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HomeMy WebLinkAbout020-1240-90-000 § o 2 $ Cz 32 00 to . \ 2 0 7 � o � § � I 2 � i 2 � � # � � 0 ? z LL 7 ) I � t % � � z Z ® § E & / z .. / � \ z :t \ j � ® ) $ 7 / E 2 @ V o } ; & } k § 0 ) \ / .. z _ 4) k 2 ) ) E 0 ~ \ � § � a E ) \ $ m U) U)3 m j - 2 K K ƒ e \ k 2 m a a 0 - k o B a) 0) ® U) � u ' f § § / Q § § 0 b Q a § ° k ; , @ a k 4 o ) a £ a ■ c , a_ . k ° ` ° \ ] k C \ § @ § o ¥ 6 \ f = a @ 4 § % ~ G S m _ ) z f -0 -� \ \ } \ / o z / k CO 2 � � k � CL — _ " a » E & ' ka § / 0 a 2 0 U) 0 Parcel #: 020-1240-90-000 12/20/2004 04:35 PM PAGE 1 OF 1 Alt.Parcel#: 21.29.19.1250 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 * TROY&LEZLIE LIBERSKY LIBERSKY, TROY&LEZLIE 505 JACOBS LADDER CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "505 JACOBS LADDER CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.567 Plat: 2135-JACOBS LANDING 2ND ADDITION SEC 21 T29N R19W NW1/4 OF SW1/4&SW1/4 Block/Condo Bldg: LOT 28 OF NW1/4 LOT 28 JACOBS LANDING SECOND ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 02/02/1998 572122 1292/149 WD 07/23/1997 1093/114 WD 07/23/1997 873/582 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49290 228,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.567 32,900 143,800 176,700 NO Totals for 2004: General Property 2.567 32,900 143,800 176,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.567 32,900 143,800 176,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 134 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 w Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP / ' °�L- SEC. Z) T -;->9N-R�� ADDRESS ^ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT Z8" LOT SIZE 2,©$ f' C&,A PLAN VIEW � I Distances and dimensions to meet requirements of I•IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6z " e 9s- Y INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used-Le off 11A.0, ?ed Elevation of vertical reference point: 4aC2.g2o �Px`oposed slope at site: SEPTIC TANK: Manufacturer: ������ Liquid Capacity: 1060a,,.P_ _�� Number of rings used: 0 Tank manhole cover elevation: �. S Tank Inlet Elevation: Q, � Tank Outlet Elevation: q • 5 Z Number of feet from nearest - Road.: Front, Side Rear, O / 35 feet i From nearest- property line Front 10 Side 10 Rear,0 79 feet Number of feet from: well �� , building: �$ (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, Ft. Number of feet from well: Number of f—t from building: _ (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: �r Width: Z Length: Co Number of Lines: Area Built Fill depth to top of pipe: 5/00.- Number of feet from nearest property line: Front, O Side, © Rear,0 Ft .��_ Number of feet from well: Number of feet from building: `/ 5 (Include distances on plot plan). SEEPAGE PIT �,�• \�o D Size: Number of pits: Diameter: Liquid depth: Bottom of seepage p.i.t 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 bot.:tom of tank: Elevation of inlet: !_ Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: - i Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj f D k �NT CiF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING DIVISION LABOR&HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION P.O.BOX 7969 A IS N,WI 3707 State Plan I.D.Number: (If assigned) NW4,cSW4 Spec 21 , T29-R19 ❑ CONVENTIONAL ❑ ALTERATIVE Town of Hudson Lot 2�, ❑ Mound Harborview Rd. Holding Tank ❑ In-Ground Pressure NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: IN P TI N DATE: Sam Miller Box 282 Hudson WT 54016 R-do -V 13130 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REP.PT.ELEV.: I Ub T REF.PT.ELEV.: Name of Plumber MP/MPR7�-- .: Co unty: Sanitary Permit Number: Dou Strohbeen 54 ST. Croix 135386 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPA Y: TANK I LET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER G PROVIDED: PROVIDED: ,a(o !,�"7 ES NO YES ®NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM 1 S LINE; S t_S AIR IN�L T; ❑YES NO C ❑YES Qt NO NEAREST—► DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: PROVIDED:RVIN LABEL LO KING OVER ❑YES ❑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: PIMP ON AND OFF EEN U []YES ❑NO