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HomeMy WebLinkAbout042-1098-20-100 ) o o0 ~ I o0 30 O 60). v y O ao o a o 2 10 porn N N T a I r ~ j V' 1 C O T •y ~ C (D .N C O C w o a N N a ° N y i N C C > Z j o Z ~x LL c O a m o o Q v I y Q °c3 I I c II 3 ~ I ~ ~ I Z W 03D Z ' p O° I ~I d m cLOn H Z Q m d m C I o I 0 z o Z Q~ - 1 .4 2 o dz:t ° c o, c z to H C Q> c E a m Ili N N 7 CL W 1, y N N I O •N am s I a~ a .U I o v o o N a Z co z z m z o N Z I N CO E N E m I > 12 _ A N co a. cL C2: ! ooa` coa` ~NI o U) U) V) U) ca U) Cl) ~L LL • ;j i'aaa_aaa a 3 co co C) 0 ~l N J V OOi 00 ° y OOi OOi Z V co n N z N _ O N co co E 'i, j _ -p 7 O O D ~ 7 C :3 N c ml c d co W C ' T Q d q} uJ I Q .o m Q Z~ m I ~ !mil p 7 N fA O O w N C LO U) C E O O I N NO O N a ! p -o N 0 (D Lw c6 O O °r ~ I Q O to O O N ti o y y co z N a"i c 0) E LO c Z: ~ v LO ca o o ° c° U O Z c z cn • O m 3 U o z g ewe = l L a v v~ d A ~a € L: L L ~ a i a ~ a CL 7T) rr`i~v ° 1`0 0 O N V ~1 A U CL Parcel 042-1098-20-100 07/14/2005 10:13 AM PAGE 1 OF 1 Alt. Parcel 35.29.18.541A 042 - TOWN OF WARREN 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 * CUDD, RANDALL P & AARON R RANDALL P & AARON R CUDD 929 QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1375 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.300 Plat: N/A-NOT AVAILABLE SEC 35 T29N R18W PT NW NE LOT 1 CSM Block/Condo Bldg: 8/2183 2.30AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 12/17/2003 749408 2476/255 WD 12/15/2003 749047 2473/648 TI 04/23/1990 457812 868/431 WD 865/310 more 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.300 39,000 151,200 190,200 NO Totals for 2005: General Property 2.300 39,000 151,200 190,2000 Woodland 0.000 0 Totals for 2004: General Property 2.300 39,000 151,200 190,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 INSPECTION REPORT FOR SAFETY & BUILDING DEPARTMENT OF INDUSTRY, DIVISION LABOFr& HUMAN PELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION P.O. BOX 7969 MADISON, WI 53707 State Plan I.D. Number: y ,NE4 ,Sec.3 5,T 2 9 -R18 El El (If assigned) NW CONVENTIONAL ALTERATIVE Town of Warren ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound F MOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Al Cowles Rt.l, Roberts, WI 54023 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: ,Lyle Myers 6219 St. Croix 135542 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ROVID DLABEL pROVIDED:OVER ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: RWAHNI OVID DLABEL pROVIDED:OVER ❑ YES [I NO ❑ YES ❑ NO ❑ YES ❑ NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: FEET FROM LINE: AIR INLET: (DIFFERENCE BETWEEN PUMP ON AND OFF ❑ YES [__1 NO NEAREST LENGTH: DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LIQUID WIDTH: LENGTH: NO. ;PIPE DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: DEPTH: BED/TRENCH TREES: MATERIAL: PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTRDISTR. PIPE MATERIAL: NO. STRNUMBER OF PROPERTY WELL: BUILDINBELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. : PIPES: FEET FROM LINE: AIR INLET: 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: ED 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: DoIA.: 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: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Retain in county file for audit. Sketch System on TITLE: Reverse Side. s SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION ILHR COU In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 241ous ~ 8 fz x 11 inches in size. Chet if evis to application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNER PRO RTY LOCATION L L J Y, t4 Y., S N, R E (or W PROPERTY -OWNER'S MAILING ADDRESS LOT # BLOCK # A CITY, STATE ZIP CODE FP-HONE NUMBER SUBDIVISION NAME OR CSM NUMBER s 5_C/6 > ~ P2"5C-er5 IJ1 II. TYPE OF B 111 IL DING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE : ❑ Public 9 1 or 2 Fam. Dwelling of bedrooms PARCEL Ax Nu Ill. BUILDING USE: (If building type is public, check all that apply) 5<~ l~1 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. g Reconnection of 5. ❑ Repair of an System System Tank Only 7 ~ Existing System I 'sting System B) ❑ A Sanitary Permit was previously issued. Permit # ! 