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Parcel 020-1116-30-000 12/07/20 P05 02:05 AGE 1 F^1
Alt. Parcel 19.29.19.481 020 - TOWN OF HUDSON
Current XST. 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
O - WARD, AUDREY M
AUDREY M WARD
888 ASPEN VIEW CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 888 ASPEN VIEW CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.400 Plat: 2626-WILLOW RIDGE ADDITION
SEC 19 T29N R19W WILLOW RIDGE ADDITION Block/Condo Bldg: LOT 6
LOT 6
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/01/1997 566244 1267/490 TI
320034 506/564
2005 SUMMARY Bill Fair Market Value: Assessed with:
92351 271,200
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.400 62,600 214,000 276,600 NO 05
Totals for 2005:
General Property 1.400 62,600 214,000 276,6000
Woodland 0.000 0
Totals for 2004:
General Property 1.400 32,200 216,200 248,4000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
00
Total 27.00 0.00
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~Dn/ (.Ji4Rl0 TOWNSHIP An5 o,,/ SEC. T 21 N-Rj'v~LW
48 I
ADDRESS 88S VIC ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ~-JJ,4 C nw LOT LOT SIZE
C) 2~U 1 ~j o -0 6o PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
JJo~PrN v'G'~06!'~ N
JOC90 G~~ S Prig },vK
C_ /~C L~ ~1 LAN a&, t✓ir/f
a
h
41
O vu EA-5 ~o ~Tr
- - INE EGA /oo "
3,1
S0(. 7H F--,f 7-
IN,D//ICATE NORTH ARROW
/'v0 Sc A4 E
BENCHMARK: Describe the vertical reference point used a ' ~o~ ~i o~ oti rsls~ vTy~,
Elevation of vertical reference point: J001 Proposed slope at site: 7 0
SEPTIC TANK: Manufacturer: L✓i~Sa~P Liquid Capacity: /c Od &
Number of rings used: Tank manhole cover elevation: /cOa, 951
Tank Inlet Elevation: /0/.3D' Tank Outlet Elevation: /oi.
Number of feet from nearest Road: Front,O Side,e ear, O feet
.From nearest property line Front, 0Side 10Rear, a ~(o feet
Number of feet from: well V building: 16
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
4
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed : Z" --L/ Trench:
Width: Length: Number of Lines: Area Built: ~~sv.Fr
i
Fill depth to top of pipe: a - S "
Number of feet from nearest property line: Front, O Side, O Rear, it Wo'
Number of feet from well: 4,2 T'
Number of feet from building: 55"
(Include distanced on plot plan).
i
SEEPAGE PIT ;
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property linat Front, O Side, O Rear, OFt.
Number of feet from well:
Number o feet from building:
Number of fee from nearest road:
Alarm Manufacturer:
1
Inspector
Dated: O C7 Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
DIVISION
LABOR & HUMAN RELATIONS
L
LAB BOX ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
P.O. 7969
MADISON, WI 53707 State Plan I.D. Number:
NE 4 , NE 4 , Sec. 19 , T29-R19 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Hudson Lot Holding Tank ❑ In-Ground Pressure ❑ Mound
ER • E . ADDRESS OF PERMIT HOLDER: INSPECTI D
Don Ward 708 2nd St. , Hudson, WI 54016 q , - a',;~L
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
00/ ~l
.
k ?
