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SANITARY PERMIT APPLICATION A g J O D rUILHA In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /YZ Q®
8% X 11 inches in size. neisionto previ us 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 ar ¢ '/a 5 E Y4, S Z T 29, N, R P7 E (o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
'7 q O oo
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
wZ Syo~~ ; /Is
11. TYPE OF BUILDING: (Check one) VITM NEAREST ROAD
1:1 State Owned ❑ VILLAGE ,k rv ~o
JETOWNCIF: Q
❑ Public 'P 1 or 2 Fam. Dwelling-# of bedrooms 3 AR L AX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo U
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
50 Hotel/Motel 9 ❑ Office/Factory 1130 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.E1 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 N 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
y-.5_ (S 4 Z L4 2 7 3 90-OO Feet 3-Z0 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 1000 e-
Lift Pump Tank/Si hon Chamber " I . El 1 F-1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): rou l u's Signature: o Sta A . MP/MPRSW No.: Business Phone Number:
p~~ r4s s tr~ti Geo~ ,f," - ~P - y 9~z z ~3 3 .2 3 3
Plumber' Address (Street, City, State, Zip Code).
IX. C NTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ra e ss ue Issent Signture (No Sa Surcharge Fee)
;f*Approved Owner Given Initial , Adverse D termination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: 1000,
SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER- Zw,g: TOWNSHIP ~I~b`so
SECTION TAN-R
ADDRESS C ST. CROIX COUNTY, WISCONSIN
d62~dn
SUBDIVISION N~ ~I 5 LOT 37 LOT SIZE f!L
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
N o U
14
Ir I
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: ~~i•k~ ; icy
T
Alternate benchmark J d 1-6
SEPTIC TANK:Manufacturer: W(x-;5,z,1 22 Liquid Cap. 1000
Rings used: Z Manhole cover elev:7;'¢O Final grade elev:
Tank inlet elev.: J'.d Tank outlet elev.: 4
No. of feet from nearest road : Front , Side , Rear Ft. - <yL')
From nearest prop. line:Front Side X. , Rear Ft. y.5
No. of feet from: Well /,jO , Building: -7
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
I~
a
PUMP CHAMBER
Manufacturer: ~v 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 :C,, (-Trench: - Seepage Pit:
-
Width: Length Number of Lines: 2 Area Built Coin
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: *1.0
No. feet from nearest prop. line:Front>,' , Side , Rear Ft.
No. feet from well:_j_jL_No. feet from building 4" 1 s
s
HOLDING TANK
Manufacturer: i~ 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: C / 7 PLUMBER ON JOB:
LICENSE NUMBER : / 3 2
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HITMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
1V W S11§?j ,sg,e c . 2 8 , T 2 9 - R 19 State Plan I.D. Number
L/!I CONVENTIONAL ❑ ALTERATIVE (ltassigned)
Town of Hudson, Ln 37
Aldro Rd. LJ Holding Tank ❑ In-Ground Pressure ❑ Mound
ESS OF PERMIT HOLDER: INSPECTION DATE:
NAME OF PERMIT HOLDER: 7740
o Rd. Hudson WI v-791
Jack Lee Aldr
re ST REF. PT. ELEV : O,, /
BENCH MARK (Permanent refereennce point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Doug Strohbeen 5432 St. 149002
SEPTIC TANK/- G&RAN14ANI .1& gU, o er = G. 3 lo, Ff
MANUFACTURER: LIQUID CAPACITY: TANK INLET EL NK OU T ftc<: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED: h
qdLP 92, &f 913 2? 0'~S ❑NO ❑YES L7N0
(.vi Q.SF
~ 1 / O~U
BEDDING: F.D4e DIA.' `6EPFT MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
UC IR INLET:
C ° • ALARM: FEET FROM LINE: ~J / f A
44
❑ YES C•3 fQ6 7 ❑ YES 21TO NEAREST >o' 66 DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
I YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LI AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL A 77-
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL :
SYSTEM: /0,G
WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING: COVER INSIDE DI P144i! LIQUID
BED/TRENCH
i TRENCHES: M T IAL: DEPTH:
DIMENSIONS ..2 ' 6'a 60'-
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. P PE DISTR. PIPE MATERI/~L: DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
It ABOVE COVE: V. INL Ti E V. END: /~GLi IPES: FEET FROM LINE: I AIR~LET I
BELOW PIPES:
_
a NEAREST ~a5 75 ~S -F.0
MOUND SYSTEM: 2
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
BED/TRENCH
TRENCHES:
DIMENSIONS
III MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
R tain in county file for audit.