9 Date Issued ` q 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 REOUI ED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) /ELEVATION uQ' CJ 1157 r 76,/ Feet 7 S Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExist-ing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank t/~c9c~ 126 e a'O,r"~~~ Lift Pump Tank/Si hon Chamber El El Ll 11 1 F1 VIII. RESPONSIBILITY STATEMENT 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 tamps) /MPRSW No.: Business Phone Number: Plu is Address (Street, Clily, State,; ip Co e t f IX. NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing gent Signatur Stam / Surcharge Fee) Approved ❑ Owner Given Initial ~ ~ /d 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. 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''4e installed. It. 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 FUR SANITARY PERMIT STC-160 This applicatiun form is to be completed is iail tid signed by the owner's) of the lion x y being 6cvcloped. Aay iiiad iic:-._;_ s _ :i y result in delays of the permit is u.r#.2c 5tiould this developmen% be i, o rc«':_ r resale by owner/ contractor, ("spec hoij , 1-hen a second form should be rf_t Tir = d .;.id completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property _(Z rLkJ 4j Location of Property V; Section S , T~N-R J W Township ~)Q VV r 1,\ Mailing Address.- ~j G Lt• 1©~ Pv ~S S'YG~ Address of Site ce ~x C Subdivision Name Lot Number Previous Owner of Property (,t1 e S t e Y a~ gZ a 0V'-.5 ~ ow) ej Total Size of Parcel , S ci C V C S • Date Parcel was Created _/0 ' Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume (PLO a 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, 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eenti6y that aU statement6 on .thi,a 6onm.afce tAue to the beat o6 my (om) knowledge; that I five,) am (aAce) the own.eh (,s) o6 the pnopen ty ded ehibed in th iA .insonmati.on 6o,im, by vt&tu.e oU a wa.!ttanty deed teco&ded in the 066ice o6 the Cocutty Reg i5 tet o6 Vecds cis Dec(m, exit No f -?zc,, ,(Q 1 ; and that I (We) pAUeWy own the mope s ed d.i;;e 6/on the sewage da po's Q-Vj,~. em (on I (we) have obtained an easement:, to 'tun (,Kth the above de uti.bed ph.ope&ty, Ooh the conatnuction o6 said 3y4tlm, and the .actx has been diAty neeonded in the 046iee o6 the County Reg.cateh o6 Veeda, as Vocutiteait SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED "TAT!, 5 n... . r a .,.1 r toll f M; . :;xatd re" a Caunty, wca F;lG:el: 8Ct8ChCd for iw'e.'1 +LyLa..tuk:>L^1.~.~i.7.GCl. ~ -`~'r~t f.A~ . - - s, s' Il ~tii^ ,sue 2~.i~ yes ~r '1 s~~~'~~ .rl ~ 'C'1 t tr P = ~ ~ s f Jfas, t (is) (is not) P ty i p; Dated this 1st day et-'_11Ar •e 19 (SEAL) Idea -4 (SEAL) We 1e G Cowles {SEAL)- Doris A. - Cowles AUTHENTICATION 'ACKNOM4EDGMENT K7. Signaturessuthenticat rithis. ._"_L_._.da of STATE OF. SM { ` ss. t. j 7 my. , P set. is day of the above mated TYi t.E: MEMBER STA M BA I2 OF WISCONSIN (If, not. a,.•'Wdzed by 4' C4.05, Wis. Stets.) This ins'rr mert was drafted "y L,~o A. }3r:5''.~r Attorney to ms known to be the person,_wboexeerteu tMfore- 2 ""UJf*0r-mff1i'f'_SC: - going iastrvmeat mad acksowtadpd the saws. F w~ r Falls, W1 5Z=022 t $ J"Y to = ; ► r►ac~t= 3 or acknowledged. Eut!t lvrtary Public County, pis. ate .snit. ao~crasa.y, y - Commission is pe: anent. (If no,, state expiretioa } F l . nF taga+ s Y 5; Ft S)<f`i}.. ,.5 • , _ . qR~ t ~a. r° A tb s . "ATx am -s~amas xs~.c.~.;a -=a 4..