Loading...
HomeMy WebLinkAbout020-1145-20-000 rL" O N O C O ar O bti p O N O d A U f0 Fs `O N LO N X Z l! C M yj {L L O U w C ! 3 ~ d Q N Cl) d. N Z H W O Z ii « C I Z € co c o z a a~i Z ~ ~ ~ o I ~ N M N d 3 O d L L_ O ~ C O I z z O Z c N I N ~l i t0 C V N W ql ~ ea C ate. y N C d = O h~ a0 CD0UU)U) 000 a z z • N C CL CL 3 4; C 0) C33 3 U) 0 co co U) cy) ch } = N O .J 0 ) ml a Ai ~ O y C 00 N j N O O N d (D O! t \ i f~ F. L O C 'O ~1 . y C LO M 4) V U s l( O C N Z ad+ '00 a CD (D p N p~ r O E C L ,`V) N I~ O N O (n p w U • o _ 2 ~ O Z c F- ~ fn st EL CL IL E c ~1 A ciao 0U) b Parcel 020-1145-20-000 12/06/2005 10:39 AM ' PAGE 1 OF 1 Alt. Parcel 17.29.19.761 020 - 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): O = Current Owner, C = Current Co-owner O - SMITH, MICHAEL G & LINDA E MICHAEL G & LINDA E SMITH 967 WERT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 967 WERT RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.560 Plat: 2276-PARK VIEW ESTATES 2ND ADD SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 68 ADD LOT 68 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 864/590 07/23/1997 835/474 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.560 59,800 182,300 242,100 NO 05 Totals for 2005: General Property 1.560 59,800 182,300 242,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.560 30,900 160,800 191,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 217 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 t 6IJ-) Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. -Z T g N-R ADDRESS w c ST. CROIX COUNTY, WISCONSIN SUBDIVISION. i~t)► ,LrtJ_.ttr LET a ~ LOT SIZE 7 PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ae It 10 n ~ 1 5 j -70 1 ~ S SZ l l s, u) o-& 4o/ ~ i 13 INDICATE NORTH ARROW BENCHMARK: Describe the ve ~t 11 reference point used Elevation of vertical ~erence point: /,04.00/ Proposed slope at site: e SEPTIC TANK: Manufacturer: U) .aAA' !~MA Liquid Capacity: /2 Number of rings used: Tank manhole cover elevation: 1~ • y i Tank Inlet Elevation:1 ~S `Tank Outlet Elevation: l ,04 Number of feet from neares Road* ~ 4ront,(PKide 10 Rear, O loo feet From nearest property line Front 10 Side 10Rear, ~ feet Number of feet from: well ~pD building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) l e,.tTn(n PTT1P 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, © Ft. Number of feet from well: Number of fee C from building:_ (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: , ,r Width: Lenith: -53 Number of Lines: _ Area Built L < , Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,O It 71 Number of feet from well: -2/ 0 Number of feet from building: 410, (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 I absorbtion sytems? Check one). HOLDING TANK I, 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I actor. Dated: Plumber on job: License Number: $ 3/84:mj DE,PA#9TMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING s LABOR & HUMAmRELATIONS DIVISION P.O. BOA 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: SW4,NE4, S17,T29N-R19W [CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson r Holding Tank ❑ In-Ground Pressure ❑ Mound ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Charles Hagen Route 2, Box 1221, Hudson, T~Tl 54015 7 - ~ z36 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: /MPRSW No.: 7 County: Sanitary Permit Number: 1ienry Nechville MP 3258 St. Croix 119419 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER p PROVIDED: PROVIDED: YES ❑ NO ❑ YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM I~ I - LINE: AIR INLET: DYES 2~NO G 1- DYES % NO NEAREST-► IIDc) 1 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PPUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ ES NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERT EL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST --I► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MA RI L AND MARKING: or excavation. (If soil can be rolled into a wire, construction 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 TRENCHES: I MATERIAL: PIT DEPTH: DIMENSIONS /`^J GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: !NO. FT . NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: EV. INL T: ELEV. END: FEET FROM LINE: AIR INLE a g 7. a~ a9 NEAREST 1 I a' 1 ~CJ 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: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: 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: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NOr E1 f L~ ~ 21 T'q Sketch System on Retain in county file for audit. Reverse Side. S, ATURE: TITLE: 17 `'oning Administrator SBD-6710 (R. 06/88) ~Q.R1L SANITARY PERMIT APPLICATION R In accord with ILHR 83.05, Wis. Adm. Code COUNTY .'