Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1057-70-225
m o R o � I � g $ Co§ 2 m /loo 3 Sig R c =am. R 2E22 � c 4 k\2 G ��§ 0 ) fk �{% S co § o / e � @E cc 3 5 £ EEEE Jc 6a Cl)■ � \ § E t § z > q § q m ) § / :3 \§ k § 7 { z 7 7 (D _ E j n § c c . m 2 / \ 0 / 7 ) : c C14 co CL 0 / k « § 0 o a E k % Z _ /■ ■ ■ _ / \ K K k ® N 0 • m 2 a a a j j § } § § \ 2 . e 2 \ { a 2 J \ e c § _ \ � § § 0 . 2 2 = & = E Q 6 � % \ c ƒ S g \ E 4f 2 \ ) E ; _ o s z k ) 7 \ ■ _ ; { ^ s \ _ ® - § § } ' � f o z / k } ) \ e k � — " a » � .2 k a § k 0 a 2 : 0 3 0 Parcel #: 020-1057-70-225 08/11/2006 10:51 AM PAGE 1 OF 1 Alt. Parcel#: 22.29.19.217C-10 020-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): 0=Current Owner, C=Current Co-Owner PAUL&BRANDYN DOPKINS O-DOPKINS, PAUL& BRANDYN 869 CLINT'S TRL HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "869 CLINT'S TRL SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.510 Plat: 4164-CSM 15/4164 020/01 SEC 22 T29N R19W PT SE NE 11.58 ACRES Block/Condo Bldg: LOT 01 LOT 1 CSM 7/1896 NOW KNOWN AS LOT 1 OF C.S.M. 7/2070 EZ-HWY-1192/460 HWY PROJ Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 8949-03-22 NKA CSM 15/4164 LOT 1 2.510AC 22-29N-19W SE NE Notes: Parcel History: Date Doc# Vol/Page Type 09/24/2001 657296 1724/01 WD 09/11/2001 656333 1717/039 WD 07/23/1997 833/535 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.510 77,000 146,400 223,400 NO Totals for 2006: General Property 2.510 77,000 146,400 223,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.510 77,000 146,400 223,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/06/2005 Batch#: 05-57 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U} u KATHLEEN H. WALSH REGISTER OF DEEDS OCT 2 3 2001 ST.REC CRO DI X CO RECaRD WI S, �I 08-31-2001 8:45 AM c11� COPY FEE: 4.00 RECORDING FEE: 14.00 CSM VOL. 12. PG. 3462 c CLINT'S TRAIL — :33'33. ...� -1< W �- W —� n— y 400.47' 13 .00 Lq zz vnr- cn x ym 400.38' A.-.t 1 - : �'' m -0m°-1 � mvN m —In x<N O mo CA z O °o �� r-mD ;0 orz cn CA-0 n v ( �w C, t� o m-4 .o I� '^z m �o C11 -1 `VA Liz z 2 cn 1 a+ C-1 Z•\ 1 to I n N — m z M s 'w Go I ° y O Ln z Z V V ° 7C 2I ° O .V In I .'.to '"� OD r to r��gGi.S?�11►'� D O+ aAo v N • p z V pI '> pz Ip m �.. m OD m I O A .n Nm �fNrl 0 � O m :� NO G O0 c ° O °-� r _ S00° 1 1 '42'E 1 I ;tn °im x-� IZ000) 333.92' _ m= zm N r (� O co co to O O Z OD N 3: - v OD 110' N m -1 n S00.02'57'W °w w to 33.00' D vo° [-' V. n? A Dm0 �O� n D Ln O i A Z cnM r -Zr CA U) m° OOo O' m MK , n x M .. L D v m I Ln Z m — O 7o m m — �W ti -IZcp �tp�1� p n r y I -iN —�• pAo C. •O cn I ;y m m n r $ I y� p 1- V z�D� ss.o2' W Z rn D : SETBACK }�ow w°° K G) o c) soo•o2's7'w W -+ o LINE ;-cv !" N m z N O A Q N 333.50' I uoi o o 206.70' 126.6o — 868.20' A 33.00'• S' 00 02'57'W 399.52' w A NZ z 00°02.57-E S 00°02'S7'W 45975• w can �� KELLY ROAD csM VOL. I I . PG. 3234 N0 m N. DEDICATED TO THE PUBLIC EAST LINE NEI/4 SEC. 22 •�' 4i 'q 1 f 7 } ✓' D1 lC. � •� L� C C- N � •L O caN G ; ° DDm D z t w X cn cn n ` O O O D C-� T �N -n a _ r.rz m o -1m o c c. a�1 n- -1 -4 -'1 r — 1 j Q Z cn O Z z r C; w N - o 0 m v -w v m-1 O - z ;a v \ G) tj ozm m w tn4 - m ro i. i 4 ui - n 9T-n v O v c CA w4- 0 m ' 0 rn C)f V V N ";v nr x N n C O W In Q) ° z to� O lJ p z ' _OD r <m z -n w mno ntn Dtn m v cn cn O m O 0 m — — c�TI "z Z z m m N m N m z ° � m ch w MUD Vol. 15 Page 4164 445353 CERTIFIED SURVEY MAP LOCATED IN THE SEI/4 OF THE NEI/4 OF SECTION 22 , T29N , R19W ,RED FR� TOWN OF HUDSON , ST. CROIX COUNTY, WISCONSIN• FARMACRED OSERVICES HWY "35" N NOTE : THIS MAP IS FOR THE PURPOSE WI 54022 N 7 CERTIFIED REPLACING RC SURVEY RECORDED RIVER FALLS, MAPS , PAGE 18 96. NE CORNER SECTION 22, T29N, R19W. (COUNTY _S I MONUMENT FOUND). oz SET I"x 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAL FOOT. • : I" IRON PIPE FOUND. UNPLATTED LANDS NE CORNER OF THE SEI/4 OF THE NEI/4. W E NORTH LINE OF THE SE I/4 - NEI/4 S U S. H. 1 2`(.105.96' M N89-42' 26 E 1 _ - - S 89. 54' 14" E 1039. 72' M .�• �--- — _\ �33'33' - ], of I vl I 0' � Q. Z I v LOT 3 W: I a v PRIVATE ROADWAY ` • ; _ J. C); EASEMENT C' 'Q. til �• �(� ` 11.58 ACMES �I �: a: 13 w /'� `` f5oa,all sa; Fr.) . `-� x �`. <<r. NI N 9.54 AC. EX;CLUDINQ p \ ROAD R. ' . W. �" O „� w Lt:• (415,460 SC. FT.) <r n ail Z O 0 / C u. O Z I /\`\ " 3 3.00' F•' '-\ 33'33' 33.00' l y ' 0 1038.01 I O ' " 110.4.01' V . N890 57 16 W J I33t33' F J up 'a I N I w Y w UNPLATTED LANDS . . . . ,.............................. o �I W. N �• . O CO:0 : z 0 I J. NOTE: BEARINGS ARE REFERENCED TO I I Q. THE EAST LINE OF THE NEI 14. Z' (RECORDED BEARING), _• EI/4 CORNER SECTION 22, T29N, R19W. (COUNTY ' NOTIs: SEE ROADL4 Y STATLM'u''11'r 01'1 l�Hi1S"I MONUMENT FOUND).,..y;t,.6r�-•Y�„��i ^ 2 FILED ,- 14 f, FEB 101989` jAMES ornNNELL 5!. cQ0Ix IOUNTr J 1�= �I�tLIJC-NSIVE PARKS WNG 4,�i�7��•.