~risYr f7~Xt. .r of *"Cox". Comm No. 3-19,?? v RIDER attached to Quit Claim Deed - Wesley G. Cowles and` Doris A: ' Cowles, to DORWES FARMS, INC., a Wisconsin Corporation;r ? Description of Real Estate 1. The Northwest Quarter of Northeast Quarter (NWkNEk) of Section Thirty- Township Twenty-Nine (29) North, of Range Eighteen (18) West, ` St. Croix County, Wisconsin. (Per Land Contract between John J. Mueller.et al,Vendors,to Wesley G.Cowles' and Doris A. Cowles, dated Dec.1,1981,recorded 12/2/81, at 9:45 A.M., in Vo1.638 , on pages 534-535, Doc. #374728, in the Office of the Register of Deeds for St. Croix Co., WI.) y 2. The Northeast Quarter of Northwest Quarter (NEkNWk) of Section Thirty- R' Six(36), Township Twenty-Nine (29) North, of Range Eighteen (18) West, St. Croix County, Wisconsin. (Per Land Contract between John J. Morrisette, et al.Vendors, to Wesley W G. Cowles and Doris A. Cowles, dated December 1, 1983,• recorded 12/2/81, at 9:45 A.M. in Vol. 638, on pages 530-531, as Document No. 4 374726, in the Office of the Register of Deeds for St. Croix Co., k.) d 3. The West One-half of the Southeast Quarter (WkSEk) and the Southwest. Quarter of the Northeast Quarter (SWkNEk), and West One-quarter of East One-half of Southeast Quarter (Wk Ek of SEk), Section Twenty-Five (25), Township Tweucy-Nine (29) North, Range Eighteen (18) West. t. (Per Land Contract between Leon M.Delander and Marilyn T. Delander, Vendors, to Wesley G. Cowles and Doris A. Cowles, dated April 2,1980, recorded April 4, 1980, at 11:00 A.M., in Vol. 610, pages 215-216,as Document No. 363544, in the Office of the Register of Deeds for St. Croix County, Wisconsin) EXCEPTING from the above described premises at #3., the following described parcel: That part of the Southwest Quarter of Southeast Quarter (SWkSEk) and Southeast Quarter of Southeast Quarter (SEkSEk) of Section Twenty-Five (25), Township Twenty-Nine (29) North, of Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin, described as follows: Lot One (1) of Certified Survey Map filed November 10, 1981, in Volume 4. page 1129, Document No. 374388, in the Office of the Register of Deeds for St. Croix County, Wis. 4..Northeast Quarter (NEk); also East One-Half of Northwest Quarter (E%NW%), Section Thirty-Five (35). Northwest Quarter of Northwest Quarter (NWkNWk), except the North 24 rods of the West 10 rods thereof. Also South Half of Northwest Quarter , (SV*A), except the South 218 feet of the West 423 feet thereof, Section Thirty-Six (36). Range Eighteen (18) West. All in Township Twenty-Nine (29) North, The above described premises contain 356 acres, more or less. (Subject to mortgage to The Federal Land Bank of Saint Paul, recorded Jan.17,1975, Vol. 519, page 380 - Doc.-1325402) St. Croix County, Wisconsin . i • • N H a STC - 105 r r >H SEPTIC TANK MAINTENANCE AGREEMENT r. St. Croix County z d n~ V~v 9 OWNER/BUYER . FQyo,S M ~S ROUTE/BOX NUMBER / h Fire Number .CITY/STATE S+- CV.01-)c (N~SC6v~S~ r ZIP $y0~- PROPERTY LOCATION: &tjt k, 41F 14, Section , Td1N, R If W. Town of W QVVCv- , St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you putt 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 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. 0 I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offk9e within 30 days of the three year expiration date. SIGNEDj&_ v DATE .?M St. Croix County Zoning Office P.0. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ' RTC"FNT OF #~"OINGS AND SAFETY & BUILDINGS DIVISION STf?'f, 1 1 P.O. BOX 7969 3(,R Ar~)1~ ~ r , (115 UMAN RELATIONS`NMADISON, WI 53707 (HG3 030) & Cl~a)~+Lt 945.045) FO GATIOg~ ONSNiP/fal'JTL"fT AT tT7: OT NO.:BLK SUBDIVISjION NAME: ~~t r , "T 41/ilr (or U JTY: I SlBU S AM MA'iLING AUUiT DATES OBSERVATIONS MADE : ION TESTS: tZH USE PROFILE DESCRIPTIONS fPJ. Rta„ifvr.~.~C1MMFfiCIAL DESGFiIPI IUiJc ~ ~'~tTesiCienee ~iFJew ~FT~p!ace s L 5 ha RATING: S- S;f'~ suity~3le fur system U= Site unsui+ablp for system ONJ~~r I ICS !^!.i ntOUr~O: tij76R'7tlN•D-_ff40£<: r E:.,tiSTEf1•IN-f!Ll'll t.