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` Parcel #: 020-1240-40-000 12/20/2004 04:29 PM
PAGE 1 OF 1
Alt.Parcel#: 21.29.19.1245 020-TOWN OF HUDSON
Current 1X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): `=Current Owner
WALTER E SWANSON "SWANSON,WALTER E
835 HARBOR VIEW DR
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description "835 HARBOR VIEW DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.984 Plat: 2135-JACOBS LANDING 2ND ADDITION
SEC 21 T29N R19W NW1/4 OF SW1/4&SW1/4 Block/Condo Bldg: LOT 23
OF NW1/4 LOT 23 JACOBS LANDING SECOND
ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 878/552
07/23/1997 860/84
2004 SUMMARY Bill M Fair Market Value: Assessed with:
49285 214,300
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.984 34,900 130,900 165,800 NO
Totals for 2004:
General Property 2.984 34,900 130,900 165,800
Woodland 0.000 0 0
Totals for 2003:
General Property 2.984 34,900 130,900 165,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 214
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
e
Form - STC - 104
'I AS BUILT SANITARY SYSTEM REPORT
OWNER sa pi `//aj TOWNSHIP ,�f,,�a n SEC. T ZJ` N-R �7 W
t
ADDRESS Y�`Z t Z-- ST. CROIX COUNTY, WISCONSIN
SUBDIVISION S.eCof s LOT ? LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
z
---- ---- (of,1,
JAL
= ',ray q3' � 36 —
70 2 s
( o e
. I S'
rJ
Wsl�
'� Q $.M - ToP o� B.�oc.� �oa�13��eh E �•=lo0-ate
5ysfcvr
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INDICATE NORTH ARROW
I
BENCHMARK: Describe the vertical reference point used 1"P Nota.s
Elevation of vertical reference point: -I.-/'s %� �Proposed slope at site: 4%t
SEPTIC TANK: Manufacturer: �Vgk.Z5cy- Liquid Capacity: loco
Number of rings used: 1 Tank manhole cover elevation: &.2j = c/g•(Cp�
Tank Inlet Elevation: Q.(PO - Tank Outlet Elevation: g.40/- 9:!r. If!r
Number of feet from nearest Road: Front,Q Side 0 Rear, O / 2 0 '* feet
From nearest property line ' Front,0 Side,(D Rear,O /OS� feet
� �
Number of feet from: well (,S building: a/
(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,0 Ft.
Number of feet from well: ``
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: e,t ysh /:OKa/ Trench:
Width: /8 Lenith: 3 6 Number of Lines: 3 Area Built:�`�T
Fill depth to top of pipe:
Number of feet from nearest property .line: Front, O Side, O Rear,O ht .9�-
11
Number of feet from well:
i
Number of feet from building:
(Include distances on plot plan). rr
SEEPAGE PIT
t '
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) .
I
HOLDING TANK
Manufacturer: r� 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:
f Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:
I
3/84:mj
DFFARTMENFOF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
State Plan I.D.Number:
SW 4,NW 4, Sec. 21 ,T29-R19 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Hudson Lot 1?1 Holding Tank ❑ In-Ground Pressure
❑ Mound
Ha INIMMEW PERIMPIPMOkbW ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Sam Miller Box 282, Hudson, WI 54016 -1q-
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: E .PT.ELEV.: CST REF.PT.ELEV:0
aA_4_�I 41111��Name of lumber: MP/MPRSW No.: County: Sanitary Permit Number:
Dou Strohbeen 5432 ST. Croix 135384
SEPTIC TANK/HOLDING TANK:
MANUFA TURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
l S�. �' RS• 5 � `�s PRO ES ❑NO PROVIDED,
❑YES Ja NO
BEDDING: VENT D A.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY ' WELL: BUILDING: VENT TO FRESH
—/ (( ALARM: FEET FROM LI AIR INLET:
❑YES r_ 0 r_ ❑YES NO NEAREST 0 5 5 a i
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MO EL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTR LS OP RATI0j4AL-.N NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑YE NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at a epth f plo ng QRCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire,construct s ease u til MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. E SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: TERIAL PIT DEPTH:
DIMENSIONS 1 �p / ,e,; /
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BEL W PIPES: ABOVE EVER: ELEV.INLET: ,ELEV.END: /� a, PIPFE1, FEET FROM LINE: AIR INLET:
L-f/lJ\ C/J� J NEAREST T-
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 I 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:
ELEVATION AND ELEV: ELEV.: DIA.: ELEV: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: UMBER OF PROPERTY WELL: BUILDING:
EET FROM
❑YES ❑NO ❑YES ❑N NEAREST-�
g
Sketch System on
t Retain in county file for audit.
