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' Parcel #: 020-1270-30-000 12/17/2004 08:23 AM
PAGE 1 OF 1
Alt.Parcel M 21.29.19.1335 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
ZENZ, MA RK R&ANNETTE F
MARK R&ANNETTE F ZENZ
843 DORSEY DR
HUDSON WI 54016
Districts: SC=School SP=Special Property A dress(es): "=Primary
Type Dist# Description *843 DOR EY DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.809 Plat: 21 7-JACOBS LANDING THIRD ADDITION
SEC 21 T29N R1 9W PT NW NW&SW NW Block/Con o Bldg: LOT 42
2.809AC LOT 42 JACOBS LANDING THIRD
ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-19
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 860/507
2004 SUMMARY Bill M Fair Market Valu Assessed with:
49376 211,500
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.809 35,000 128,600 163,600 NO
Totals for 2004:
General Property 2.809 35,000 128,600 163,600
Woodland 0.000 0 0
Totals for 2003:
General Property 2.809 35,000 128,600 163,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 205
Specials:
User Special Code Category Amount
018-RECYCLING SPECI L ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
I
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Sa W TOWNSHIP h'4 /-s o.1 SEC. z / T
ADDRESS ,3or0'2-$ Z ST. CROIX COUNTY, WISCONSIN 1 /33 S
SUBDIVISION Jacobs LOT LOT SIZE S
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
sa
w�l
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p- V.141'
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?;P- INDICATE NOR HARROW
BENCHMARK: Describe the vertical reference point used
t
Elevation of vertical reference point: 2-25�=/00.00 Proposed slope at site: $o F_As7_
SEPTIC TANK: Manufacturer: Wo,' scam✓ Liquid Capacity: /DpD 4
Number of rings used: �_ Tank manhole cover elevation:
O�
Tank Inlet Elevation://3S Tank Outlet Elevation:
Number of feet from nearest Road.:
Front, Side,O Rear, Q feet
From nearest property line ' Front,(DSide10Rear,0 /Q S, feet
Number of feet from: well 6.5 building: 17�
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
r
PUMP CHAMBER
Manufacturer: 1/!/ Liquid Ca,)acit.y:
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:����tsh'��os�� I Trench:
Gyp S 7T
Width: /� Length: 36 Number of Lines: Area Built:
Fill depth to top of pipe: YDO
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . 03�
Number of feet from well: /D O
Number of feet from building: L/D
(Include distances on plot plan).
SEEPAGE PIT
�� /G•'/i = �S.Sia —� f--� R.H. ►�.Gt - $s.�o
Size: Number of pits: Diameter:-ea
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
DEPAFKIVIENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
�vt A ,WI 537 7
SW4,�V 4, Sec 1 , T29-R19 sfasslgned) 'NUmber:
Town o f Hudson Lot ❑ CONVENTIONAL ❑ ALTERATIVE
Harborview Rd Holding Tank ❑ In-Ground Pressure E] Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:
Sam Miller Box 282 Hudson WI 54016 lj—1 - � ``3d
BENG�I MARK(Permanent reference point)DE CRIBE IF DIFFERENT FROM PLAN: ELEV.: REF.PT.ELEV.:
Name of lumber: ► MP/MPRSW No.: County: Sanitary Permit Number:
Doug Strohbeen 5432 Croix
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.:I WARNING LABEL LOCKING COVER
1�� PROVI PROVIDED:
lam/ I v O YE NO YES NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:I VENT TO FRESH
ALARM: _,( FEET FROM LINE: AIR INLET:
❑YES 0 -- ❑YES 2 NO NEAREST111I
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS 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 moisture at the depth of plowing FORCE LENGTH: DIAMET R: MATERIAL 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
Q TRENCHES: MA RIAL: PIT DEPTH:
DIMENSIONS /S 3 G — G -
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: N0. TR. NUMBER OF H
BELOW PIPES: ABOVE COVER: E. LET: EV.E D ^ PIPES: FEET FROM LINE: /Q AIR IN ET:
v � - v O . L NEAREST�'� I(� `� O
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 El NO— ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
[DYES ❑NO [DYES ❑NO ❑YES r_1NO_]
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: I 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: DA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MAT RIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO I ❑YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO NEAREST��►
N
L}
1
Sketch System on twin in County file for audit.
Reverse Side. TITLE: Z A
SBD-6710(R.06/88)
��` _j
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05,Wis.Adm.Code
!7j. dut-W
STATE SANITARY PER OT#
–Attach complete plans(to the county copy only)for the system,on paper not less than ❑ Z - �°7 8%x 11 inches in size. i rev ion to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION.