[31hdG TAfiK: RECOMMENDED SYSTEM: (optional) If Percr,laticn Tets are NOT required DESIGN RATE: if any portion of the tested area is in the [under s,H63.09(5ilb), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS s' G BORING TU~f~L P TH T R NDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR. TEXTURE, AND DEPTH NUMBER I~Ef'iH IN, ELEVATION OBSERVED E HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B. l > 0 1 B~ /s d in l t. 8 ~ rc B- > > 9,i i2 A3'!1 / 9' n P-!. '15 B- yd t ' dt' .6' c 'D.~ ' ' ~prs ? ' s es B- 7 v f B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L VEL-IN HES RAPER INCH NUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P I D P f 1 P- P- P a JS 3 d P- P- 3 ,t 9 Z 3 i 1 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 i i SEC g77/dcITo SNFFT 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 knowledo and belief. NAM print : TESTS WERE COMPLETED ON: ADDR SS: CERTI CATI N NUMBER: PHONE NUMBER (optional): CST SIGNATURE: l~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBO-6395 (R. 02/82) - OVER - 14 r >r Ir )r. 'M f a, bo ` 1 1 t V / } 1 I \ti • ~ H M r' tl% ©Q - s V ~ M ~ • c L i VS • \ rA 3 1 1 3 a Y Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER G TOWNSHIP SEC. 3 T N-R 1 ,VW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE /D PLAN VIEW Distances and dimensions to meet requirements of I.IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 70 Ale Slo® c ? 5 z9 ison A? s.f - A /Z' 3s i ¢sSa~>r /~'G; C7 /rIllet INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 'W' 2ge Elevation of vertical reference point: 1610t e2 Proposed slope at site-` SEPTIC TANK: Manufacturer: 1,j!5~e in,~ Liquid Capacity: Number of rings used: Tank manhole cover elevation: lp 2, 7 - 40o,/ Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, ide, o Rear, O Z~!d feet From nearest property line Front, 0Side , DRear,0 feet Number of feet from: well 71~ , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: 7 G Number of Lines: 2- Area Built: Fill depth to top of pipe: /Z Number of feet from nearest property line: Front, /ide, O Rear,O Pt._.' Number of feet from well: = ~44 Number of feet from building: (Include distances on plot plan). 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 line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS iLAPOR & HJ1MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, IYVI 53707 NE4, NE~,S35,T29N-R18W nCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Town of Warren If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 70th Avenue NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE Al and Carl Cowles Route 1, Roberts, WI 54023 III -9'r 4. /5 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber MP/MPRSW No. Cn-1V Sanitary Permit Number: Dave Fogerty 3289 St. Croix 106078 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. L ABEL LOCKING COVER VI ED PROVIDED, ~ Q t ~ . 1 P t•~ IWARNING YES ❑NO DYES 1JNO BEDDING: VENT DIA.: VENT MALI HIGH WATER NUMBER OF ROAD PROPERTY WELL. BUILDING: VENT TO FRESH I 1' L ALARM FEET FROM /f /1 NE/ r 171 71 O AIR INLET DYES NO DYES NO NEAREST (/V Q T v-f/ DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI TV PUMP MODEL PUMP;SIPHQN MANUE ACTIIRER WARNING LABEL LOCKING COVER PROVIDED. PROVI DE O: DYES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMPAND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST op SOIL ABSORPTION SYSTEM. Check thesoil moistureat the depth of plowing 1111AMI TEH JIIATI HIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF UISTH PIPE SPACW(; COVER INSIDE. JUTA -PITS JLIQUID p -7O THE NCHES MA HIAL PIT DEPTR. DIMENSIONS 0( GRAVEL DFPi Fi FILL DEPTH UISTH PIPE UISTH PIPE DISTR PIPE MATERIAL IN DI$ T UMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPE$ ABOVE COVER ES V.INLF I ELaE V/ EN( PIPES LIN .576 / AIR I{1 I ~1 1 .0S l(o. V 9 EET FROM ll ~~EAREST s MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PEHMANI NT MAFiKEHS JOBSERVATION WELLS DYES DNO DYES ❑NO DEPTH OVER TRENCH BED 7DIPTII OVER TRENCH HED I)F PTH OF TOPSOIL SOODFO SEEDED MULCHED CENTER DGES DYES. ❑NO DYES DNO DYES 0N0 PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING IGHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR JD~STRPIPE DISTHIBUT ION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEVCIA ELEVPIPES DA.