none >6.66 .83bl.1.~1.25bn.sil. 4.58bn.l.s.
B
B_5 7.41 103.16 none >7.41 .83bl.1. 2.08bn.sil. 1.83bn.l.s. 2.67bn.m.s.
B _
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DRO N WATER LEVEL-INCHES RATTER INCHES
PERIOD3 NUMBER INCHES AFTER SWELLING INTERVAL-MIN. D P
P-
P- see es' rate
P
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-
n,ntal and vnrticai uiuvation reference points and show their location on the plot plan. Show the surface elevation at all borings and the diraction uml pureunt
of land slope.
SYSTEM ELEVATION 100.43
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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 data recorded and the location of the tests are correct to the best of my knowledge and belief,
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 10-24-90
! ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 715-246-6200
CST SIG RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DiL1iR-SBD-6395 (R. 10/83) - OVER -
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