PROPER OWNER PROPERTY LOCATION
Mi Y4 W 1AY4, S T 2 J, N, R E(or
PROPER OWNER'S MAILING ADDRESS LOT# BLOCK#
- 4% '7i
liot CITY,STATE ZIP COD�Ey PHONE NUMBtE�R SUBDIVISIO NAME OR CSM NUMBER
Au d w "TQ�� � v� Z� T,Co9 "W
El 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROA
❑State Owned ❑ VILLAGE; ��sotJ IITt , v I
❑ Public EX1 or 2 Fam.Dwelling–#of bedrooms— PARCEL TAX NUMB O -
III. BUILDING USE: (If building type is public,check all that apply) Z,
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. NT
1P New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.El 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 El Specify Type 41 El 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
REQUI RJsq.ft.) PRO4P'ONEP6 q.ft.) (Gals/day/sq.ft.) (Min./inch) t! ELEVATION
4. `j O 1 4 '7 �� Feet �11 r 9 Feet
VII. TANK CAPACITY Site
in ciallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION _ glass App.
Tanks I Tanks
Se tic Tank or Holdina Tank 1 1 Ib6j) `
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: 7 S'
Plumber Address(Street,City,State,Zip?00e):
r � �► WL g5qon
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee(includes Groundwater ate Issued
Issuing Agent Signature(No Stamps)
pproved ❑ Owner Given Initial
?� I OG Surcharge Fee)
Adverse Det rmin tion ` r
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.
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 !W 1/4 _ 1/4, Section r-2— T�N-R �q, W
Township 4ufjs.6
Mailing address �Y ['x�+� , �a �� oMl�
Address of site A y' '4 Q, u {so tj uL
Subdivision name AC[ ? CA
Lot number
Previous owner of property � ' � ,` ���` ��. IVl T-11A SD
Total size of parcel 2 bri A
Date parcel was created -�- 2-Z - �
Ate all corners and lot lines identifiable? as No
Is this property being developed for resale (spec house)? Yes No
Volume qL 6�7' and Page Number L 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.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (out)
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. l %t; y,JZ; 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 Regis ter o Deeds, as Document No. Ng . 41'j ) .
gnature of Owner Signature of Co-Owner (If Applicable)
b - 3 l -- .V
Date of Signature Date of Signature
fnOC..Ultrrll NO WARRANTY DEED 164 111 SPA E RESrnv LO FUR R7CORI.IR., UAIA
STATE: IISR OF WISCONSIN FORM 2-19112
43 1417 r' REGISTER'S OFFICE
L" ��`�� ST. CROIX CO., WI
Virginia M. Ilanson, a single woman Recd for Record
MA q 12 1999
N 8:00 A M
eon%c)�
and to Sam E. Miller, a single man � /y
Itelo of Doe&
the fl.11..wint, de,erlhed real estate in St. Croix Om t,
State or Wisconsin:
Tax Parcel No: ... .. _ . ...............
West half (W'..) of Lite Southwest Ouarter (SW';,) Ill SecLion
Twenty-one (21), Township 'Twenty-nine (29) North, Range Nineteen (19)
West, St. Croix County, Wisconsin excepL that part South of Lite Public
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 (W!4) of Lite Northwest Quarter (NW'L) of Section
Twenty-one (21), 'Township Twenty-nine (29) North, Range Nineteen (19) West,
St. Croix County, Wisconsin lyllig South of Lite right of way of the
Chicago, St. Paul, Minneapolis, and Omaha Railway Company.
'!'}tpNSV2h� 0
$mil
EEF
This is not hmue lead prrq,lrt:.
tick Ills not)
><eel•'1;,n to, w:ITI and ies: easem%nts of record and prorective covenants and restrictions
of record, if any.
Iv� I S
Ihlted tins ,I;,� „f m 111 ( 111 88
1 EA 1.1 �/����� ^C/ 1SEAI.1
• Virginia M. Hanson
ISEA1.)
AUTHENTICATION ACKNOWLEDUMENT
Signature(s) . ..... STATE OF WISCONSIN
. .. ...................... SS.
.
authenticated this .._ day of 1'ountc.19 Pursrmall.% came before me this t day of
A c , 11.1 88 . the above nann•d
Virginia M. Ilanson
TITLE: MEMBER STATE IIAR OF WISUONS1%
(If not•
authorized by S 70li.06, Wis. St:ltt.)
to ale Lno«n to hr the iwr.on «ho eserulcd the
foretroin• trumrnt anij ai'koowledpr tiu, same.