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORHECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: 'FROM LINE S (f DYES ❑NO DYES ❑NO NEAREST D l V 0 ~ J ~ 2.53 Sketch System on fl = tarn in county filali.1t. Reverse Side. SI TIT Zoning Administrator DILHR SBD6710(R.01/82) pp- SANITARY PERMIT APPLICATION COUNTY 1~)DILHM In accord with ILHR 83.05, Wis. Adm. Code 7 " 0 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. /NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROPERTY OWNER PROPERTY LOCATION 3524AZZ A16 '/,,!/E '/a,S S T N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE 7PHONENUMBER CITY NEAREST ROAD, ❑ VILLAGE : 74 Ale 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family A/ OR ❑ Public (Specify): 111. PURPOOSE~ OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. [ J New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. Vonventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 'See a e Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~y P, f20 I Feet L f~I_.Ir'rivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete structed Steel glass Plastic App Con- Tanks Tanks kr &9V Septic Tank or Holding Tank w e [T F1 El ❑ 1:1 Lift Pump Tank/Si hon Chamber 1-20" FIR::FTF-17F 1 VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) _ MP/MPRSW No.: Business Phone Number: ~r A-L s6 Plumber's A ress ( reet, City, tate, Zip Code): Name of Designer„ VIII SO L EST 1 RMATI Ce 'fied Soil Tester (CST) Name CST # I .2 S C T's ADDRESS tre ,City, to ,Zip Code) Phone Number: IX. C UN Y EP ENT USE ONLY ❑ Disapproved ~ary Permit Fee Groundwater ate issuing Agent Signature (No Sta ps) Approved ❑ Owner Given Initial S charge Fee / / Adverse Determination 1 fJL.~ lJV X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03186) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) -should be pumped by a licensed` pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed: 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ili. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 fanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundyvater- included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge-, took effect on July y 1, 1984. All of the water that burled freasure~ is, used in yo;!r hiilding is returned t~_, the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. ponies collr t~,, through thi,se -irckarges are credited to the groundwa.'er fund adrmis- f.-re^ by he Dep. rtment of Natural R sources. These funds are used for monitoring g;ou,d- ik,, g•.ur.-iwa,ercontaminaU.xi investigations and establis Est-rttof standards. around t+ s ~wcr ' protect ng. ;313 s, =9,~ ;;.03/86) H z STC - 105 r' r 9 SEPTIC TANK MAINTENANCE AGREEMENT ryi St. Croix County z d a OWNER/BUYER FaV 0, H ( yuj, ROUTE/BOX NUMBER i - x Fire Number .CITY/STATE_ S4-cyr';x (N~SC6Vt 5zip Syo~ PROPERTY LOCATION:/►/w X14, Section, Td q N, R J W, Town of w aVVcv\ , St. Croix County, Subdivision , Lot number ii Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. 0 I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S I G N ED DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ;g rim ~I Al, 4X MJ" X '1 ~ 4~s ~'.T t e k I~ p n lot Yu M#tCaAT1l F'I.E~it1T AN* 4r 3 s i NY yy' S 41 1 t T + *y '41 1 - as e t t2'9 .fit. =10 t g =3. heel 1, at &Ij 4 ~ .l:rl,.ra~+rded 12/2181, ~ . 4P~►' S ;374M in the Offt", o `1 L -in t of Est Quarter (NZkNffk) of Tames ip TMerity-91*4 (29) North, of Range Biahta tYS ~s~~ , wig F -40 a`rae :between okn J. lforri etts , et al, Ala Do~s'ia A. Coi► es. d Elyd D"46bsr 1. 