��=a+ +r,C, r. SL o*Co"W1 AIVI/{.Q1FNG COIVMIIM N It. = 200' m.wcssr- $CAL E JAMES M. WfE AND ASSOC.ER WEGERER, WEBER A 0' 100 200' DATED \oo SHEET I OF 2. THIS INSTRUMENT DRAFTED 87 - 350 VOLUME 7 PAGE 2070 s COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 C3:lr k4� 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 962 - 4030 192- 6 f ST. CROIX ZONING REPORT NO.: 40871/01 PAGE 1 ST, CROIX COUNTY REPORT DATE* 5/07/93 COURTHOUSE DATE RECEIVED* 5/06/93 HUDSON, WI 54016 ATTN* THOMAS C. NELSON OWNER* rr arent i LOCATION* 669 E. Hay. 12, Hudson COLLECTOR* M. Jenkins DATE COLLECTED* 5-5-93 TIME COLLECTED* 12*OOpm SOURCE OF SAMPLE* Outside faucet Re-test NITRATE-N* 14 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Nitrate-Nitrogen, mg/L I i i ICI 12 LAB TECHNICIAN* Pam Gane �� WI Approved Lab No. 19 00 0 r '2,93 > �0 w, OF,\NOFOEIy�EH,G4 / I t Means "LESS THAN" Detectable Level Approved by* PROFESSIONAL LABORATORY SERVICES SINCE 1952 i COMIAERCIAL TESTING LABORATORY, INC. -r14 Main Street, P.O. Box 526 + Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 y FAX - 715 - 962 - 4030 J it ST. CROIX ZONING REPORT NO.S 40451/41 PAGE 1 ST. CROIX COUNTY REPORT DATE: 4/26/93 COURTHOUSE DATE RECEIVED: 4/22/93 HUDSON► WI 54016 ATTNS THOMAS C. NELSON �3 i OWNER: Larry Parent LOCATIONS 669 E. Hay 12, Hudson COLLECTORS M. Jenkins DATE COLLECTED; 4-20-93 TIME COLLECTED#' 2t15pm SOURCE OF SAMPLE'+ Outside faucet (RETEST) NITRATE-NS 11 ppm Above 14 ppm exceeds the recommended PubLic i Drinking Water Standard. Nitrate-nitrogen, mg/L LAB TECHNICIANS Pam Gane ! 2 WI Approved Lab No. 19 °� RF�E l p 00 291 X93 Sr A'/Co C,yp,X �,.\NDEVFNpEHj V 2QN/ n 9 O�^ CU NV � i A A a Means "LESS THAN" Detectable LeveL Approved byt PROFESSIONAL LABORATORY SERVICES SINCE 1952 COMj4ERCIAL TESTING LABORATORY, INC. -kS14-dain Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 a ST. CROIX ZONING REPORT NO.S 38965/01 PAGE 1 ST. CROIX COUNTY REPORT DATE'$ 4/01/93 COURTHOUSE DATE RECEIVED: 3/31/93 HUM, WI 54016 ATTN'$ THOMAS C. NELSON `. _ _.. .. -i.. a «.. ,:::. _._. . .:. � ... -• _s 'p: 4 >.. _ ,. s . OWNERS Larry 6 Kimberly Parent LOCATION: 669 E. Hwy 12 East, Hudson COLLECTORS M. Jenkins DATE COLLECTED. 3-29-93 TIMIE COLLECTED'* 10S30am SOURCE OF SAMPLE'* Kitchen faucet DATE ANALYZED2-31-93 TIMiE ANALYZEDS2S00pm COLIFORMf S 0 /100 m L INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 12 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. s. Col iform Bacteria/100 m Nitrate-Nitrogen, mg/L , 11 1 APRpS C'`'�11tr ° +cE w LAB TECHNICIANS Pam Gane OfA DEPENOfHj t, WI Approved Lab No. 19 V Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 1 r '� � � � ., .. �� ' ;{ A � M i ..`.^�^r..� ��!'�"�.�.3 5 �O �'�" � .�a� � a i- r,�' ; � �` T►� 6Qp, .,` �r,(' s���='�Z�, .. .,��-� .� •4r 3 l ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 / Telephone - (715)386-4680 Yhe St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion gf this form is essential z4 that th.g Property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, qlJ along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING---------------- -------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) / SEPTIC SYSTEM INSPECTION-----------------FEE: , $25.00 ✓ (Determines if system is properly functioning at .*time of inspection) _ PROPERTY OWNER'S E: PROP. ADDRESS: 6 Gc� oZ CITY Legal Description 1/4 of the 1/4 of Section Town of Lot Number Subdivision: FIRE NUMBER LOCK BOX - -7U 2z� � NUMBER ar/C Color of house Realty sign by house? If so, list fir to PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the waterline must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPORT TO BE SENT TO:_ ,L,*ieX CLOSING DATE: S signature t N ST. CROIX COUNTY ? F WISCONSIN r � ZONING OFFICE ST.CROIX COUNTY COURTHOUSE I Off-OWL=MA.L Ilk maize`�• r j ` 911 FOURTH STREET • HUDSON,WI 54016 - - (715)386-4680 March 29, 1993 Larry Parent 669 E. Hwy. 12 East Hudson, WI 54016 Dear Mr. Parent: An inspection of the septic system on the property of Larry A. & Kimberly Parent, located at 669 E. Hwy. 12 East, Hudson, WI was conducted on Mar. 29, 1993 . At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. S •ncerely, e y°i Mary J. Jenkins Assistant Zoning Administrator cj NOTE: The tank was uncovered for pumping and must be covered again. ST. CROIX COUNTY ZONING OFFICE ' St. Croix County Courthouse t 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 Yhe St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion p_t this form ig essential = that -tb-q property can hg located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING----------------------------FEE: $ 35.00 * ✓ (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (� (Determines if system is properly functioning at .:time of inspection) _ PROPERTY OWNER'S NAME:_ 1-#,e433 //tF PROP. ADDRESS: ���� /r�f�ys/ /� �i�Sl CITY �Cl4�on� Legal Description 1/4 of the 1/4 of Section Town of Lot Number Subdivision: FIRE NUMBER LOCK BOX HIMER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged. by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPORT TO BE SEN TO: � / S CLOSING DATE: Signature s Form — S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L,4R.e5:f 10A a ,JT TOWNSHIP y-1u65 ,j SEC. Z L T ZR N-R l a W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ! �nAj voL 7 Pe Zo7o LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM NOTE Z jA /f Air o✓se goo, fa3A4 Arx TIA/C7 fTi1_t..tG7�/QLt 4 \fix,ST,�l�7 �x,5 r.,./17 e?A RACE \ IooO GjAL(n,Jr _ i 6FFLu6 I�oTf:; ����` /,+ 24:5 "t u.,✓e M„J 2° fcovE $� ftovE �oTE: / /fLC wy� $� 6V S 7 f c LFiC f02 6vF J D,fTKiBu7ro.J +ef 60'fcuSA jr � , ---- /7 - A u/.r T RROPfrc J O Lln/�r �od'r.. tOPCr'' c( --. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4kl ARn'-6R7, 11�QAhSg IF Elevation of vertical reference point: /Op Proposed slope at site: _ SEPTIC TANK: Manufacturer: VL/,�/S Liquid Capacity: /aoa Number of rings used: Tank manhole cover elevation: 100, 97 Tank Inlet Elevation: q`f,(07 Tank Outlet Elevation: q �; 7 7- Number of feet from nearest Road: Front, Side,O Rear, O -- feet From nearest property line Front ,OSide,%URear,O 2�, feet Number of feet from: well 5,? building: /7 (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) A1+ +T*Aw.n� TTw 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 feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, O Rear,OlFt . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: /302 !-2A L Number of pits: Diameter: 7 Liquid depth: S� � Bottom of seepage pit elevation: gg•(p Area Built: as either a drop box O or distribution box O been used on any of the above soil sorbtion sytems? (Check one). :)LDING 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: _1 Plumber on job: „__ License Number: 0 3/84:mjy DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.3OX 71,69 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: Sri' W'k S%'? T29r1-pn9w (If assigned) Towne Of Hudson � CONVENTIONAL El ALTERATIVE ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 110 OrFERMIT HOPUR00 ADDRESS OF PERMIT HOLDER: INSPECTION DATE: , Larr and I�im parent Hudson, ,JI 54016 3_ $ ` BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.P V.: Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: Gary Zappa 3300 St. Croix 119420 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: xw , ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST—� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P 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: DIAMETER: I 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 'I, TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST----1111- 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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: 7SOD�DED SEEDED: MULCHED: CENTER: EDGES: ES ❑NO E-1 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: DYES ❑NO ❑YES ❑NO NEAREST—♦ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) `Ori1ng A�hninistrato LYI DILHR SANITARY PERMIT APPLICATION COUP, Cl�D�X In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARYPERMIT# I/94/ —Attach oomplete'plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'h x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION S P,� T N, R /9 E (or)o PROPER OWNER'S MAILING ADDRESS LOT NUMBER [BLOCK NUMBER SUBDIVISION NAME L v v CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LA E OR LANDMARK 6 ❑ VILLAGE: t� oC. II. TYPE OF BUILDING OR USE SERVED: Ark- ' - d— --70 Number of Bedrooms if 1 or 2 Family —2 OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System a_ Exist* System 2. X A Sanitary Permit was previously issued. Permit# 0 g� a Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ®Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑Seepage Trench C. X seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): <2 9Is 1 . 