Sketch System on
Reverse Side. SIGN URE: TITLE:
SBD-6710 (R. 06/88)
• APPLICATION FOR BAIIITART PERMIT
• 9TC-100
This opplic■tlon form Is to be conplotod In full and slgnad by the owner(s) of
the property being developed. Any Inadoquacles will only result In delays of
the pit MIt issuance. -Should thls development be intended for resale by
owner/contrsctor,(spoc houoe), thcn a second form should be retained and
coxpleted when the property is sold and submitted to this office with the
appropriate deed recording.
------------------------LL-----------------.-------------------------------------
Owner at property ~4G1~ ~4d
Location of property 111W 111 SE 1/4, Section 7-8 . T-91--N-Ft /9 r
Township Hu- 0 0
Halling address 7yc1 1,4('n dS
H LLB` 5 a h Ira .S YO 16
Address of site 7YC//~ Aid✓v foci Wu~ ~,ti luZ S~10/G
lubdlvlslon nas►e_CaAsr S
Lot number _37
Previous owner of property _ 0-0ylaare( 11c. S wctvt S^tA
Total ■lre of parcel 2, 1 g A C.
Date parcel was created -2 2-
Are all corners and lot lines ldentlflabls? k_--_Yes No
In thin property being developed for resale (spec houae)?,es X No
volume ►'3 and Page Number sal as recorded with the Register of Deeds.
INCLUDE VIT11 TNIe APPLICATION TIIZ FOLLOVINC!
A VAARKXTr DatD which Includes a DOCUHKHT HUM6tR, VOL"K AND PA02 KvxetR, and
the GK L or T112 RBOIBTRR OF DRSDS. In addition, a c a r t I f I a a survey, it
available, would be helpful ■o as to avoid delays of the reviewing process. If
the deed description references to a Cettlfled Survey Hap, the Cattlfied Survey
Hap shall also be required.
PROPERTY OVIIER CERTIFICATION
I(ve) eettlfy that all statements on this form are true to the best of ■y (our)
lsnovledgei that I (we) am (are) the owner(s) of the property deacribed In
this intatmatlon farm, by virtue of a warranty dead recorded In the office of
the County Register of Deeds as Document mo. y(o!o G Q D • 1 and that I (We)
pteeently own the proposed site for the oewage disposal syaten (or I (we) have
obtained an easement, to run with the above dIacrlbad property, tar t.ho
conettuctlon of sold system, and the same has been duly recorded In the otllce
of the coynt Register of Deeds, as Document No. kk / L k0
21
11 nature t Owner Signature of co-owner (It Applicable)
- Z-1- rf
Date at signature Date of Signature
DOCUMENT NO. ran
WARRANTY DEED
REGISTER'S OFFICE
Leonard R. Swanson and
This Deed, made between ST. CROIX Co., WI
Sandra L. Swanson, ___hus-band---4Dd_.3~1f_e ,
Leonard R. Swanson is also know as 'teonard Recd for Record
___Swansori, _ana--Sandra.__L,.__.Swanson__s__----------- Grantor,
and . - - FEB 2 1199.
Ja-ck--- - - M.-•------Le-- '01 M
. -----e -1 - Z : 10
- -
0
Grantee,` R89i3fer of Deeds
Witnesseth, That the said Grantor, for a valuable consideration------
of one- dollar- and__o_ther--vait~?bl.e_._eons.i d-era.tinn_-_____
S 1 . r0 1.. RETURN TO
conveys to Grantee the following described real estate in .____~-._._-l_.
County, State of Wisconsin:
# also know as Sandra Swanson
Tag Parcel No-
Lot 37, Cedar Hills Estates II in the Town of Hudson, St. Croix
County, Wisconsin
is not
This - homestead property.
