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HomeMy WebLinkAbout020-1240-80-000 CD 0 vy 4 o ts 6 o � � o � I I 0 v ! w I m Q I Z I U. 0 �� I v Cl) CD z 4i cn :: c Z r a 0 °' N FN- Z o I E o Z Z � ' c r o w m 'z c' z N H r Z 2 r> a� c rn m y c y (D c c v d O o Q o CD c Z CO D p N .: Z l0 0 J w C' r N c N O 0 o G C a °n t CC N L O h� z r+J oaaa CL 0 CO to J U i � � } O U v r (D N � 0 � � o E m N a) a m CC a ti _� Q4) in m I N U i Ila �1 N C) t ' N C E y � LO O O y d n, O V O r Q m c Q ( N O O ~ ! U Q c c 5 v l N N .2 � N .Qc � CO � C d O j co Q V/ N m U Oki O N 2 O z� C (n Vj a a CL z^" 2 rr�� as _1 A cia2 oA 0 Parcel #: 020-1240-80-000 12/17/2004 08:05 AM PAGE 1 OF 1 Alt. Parcel#: 21.29.19.1249 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 *MORTIMER, MELVIN H &LORI A MELVIN H&LORI A MORTIMER 504 JACOBS LADDER CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *504 JACOBS LADDER CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.308 Plat: 2135-JACOBS LANDING 2ND ADDITION SEC 21 T29N R1 9W NW1A OF SW1A&SW1A Block/Condo Bldg: LOT 27 OF NW1/4 LOT 27 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 854/257 I 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49289 226,600 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.308 31,600 143,700 175,300 NO Totals for 2004: General Property 2.308 31,600 143,700 175,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.308 31,600 143,700 175,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 124 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 j Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �����/ TOWNSHIP c�/S6`i SEC. 01 / T o?°f N-R._L1' ADDRESS , c�sr` BZ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ro 6z la,./'^ LOT a 7 LOT SIZE Z, /y &,e e,/-s PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Lo/ a,e,y i x J 9 N x a 78" INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 1T_� �")Cy �R ' SF- 16`rcorfoy- Elevation of vertical reference point: 11)0.bo� Proposed slope at site: SEPTIC TANK: Manufacturer: lay Scr/ Liquid Capacity: /e2DG�c.Ll/ Number of rings used: ® Tank manhole cover elevation: ^'Z Tank Inlet Elevation:°t- D ` ��Tank Outlet Elevation: Number of feet from nearest Road: Front,O)Side, feet Rear, O / xe From nearest,property line Front 10 Side,©Rear,O �7 Z feet i Number of feet from: well �4, building: 3 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE • 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: -eny.,t;6,j :% ) Trench: - Width: 18 ' Length: �? 6- Number of Lines: Area Built: ?7"' Fill depth to top of pipe: �/z Number of feet from nearest property line: Front, O Side, ® Rear,Oitt . 7 Number of feet from well: i Number of feet from building: 3 (Include distances on plot plan). 314. 10,q? ? 4/ SEEPAGE PIT Size: 4A Number of pits: Diame P Liquid depth: Bottom of seepage fit 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, 0Ft. 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: - Z 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING DIVISION LABOR&HUMAN RELATIONS P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: Ma, SW, 21, 29, 19W M CONVENTIONAL ❑ ALTERATIVE (It assigned) Town of Hudson El Mound (ding Tank El In-Ground Pressure NAME OF PERM HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Box 282 Hudson, WI REUCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.EL .: CST REF.PT.ELEV.: Name Plumbe: MP/MPRSW No.: County: Sanitary Permit Number: Dou S rohbeen 5432 St . Croix 128599 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER // PROVIDED: b t, �ES ❑NO ❑YES NO BEDDING: VENT DIA.: I/ V T MATL: HIGH WATER NUMBER O ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH O LIN AIR INLET: ALARM: FEET FROM I // ❑YES NO ❑YES NO NEAREST—♦ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P P MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING OVER E]YES YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: uM AN CO O S OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF YES ❑NO NEAREST—* SOIL ABSORPTION SYSTEM. Check the