6 O Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed El Septic Tank or Holding Tank 6,00 D Q - - ® ❑❑ ❑ ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## d CST's ADDRESS(Street,City,Stat ip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Sta s) Su harge Fee Approved ❑ Owner Given Initial I !1,^'C)o Adverse Determination `GV vll 1"kl X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION .r TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which WisCO EirS a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TSrif4? is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, its worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 'I DIVISION INDUSTRY, LABOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.090)& Chapter 146.045) LOCATION-"� SECTION: TOWNSHIP/hl V: OT NO.: LK.NO.: SUBDIVISION NAM '/N�/ Zz /T29 M/R i901(o W �s.,� I — CSM oT0 SK COUNTY: 'S NAM MAI LINU ADDRESS: C-ft-Y bookv tm t&- r USE _ DATES OBSERVATIONS MADE NO. E CO R TIO �r ew ❑Re lace Residence I{tN P 1PROFILE DESCRIPTIONS:1PERCOLATION TESTS: uNk -- Nta4�cw 2v /9T9 MiaAcK 2i i90 S$ 'SoICS a'q - ►Lt4r RATING:S-Site suitable for system U-Site unsukable for system 19oA X wq*> ONV NAL: MOUND: IN- -FILL OLDIN TANK:RECOMMEND D S STEM:(optional) Ds ❑U ❑S ❑U ❑S C]U EIS ❑U L7 S C)U 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: (, ��4SS Floodplain,indicate Floodplain elevation: ts/A cc 1-'T PROFILE DESCRIPTIONS BORING TOTAL I DEPTH TQ UP D ATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH-W. ELEVATION OBSER EST.HIG TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- /( �3 DO-$S e)NtC ? 3 /O"$LLTS 11wi9£ws,L fSO� - tWsto�3 B- 14"&gCS`E61t S� Rem ms 49�isk-CS46A B- Z 1-7. 17 /D1.l0 /VDNic 17.7) (Z"8 LL 7 ,r S,L B- MS AegAN CS B- J Z� /OO �S 0 >I�.Z5 "BLLTS -Z6"&R L S l' nl€- S /NLLt�S►oNx B- 60 ' mss' " G PERCOLATION TESTS TEST DEPTH I WATER IN HOLE TEST TIME RATE MINUTES NUMBER I I AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD2 PERIOD 3 PER INCH P_ 1 S D o 0 3 > >2 P- Z S.4d o Q •S� 3 >Z -�'- 2 >2 < P- ,L A-T1 ovq. A-r G. p_ tt±t S TIa dt KOIN4S) 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. A/drEN. -rOt LAYEk OF SAIL ftjt,.)UN ZO AND Cfd SYSTEM ELEVA 10N 88,6 0 mcwLs is mA Ax uP hos-rty of FrN a T a M6dwr► `SAi,44, -anal C AC& Fwir sAw.,, AN& SILT 1NCLUS tw A APfikox/mATELV ON°E Td TWO CoMIe'0n N 1 � TN(S C4 v6 . t4-Ma _ 1E4EitAT f ON ON TOP pR 4 r n16,ti ,AWN h h, MOt^I-1�or A$v- cam 1MO1rJ gLac - of. S& r5 /o,48o, TO& 1NruFnktS AtouN.L-rlilsr 1NCLuSIov,4 StoPL fs 1 p/ dR �Lrss g 3 Sc►ou - 1=:4o" ��cw►�oA�' ►Nl�r,n! dc�'SS PIP4 - 100.00 $�� {�i21M,4'Ry ASE � A &A 44' II 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print): __ ^T TESTS WERE COMPLETED ON: /4Q\/t: �ouws<>N �Lf� _�_��Ev�Hc� /�yc MbRcN ADDRESS: v CERTIFICATION NUMBER: PHONE NUMBER(opltonal):R x6 CST SI ATURE: DISTRIBUTION: Or rguuel and mw copy i(r I oval Aulhor ity,Proper ly Owner and Soil l usuer. DII.H" 1513(1.6,39), 6,r? n"I/6,i^i - OVER DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, 1 DIVISION LABOR AND PERCOLATION TESTS (115) MADISON BOX I 53707 HUMAN RELATIONS (1-163.090)&Chapter 145.045) A I'%N ,/4 z2 /TZ9 N/It 19�(o w TOWNSHI��: OT;O.• LK-NO.: �SMtSION NAM O�O COUNTY: OtlMNfff'8 U ER'S AMPAtFqr M I C.ftix L>'a>Pty I USE DATES OBSERVATIONS MADE NO. DRMS.: COMMERCIAL R PT10 S7p Residence �.. New ❑Replace I 20 ! 9 AIr�C 21 1 7 � Gt Nk, L,� QcW � K 5o lo' d G � 'Salts q - . t.f_OT RATING:S-Site suitable for system U-Site unsuitable for system ,��,, - IgUAK Hsq� ONV I AL: MOUND: IN-G -FILL OLDING TANK:RECOMMEND UDS STEM:(optional) El S ❑u o S ❑u o S au o S oU ❑S ou If Percolation Tests are NOT required DESIIG N RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: L4,LASS ' Floodplain,indicate FloodPlain elevation: dA EC'i—'r PROFILE DESCRIPTIONS BORING TOTAL DEL H T R U WATER-INCHES HARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH-W. ELEVATION OBSE V D TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) a- /L93 > /U *9LLTS i) 1 B- �Q''$evCS�6� 53 Bari ms 411 gre>tics� „z B- 2 F7. 1_7 �o�.�o n/oNf� > 1`7.7) ►2" �(, 74"9,erxS,L 8"8 F - iivau,16 JZ B- � MS 49104 'c- B_ z� /�o �S o >/t.Z,5 ~BLLTS z6'&* L'S 1~ rJ V- S 114C-L )SioNs B• tSo MSS 4$" PERCOLATION TESTS -TEST I L DEPTH WATER IN HOLE TEST TIME RATE MINUTES NUMBER IBS AFTER SWELLING INTERVAL-MIN. PER INCH P_ Z S.9b o Q 3 >'2 Z >2 < P_ .