1987 1. at;` Jr*5 A,M. itt' 633W On . I~ei 530-531, as moister of Deeds for St. Crux, • 6~ a:A th4 Office or °fl %gif of the , t Qmmta= (alt k) and tbe, Of 00 u t W fib) + and Best One- 0"*A ! Est Qoa~tt oft: Ift of SBA), Section Ttteaty~-!!f~' <t119IN~ Ihne (29) Range Bighteen (18) Weatt - between' neon K- landerand Marilyn T. Dels to p, G. Cowle and Doris A. Cowles, dated Aprils 2,11* x = ,April' 4, 1980, av.11:00 A.M., im Vol. 610, Pages 215t2*,0 U6. 363544, in they Office of the Register of Deeds f' y,., WAWkftsiu) fR the above' described premises at 13. , the fo tit .4 That art of the Southwest Quarter of Southeast Quarter A $o~ Quarter of Southeast Quarter (SUSEU of ' Sec w Rang . r Figs, (25), Township Twenty-Nine (29) North, of h' } t, Town of Warren, ;St. Croix County, Wisconsin, descr s Lot One (1) of Certified Survey Map filed 'Navel 14 ` s*' us` 4, 1129. Dociaent No. 374388, in the, Offi+ie;; of tb Of "for St. " Crroix County, Wis. r F also Bast One-Half of Morthwest. quart, -4 (35). 1Mist Quarter of Northyest Quarter MANA) except the N sEf, t nest 10. rods teof. Also Routh )Half of Notes .ai~px thie- South 18 feet of the West 423 feet is # Sic C V. d - . Tamship ,T"nty-Nin (29) Vorth, Range-'Eighteen (}8)' i t* *bov6 described premiss contain 356 acres, more or less'. jest .to s artggage to Ths Federal Land leak of Saint pawl, - 2) - . M ;17" 54 Val. 519, pate 380 - Doc.-#32540 = fs- . Caoi County, WisconsIn, 1 1 J 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 Op t ck) Cf O rrn S 2 11 C Location of Property AZ_W WE k, Section T~N-R~ do' W Township W ct VV Z: ( I Mailing Address b G Address of Site.S Ce ~ ,r - Subdivision Name Lot Number Previous Owner of Property ~N es (e Y 2,1 oW) eJ Total Size of Parcel m S Ce C V C S Date Parcel was Created _/0 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume LAP,) and Page Number 4LO7 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PRCPERTV OWNER CERTIFICATION I (We) cexti.by that att statements on this bonm, cute true to the but ob my (oun) knowledge; that I (we) am (cute) the ownelt(s) ob the pnopehty de,6cAibed in this inbonmati.on bonm, by viA tue ob a wai arty deed neconded in the Cbbtice ob the County Register ob Deeds as Document No, 1 and that I (We) pt uentty own the proposed site bon the sewage dis pas s ys em (an I (we) have obtained an easement, to tcun with the above de3cA bed pnopWy, bon the corvstAuct on o6 saki system, and the dame has been duty neconded in the Obbice ob the County Register ob Deeds, as Document No-&:2-"%2>SU k 1. a SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAB✓11 ANA PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LSECTIOTOWNSHIP/ LOT NO.:B LK. NO.: SUBDIV141ON NAME: V4 V4 111/11/i E (or, NT~YJ: S BUYER'S NAME: MUSE wT S`/OJ 3 NO. BEDRMS : COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE Residence E4LO FI TONS: A ION TESTS: 2' 9 3 New ❑Replace 6 s L RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) CAS ❑U CAS ❑U MS DU If Percolation .n Tests are NOT required DESIGN RATE: under s.H6309(5))1b1, indicate: I If any portion of the tested area is in the LFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS NUMBER BORING DEPTH ITOTALN, ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH T CKESS, CO OR, TEXTURE, AND DEPTH OBSERVED E T. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 0hL > /0 1 se S A, A .7, B- 2 ' 1.3'9"151 f 77 7. 1 > ?,7 B- PERCOLATION TESTS TEST OEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI002 PER RAPER IINCH ES p_ yrl s p_ 1 P- L 7S / J//o P- P- 3 .t 9 Z, 3 r / Pp_ 3 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 , t , , ~y 3r . ~N SEA grp/ocfE. s ~ FT , 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. NA (print TESTS WERE COMPLETED ON: ADDRESS: S > 6 CERTI CATI N NUMBER: PHONE NUMBER (optional) : CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R, 02/82) - OVER - a f l~ M ! A K 1 LO N ! Q 1 ~ r Na .n t { v M 1' -to o. i ! if I V ,i h f / i i i i i I~ ~ h i 1, Ni I i I I i i O I 4 x r / e 3 ' t 3 mcj i 0. ~ Cm" z f y*k -&Vd `c JCM C ~.m ~ 0 m r a m 4~ _L k~ ~l pi Z r , .y> 1 Cj \ ~r I ~ IIII ~ , i. ~ ~ `Sl J \ A„1 I ~ *r ~ ~ ~ h I L I Y ! i I~