(is) (is not)
Together with 11 and singular the hereditaments and a purtenances thereunto belonging;
And,eonar, R. Swanson and n_d Sandra . Swanson,-------------------------------------------------------
- - - - - - - - - - -
warrants that the title is good, -indefeasible' -in' fee simple and free and clear of encumbrances except
easements, restrictions and covenants of record, if any,
and will warrant and defend the same.
Dated this 21St--- day of Febr'Uar17---•--•--------•--- 19.9-1----
al
SEAL
"..(SEAL) ( )
Leonard R. Swanson
* "
(SEAL) . (SEAL)
andra L. Swanson
AUTHENTICATION ACKNOWLEDGMENT
Signature (B) STATE OF WISCONSIN
St. Croix gIle
---------•----------------------------Counter:' <
-21st. of
authenticated this day of 19 Personally came before ~4th*•_-i`__4'~s .
SwaFebnr-- - rx Y8-'-y~ ea
Leonard__R . SW. nr_Qb_ A a i~h d± a
_
- son
TITLE: MEMBER STATE BAR OF WISCONSIN
t - E
(If not- -
authorized by § 706.06, Wis. State.) to me known to be the person _.S_..:'':.,who~xeciited the
foreg - s ment and ackn ledge they same.
THIS INSTRUMENT WAS DRAFTED BY
Robert F Wall
WALL ---&---MILLER
522 Second Street a------ RQ) ext<_.f~__.Ws311
Hudso.n.,---W_Z----- 54-01-6---------------------------------------------- Notary Public t-=---CrQ•I-X-•----......------County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) 19...)
date- 1
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
n
SEPTIC TANK MAINTENANCE AGREEIIENT
St. Croix County
0
014NER/ BUYER o
~J Fire Number
ROUTE/BOX NUMBS % 6 ft ~y'O A 0
CITY/ STATE y C~ 5~' ZIP 2ilo
IT W
PROPERTY LOCATION:'.'L' _k,~3c, Section T ?gN, R/
Town of Lk:& s 0 n St. Croix County,
Subdivision ~'ecer t 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 licensed''se tic tank um per. What you put into
the system can affect the .unction o, t e•septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents-may be eligible tofrecieve aggrantefor
a maximum of 60% of the cost.of rep St. Croix County
whic was in operation prior to-July 1, 1978. accepted requirement that
this program in August of 19
•'ems agree to keep their system properly
80 with the owners of all new RXst
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a plumrber,
veri-
journeyman plumber, restricted plumber o
fying that (1) the on-site wastewater disposal system is in proper
operating condition and -(2)-after inspection and pumping (if nec-
less than 1/3
essary), the septic~ill kbe is
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- L
days
ment of Natural ReoSCCe~roixeCountyaZoningoOfficetwithinm30e "a
and returned to the
of the three year expiration. date.