Name of Plumber: MP/MPRSW No.: ~i County: Sanitary Permit Number:
Zappa Bros. Inc. 3395 St. Croix 135503
SEPTIC TANK/HOLDING TANK:
MANUFACT RER: LIQUID CApAkCITY: ANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PR_~O..,,V~19FD: PROVIDED:
V e S r ? E?IES ❑ NO ❑ YES X10
DIA. VE NT MATS.: HIGH WATER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
BEDDING: VENT ALARM: M / / AIR INLET:
❑ YESNO ❑ YES ❑N-► {L! b
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP M DEL: PUMP/SIPHON MANUFACTURER: PROVIDEDLABEL PROVIDED:OVER
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND C NT OILS RATIONAL: NUMBER OF PROPERTY WELL: BUILDING: AER NLET RESH
FEET FROM LINE:
(DIFFERENCE BETWEEN Y S 0 NEAREST-♦
PUMP ON AND OFF
SOIL ABSORPTION SYSTEM. Check the soil moisture the d pth f pi I 9 FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, constru t n s all c as tint I MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: ~WE ITS: LIQUID
BED/TRENCH r- TRENCH MATERIAL: PIT C~TH.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: O ST NUMBER OF PROPERTY LL BUILDING: V NT TO FRESH
BELO PIPES: ABOVE COVER: ELEV. INLET: E EVE ND: i PIP LINE: AI INLET:
: FEET FROM -
NEAREST
MOUND SYSTEM.
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
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
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:
COMMENTSFEET FROM LINE:
(fl ► ` ❑ YES ❑ NO ❑ YES ❑ NO NEAREST
t
I '
Retain in county file for audit.
Sketch System on
Reverse Side. S GNATURE: TITLE:
SBD-6710 (R. 06/88)
I
SANITARY PERMIT APPLICATION couN
`_~DI„vLHR In accord with ILHR 83.05, Wis. Adm. Code
. (:~4~
t STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than El ~~toious 8% x 11 inches in size. Check rev si 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
Aen /l:,e' '/4 AA-144,S 19 T ,N,R 1'7 E(o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
9or C119 Nd in-
CITY ))STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
f' Sv v GJ` S`/0i¢ 9/S B'G-553 6✓/4 La /QG'e-
11. TYPE OF BUILDING: (Check one) 1:1 State Owned VILLAGE : NEAREST ROAD
• ~OSo/~/ ~l/c9i(rH i//~~ t;/~CL~
❑ Public K1 or 2 Fam. Dwelling- # of bedrooms 3 TA NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 0.2 0
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. & New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 K 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
4/15RO /S rd. , 4) - ~',ISIS. A- . 1)a If Feet loC~ ~ Feet
VIII. 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 strutted
Septic Tank or Holding Tank E00 000 / W iESC
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber' ignature: (No Stamps) MP/MPRSW No.: Business Phone Number:
x.0,4 A1p& s3 gS 9/~ 3$'~ ~sso
Plumber's Address (Street, City, State, Zip Code): /
,7
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signature (No Stamps)
❑
,f
I Yl Approved ❑ Owner Given Initial Surcharge Fee)
o s!~-Q/v ~
~V Adverse Determin tion ~•L ,
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
i
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 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.
Vlll. 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
+ 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 O k t:~ W/ ~D * oz tze
Location of property f 1/41/4, Section
Township
Mailing address Z26 ~~/U STY~e~-T
Address of site gCv %7'S~e-Al 1 ea ,2e- t
Subdivision name/ LAY- 44-J Wt D EF If T. 1,14 &1
Lot number
Previous owner of property eye/ -7 V14 7~1.5e~(J
Total size of parcel X
Date parcel was created la
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes 0
Volume and Page Number v- 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. 00 ; 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 a Count 71ster f De s, as Document No.
W
S gnature o owner Signature o Co-Owner (If pplicable)
1-47
Date of Signat re Date of Sig ture
l
u~- . ~r'lY`a: , ~ .yu.r v, .d ~ ' h5'S Nr max, rn S+~",~"c'& s,'w+rd+y~_rbx fia. r ..i>>` i * 4 ~t; ~ ~
~1. DOCUMENT NO. -ktAi 1#1112' old` Wt C6NSiNl~ MV 2 n
"WARR MITV DEED
/1 ®1j 8 ox fi~.~ PAS V4V YHI$ SPACE RESERVED FOR RECOpbiNG DATA
0 3 4. 1
BY T MS DEED, Arnold R. Bertelsen; and Virginia A, REGISTERS OFFICE,
Bertelsen, his wife, ST. CROIX CO., W(8.