Reverse Side. SIGNATURE-: TITLE
SBD-6710(R.06/88)
s ��HR SANITARY PERMIT APPLICATION =In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PER
–Attach complete plans(to the county copy only)for the system,on paper not less than ❑
8%x 11 inches in size. c ec i revis n o pr vious application
–See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
/ 5 '/a AIW14,S Z T-27, N, R /9' E (o
PROPERTY dW`NtR'b MAILING ADDRESS LOT# BLOCK#
� 28z 3
CITY,STATE TT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
�1 G IG 4a
11 ❑State Owned ❑. TYPE OF BUILDING: (Check one) CITY NEA ST ROAD tr1
VILLAGE; e /b,r /; K
❑ Public iAJ 1 or 2 Fam.Dwelling-#of bedrooms AR E TAX N BER( )
III. BUILDING USE: (If building type is public,check all that apply) — Z /–/0— Z / O
1 El ApUCondo /
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.W New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ 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 El Mound 30 El SpecifyType 41 El HoldingTank
12 6 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
V_i5_0 <''1.>T 49 1"Ir 0. 72 < Z `1 2-4'� Feet r Sa'Feet
VII. TANK CAPACITY Site
in nallons I Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdina Tank X U&i S vc✓
Lift Pump Tank/Siphon 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): Plug" er's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber's-'Address(Street,City,State,Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved I Sanitary Permit Fee(Includes Groundwater ate Issued Issuing Agent Signature(No Stamps)
Approved ❑ Surcharge Fee)Owner Given Initial �'G –�� /!
Adverse Determination / 1�--
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:
I. 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.
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.
SBD4M8(R.11/88)
1
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 , Yl
Location of property �_1/4 ._.���)_i/4, Section 21
Township ,
Mailing address -1- oij FJYno Z(5 t"(ijd--6V) ,
Address of site 1+
Subdivision name .:`
Lot number I
Previous owner of property _ �11G�O��I�i 1V ttl� soj
Total size of parcel __ Z • 1�1� C' S
Date parcel was created '� c
Are all corners and lot lines identifiable? _Z Yes No
Is this property being developed for resale (spec house)? as No
Volume ' '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 PACE 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.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that t (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. o j .�"'-e -71 ; 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 t County Regis Deeds, as Document No.
Signature of Owner Signature of Co-Owner (If Applicable)
Date of Signature I Date of Signature
noc.w irpfl NO WARRANTY DEED I.nS SPA r al.stnrin Inn nlr.r,nlone I,...
tiT.\TF: IIAR OF WISCONSIN FOR11 2-1082
43,P5417 z:. Q j►11sc REGISTER'S OFFICE
ST. CROIX CO., WI
Virginia M. Ilanson, a single woman Rec1d for RQCOrd
�. 8:00 AOM
cnll�r�� aa.l u.Iranl, to Sam E. Miller, a single nian
RNNN►+I O�aM
file f1•11--ne dc.crlhe.l real e0ate in St. Cruix 4, l'•nl.al.
Slafe of Wisconsin:
Tait Parcel No: ... ... .... ................
West Half (Wt,) of the Southwest Quarter (SW14) I11 section
Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19)
West, St. Croix County, W1.SCOnsin except that jlart South of the uublic
highway and except Lots 5, 6,, 1, and 8 of Certified Survey Map n Vol. 6,
Page 1747, Doc. No. 419479.
That part of the West Half NY of the Northwest ouarter (NWIL) of SecLlon
Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West,
St. Croix County, Wisconsin lying, South of the right of way of the
Chicago, St. Paul, Minneapolis. and lhnaha Railway Company.
.[RAN St E h0 �
FEE'
Thix is not hmnral•'ad pnq•wt:.
title fls na()
F:ICref.•iarl l.. Warranties: easem•:nts Of record and pro►ective covenants and restrictions
of record, if any.
(laud tlus J:1! ..f r( .,14 88
(SLA1.1 C/L�r�-��//� f/ I�t:A1.1
Virginia M. Hanson
AUTHENTICATION ACKNOW LEDUMENT
Signature(a) . .. STATE OF WISCONSIN 1
. .. I se.