-L aA -r C-. P_ kee-s Tea d 8 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, NcrENZ -•rWt LAYLe dF SOIL E3L:jL�UN 20 aNt1 7d SYSTEM ELEVNION g$•b 11,404C-S is mAML uP hOS-rLy OF Vtwt,-rd M ta0n 'S A*I4, -mteC 4r,lii F)Nir SA AA AN& SI L-r INCLUSto," APPPk6xIMATELV 6&m Td -no-Jo FECY ltt hiAME'r&#_ CtlMMO►J /N T'NIS LAV&�• Na-r a E4F\t�low oN To�P OR' 4, l�+�IG,x ;ANt eEQ 9 ZuM.L rLCS Ate CoMM4�J Bock aF ,I i sF_ �5 ioz,9U ,a -r 1� ►KrrUrrl4c is -�'N ESr INCLuS10v14 tN Sto�� IS I°z (mss g 3 Belau, - /.'40,• NI k6N Across A+errf��- 42A 44' 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. NAME print _ TESTS WERE COMPLETED ON: 1�A2�fry Jo11hISaN �usc�! S�R�Ey,r.,G, /N<- MARC-ti - ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): O-? ��vN� CST SI ATURE: DISTRIBUTION: 0iigmal;nil ono ropy io Local Auihmily,Properly Owner and Soil Tester. DII_Hr'SRO-6305 iR n0%9^1 - OVER - ND7F /No/tT1J op�pF2rY L.zrve =.s ovE✓L .?oo' fltorn ST/Z�j,GTL/2k -�-Z' 7 1 7 EXlSTSNG ExrsrsJs, iAiJELL4W p/ Lo7 .ANn cAoIS 4zzv6Wx►Y 3S —°� .E.Ats-izNO P/Z UJ�c7 1?ES14E NCE L pAAy /� A&VT cpILA 6 t t N \yc.r rsLn� //ll �To h/N OF �vUDSo N ST,_ Cnosx C.D.. /oba CAL TE/DTYG O tVb- .= TbP OF 1C014,JnAr=N TANK C BLocf. Elrv.z./lea-lo/ 7 /1orF=EAel4UtNJT LANE 39' / Tb/JAvE 17ziv 470 SLaPF A✓0TE=ALL WYES 7o dE /3/ LEVEL Fore 4'VE/v /-)ZST- .SLOPE /ZIQbIT�bnl ar- EFfLt�tivT Y� 17170 wr s l'---,�/ \ 8�� Q )E- g-�/ O` "8 -� �F-- ovEn. -700-'7-ID --'> �iioAER1Y Ls�vE / ,EAsr W)OZ zTY QT � ..• Lz rd E 4 -/300 GAL. ,DAYWELLS T /VO SCALE 0. 30' o /ro /� sOUTLJ /�i2aPE/tTr L.2niE t— ,A SS .roUTN WEST /-nopkary Con,vE/L I SZON /1PF SSCrvt - FLXv. = /On. DO/ 2zcfvs-r � [� DATE Z�EZ °9 C/ZoSS J cCT-roiv OF I J300 SAL. oAYI ve-LL VrwT CRP •� �no/�ol�a /�snr7�'N G�•o0E — � /�Ca✓�R ovEbi M.hk. So2L TESTZ,,IG 9Y yC,T. V-rJvT { -MACK 1atiHbeE �iSE2s AIAAVEX V119PAAr ON G XCAvATAW S.Za,awALj_ ToP of AG(� L"xcAVplao SSOPWAIL ❑ ❑ r FNoTr' e `To Ex7EH,o 6"PAST 7 J ❑ sNs=at O.ZA. of m ❑ ❑ X��I2Yw6LL Cl ❑ Q . ❑ O 0 ❑ ❑ p zoo p ❑ 00 p , D ❑ D O D O ❑ �'�`�' ELEv. of Dh>WELL " FL UoaS .one ��.60FT. ❑ �; DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&KUMAN RELATIONS DIVISION PJb.BOX 7Q69 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: S?✓47N-7k,S22,T29N-81911 CONVENTIONAL ❑ ALTERATIVE (It assigned) Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound - M OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Larr & Kim Parent 19060 Manning Trail, Marine, r11T 55047 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: HER PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William Schumaker 6382 St. Croix 119412 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 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 LINE: AIR INLET: ❑YES ❑NO [--]YES ❑NO NEAREST�� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES [IN O ❑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: DIAMETER: I 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: I DISTR.PIPE SPACING: COVER PIT INSIDE DIA.: #PITS: DEPTH: TRENCHES: MATERIAL: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET:I ELEV.END: PIPES: FEET FROM I LINE: AIR INLET: NEAREST----101- 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 E]NO ❑YES ❑NO NEAREST- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Z�1T1 L�C�IT11T11 SANITARY PERMIT APPLICATION COUNTY (Z� DjLHR In accord with ILHR 83.05,Wis.Adm.Code CRO/y �.A..,. .e..�,.. �.,o. STATE SANITARY PERMIT# //9 y/'a —Attach oomplete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 12N NO PROPERTY OWNER PROPERTY LOCATION 4 Ste '/a S o'1 Ta ' , N, R A/ (oryW PROPERTY OWNER'S MAIL I INd ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZI ODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK ,y_ ❑ VILLAGE: ct O si - II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. W1 New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. [l Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Z seepage Bed b. ❑Seepage Trench c. ❑See age Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): / ' j4 Private ❑Joint ❑ Public Cl .� !`�- Feet VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank GC u Lift Pump Tank/Siphon Chamber ❑ ❑ I Li VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumbe//r's Name(Print): Plumber's Signature:(No Stamps) P MPRSW No.: Business Phone Number: P umber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST#/ CST's ADDRESS tStreet,City,State,Zip Code) Phone Number: C' s` s _ ; / - , IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee 12o,c�a as.ao -13-g9 Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT , , APPLICATION r TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; Vlll. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. ---------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over,2 years-of steady negotiation and public debate. The groundwater bill Groun included the creation of surcharges (fees) for a number of regulated practices which Wisco (h'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried IrBSUf$! is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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-- - �1 Location of property t5-E_1/4 1/4, Section O� , Tk LN-R 10\ W Township `A Mailing address t Address of site l (a 9 j= cwt h A Guy �lSdrt w� v�u� Subdivision name v �Y Lot number Previous owner of property Total size of parcel 1 <43 �CS �+ Date parcel was created _ L7 Are all corners and lot lines identifiable? X,-.—Yes No Is this property being developed for resale (spec house)? I Yes No .---J Volume and Page Number 53 1� 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 (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warrant deed recorded in the Office of the County Register of Deeds as Document � S�� � ; 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 eeds, as Document No. ) . ignature o wn r Signature of o Ow er (If Applicable) L- /-Z2 -82 Date of Signature Date of Signature DOCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 'I STATE BAR OF WISCONSIN FORM 2-1982 :Yet._ ew REGISTER'S OFFICE ST.; Cza�x co., wt Farm Credit Bank of Saint Paul Recd for Record • .... I� L 1 1K%J i ar 11:00 A. M conveys and warrants` to Larry A and Kim J Parent, ;I hua end..and.W?fe.as•-3ont..fenants_.. ..... --• RegsrerofDeeds _ - ---•- -----*-------------------------------- -----------*--------------*---------------- - - ......... ........ .................. ......•--•--•._._..._......... .................. I! ,i .............................................. i Y "- RETURN O .. ......... ....... _ .. ........... .... .................................................................................. {! the following described real estate in ...St_ ..... . ... _CrO1X:..._...._.::. County, State of Wisconsin: Tax Parcel No: .............................. A parcel of lard coltairL>,.j a portion of the Certified Survey Map recorded in Volume 7 of Certified Sys, ' 1ti9Ci aeulg looted in the Wb of the NEi of Secticn 22, T29N, R19W, TMn Of Eb.XIsai, St. Croix>O:;ulity, W in, more fully caqribed as followz: 03rmffr_.LTj at the'E4 conliec of said Sectien 22; Tt o-n—_ t&02157" E alo g the Fast line of the D 4 a distance of 866.20' to tlk--point of beginning: rlt118171ce 1 9057'16"W 1104.01' w the East line of tilt: Cep—ufied Survey Map rid in Volume 7 of 0 ctified &xveys, Pack, 1817; rlht oe N:?ll'4l"W along said line 453.231 to a Wint w ttlie Nxth line of the SE,of the IMF; of said Section 22; f Wit. 7herne M'42'26"E Wlalg said line 1105.96' to the IE v xa ac of said SE4 of the Imo; i T a 80002'5TV alaig the. Exist dine of said SE4 Uf t i- ►;a a distance of 459.75' to the point EXEMPT ier of begimiry. i ;i Gcntr3ir>,s 11.58 acres subject to Fbily lbid right-of4ay e%r 1-i iLst�!y arld U.S.H. "12" right-of-way over the Northerly particn as s?xxM. AL_v, i xxijd::c zu w I� A16 all easeTents, rights-of-ways or o3lveyarleras of record. Being Lot 1 of Certified Survey Map in Vol. 7, page,2070 ,# Together With and Subject To the 66 foot private roadway easement as shown on said This —is not homestead. Property. Certified Survey Map: (is) (is not) ! Exception to warranties: easements, - restrictions aid rights way of record, i if any. Dated this .. ...30th............................... day of i December..:- • . . . --- -- 19 88. �i The F Credit nk f Saint Paul, ...................... (SEAL) ..(SEAL) ,! - by:• err . L hertz, Regional Vice Pres. •-- •...... ... ... .•-•-•---...---(SEAL) ._......— ... .....................(SEAL) I ' ........................... rt ....... . ... ....... ..... ....... -- . .._. .. 1 AUTHENTICATION ACKNOWLEDGMENT Signature(s - . _-- ...... STATE OF WISCONSIN ......... 53. --.••.... ......... ...... . .•-.•. . •... •......- St Croix ......................................County. ! authenticated this --------day of........................... 19...... Personally came before me this ..3Qth day of December...... ...............1 19..88. the above named •------- •-•----- --------• -•-•-•. --....