~••ao V / 1. ~ STATE SANITARY PEBMIIT -Attach complete plans (to the county copy only) for the system, on paper not less than j/ , 8% x 11 inches in size. ❑ Check if revision to previous 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 'W t/4 S J? T N, R~ 9 E (o W PROPERTY OWN R'S MAILIN ADDRESS LOT # BLOCK # g A IX CI STATE ZIP CODE PHONE NUMBER SUBDP(ISION NAME OR CSM N BER 11. TYPE OF BUILDING- (Check one CITY NEAREST RO D F-1 State Owned ILLAGE : ❑ Public Kr 2 Fam. Dwelling- # of bedrooms PARCEL Ax NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 74 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 O~ PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 El epage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 e 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) q ELEVATION ~/9oj S'ma C / 4~ , G~ Feet .g Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New P_xisting Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 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: (N Sta ps) MP/MPRSW No.: Business Phone Number: h~rAli-y IVcc ~~~E 3:t S $ 7/S 7Y9 -3 Plumber's Address (Street, City, State, Zi Code : IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Stinitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) TA Approved El Owner Given initial Surcharge Fee) i 1 -a 6 _ ,cam Adverse Determination 1 L v I~C•~ ~ 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 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. 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'f 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 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 C 4 f4~ ✓z-1- 25 cr 2~-IJ Location of-property ~tt)--1/4 Ae- 1/4, Section , T -N-R-L1W Township J / l/ ~lS A Mailing address /2- ; 13 Ux Address of site e2 vl~D Subdivision name Lot number Previous owner of property swzz- dZ Total size of parcel / -~G J2 L S' 2 Date parcel was created -7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes ~0 Volume d 3s- and Page Number 1-/ 7 ( 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 1004 certify that all statements on this form are true to the best of my (our) knowledge; that I 409) am Wow?, the owner W* 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. ; 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 h been u y recorded in the Of ' e 7 D of th Count Re ister of Deeds, as Document No ) Y Signature of Owner Signatur of Co- her (If Applicable) Date of ignatur a of Signatu VOL 474 :C !i DOCUMENT No. WARRANTY DEED i! THIS SPACE RESERVED FOR RECORDING DATA ii i STATE BAR OF WISCONSIN FORM 2-198211 i 44G07G - - - REGISTER'S OFFICE THOMAS C. BLAIR, SALLY J. BLAIR and ST. CROIX CO-s W1 . j INGRID E. BLAIR, Grantors i! ReCld,for Record If MAP,13 1 89 M at 11 -00 A. /J If conveys and warrants to HAGEN,----Gr riCe~' „ ryl ~~~nN ~;.•/~X. I - - ~f RegtsterofDeeds Ij - - - l RETURN TO jI - ~I - St. CroiX.._.. Ce~~nty, II t e following described real estate in - , 11 State of Wisconsin: , Tax Parcel No:.. ~ li it I l Lot 68, Second Addition to Park View Estates. Zia I I i i ~ II i~ TOGETHER WITH and SUBJECT TO restrictions, reservations, easements i and right-of-ways of record, if any. I~ I ,f 1 This is n -t _ homestead property. ~I ~w (is not) ~I Exception to warranties: it ~i I ti Dated this 1% day of Mar _h 119--89._ . I (SEAL) (SEAL) x. - - ) b ?am,d/a,~ ~fH THOMAS C BLAIR BX J • -BLAIR y Po~ea~o< c ------------------------------(SEAL) ------.(SEAL) II I INGR -D E. BL II _ it AUTHENTICATION ACKNOWLEDGMENT ~ I I li Signature (s) STATE OF WISCONSIN i y ST C,ROIX county ' y I authenticated this da of_______-------------------- 19 Personally came before me this ...da of March 89 the above named =Y II Thmas__C._ Blair,.' S 19..qP.