• �1� � �u Vt, Count}.
authenticated this .... dad of 19 PerFon:dly came b1-fore me lhi� � ` day of
(11�\ r�f- , I11 88 . the above nanird
Virg;inla M. Ilanson
TITLE: MEMBER STATF, BAR OF WISCONSIN
(If not.
authorized by 17or..o4, W is. Stak.)
In nle Lnnan In he floe iwr.,on Wh.. rsrrulcd the
1nn•I oin• 'In►Inont au1J ai-kilowicdhe file same.
T•• S INSTRUMENT WAS DRAFTED nY
V '•
Lois„A. Murray, )Ieywpod,..Cart S Murray
1'.U.'(;Ox 229, 1ludsllns Wt... 54016 IIAI'r P � •�4f (.. ..
t r, ` f'nulll}. tris,
ISienntures Ina!• he authenticated ur ackoolclydze,l• Bnth \I•' 1'...u, inn 1 41,�If1aiMlll.l if not, stall• a;n ralio.l
tire not nece59i11'y.) �
dal••. '7:°. "�Y 111
.1
*Names of e.rv.ni rinnins in •ny rsps.il,' .L...,••1 L. 1.,. • �
WARRANTT DI[F.D STA'1F. BAR OF R1S1'N`••V
Yr1•IM No 2-- 1.. N.•'•..•m 1.*rl IUw• . •.
..
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER /h //�. ���►
ROUTE/BOX NUMBBE��R 0240 FIRE NO.
CITY/STATE /`yd. / '-' `+ < ZIP �"'�/Q/ r.
PROPERTY LOCATION: 1,5q,) 1 14/v 1/4, Section �l , TAN, R. 00
Town of St. Croix County,
Subdivision:& 4 h , 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 NAY 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.
SIGN&D
DATE
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
EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
FLABORXIND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.0911) &Chapter 145)
LOCATION: SECTION: TOWN HIP OT NO.:BLK.NO.: SUBDIVISION NAME:
sw1/ Nw1/ zi /T29N/R*/ (or ! UtosoN z> �acaes L.vN,�,
COUNTY: MAILINu ADDRESS:
S,-Cle SdM M It.«te 1-7;?oUr 0 A NUd�N
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION:
rvf I 1PERCOLA Q�
i Residence LINK New ❑Replace I ocy 31 /919 /�Dy Z ( /�•9
Sa t L', aiL -0k 'r, ll V_t1 A4U7
RATING:S=Site suitable for system U=Site unsuitable for system Scics !, - S'Tr T RE
r O�ENTI�NAL: M�D:Q� IN-G�ND•�ESSURE: S�� I❑�L D�G TA K:RECOMMENDED SYSTEM:(optional)
SS UU S S U Co'�vEN-r/0 d1_ Ret
DESIGN RATE::
If Percolation Tests are NOT required D If any portion of the tested area is in the w,
under s. ILHR 83.09(5)(b),indicate: C tfd�SS ' Floodplain, indicate Floodplain elevation: 'Y
1;_r PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- i , 11 9247 r4og& > 1$.17 &`$LSC.Ts 10"Se,,.CSi6kCAGo,. LS I"PhiN C I&I
B 9.0 S.%Z IIJoN C '> 9.0t S/o'BaNC 2g 'Rd$ cs�s 44 WIRR"CS266A
B- 3 la.00 95,4C r4cw s > 8.ob " L it'&,4Ms 6k '�a�QNCs�dIQ
B. 4 > Z5 -6"BQ,SC Z3"$Q•�,CSf'�I� SS"�QN/'hs�SG Zq„$rtNCs e
B- 9•�7 9� >jV14 L L $Q L 3i”Qit,&v
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DR I WA R L V L•IN HES RATE ER INCH
ES
NUMBER 1 I AFTER SWELLING INTERVAL-MIN. PERIOD t P RI D2 P
P_ 1 3.4so Nt s.go >Z 1>�t -.'4'
P- Z- 3-5 6 NOQ IC >2 7 2 4
P_ 3 ZO b6wt 4 .20 >Z ?�-
P-
P_ I I A tRc
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or istances. 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 t orings and the direction and percent
of land slope. ---------• -
SYSTEM ELEVATION. Qz•ao
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I,th ndersigned, 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): ITESTS WERE COMPLETED ON:
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ADDRESS: CERTIFICATION NUMBER: PHONE NU BER(optionall:
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CST�SIGN URE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR•SBO.6395(R. 10/83) - OVER -
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