NEAREST ETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAM or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH / TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. IPE DISTR.PIPE DISTR.PIPE MATERIAL: N0,DISTR. NUMBER OF LL: IL I FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: � o AIR INLET: q'i ), ,�ti 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; [DYES ❑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: 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 ORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: p ❑YES ❑NO ❑YES ❑NO NEAREST---► 5� 2- ��A7Zetain in unty file for audit. Sketch System on TITLE:Reverse Side. SIGNA E: y SBD-6710(R.06/88) R SANITARY PERMIT APPLICATION COUN&Y, 7UILH In accord with ILHR 83.05,Wis.Adm.Code STA TA�R"Y'CP�ER��M%IT -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ Ch/JrT1s11% to"pr vious application 8%x 11 inches in size. -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. PRO ERTY OWNER POP ERTYLO TION� : '/a,S T , N, R E(or LOT# ^ „! BLOCK# PROP RTY OWNER'S MAILING ADDRESS L`6 2%Z C)TY,STATE ZIP CO E PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER i h ✓c 816 `- 6- a [a CITY NEA ES ROAD ( P11. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE: ❑ Public -711 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX N MBE ) 111. BUILDING USE: (If building type is public,check all that apply) Z�f Q6 1 ❑ Apt/Condo 10 El Outdoor Recreational Facility 2 ❑ Assembly Hall 6 1-1 Medical Facility/Nursing Home 11 El Restaurant/Bar/Dining 3 El campground 8 El❑ Mobile Home Park Merchandise: Sales/Repairs 12 El service Station/Car Wash 4 El Church/School 8 13 El Other: Specify 5 El Hotel/Motel 9 ❑ Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 New 2. ❑Replacement 3• ❑Tank cement of 4. E1 Existing System 5.E1 Existing System System System y B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued V. TYPE OF SYSTEM: (Check only one) Other Non-Pressurized Distribution Pressurized Distribution Experimental 21 F-1 Mound 30 ❑ Specify Type 41 C1 Holding Tank 11 � Seepage Bed 42 ❑ Pit Privy 12 Seepage Trench 22 ❑ In-Ground 43 ❑ Vault Privy 13 ❑ Seepage Pit Pressure 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 12.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. (Min./inch)RATE 8. SYSTEM ELEV. 7. ELEVATION GRADE LI 5 ,` REQ�I1�(sq.ft.) PROPOSED'�sq.ft.) (G 1 Z ft) L 5 —10 Feet ��' Id Feet l (mil t� 4�. (,� � CAPACITY Prefab. Site Ex per. VII. TANK in alIons Total #Of Manufacturer's Name oncret Con- Steel glass Plastic App INFORMATION New istin Gallons Tanks structed Tanks Tanks Septic Tank or Holdina Tank Lift Purno 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: -^��y Thou, `�hvo h ��d� 5 z 3z 3, Plumber's ddress(Street,City,State,Zip Code): C�N LUL. IX. COUNTY/DEPART ENT USE ONLY Issu' g Agent Signature(No Stamps) ❑ Disapproved Sanitary Permit Fee(1surcha gerFeej Water a e Issued Approved ❑ Owner Given Initial B6 �� Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD41398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS r j 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. 188) J i + 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. -----------------------------------------1-------------------------------------- Owner of property Location of property 1/4 1/4, Section Township A L4 d f�otj Mailing address Fy otj R.�r-00' .1 .- Address of site A S_0 �. =� �`"``-� " �"`�1 �l1 U=Di�� � i.�J�_ 540) (p Subdivision name Lot number Previous owner of property I tj t � VI E YZ`_.'Crj Total size of parcel 1 4,-7 f'r'CJ^ < Date parcel was created w Z Z ­':z Are all corners and lot lines identifiable? ___k_Yes No Is this property being developed for resale (spec house)? 7` Yea No Volume 05- and Page Number yb Z_ 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 cjeed recorded in the Office of the County Register of Deeds as Document No. y 35 y-I'7 ; 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 Reg ter of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) / b - 31- Date of Signature Date of Signature not-omr►)1 No WARRANTY DEED tm• S -r ar.ornVan FOR ar<.