SIGNED
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DIEPARTMENTOF BORINGS AND SAFETY & BUILDINGS
INDUSTRY, REPORT ON SOIL DIVISION
LABOR AND PERCOLATION P.O. BOX 7969
HUMAN RELATIONS TESTS (115) MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: Syy~~BDIVISION AME:
Nw 1/ SC 1/a Z8 /Tz9 N/R /9 E (or) 0 37 K:A4le / t[ 5
COUNTY: OW4E -S BUYER'S NAME: MAILING ADDRESS:
S-r Ckoot ),4r_K LrL
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF LE DESCRIPTIONS: PERCOLATION TESTS:
R nce (NV ZNew ❑Replace &IL ~ X99/ 4PR IL 2X99/
-So!C-~ goo tk-U AQAT
RATING: S= Site suitable for system U= Site unsuitable for system ILS _ ILC " 1 "
r N! KS Q-_STIO❑NAL: MOUND: JI UJI C~QMMv~IDEDSNSTtM„(CS~ n ~i~~NC.dI~S
D~N RATE:
required If any portion of the tested area is in the
If Percolation Tests are NOT ES
under s. ILHR 83.09(5) (b), indicate: Lgss / Floodplain, indicate Floodplain elevation: ~tN
F PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH=.. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- /0.67 15 /Q. 67 1-7 LETS /7 NS L 70"6 ea thS44 24 CT &,v M5
B- Z /033 4,06 46NE > /0.33 /6"BLSt-T S 20"Qe►atS '50'19e14 M646k 3 ntr /h5
B- 9,575 41.5 $ NME > 9-458 L7 ILLTS ~Z"geaS iD ~eN n~S 7~'B+eN MS S
B-4 /025 91.7 LZ- > 10,25' /S" 6LSLT5 /3"6,e 5C 37 "1QdB n r~'lS~Ge 5 BRN MS
B- S 1/33 96.42 E 33 ~q ~~8~sL7s /o Qfjsc f3a`8 N ~'hS~G~R 2~
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER M==S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH
P_ I.ab 1. o 3 4Z <Z < >
P- 2-0 96,10 3 < <Z <Z > 3
P- .70 An q1,70 3 42 <Z < >
P-
P. A
P_
PLOT PLAN: Show locations of p rcolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation refere ce 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 ELEVATION
~ E
t 1
1- _T
IE
'
.0e_
r
Ac;
E,
g
411
67,
_ _ TN
g
»
41-
S7~
n~CNtkt►4Pti-35P~ K_._~ N Lrl~/~R'
%__.I
SA K~_ l;s 6_u A$ov~ ,~,aquNb
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): 3614NS6N \ TESTS WERE COMPLETED ON:
HAUEY J0141YSON ~✓~Y/N4 AkIL 2 144/
E NUMBER (optional):
ADDRESS: CERTIFICATION NUMBER: IP ON ltO
~ rr
J
so ~ k/i 5401 3~4g 46 a6
CST SI TURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER - `
y~a,t~ ~--¢-a- /✓or~ let i;vtac. aag
Cza a r N♦~ S Lot, 3 '7
5y, rte,,,, Elv_ = gd.oo
a i
13 . M.- Sp'.
NycT to B-I-EIV 100-00
~`~or~,s C Back r.ou.~
''Pav c s(Ti.tt $e'~ona~\ = 90,00
AI P 4--f
a
Y
`a
J`
4
d
1
B. M S, k c n Caelar N o a s a-!
lUaxt Te B-1 I. z 100.00'
y
I s P: k . s 4"A bov~. G ~eu.~ ~o
I Gara~~
2S 'To
/ hl'►FR KTF - 2 R
/ ARE q 1 r
4.(o s= E
27
AA LA.)
A
30'
-
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4 s~ Idfi t X09'
ALDRO ROA D
i
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IND STRY, DIVISION
LA ON A'ND PERCOLATION TESTS (115) MADISP.O. BOX 7969
ON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LO8DIVISIONI ~AME:
JE ION: SECTIO N: TOWNSHIP FFY:
SC 1/ Z8 /T~9 N/R /9 E u o CLrdal2 MLLs
Y: OWP~ER"~/BUYER'S NAME: MAILIN ADDRESS:
C'QO)X )Acx La~e
DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: R F L DESCRIPTIONS: PERCOLATION ESTS:
WRi4dence ~A, V, ZNew ❑Replace / 17 ,Q~IL Z /94/
'OILS G 66 SoI~S xDZ t1X_u,oQQr
RATING: S= Site suitable for system U= Site unsuitable for system M,41 'r
r S U I ms IMS I I NENTIO~NAL: MOUND: r-iu IN-GRO S E1ESU SYSTEM 1❑U LHOFI LDING S TANK: REC,QOMMY~NNEDSNST`M;(oC~pe n YACNCU&S