T•' S INSTRUMENT WAS DRAFTED nV
Lots.A. Hurray. .Heywood, Carl S Murray7_c'.
P.0,' llvx 229, Jludspn, W1 54016 4 i
\ota• uAl�r P � 4 ('-111111%. wig.
ISiennturrs nut} he :+ulhrnticaled nr ackn'ovled�ed. Iloth �I` t ^•u•li`---lr,n �rl(�l�l�ailelyr.I If not. stale t••;n ratio))
are lint necemney.)
19f
•Name. of P•r,%r,n• .iSnin[ in Any ro pn,ily ,L.,I'•I L I,I..i .. nl••I 1 ' u •h ., ,..
WARRANTT Dt:F.D STATE "An OF {il141'OV,IV
101IM No 2-- 1.•'
STC 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER / Y
FIRE N0.
ROUTE/BOX NUMBER_ �?� 2'�Z
ZIP '57 L401 4b
CITY/STATE t'*'
PROPERTY LOCATION: W 1/4 N 1/4, Section s T__7:6_-N, R_��Vi
Town of _ t-tU Il _, St. Croix County,
Subdivision
LA C V+ri , Lot No.
L.+Z,► .
Improper use and maintenance of your septic system could result in its premature
failure to handle wastes. Proper maintenance consists of pumping outAthePseptic
tank every three years or sooner, if needed, by a
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
Of
prior to July 1, 1978. St. Cron =suofyALLaccepted
SYSTEM3 program
tonkeepustheir
1980, with the requirement that owners
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 Y►� P lumber,
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. JL%-f
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
i
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
II'IYUSYRY z .F. BOX 7969
LABOR AND �
HUMAN RELA PERCOLATION TESTS (115) MADISON,WI 53707
(ILHR 83.0911)& Chapter 145)
LOCATION: TION: TOWNS IP/��Y: OT NO.:BLK.NO.: SUBDIVISION NAME:
Sw 1/NV,( 21 /T19 N/R 15 o _ Lsw 4-z LANAIN
COUNTY: MAILING ADDRESS: /� IIII , /
S;G�olk SdM 1'1ILt.9� , QRaO 1'Qo4o 14uts W ► OI�
USE DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMERCIAL DES RIPTION:
%Residence ANY New ❑Replace p�T 2S �9s9 UcT Zc 19a9
�ILS �k dG� S8 • ��.- $c1Rk^�nQQT
RATING:S-Site suitable for system U-Site unsuitable for system SOILS
ONV NTIaNAL: M�D:❑� IN-GROUND QESSURE: S TE -INa-FILL OL�DING�K:R COMMENDED SYSTEM:Io tional)
S U S S U S U S CoNA-,T lo>.,f4
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: l LA ' Floodplain, indicate Floodplain elevation: /Vd
PROFILE DESCRIPTIONS
rBTOTAL DEPTH T R UNDWATER-INCHES HARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
DEPTHit ELEVATION OBSERVED NE TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.)
SU 84.3
3? g.7c� � 9.33 8'BLLTS 9"90WSC
B- 3 .9Z -7.34 t46NE > 9.9 Z RL S ,L 24�BaNCS�cG�ns'$Q�MS 3$"RcNCS
B- .17 �6$ 1 i�vN K > $.17 6,'QL �°gea Z8-" a M 5 G e
B- S o 40. 17.0 I r > /0 2 'g,LETS i S"igomS,C A '$a,4C-S14se 41'$a.,,cs As
B-
D� PERCOLATION TESTS
TEST is
DEPTH . WATER IN HOLE TEST TIME D WA LEVEL-INCHES RATE MINUTES
NUMBER IBS AFTER SWELLING INT AL-MIN. P RI OD 1 PERIOD PER INCH
P. I S .od 30 3 .Z > Z >Z N Z <�
P- Z A-to t4ism< .70 3 v
P- 3 .00 fJ.4,C -6-7.30 3
P- 1
P- JA t
P-
PLOT PLAN: Show locations of percolation test, soil orings and t dimegqlions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and(show their Ioc�i n the`plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. Dt'� \
SYSTEM ELEVATION. I ■ g-3 - I16 84 .30
i
I -- - --- -
T
9'
,
_ `
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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.
NAM (print): ` /� TESTS WERE COMPLETED ON:
NAM
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JON Nson, S I,_<j'ev,E;e ,LG 1 NC CTO 26 1989
ADDRESS: CERTIFICATION NUMBER: JPH NE NUMBER(optional):
CST S ATURE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
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