- the above named o f TITLE: MEMBER STATE BAR OF WISCONSIN and In rid E. Blair ;•,o'., - - (If not, authorized by § 706.06, Wis. Stats.) ~J c~ 'y to me known to be the ~tho e ted•. ~ persons __x:y,_ _ 1 foregoing instrument and acknodled~e tfr s m 1 THIS INSTRUMENT WAS DRAFTED BY ,a] li Attorney Barr C . Lud - c~------..~...... y---------- ---n-----e------en GILBERT , MUDGE , PORTER & LUNDEEN 110 Second Street,.--~IudsonL_.W-_•5-016 St. Notary Public r ! n s. I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If nois~t1`1tion are not necessary.) date- 199-X---•). *Names of persons signing in any capacity should be typed or printed below their signatures. 3 WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ YER 2 '`6: E I ROUTE/BOX NUMBER FIRE NO. CITY/STATE H UbED N W ` ZIP PROPERTY LOCATION: V W/4 1/9 Section T N, R W, Town of U , St. Croix County, Z Subdivision ~~~~VJr;W11 s~T Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department 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. SIGNED -7 DATE 7 ) )3 ~i St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION P.O. BOX -LAg REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: P/.41_111 11 E;-T'_: LOT NO.:BLK. NO.: S BDIVISION NAME: kJ'/a / 1To29N1R P(o T .rota 4 l &r", COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: r / i, C' G. A. 4464 LCl e az USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMER IAL DESCRIPTION: PROFI DES RIPTI NS: 17- A ION TESTS: Residence 1-3 IiIA New ❑Replace I , a. RATING: S= Site suitable for system U= Site unsuitable for system e. S Q CONVENTIONAL: MOUND: IN-GROUND-PRESSU E: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®s ou ®s ❑u IS au o s ®u a s u r " 6` If Percolation Tests are NOT required DESIGN RATE: / If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PR FI E DESCRIPTIONS BORING TOTAL/ DEPTH TO GROUNDWATER I!S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPfH.I ELEVATION OBSERVED ES HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Qord'• 7 C~/.S~ • 9B~s J fj G S S~. ifr. 6:#- Ads B- 2 ,D' /00.3 ' A4We, 7 ~d S. -7 Bn Cr_ A S B-_3 , 18FG, 0 I I W /J l -744 + / I I ,04 6 /S v 49n &A4dB- o' /00.0' Al4t~ 7 4 .19 S /0 ,ins' 9- 6n /S 3 An a Al 9_1 0 e. or 2 Aft 14 CoAft 007 a,~w -S B- PERCOLATION TESTS TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 44191 OF! AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P- / r3' a 1- 4 6 c~? P- 3. 0 3_ 6 d-'3 P- 3 ' a G ~-3 P-_ P_ t4 PLOT PLAN: Show locations of percolation tests, soil borings and th ensi~ le soi r s. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location he plo?/e ^ e's ce elevation at all borings and the direction and percent of land slope. , jDyey V SYSTEM ELEVATION 1 I_. r r 4- - T i- i i t E 3 d F _ _d i I /coo, 0 ~ p s -s i 7 / :~A t r *2 _0 lit! 7i} S ~~L I 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: A0,Ws /Ot, C 4r 9-2- ADDRESS: ADDRESS: / CERTIFICATION NUMBER: PHONE NUMBER (optional): CS TUBE: t DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - w IN-IZTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6595 To be a co accurate soil test, your report include: ~ 1. Compl(. )tion; 2. The use List cleat,y ndicate, whether th sidence or commercial project; 1 °"f ? P t'vr r.rmber of k,- is or commercial planned; 4. 1, ~ n::vv (,r replacen, ern; the siwritabili, ! axes. A SITE IS SUITABLE FOR fH~)LDING TANK ONLY IF ALL _YSTEMS A:.E OUT BASED ON SOIL CONDITI S; 6, he a', gown here for writing profile and completi `ot plan; 7. L'':3IBL~ °?=rately locating y-- `^,t L'~ravving to v-1 ' ;ed. A may be red; S. your benchi ertical elevation , C, arly ° Went; 9, as to dates, nan- in data, t. exemp- plaint, elevation} do y, .-'ace N.A. in tho apprcr)riate box; cur.'ent address and your.: ''9n number;; td d,uibute as required. A iL TESTS- MU FILED WITH THE WITHIN 30 DAYS OF COMPI _ l ABBREVIATIONS FOR CERTIFIED SOIL TEST I d Other Symbols E - c> € k 4 ` ~ rzt g 5i`I - it Fici mot HWL - H dh `ix, 4: soil textures 1 caste disposal E _ B3nC l - `cortical L..`r y TO _ al-AN i o Pte- C d~ i L 141 . 177 - i s J -124, ~80 ~ Rbr roll, i 1 N° 2- 3 / ,RJw' J a