If Percolation Testswe NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.0915)(b), indicate: l/.'/ss / Floodplain, indicate Floodplain elevation: ~Q
IF PROFILE DESCRIPTIONS
- C IF,-
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUM ER DEP+=.. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- l /6.67 9115 > /D. 67 1'1 LETS I? , "D L 70"6 e4 fhS'1Ge 24 *1--r &AI M S
B- Z /0.33 4.oa NE > /0.33 6"BLSC. ; s zo"BeaCs so BeN M644f, 3 "4r9 MS
B- 9,SF5 91.S% > 9 .58 17 *$CL-rS /Z " geA S L D QQN M6 77'6 +eN M5 -~G
B- Q /v K 91.71 AJAN L!:- > /d-ZS /S' &c.sLT:5 /3-8je-St 3_7 "QA8 M AVSs des ' 9Q,4 Ms
B 1633 94,31 A16 N k >11.33 14 "BLsLTS /or"el', si- 88*8 N fiS46AR 2i1'&N
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD I P RIOD P R PER INCH
P. I /-4o0 we o 3 <2 <Z >
P• ,7D -15 D 3 < <-Z <2 > 3
P- ,10 <'Z <Z < >
P- - -
P_ `fG 4 A
P_
PLOT PLAN: Show locations of p rcolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation refere ice 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 ELEVATION
-
- z
I
A
. Z
t I ° P 3-
P ,
1 '
-tV
~I »
_J CeQnQ....----
SS~ Ni?~Cr Tp CtI-va~o~
_ -
/ SR u~ i's. o
ViE.Rquf~~ _
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): S WERE COMPLETED ON:
HWE J04NSnN _04Ns6N :SO12✓ty1N4 TEST QP2/L z l99/
ADDRESS: CERTIFICATION NUMBER: P ONE NUMBER (optional):
90&S.64 I `4014 34g gtS 4d$0
CST SIG TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
'p=PAFEfMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION P.O. BOX LABOR AND PERCOLATION TESTS (115) MADISON WI 3909
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.]~BLD IVIS IOAM E:
Nw 5C'/a Z8 /T~9 N/R /9 E u a /Y I 37 sdai2
COUNTY: 0W4&FIAS BUYER'S NAME: MAILING ADDRESS:
-S; CRo)x SACK L.~ QZO - //r6--0 -0&--)
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence Al ZNew ❑Replace / /99I /~fL 2 ~9gJ
,01L:~ 1C S'5iLS XDZ f411AQd7
RATING: S= Site suitable for system U= Site unsuitable for system /)1M 7
ICONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYST~ I~~LHO~LDING~NK: RECJ~OMMv~/DEDOSNS LMoption~h
YnENCUn _1 A If Percolation Tests are NOT required DES If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: CIG'N RATE: ~SS 1 Floodplain, indicate Floodplain elevation: / ~ Q
C~ PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTF=. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- I Y6.47 99,15 > 10.0 1-7 LL-T'S ~'Rh N S L 70'*$9-iJ MS44e, 241T& M s
i6"8~sc Ts Zo~QeaCs so'6eN MS~Ge 3 MS
B- 9 Z X0,33 6.oa NE >1633
B- 9•S$ 9) .'S8 > 9.5$ lZ°&_TS 2"UtsSL ,D $e, MS 77'6,64 M'S
B- 4 162K 91.-1 > s /S" 84-sLTS /3w'$4NSc 3_7 "RAO M MS~U 'S' 9QN ms
B- 1133 901 It 33 14 "iSLsLTS /o RA) S 8 a - B M Mi W 61R 2 T'&•j
B-
G PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RIOD 2 PERIOD PER INCH
P_ 3
P- .7 96-10 3 < <2 <2 > 3
P. /.-70 NoRlE 91,70 3 <2 <'Z < >
P-
P_ A
P-
PLOT PLAN: Show locations of p rcolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation refere ce points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
i
of land slope.
SYSTEM ELEVATION
10
A t-T_EEM ATE
.
1~ n
,
.
Ic*
3$ 30 _ . B-3 T N
n
p p N
„cuM►4~~-,SP, K_~i. , N___CJ Chii+t;
SS' NO(T .~.o_ B-'l Ce.cvd o>a =100.00'
SRK~ is 6NAov~ Ga,?uNa
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 WERE COMPLETED ON:
IVEY 30;4NS6N _ O04NSoN ~>2✓~yiN4 AkIL 2 /94/
ADDR S: CERTIFICATION NUMBER: P ONE NUMBER (optional):
5461Z 34g g6 46 z~a
CST SIG TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER - `