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HomeMy WebLinkAbout020-1280-30-000 M O m o a o o I' c ' N O f6 N i O O O C O s r t ° x z U l6 i N N N N C Z U c o w. LL -O L Q H M Z y E z ~ 11 E ~ °'w am c) H U) C O E p U O Z c _ r y Z- a~i Z ° c 0 co I- r O N Z c E '2 N Cl) N CL N (A N W W may.. C t O L O 0. - C C Y ~ U N Z F- ~ :o Z w C C d N to R N O = Va! •w d C N N O o ro a cu M U) U) 3~ 7E ~ a i= U m I o~ aaa R CL ~N 7 O U) C ° N fA J V OOi OOi O ~ Cl) S M O ~ N ° r N M C r O -p ~ ~ N y ° J m N C a\ W 6 d 4>- C O r (V ~V O O C O y E O C T C O o~ 3 ~ w c°7i a' o o rn r Li ch d -O N N V vrno i~ N C m o d C I~ M H O N j C~ p w E U • O O M 2- 0 Z c '7 `L (n C ~ v con € a 3#k a Lai. v • a m d E c c S rrww a~ 0- 0 U) L) • Parcel 020-1280-30-000 01/21/2005 05:08 PM PAGE 1 OF 1 Alt. Parcel 34.29.19.1341 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner BRADLEY W & JENIFER L JONES JONES, BRADLEY W & JENIFER L 682 EDIE LA HUDSON WI 54016 Districts: SC = School SP = Special r yAddres es): Primary Type Dist # Description 682 EDIE LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.573 Plat: 0170-CHERRY HILL ADDITION SEC 34 T29N R19W PT SW1/4 & PT NW1/4 LOT Block/Condo Bldg: LOT 6 6 CHERRY HILL ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07123/1997 885/100 2004 SUMMARY Bill Fair Market Value: Assessed with: 49382 378,900 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.570 49,400 243,700 293,100 NO Totals for 2004: General Property 3.570 49,400 243,700 293,100 Woodland 0.000 0 0 Totals for 2003: General Property 3.570 49,400 243,700 293,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 156 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~✓1 0171?.i6/ TOWNSHIP Z~,-/X~j7 SECTION TAN-R W ADDRESS ~p 8 Z~~'u~cwu~. ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~trzr~"3 LOT LOT SIZE OZO PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 ~.~rtck~s Sx60 ~d 175 1 f v • 0iq 61 /J INDICATE NORTH ARROW BENCIiMARtK:Elevation and description._ Alternate benchmark SEPTIC TANK: Manufacturer: Liquid Cap. jpCiL Rings used:-LManhole 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. //JO No. of feet from: Well Building: 4 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE .r 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: X Seepage Pit: Width: Length -%c> Number of Lines: 3 Area Built 76~6' Exist. Grade Elev._ Proposed Final Grade Elev. ::)Ilzlz~ Fill depth to top of pipe: "</2//- -3,:) No. feet from nearest prop. line:Front , Side,ARear Ft./D No. feet from well: DI>t No. feet from building /UO 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 : _ `Z` ✓«~°w~ LICENSE NUMBER: 6/90:cj . ~ GjOdU ~0~' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION 96's s9ec . 34 , T29-R19 State Plan I.D. Number CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson Last, 6 X Edie Lane LJ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bradlev Jones Edie Lane Hudson, WI 66 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. T. ELEV.: CST REF. PT. EV.: M n A) Ito Name of Plumber:, MP/MPRSW No.: V County: Sanitary Permit Number: 847 o-Ji Ro er Timm 3224 St. Cr SEPTIC TANK/ Iu ' P" _ MANUFACTURER: LIQUID CAPACIT ET ELEV.: NK OUTL V.: WA BEL LOCKING COVER / PROVIDED: PROVIDED: "11V YES ❑ NO E] YES NO BEDDING: VE"T DIA: YCIOT'MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT FRESH C, 49. .Q,t7. ALARM: / LIN\lE:~ AIR IN T: FEET FROM ❑ YES NO _X14 11, C-a S& ❑ YES NO NEAREST v~ DOSIN CHAM ER: MANUFACTURE . D G: ITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑ NO ES ❑ NO GALLONS P LE: PUMP AND CONTROLS OPERATIONAL: NUMBER O WELL: BUILDING: VE TO FRESH LINE: LET: (DIFFERENCE! BETWEEN PUMP ON AND OFF ❑ YES [I] N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture ,a o plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, cotfstruction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID S TRENCHES: MATERIAL: I D iso / ~ .3 1 10 T_ DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: NO. ISTR. NUMBER OF PROPERTY WELL, BUILDING: VENT TO FRESH BELOW PIPS: ABOV OVER: ELE INLET: ELTD: A S-r/y1 _ PIPES: FEET FROM LINE: / AIR INLET: I 0 f.) •/~O ` X07 YY (\~I f7 V 3 NEAREST MOUND SYSTEM: MOU lowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM sl pe and furrows unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES 71 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: ❑ O ❑ YE S ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DE OW PIPE: FILL DE TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD E MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: ELEV.: PIPES: DIA.: ELEVATIOILAILO_ DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO MBER OF PROPERTY WELL: BUILDING: PERMANENT MARKERS: OBSERVATION WELLS: iAREST... COMMENTS: ET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO ~ .r '!O ,#srArl --b - a66 S a. Cj Cy 'Por'zz, coo CD O'~ 7/% - A d ~ ~fg , ~nc~ of ~ ,5'✓~ ~ 6~f~/ ~ ~ n d of'3 ~ S% ~ 60~~ 7~'"- ~CZ+r~ .~2 d rcoc aiTt in county file for audit. Sketch System on Reverse Side. SIGNAT E: TITLE: SBD-6710 (R. 06/88) C'vt SANITARY PERMIT APPLICATION 4 Vl®n/ Z ~ -70 LHR 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 ❑ ! 0-- ~Ious 8% X 11 inch@s in siz@. Check if revision 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 '/a 4, S T l_~ , N, R 1 (or / PROPERTY OW R'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR M NUMBER _4 o E:I II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned 0 VILLAGE ~ i ❑ Public ®1 or 2 Fam. Dwelling-~# of bedrooms A EL AX UM R() ~ d III. BUILDING USE: (If building type is public, check all that apply) 12L4 ~v r a9c - 3e, 00 1 ❑ Apt/Condo 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. 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 IS&Feet id f k Feet 75t, -7 6a VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber F1 1 1-1 1 r_1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum Zs Name (Print): Plumber's Signature: (No S~mps) MP/MPRSW No.: Business Phone Number: 77 1 Plum be dress (Street, City, State, Zip Code): n IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing am Signat No Stam 14 Surcharge Fee) XApproved ❑ Owner Given initial ~ 3 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 a 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. ll. 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) APPLICATION FOR SANITARY PERMIT 9TC-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 p:tmlt Issuance. -Should thla development be Intended for resale by owner/conttactor,(spec houaa), then a second form should be retained and completed when the property is sold and submitted to this offlce with the appropriate deed recording. Own: r at property Location of property 1/4 1/4, Bectlon - T,_11•R Y Township .I~Tt,~rJS o-tj Marling address RR ;t s Z T, A) 6 Marcos of alto ..1.6T Z c L-A Eubdlvlslon name- Lot number Previous owner of property _Cj4a4wl JCC Total sire of parcel Date parcel was cteated Are all corners and lot llne■ ldentlflable? on Ao is this property being developed for resale (spec house)? an Volume and Page Humber _Z_0Q as recorded with the Register of Deeds. INCLUDE VITH THIS APPLICATION THE FOLLOVINCt A VAARANTY DIED which Includes a DOCUHENT NUHRRR, VOLUHti AND PA02 NUMB IR, and the BIXL Of THE RE018TER OF DEEDS. In addition, a certllled survey, it available, would be helpful so as to avoid delays of the reviewing process. if the deed description taferencas