<.ar,.n,, Para tiTATF: BAR OF WISCONSIN FORM 2-1982 U5417 r REGISTER'S OFFICE •N ��IIIJI ST. CROIX CO., WI Virginia M. Hanson, a single woman Recd for Record MAR 12 1469 M 8:00 A M c.mtr>. and ,,.Irani. to Sam E. Miller, a single man n a �Q}ant1..RMW.9f D"i the (t•Il.ta•In¢ de.rllhc.l real ertale in St. Croix Stale u! Wmconrin: Tax Parcel No: ... .. .. . ............... West 11alf (W',) of the Southwest I)uarter (SW'I,) ill `section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wl.sconsln except that jlart South of the I•ublic 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 (W14) of the Northwest Quarter (NWO 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 Colnpanv. '['PANSF•'h� 0 . $j 11— EEE Thin is not hnnu%l•ad pnga rt:. *ink Its not) t:Ilret••iao t.• warranties: easem•_nts of record and pro►ective covenants and restrictions of record, if any. Ihllr'd till% i1 „f 'Y1 tf�t ♦( i. 1,1 88 Virginia M. Hanson AUTHENTICATION ACKNOWLEDUMENT Signature(a) . ..... STATE OF WISCONSIN I S!. authenticated this .._ (J Ibunh' ay of 19 1'ersnnall.' came before nip this `�' , day of MA 'L L- , 19 88 . the above named Virginia M. Ilanson TITLE: MEMBER STATE. BAIL OF WISCONSIN Ilf not. authorized by 1 411r:Ati, Win. Stall.) In me I'mmil to he the laer;nn uh.. v%.-rolled ll.e furrcuin• -trumenl soul aikonalydFr till- s m,e. *•• i INSTRUMENT WAS DRAFTED nY V' Lois,.A. Murray, .Ifeywood, .Carl b Murray �n h,O.'Box 229. Hudson, W1._ 54()(6 :.di,.. uA1'r /� p (Siennturrs nitt}• he Iutlhenlicall-d or nrknntvil-d:ed. Il(tth �1`' '" Ir'li1'V'n M WFIVai,el�.I If not. slat% eel. ratio., ore not necessary.) dat••: 19 ! .1 •N.mn nt Mrwm .itnintr iA Ally -ml.owity •1....,•.I 1.. 1" 1 �. ,a••1 I • ,. •Ir•. r. WARRANTT DI:ED STATE BAR OF V6I%cIiN-W N..•.L•e. 1.*..t 1'I:v Y�NIM No 2-- 1—• - STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER OX 2. FIRE NO... t CITY/STATE I/( d IA ZIP PROPERTY LOCATION: 1/41/4, Section 2 , T_' 9 N, R��„� Town offA�1C�t��� , St. Croix County, Subdivision �kC1?- ` �d 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 (1) 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. SIGNE 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 DI=PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/WMftK 4A"W: OT NO.: BIVISION NAME: 14 L) �4sW �/ Zi /T79 N/Rr98(° W /,/UoS0w 7-8 o@s LAN4,IN4 COUNTY: MAILING ADDR SS: ST C(Aalk SAM MILLtk Q R6At /4vds4u USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: Q S: ,Residence p New ❑Replace ©tx 31 egg NOV ' JU1LS �� SOILS - orCZ- "V'44Qt"r RATING:S=Site suitable for system U=Site unsuitable for system QjtNLV ou. L _�IJ.ou IN G J ��RE: S STEM-IN❑-FILL OL:1 S TANK:R�C�',1`/4�"r )G"4 AC:lop K4 /�AtliXI, Q� �(�1 I(cnjJ'S U S 1(,d�J�N� /., c DES If Percolation Tests are NOT required IgN RATE: If any portion of the tested area is in the /1 under s. ILHR 83.09(5)(b),indicate: Q ms / Floodplain, indicate Floodplain elevation: AIA C_ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO Q R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH`W ELEVATION OBSERVED EST.HI=HST_TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- S.33 $0 Ml,,Ij t > 8.33 74'SLLTS 7-s BeNC. Sr Q4 MS4(A-A B- Z S-st C4 E B.5 8 24'gLLTS 7" N L gsr*'9eN MS ZA"$e,MS6 6,, B- 3 9.97- 9 VZO r4ol-i > 9 97- 3o"gccTs -z9.'8e-,L -?"R NM st iRe-, Msg4vt B- 8.6a 9 o.ZZ 140-4t > ll�.off 7-4"QccTS re L 6 r"igk,4 c-SI&,it- B- t0.1-7 9Z rAONL. I > io.l-7 &cc.TS `Z?, QiuL 3 gl+J 6S 2O� LQI? r B- PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IlifS AFTERS ELLING INTERVAL-MIN. PERIOD t P RI D 2 PERIOD 3 PER INCH P- I T %o >Z > 2 > .4 P- 91.7-0 P. 6.9U oNii;. 9Z. P- P- to Rt_ 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. — — 9- SYSTEM ELEVATION. 0 _. _._...r_ -� a u it i I a ' � I V i j �� a tN i t Y Wi 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): ITESTS WERE COMPLETED ON: UAQV&l o(��s�,► s,scu SUay�y��c>, /Nc N v Ste. / /90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 07 7SE�Na 'ST I�UosaN s' 34 3Ts6-4o sa CST SIGN URE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - y�V• =/Q�.D' �4G0� S L4hdj qo TROT(. % Q ��-✓c s CT�'sf $e�oWtE1•=$s.4o' k A ✓1 , d br. � \ 2 ` ea,b (tlI U`2A °9 Sz N do d Y'3 5/0 i is i w C � v xa" Y N r � N .� -s W Qo Q It n