Reed for Record thls._j~rd
day oU_qovrt _A.D.19J4
a Grantoi coltveys'and warrants to Donald (i. hard and Audrey M.
i hard, husband and wife, as Joint _8U0 A.~ M.
tenants,
Reghter of Diode
Grantee
for a valuable consideration Five Thousand Dollars RE RN TO
Law Offices of
the following described real estate in _ St. Croix County, State ofWiaconsin: John W. Fetzner, S. C
Tax Key p
This is not homestead property.
Lot 6, Willow Ridge Addition to Township of.Hudson,
subject to recorded easements, covenants and restrictions.
TRANSFER
~ .0a
FEE
I
I
Exception to warranties:
Executed at Hudson, Wisconsin thls 26th da oI September 19Z3_.
SIGNED AND SEALED IN PRESENCE OF (SEAL)
Arnold R. Bertelsen
- • .Q4
(SEAL)
A. F. Yoer Vi inia A. Bertelsen
4 i,_~ --'-l ~ (SEAL)
Elaine Peterson
(SEAL)
Signatures of
authenticated this day of 19_.
Title: Member State Bar of Wisconsin or Other Party
Authorized under Sec. 706.06 viz.
STATE OF WISCONSIN j
St. Croix County. J} Sg'
Personally came before me, this 26th day of September 19 73
the above named Arnold R. Bertelsen and Virginia A. Bertelsen, his wife,
to me known to be the person S who executed the foregoing instrument and acknowledged the same.
b t 71
This instrument was drafted by*. Hugh F. Gwin
Hugh F. Gwin, Atty. .d
county, Wis.
Hudson, Wisconsin Notary Public St. Croix
The use of witnesses is optional. ® s+ My Commission (E/Ws) (Is) Permanent
Names of persons signing in any capacity should be typed or printed below their signatures. II
N.CM.'brCortqury~ IWARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 2 - 1971
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT rt
St. Croix County
r
r ~
OWNER/ BUYER ,vr4 11 Q T~
0
ROUTE/BOX NUMBER V-tz) Cj Fire Number :3
d
CITY STATE U ` ZIP '!g'y
.LW
PROPERTY LOCATION: 'k k, JY k, Section, Tzdj:~LN, R_/
Town offhS~y,~c~ St. Croix County,
11~o~/RfQ~ r,,, rc3 Lo t number 6
Subdivision
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 septic tank~pum_ ear. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
whit 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 'sys'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-
essary), 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.
H
I/WE, the undersigned have read the above requirements and agree o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed .d
and returned to the St. Croix County Zoning Office within 30 days
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.
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INDUS
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DUSTRI~ 11 DIVISION
LABOR HUMAN. REDLATIONS PERCOLATION TESTS (115) MADISOP.O. B N WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MV1gtC R7 t'T'IY: LOT NO.: BLK. NO.: SUBDIVISION IPME:
nr /ntl 1/a 14 /T-z9N/RIAA 14U&SON 6 (.JIu-01.,, i►N&E
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
SrckoIA N W 2 76% ZN>s S, lJbSbM-~
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE ~CRIPTIONS: JPEN TESTS:
XResidence MN< OrNew ❑Replace S 9a 5 9 90
Scl I cs K G S? ~o Ies
RATING: S= Site suitable for system U= Site unsuitable for system S~1C2 5 A'rTfZr~
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S E]14-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optio al)
[[,11pi 5 UU SS $ ❑U ~S ❑U ❑ S ZU CoNy&h/TI ou/e 4,
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the A/
under s. ILHR 83.09(5)(b), indicate: L /OS S 1 Floodplain, indicate Floodplain elevation: A
T PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- I 33 /00.61 If >9. 33 isl scrT 19 &Ss s► 3660,4 Ms 4S"8aN MS ~*c
B- 2 10,00 '97.11 NO-4116 > /v ,0 v 9 "&SLTS ~z"g&.S,SL ~~&Na~~ Rr~Beu /hs 40'"8RN CS{6e
B- 4.17 97.159 O k > IZ"&SL-TS 17"94-l:2 -7'48RYS~s. ~4~~Tg n'IS?CiR
B- 4 9 33 0 . 0 0 > 9, 33 x "&Lcrs zo 8a L s~JBQN ~1s Zoo "I-r N F -Ms
B-
% 0 99.75 if oN ~ 8 •s0 g tsz-rs z3MS-Gc xo k gA Ines
B- 66` BkNCS~tG,,Q
C °T PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- I Vises bfimc 1/00,00C 3 ~>Z >'Z >Z
P- 2 345- r4awg 99-Ro 3 > 2 ? Z ? 2 <
P- 3 .ZS Nowt. tbb.4 ! 7 4 7774 A
/
P-
P- 1>rY A7 rkc
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 ELEVATION 46. /S'
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedu s 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:
A Y JQJ-INSoh► . Old SoN 1~011k.LYI MrQ /970
ADDRESS: CERTIFICATIO NUMBER: PHONE NUMBER (optional):
67 S~ asp As4N W, -s-4014 34Z+ 1 U6-4oto
CST SIG RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
r
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6355 .
To tie a complete and accurate soil test, your report rrlust include.
1. Complete legal description;
2. The use section must clearly indicate whether th';s is a residence or commercial project;
3, MAXIMUM number of bediocarns or r,?Mmercial use planned;
4. Is this a new or replacement system,
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED OIL SOIL CONDITIONS;
6. PLEASE use t. eviations shown here for writing profile descriptions and completing the plot plan;
7, MAKE A L- diagram accurately locating your test locations. Drawing to scale is preferred. A
separate shF ,.,i s y used if desired;
B. Make sure yo t nchri:ark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate,
103 If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL. SOIL. TESTS MUST BE FILED WITH THE
LOCAL. A THORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS
Soil Sep cites and Textures Other Symbols
st (over 10") BIB - Bedrock
cob - Cobble (3 - 10") SS - Sandstones
gr Gravel (under 3") LS - Limestone
's - Sand IIGVV High Groundwater
cs - Cnarse Sand I'erc - Percolation Rate
raged III, diuln Sand W Well
fs s;ad l-1'ido f'.:iIdin g
Sand r Than
sI Lt";r f ;s Frian'
d - I am BI I, K
G
Y
scl C.-: Lo,)rn R
i i Clary Loarn rnot F Jes
sr S<<ady Clay s", - with
sic Silty Clay fff few, fine, faint.
kc Clay cc - common, coarse
pt - Pel t mm Many, mediurn
ill muck d distinct:
P prominent
IIWL High water level,
= Six Of,' €>ral Sod textures surface water
for Iictuid vs,aste disposal BM - Bench Mark
VRP - Vertical Re:feience 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
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ti
PLB 87
PLOT & CROSS SECTION PLANS
/ ZAPPA BROS. EXCAVATING INC
/VoiPT~ PLUMBING UNIT
p o PROJECT
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/-N~ ~RJPbSLO h CAST
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,+exoF PRoPosto
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3~1~1
5c~urN
P~'~oGPT~r NO
SCALE
FRESH AIR INLET AND OBSERVATION PIPE
S APPROVED VENT CAP
MAXIMUM 12'
ABOVE FINAL GRADE
4' CAST IRON VENT PIPE
MAXIMUM OF 42' ABOVE
PIPE TO FINAL GRADE
SIGNED:
MARSH HAY OR SYNTHETIC COVERING LICENSE: /✓~'~/~S 3395
MINIMUM 2' AGGREGATE DATE: 19c?
OVER PIPE
DISTRIBUTION PIPE
TEE SOIL TESTING BY:
C
ELEVATION BED 6' AGGREGATE •
BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW
TEST IS • COUPLING TERMINATING
f~ ~/S FT. AT BOTTOM OF S YSTEM