to a Cettlfled Survey Hap, the Csttlfled Survey Hap shall also be required. T PROPERTY OVHER CERTIFICATION I(Ve) certify that all statements on this form are true to the best of my (our) lnovledgej that I (we) am (ate) the owner(s) of the property described In this lnformatlan form, by virtue of a warranty deed recorded In the Offlce of the County Register of Deeds as Document No. ~ and that i (Va) presently own the proposed alto for the sewage lAposal _ system (at I (we) have obtained an easement, to tun with the above described property, for the conettuction of sold system, and the same has been du y s eotded In the allies of th County Rag rtes of Deeds, as Document No. slgnatute of Own 8 gnatuta of Co-0 tit Jlppllcable) e~ D a t e o f tl 1 q na L u c a Data of Slgn tuts J DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE 13AR OF WISCONSIN FORM 2-1982 U 4G371,8 Ir - REGISTER'S OFFICE Carmichael Residential ..Group, Inc, a ST CROIXCO, WI Minnesota corporation Recd for Record - 001' 3 i 1990 - - - and warrants conveys - - - to radley..W,___Jone. s -and.- J eni .fer at 11:15 A.. M T L._-Q{Zes...husband..and _.laife_ R11sterof0eeds',-7 RETURN TO - the following described real estate in ......_......'...~T'01X ...County, State of Wisconsin: Tax Parcel No- Lot 6, Plat of Cherry Hill in the Town of Hudson, St. Croix County, Wisconsin. x_10.7.7-0 R. This 1S..r1Qt.......... homestead property. (is) (is not) Exception to warranties: easements`, restrictions and rights-of-way of record, if any. Dated this 4....-?.................. day of _.._.OGtObeY' 19._9 Ca i ' ael IIR~~e.id n ' al Group, Inc (SEAL) •------y .•-----L'~l --f- ' Ge e e , Jr. •------------------------------•-----------------------------------.-(SEAL) • ---•----•(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. 1 St. Croix ------------------------------------County. 30 authenticated this ........day of 19...... Personally calve before me this ..---__-day of QCt01?~ ' 199Q_._. the above named J)2 ..Baordal------------------------------------------------------ TITLE: MEMBER STATE BAR OF WISCONSIN - (If not- = authorized by § 706.06, Wis. Stats.) A~ to me known to bet !Ye~ o executed the f r ng instru of ac wled ame. THIS INSTRUMENT WAS DRAFTED BY O Kristina Ogland Lundeen ` o.. Attorney._a~---Law--------------------------------------- . - ~ Notary Public X --County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is ate, expir tion are not necessary.) date_ ____________July-__-_- F 19......... ) '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. FORM No. 2 1982 Plilwnukee. Wis. Z N j/]~ SECTION 34 J F- a Z GII T29N, R19W NW-SW SW-SW EDI S ~r . z N ~ w w NOTE: OUTLOT 1 IS TO BE ADDED TO LANE LOT 3 OF ST. CROIX COUNTY w C.S.M. VOL. 8, PG. 2117 AND L!IS NOT A SEPARATE PARCEL. - - ANE to OUTLOT 1 m SE-SW 03'20' W 145• ~ .zre~I!BPOINT EGINNIF 0.050 AC. 1 .125.75....... 2, 199 S.F. o w ° 1 I t0ii m °0 CERTIFIED SURVEY MAP I VAR rn o u`Di VOL. 8, PG. 2117 ~ iv ° m " - - - - - " - - 1 PART OF SECTION 34, W 9 ~ Z I T29N, R 19W . z n 335.91' Q cu N 00 06'35' E J w 0 0 355.91' V 0 24 to N S .n co I w w m Q1 N ( - n 'n lD ' z ~ n ~ LO N I 4 in ° 66C\j m m I co m2.355 AC. co co CERTIFIED _SURVEY _M_A_P m 23 I O Z? VOL.- 7,_PG. 1813 I I 102,574 S.F. \ I \ W \ H 324.38' I \ N 00 14'30' E ~LJJ \ (NO0'00'19"W) \ a 29 6° z 9, of X01 ~9 \'G 22 O~;e wI 9s, 5 ai 69~ 'B. 21 ' 4,2:17 AC. m' z• >i 183.684 S.F. ~ 1 \ 1 1 I 20.1 O N 0009'46' E 1 8 .3 517.51 N~ W 034 AC. ti w v o°j rn:v N12'57'36'E 58 S.F. 50.00' y 19' 7 6 r _ I 3.573 AC. °o I• 155.660 S.F. m '89'56'40'W I I o N 15.15 , ' I I 66' Q Q1. 