soil moi ure t the th of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,co struction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF ISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID DEPTH---^ BED/TRENCH TRENCHES: / M TERIAL PIT. DIMENSIONS fABECO O 1��/ GRAVEL DEPTH H DISTR.PIPE DISTR.PI DISTR.PIPE MATERIAL: O. R. NUMBER OF PR PE TY WELL: BUILDING: VENT TO FRESH B �wES: yR: E EV,INLET; ELEV.END: '� PIPE FEET FROM LINE: Q AIR INL 11 771244// 5 NEAREST U v MO ND 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 I 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: DYES ❑NO EYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: 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 ❑ S ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM I LINE: ❑YES ❑NO NEAREST----00- Do 1 � i 1 IV \ F Retain in county file for a�dit. Sketch System on Reverse Side. NATURE: I TITLE: S B D-671 0(R.06/88) �vVU oning Administrator Ufloffias U . N e son E�Dq: l SANITARY PERMIT APPLICATION COUNTY , In accord with ILHR 83.05,Wis.Adm.Code Y ` STATE SANITARY PERMIT# -Attach bomplete plans(to the county copy only)for the system,on paper not less than 1:1 A2,IP � 8%X 11 inches in size. Check if revision to p evi s 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 cr N'A1145W'/a,S Z TZ , N, R / 11(0 PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 80 40=8Z .77 1 CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ff�c.o�' ert wr S 3aG Z �Q� b s Lap i TT 111. TYPE OF BUILDING: Check one CITY / NEAREST ROAD ( ) F-1 State Owned 10 VILLAGE ISO ❑ Public tO 1 or 2 Fam.Dwelling-#of bedrooms_;; _ PAR EL TAX NUMBER(S) �7 III. BUILDING USE: (If building type is public,check all that apply) Lto 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. X 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 ❑ 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 _Z_ /� o �o/5 SgFT 4`fS sq 1=T_ 0_72- _-_-_ 3 $7.'/0 Feet 40-4,0 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 000 e 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): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: 00 tick,�IN I col'- z y Z 3 3 Plumb Address(Street,City,State,Zip Code): F # s N-.,j t2• ,P, / IX. COUNTY/DEPARTMENT USE ONLY Disapproved S itary Permit Fee(includes Groundwater Date Issued Iss gent Signature(No S mps Approved ❑ Owner Given Initial Surcharge Fee) ^� Adverse Determination . 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. 11. 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 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 Location of property NO /9, Section Z/ , T Z9 N-R, /-! Township yr /Li1 serr Mailing address Address of site Subdivision name T r-.,h s ky-A ki tia Lot number Z9 Previous owner of property U; r-Q ih t cc, /yl. �a•� L� Total size of parcel a >30 A-� �✓5 Date parcel was created i Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)?_ d Yes No Volume LND!�' and Page Number i'!0 2 as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. !k;bn S'-/ 17• ; 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 the County Register of D eds, as Document No. U:3-'`fl7 ) . Signat re of Owner Signature of Co-Owner (If Applicable) -7- 3 ( -S � Date of Signature Date of Signature noc-ukirFll NO WARRANTY DEED 11111. SrAI.c acscnv[n son a[CnAlllNli UAIA STATE LIAR OF WISCONSIN FORA 2-1982 43;41.'7 � r�s� REGISTER'S OFFICE L'' ST. CROIX CO., WI • Virginia M. Hanson, a single woman Recd for Record AJAR 22 Vat « 8:00'� A A�MA� Iome�s all-I to Sam E. Miller. a single man tMIMM of DO*& the fnllowinl: drerrihed real estate in St. Cruix S ale of Wiscom-in: Tait Parcel No: ... ... ..... ................ West Half (WA of the Southwest Quarter (SWti) nl Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of the ttublic highway and except Lots 5, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (Wit) of the Northwest Quarter (NW't) of Section 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 Omaha Railway Company. . I WF This is not hnnle�tl ad pnga rl;:. tixk 1 is tint) F:><IC•r'i:Irr t1. (enrranties: easem•snts of record and pro,-ective covenants and restrictions of record, if any. aZ � 4 r y� 14rted this day of 11 ' r( t988 tSEAI.1 Virginia M. Hanson • ISF:AL► ISF..1L1 AUTHENTICATION AC' KNOW LEDUMENT signature(s) STATE. OF WISCONSIN 1 ................................ ss. r u Countt.'. authenticated this .... day of 19 I'ersonall} came before me this `�' day of . .. m A 'L L— . 19 88 the above named Virginia M. Ilanson TITLE: MEMBER STATE BAR OF WISCONSlX (If Tint. authorized by 6 704.0r,, Wis. Slats.) In me 1,11-- to he the +rer.on Whit ererulc(l life furecuin• Irulnent atu) :tAilowledge lice +ame. T•I'i INSTRUMENT WAS DRAFTED nV L.o.is,A._tlurrayA,.l+eywppd, Cari S Murray P.O.,'Box 229, 1ludson,, W1._ 54016 �:nla• uRl(r ? - y f (•• c'nuntc, tt i<. (Sirnntun•s may he nuthenticated or nrknoa-led;rrd. Both Nit' ( tr`+i`--fin (�r14r�,ni,er�.(if not, slate ret- ratinn are not necessary.) �Y �j loll•. ���. 19� / .1 •NAI.IeA of psalm 0it"intr fn Any ry.A.its .1,..,'d 1.. t.,..., r,r•.1,. `.,. rl,••r r WARRANTT DELD STATE "Aft Of 0.C:('ntif-IV I.tO PN. , •. F'nItM NO 2— t.. ,,. .. (c.. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S A11e4,,' ROUTE/BOX NUMBER FIRE NO. CITY/STATE��/i.�Seti G[JL ZIP Sf0/�- PROPERTY LOCATION: 1/4 SS/u� 1/4, Section TAN, R W, Town of St. Croix County, r Subdivision _L,,,obs Lot No. 7—:4 . 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED Q DATE - 3/— u St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street • Hudson, WI 54016 (715) 386-4680 ' Sign, Date, and Return to above address I RY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 ) .HUMAN RELATIONS \ / MADISON,WI 53707 (1,163.090)& Chapter 145.0451 LOCATI 5 �.�p TOWNSHIP1MNAi�1i:.R.AAJZy. OT NU.:BLK.NO.: SUBDIVISIO NAME: N !/4Q14 � � / f Vl N/119�(o uU'SpAt 2? -JAC.6QS LANk1#42AIA COUNTY: W FAILING D S : /f Erato ly b i� 111 ik 7 rare 1 4j ov' DATES OBSERVATIONS MADE TIO�Rseldsncs ES" u FokiN- ew ❑Replace Mot 2.s 1119 J ULy. Z�I /9 g ...-...�.-._ 5011.5 &OIC RA4L :r 7 r.)Ls - Sig- RAT"03:So$I%suit"for rjam U-8_ate wmukebh for system Qom- j&Q e HT -FILL OLDING TANK: ECOMMENDED SYSTEM:(optional) cc Pr sob S ❑� ZS ❑U ❑S Nkj)fd v>1uuwt- �>�4 If Pprceolation Tssts are NOT required DESj�j N RATE: ' FF a ny portion of the tested area is in the tmders,1 3.06(Stlb1,ittdit ste: t,,.1,d 55 oodplain, indicate Floodplain elevation: JV4 PROFILE DESCRIPTIONS TOTAL ELEVATION R ATER-INCH S C A ACTER OF SOIL WITH THICKNESS.COLOR, TEXTURE, AND DEPTH p A TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) Qal� O � �',QZ ZSrBCLT5 1$�t` Q..tI. 9`*kN&rjS-t(,� •� "t.Z'S� QNL' > 9.pg 7"$CSC /3~BJCS 1<l,•e„ S`1°�?,k',,i�1 T �- 9.33 `is�•?S > 4 33 'I.RLL-r5 SiL /608-Pr,cs 54., RQ,J Olsi k)_ B- 9 S$ 38~ekcrs 2z St(. 14"gie"MS 41'6'4M-c� G 1• PERCOLATION TESTS —�- WAT 14OLE TEST TI NIF DROP IN WATER LEVEL-INCHeS RATE MINUTES -maw I AFTER SWELUN INTERVAL-MIN. tg_ t PERT a PER INCH P. 1 0.g > > Z > < 3 P• o "to >Z >Z > Z < Z. o 01C >Z > < P P- 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are t hori- =ontal OW vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and Ix., Pint *f lend shops. Z YSTEM ELEVATION '7. 4o ` SG, (2UL- PA N<AMbiLk -ToP o Po>.1�.rZ E go), ,fir LsT CdRN�R 1,ft wKWsjpndd,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specilt d in the Wisconsin Admialaretivs Code,encl that the date recorded and the location of the tests are correct to the best of my knowledge and belief. =�_*lTESTS WERE COMPLETED ON:.y JouNS6-�'j Ru-SC't4 ;U k,/&//IV6, __ JULy 2% ,9�g AD4DcRESS CEHTIFICAI10N Ni)Wfif 1. P�fONE NUMBER(opitot, 7 Sl c N �,� /�u�Sc,�v 1 ► -- SA0I6i` �4% 4 711 U6 4090 CST SICK URE. DIST11111UTION:Original and one copy to Local Author ily,Properly Owner and Soil i-esim. of u+R-Soboiltiot., i� co r N LA u P V In wms -`, rrP w P U ? e i► P o bi o -v ;5 �. :04 P rn m 0 �+ < P 00 14 �o tA r o � r N tA acid H Vy y w N o N !f j 1� P r � � n 'k 273.80 •� 1-11 � � ��._ � J P �i E—�-•�i p � � -ac N� � P P p• P Ell � LN ' t � fJl A..•T . .4 _ —• ;v W o C:CN,;S