•• -----•..•.. ...°-----••. • .......................................................... Jerry Lehnertz, Regional Vice President --....------•... TITLE: MEMBER STATE BAR OF WISCONSIN ........ ......-• ---...-•--- (If not ....................... . authorized by § 706.06, Wis. Stats.) to me known to be the Person .. __ who executeii•,the foregoing instruni and sewn edge the same...,' THIS 5 INSTRUMENT ?�• WA R S D AFT. D BY arm__Cred t _Services R hwest_ Wisconsin ' -r " Mary Lo Levi r� f --- t WI_ .54022 Notary Public -_.Pierce ............ ,_• -.„_.County„TV1s. ..._... •- . (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not;-state ��IPa1i6p are not necessary.) - date Z 11 90 - ---•---- -------- -------- - *Names of persona slening in any capacity should be typed or printed below their signatures. I -. KC.MillerCorlpervy ryI - STATE BAR OF WISCONSIN r...»..wu..•w ® FORM No. 2— 1982 Stock No. 13002 TOWN OF HUDSON ST. CROIX COUNTY STATE OF WISCONSIN CERTIFIED SURVEY MAP APPROVAL I, the undersigned, do hereby attest that the Board members of the Town of Hudson have unanimously agreed to approve the attached Certified Survey clap of Lot 1 consisting of 9.54 acres excluding road right of ways. Said approval is conditioned upon the consummation of the following: - The private roadway shown on said map shall be brought up to Town Road standards as described in the attached letter dated October 29, 1987 and signed by Eldon A. Ramberg, Construction Supervisor for St. Croix County. Or; Alternatively, an amount equal to the greater of the two (2) construction bids attached shall be escrowed and held in a Wisconsin Trust Account, prior to recording, solely for the purpose of bringing said road up to Town standards. Said funds shall be expended only upon approval of the Hudson Town Chairman. Dated this 36 day of December, 1988 VOLME 7 PAGE' 2070 TOWN OF HUDSON St. Croix County, Wisconsin I�ernard E. Kinney, Town CWXman 717 Badlands Road, Hudson, WI 54016 I 44535 CERTIFIED SURVEY` MAP LOCATED IN THE SE1/4 OF THE NE1/4 OF SECTION 22, T29N , R19W, TOWN OF HUDSON , ST. CROI'X- COUNTY, WISCONSIN. PREPARED FOR: FARM CREDIT SERVICES NOTE THIS MAP IS FOR THE PURPOSE HWY "35" N OF REPLACING THE PARCEL RECORDED RIVER FALLS, WI 54022 IN VOL. 7 OF CERTIFIED SURVEY MAPS , PACE 1896. NE CORNER SECTION 22, NT F (COUNTY MONU MENT FOUND). O a SET 1"X 24" IRON PIPE WEIGHTING 1,13 LOS. PER LINEAL FOOT. • a I" IRON PIPE FOUND, UNPLATTED LANDS NE CORNER OF THE SEI/4 W E OF THE-NEI/4. NORTH LINE OF THE SE 1/4 - NE 1/4 S U. S. H. „ 2 „ M N89°42' 26"E 1105.96 n S 89. 54' 14"E �_ 1039. 72' M T ., 33' 33F K -to 'D. 1st t PRIVATE ROADWAY I �S EASEMENT 3I 3 cr: CL: I3 WI' 11.58 ACIkES `4'. J• (504,411 SO: FT.) t � I ~I sf 9.54 AC. EXCLUDING t`r' Ll: = I ROAD R. b.W. C o N c (415,460 Sq. FT.) i.'�. � '. o� � w ti• o r I z C• us 133 33`. 33.00' �`.: 33..00' F- O. ` 1038.01' .� `x d'. N89°57' 16 W 1104.01' W 33�33'I H J' 1 I a W• y w Y. UNPLATTED LA-ND $ oz w ui ap-N Ico.0 I a. J NOTE: BEARINGS A.RE REFERENCED TO o THE EAST LINE OF THE NEI/4. Z a. (RECORDED', BEARINGG). I I Z• EI/4 CORNER SECTION 22, _• NOTIi;: SE'ls'ROAT)W Y STATE,WENT ON SH ;LT T29N, R19W. (COUNTY 2 n� MONUMENT FOUND) FILED S FEB 1019890", JAMES Q�f1NNEL1 5i. C7TC11X^(�i�,"t'r .r �,, Ra tet O 12 l A PU WNSI VE PARKS kR{u�I,(11i SL Croix CO.,Wi ANO zowc,CiQM1P4Rfifr_E SCALE I = 200' JAMES M. WEBER S-1804 0� 1OO' 200, 400' WEGERER, WEBER' AND ASSOC. DATED ZMc \°\6.1. SHEET I' OF 2. 87 - 350 - THIS INSTRUMENT DRAFTED BY e9&44-4 ?naUlonl VOLUME 7 PAGE 2070 N a **SEE SHEET 1 OF 2 FOR MAP INF0RMATI0N" DESCRIPTION A parcel of land containing a portion of the Certified Survey Map recorded in Volume 7 of Certified Surveys,, Page 1896, being located in the SE711 of the NE' of Section 22, T29N, 1119W, Town of Hudson, St. Croix County, Wisconsin, more fully described as follows: Commencing at the E-1 corner of said Section 22; Thence NO°02' 57"r along the-mast line of the N l a distance of 868.20' to the point of beginning: Thence 1d89 0 57'1611W 1104.,Ol' to the East line of the Certified Survey Map recorded in Volume 7 of-Gertif.'ied Surveys, Page 1817; Thence 110011'4141 along said line 453.23' to a point on the North line of the S E;li of the N i� of said Section 22; Thence N89 42126"L, along said line 1105.96' to the NE corner of said SL' of the Ills:'; Thence 9000215711W along the 'East line of said S.E4 of the I1 E a distance of 459.75' to the point of beginning. Contains 11.'5,8 acres subject to Kelly (toad right,-cat's-way over the Easterly and U.S.I-I. 111211 right-of-way over the Northerly portion as shown. Also subject to any and all easements, right-of--ways or conveyances of record. SURVEYORS CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision.Ordinance, I have surveyed, divided and- mappcd said .parcel of land and that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed. James M. Weber `S-•1804, t4ogerer, Weber and Assoc iUver Falls, WI 54022 Dated this Z S 4- day of n me*c , 1987. Note: The roadway shown on this map is a private roadway:. Any maintenance costs of the private` roadway, after the approval by the Zoning Administrator as a standard road, shall be shared pro-rata by the adjoining; property owners. Should the roadway be taken over by a municipality as a public road, maintenance costs thereafter shall be a public exper-i e. A PPP +v^ S 1^3.1 t SRW';J ALLEY � VOLUME 7 PAGE 2070 SHEET 2 , OF 2. 87— 350 THIS INSTRUMENT DRAFTED BY "� "� r STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER — ft`) `� �'I r-n 9 je- rz z-L-) , ROUTE/BOX NUMBER _ ( L L�( 'c� FIRE NO. CITY/STATE t. fl ;s n R1 4 L&'3 L ZIP 210 1 6 PROPERTY LOCATION: 1/4 1/4, Section �_, T_2�_N, R W, Town of }�u ,p; cam n1 , St. Croix County, Subdivision , 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address i INDUS RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVI ON 1ND�ISTRY, DIVISION Lcw80h: AND � 1 H('tUAN RELATIONS h� '�''O�,A�10� TESTS ����/ P.O. Box 7nc9 MADISON,W! 53707 (H63.0911) &Chapter 145.045) LOCATIOWN TOWNSHIP/�: OT NO.:BLK.No.: SUBDIVISION NAME: SE 1/4 L 1�4 22 /r29 00 4(or (-/uhSGr^d — — COUNTY: N AM MAILING ADDRESS: S+Ckelx 44W f >�► 1�Aa$ VT 1 /9060 /l,a/yt/blN4 1044 �'1'> 1n1�" /'jAj E DATES OBSERVATIONS MADE NO.BEDAMS, CO MERCIAL S: N E TS: Residence M N ___.. New Q C ' ❑Replace /'�� /,'d 01/, 1 �� I�8 ^/O V 2 a/9�� lZa l .S oo)e_ ICIe!j,l� i8 So 1,L& RATING:Sr Site suitable for system Ur Site unsuitable for system xe.Z - ofaKk AP.h ��KGW—TIONAL: M �•o� IN � Q� � ❑�L EIS G�_K:RECOMMENDED SYSTEM:(optional) I WS U CaNV6/Vr/O►V,4L if Percolation Tests are NOT r ulred DESIGN RATE: e4 n / If any portion of the tested area is in the under s.H83.09(bilb),indicate: C c;,S / Ftoodplain, indicate Fdoodplain elevation: /vA --!! PROFILE DESCRIPTIONS BORING AL ROUPIDWATERQW t-HA—RAC—T—E—R—OF—SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER t�I+ ELEVATION V TO BEDROCK IF OBSERVED(SEE ABBRV,ON BACK.) cu / \ R�Lr3 12" &-.,L 6d-&N 'h-F'S /iVC�.USt6kjS sE� • v C\..+. .� �$v°`.i*_' ,.�'�l.� �'�/f.l?,. "•K,y.�,d� d!1���iQo.=ftils /u1Tttrr B. Z /D/.42 B 'S> 17-.3 /b/.Og ONg >/2. 3 // TS $�� StC 63"B,eNMS-/evee�ta�s' i' 66,. /19'S B- 4 17-.33 vG4L QNac > /-Z.-33 /z'' �c-►-5 2 ' „S,L S��BeN -I u- ,, 5.4-SiZ,IMS B !; ►2.00 10456 > �3<<� 16*'J5R',Sl L PERCOLATION TESTS NoTc ON POLQSt� _ TWr WAT R N HOLE TEST TIME ORZ5P IN WATER -1 HES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. I _E PER INCH P. J 6 C /00.7-5 >>' >'z- P. 2 37- Nor4k. 101.47- >-Z > > ? < P- 7.91 3 > Z >> > Z C P w ... _. _.___-, _ ttJ1Ac t o AT P �. PLOT PLAN: Show locations of pe coletfon tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are tho hori- zontal and vertical elevation refere ce points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent. of land slope. 2 CLrn1rEdtGr 14G.t4t->AN% 1 12 '"•ate t esr e � To r n Krz LL\, e6wb ' gU`K Iah'a�IC- &I_WATIUN /00,00' 31391 _ '( -J g[ , v'► 3 _ �xOPs Is 1 oR LEES A I 4L ACP_oSS. } 6 �Qlt rt1� - )jd I / x ,40' N71 t si 40 All f,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures anti 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. :1RESS'AR J`OB( u+�v /n•IG- , �N_<�. TESTS WERE COMP,I_{E;TEg D O _� ?M3116P' C ERTIFICATIO 1 y NUMBER: jPtj0NE NUMsF B E- R(uptrunal): "y 46-7 'S LcoN ti u-t�So► + �'4U/� _ � � _-,� J__ k 6 .4c° � .� CST SIGbI#1 URE: DISTRIBUTION:Or ivlinal and one cot)y in l neat Authority,Property Owner unit Sod Tesler, DILHR-SBD-6395 M.07/82) —OVER -- . r r r i 1 °uaajsAs ay, aanoo of 'It ao-ejdoa 01 UT jq�Jnoaq jios Mau pule alTs aqa uzoaj Ajajajduzoo panouaa z aq Isnua jtos jo aakej stg4 'pajju;SUT St Wa4SAS -e aurt4 aqj 4V asagj punoa-e so ejaalui 0144 4E uou-'U:zoo aa-e s0144cuz pal pule aou-exo •.zaAej STg4 UT uOUlul00 aa19U:z'eTp UT jaaj oMl of auo Ala4,euzlxoaddv suotsnjouT 4jis pu-e pines autj aXie aaagl, -puts uznipoui o4 auij jo A14souz do ap-cul st sagoui 06 Pu-e OZ uaaMlaq Ajg2noa jios jo aakej aqy :a,LON A Al, 722' Y e