18 I O N m N 0003'20' W- w 196.53' N 00'14'30* E' io 445.00 r in m S 00 03'20' E m ..196.53_ Z ro 66' Z ''1 W Z I Q ° l 0 6.489 AC. W PF32f3f;R .1; - F: N SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County ~ w OWNER/BUYER rt t o ROUTE /BOX NUMBER LE L Fire Number :J d CITY/STATE ZIP rt PROPERTY LOCATION:'.'' k SectionT N, R W, Town of H V b a©~~.. St. Croix County, Subdivision L_.L*__, 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 licensed''s'eptic tank um er. What you put into the system can a ect Me function o' Lne ~eptic.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.o£ 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't'ems 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. y 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 Depart- ment of Natural Resoures, completed a and returned to the of the three year expiration. date. SIGNED G~Und~~ DATE 7'l si1?~ ITLL St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. D MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING: '1dOIJIST G(JCTRY, DlvlslOr LABOR AND PERCOLATION TESTS 115 P.O. BOX 7961 HUMAN RELATIONS MADISON, WI 5370' (ILHR 83.09(1) & Chapter 145) LOCATION: btt; TION: TOWNSHIP T NO.: SUBDIVISION . fM 4 3b, /T-4 N/R in-EI(or $D L'/lt~'iC`/ / - 5L144 CO NTY: ~y OWNER'S BUYER'S NAME: MA LIN ADD F-55: &r C~ r/1 USE DATES O ER ATIONS MADE NO. BEDRMS.: COM MERCIAL DESCRIPTION: /?0N TESTS: Residence LAN New ❑Replace /~j Qa /g 40 sn t ~s 2C4K 4 r / 7 66 RATING: S- Site suitable for system U- Site unsuitable for system ~f SYSTEM-IN ONV,N ~U M '❑U INGS []U ~ULH❑SGL~JU (optional) If Percolation Tests are NOT required DESI N RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Z L/1SS Floodplain, indicate Floodplain elevation: • CF r- PROFILE DESCRIPTIONS BORING TOTAL PTH T GR UNDWATER•INCHES CHARACTER F SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHt%. ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) Ln►~ B-•/ ~.67 ~.Z7 I,ta 6.~7 "~r_Stc~s JS'"kAAk*SiL 4'&,BegMslw 6'Z" $!Z B-.Z 00 2.g37 r~- UV ~~gc.S,~TSi9"Be~S,~61'Qal s 't. 46'QaN~S B- 3 totzS /oz. 6-L 0t! if /~.ZS e '$f_s•t_-2 iv GYIBRws~~ ss"+2S~~N M5~ 4Q BRNcs~ B-4 >.'7,__, 9zA No., "BLs,Crs II'$~Ns,~ T /S, z'~tM s1o~ B-S 3.6~ 9~.a7 hfo,.l_ ? 3•C7 -7 "9,L<,,L /7" 9k-, 'St B- ~EC~T PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER it&QW;eS AFTER SWELLING INTERVAL-MIN, p R PER INCH P. 1 a o►.11= /U~.UO /o >Z >Z >Z <t' P. ~►30 01IL.!U l /O g Y P. O o.:Le ,70/ P- P- - Y1T l A-t' 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 hot 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 percer of land slope. - 4 5,~1%O SYSTEM ELEVATION g S, ~r, T c7 T I : t ' - 74 t7~ I T I .T LOP 3 4 . _ J~ _ d - , _T-~ E - - - - r -----r ! 1-70!t I, the undersigned, here I FPrtify 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 at the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM print : TESTS WERE MP TED ON: At~vc AI.u~xu. Jr~>`:~,so~, ~v ~~uc g 79/90 AD DR S CERTIFI AT N Q % O NUMBER: PHS16 NUPASER(o op-tional): j~SOi~/ c~► O --1 S-EC-ONJA CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - T ` JOB gr~ ✓csli~t TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 T WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ...........s i Cc/ e !P 4 , r4~~ 90 ' . I . ~s _fc <~t 0 . . 55s - 8 . c...... ~L rry /s°: . i I ' l f FMS, I I l . ~f 6' 0 0 59~ t _ 5 ~r~PS r?f!4.. , , i....... . l r, s? PRODUCT 205-1 ~Inc., Groton, Mass. 01471. To Order PHONETOLL FREE I-BDD•225-00 -t.! JOB &,!-"d -~Ia 4eS TIMM EXCAVATING SHEET NO. 2- OF Z Route 1 Box 192 m 7 _ So WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS 03224 WI MPCA #696 MN CHECKED BY DATE SCALE . T U`~41.1V~~C w~ r ,i ~C.'~ - lr J ~j.......... 0 r.w. . t r r 6 rr . ! _ - PRODUCT 205-1 ~ Inc., Groton, Mess. 01471. To Order PHONE TOIL FREE 1-800-225-6380