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030-1019-40-300
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I-arcel#: 030-1019-40-300 CI ur ent e1# 05.29.19.80E Creation p''Xj ate Historical pate 02/18/2005 Map# 1047AM Tax Address: 00 Sales Area 030.TO PAGE 1 OF 1 0 Application# ST• CROIX TOWN SAINT JOS JAMES p Permit# UNTY, WISCONSI H Permit T N LYNpA J ANDERSON Per 414 RIVER AND ON Owner(s): Type HUDSON WRD 016 "=Current ANDERSON►, JAMES D&LYNIpq weer Districts: Type Dist# Description SC-School Sp SC 2611 Special SP 1701 SCH D OF HUDSON Property Address(es) 414 RIVER RD : '=Primary Legal Description; SEC 7121059 3 24AC 19W PART SW NW LOTAcres: 324 1 C.S.M. 3.240 Plat: AVAILA N/q_NOT Bloc►dCo BLE ndo Bldg: Tract(s): Notes: 05-29N-19 (Sec-Twn_R W n9 40 114 160 1/4) Parcel History: Date 07/23/1997 Doc# 2004 3U 07/23/1997 Vol/Page N►MARy 8621427 Type Bill A 856169 Valuatio 4871 Fair Market Value: ns: Description 197,100 Assessed with: RESIDENTIAL class G1 Acres Last 3.240 Land Changed: 78,400 Improve 07/07/2004 115,500 Total State Reason 2004: Totals for 193900 NO General Property 3.240 Totals for 2003: 0.000 78,400 0 115,500 General Property 193,900 Woodland 3.240 0 Lotte 0.000 46,100 ry Credit: 0 92,700 138,800 Count: p i'pecials Claim Co : 1 Certification Date: ser Special Code Batch#: 108 Category Amount Total Special Assessments 0.00 Special Charges 0.00 Delinquent Charges 0.00 w A1DC OA ' W b! It A I &CL 8 N �Ve ~ N 'C5�1 Yv'r �ZSNO Vv r tri' zN'� Q `y y�C, �... �I H ® nl H • ST �O 00 V Richard& ,� D im CO 0 �Q roola .P 01 b0 Z /��` V Durand 26 I �' I V A 000 K A JJ V ✓✓/I ' c G rh Georgalm rn m m 00 0 E&M Gw• <o x R Kilbane i z N m 77 ro IO mum 19 it M V 80 w Xx 15hST rn dC I w �y p�po ��03'� E3s� r�f!7�gC 9 7J:. T. I gp A a 4q6 m piIw w^ W n•t5,.�� v -i m .+ m � wtl m � A d. ' 'C o $ W 9P 7�0 V - --1 A 0 I o0 A S Mazk a l &$ 1 a0 _ O th ST° Sutter 400 N. , 'ol Croons g N _ Edward&M4r1y s^'p�^ N v M&DM&RV o�C t9 JB ✓t S Gillstrolrl a 16 0 6 D 115 a Ea��sm m Dakota 59 24th 3 ri n Richards " �!g� Development ST �FIBergetta a a w �V �# o IL LC '&Ted © o- A 53~ N a I' ^ .+ 3nv u�ss /J t T Anderson Frederick tX a o I is Z Donald tw Buttke N g ; w y C 20 Birch C!" Park LLC�L142 Roettger $a c ` C N g Jew u H <. 80 gg m :P-lr o o s n N �i Q 106 " ICM6 �..— O � nq�9 iN 30th ST w 7X >� HD - a y Town o0. P&N 9 r1�-N A• Joseph r f P- J&E J 9 0~o ao N N8 3 N Ct `i CO M C; q;c s&J s 61 9 L&) B & " S ' o�'" IPearo& ? <>A m G)4 Peterson 54- J&CP 10 B000acker m A N m Cn,,,, w EN 4 G 27N�a CKINLEY R&P M& N aorm� 34 3 )1 �� L° , Barbara n 19 v q R A&RT ' M Ur t{. ` �sthoek q 22, K trf Re to " g C B°' C 12 qq y„��yy� Ness 1'^ x S&K .+ �r OL I'I 37" Erickson .P A' C °',N.I W E r. &D. �n ACfo 9& a a �,� w`6 w bO jZo t+7 .Na a ''^ .�rye O. m 37t tt D&) p�, 2 Lip gn poi zx `p I `�° '$T B 10 a m V IO`ro' K °� w80 on N w ° 'N sM20.", M&E R 5 w b' .o _ -C�I1� &SP 0_0_ A �e m 1 a+ Patricia s Hazo1d� eL M g -* .P 8 �; JeowB v Kavolov R. w $ Marjorie ii e 0 A n ` iii, �&L a ti 5 Dtmcan R&B 16 Best n~i 'I0',^,,f r= , 0 7 42 H C7" R&S Cl 30 41_ Freese 1 St ST ° z m III J&D ST 0. �' DH 12 .+x R&C R �, W&C D&J O `I G7 Z! �t7 a p 7� h'7CG12 F Ti RRS g� Z !e2ep1}} c gCAP PP C DZpIO S§ �` O B $ O V� M&DA �i1. '�I ,�N G&6 AT& W O &S u,� ,° ,e ��w�i+ ' O� $ �+ -MurPh➢ MK 20 G&M R 12 .n� � �� I re (� R&SM .a.i &CP M&TK 13 . 47th T K y W 6 0 on 'O s ro Cl 48th 12 J es& Wald . Michael D .20 &M N Nom°ST Ci ��y a Fc s_ 4 Murphy 74 O m N 11 BLUEBIRD DR ex N (? 52nd ST 00£1 VALLEY VIEW TRL 0041 50th ST 0051 N O 915 3`)Vd.3a Hd3SOf'ZS O N-_ z N DSO N 1 J If Ail jiubalml ) W `W u� lei iuu t", �Kj Lij LLS- as [.ALi r`. y DEPAP-3,`AENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SW 4,NW 4, Sec. 5 ,T29-R19 CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of St . Joseph ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 11 LT HOLDER: ADDRESS OF PERMIT HOLD R INSPECTION UA-T--, Cal Burton 1314 Plega Robp-rt--,q WT BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: RE 7F,PTr .ELEV.: LEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Lyle J. Myers 6219 St . Croix 119,188 SEPTIC TANK/HOLDING TANK: MANUFACTURER: / LIQUID��Y: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER P VIDED: PROVIDED: N YES 0 BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT 0 FRESH ALARM: FEET FROM Li LINF' / AIR INL ❑YES NO ❑YES ❑NO NEAREST—♦ TJ O S A) DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MP/SIPHON MANUFACTURER: WARNING LABEL LOCKNG COVER PROVIDED: PROVDED: ❑YES E:1 IN ❑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: 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: BEDITRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA,: PITS: LIQUID 1, TRENCHES: M IAL: PIT DEPTH: DIMENSIONS / GRAVEL DEPTH I FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF BUILDING] ENTT6Tffff9iT_ BELOW PIPE: ABO E ER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LIN �� AID ICLE is r Z Z NEAREST�� �� 125 G> 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 ED NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: N0.OF LATERAL SPACING: I GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. I DSTR,PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV: ELEV,: DIA.: ELEV.: PIPES; DA,: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATFRIAL: VERTICAL LIFT CORRESPONDS T INFORMATION APPROVED PLANS []YES ❑NO I ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY I WELL: BUILDING: FEET FROM LINE: 1 ❑YES ❑NO ❑YES ❑NO NEAREST-111110, t �• P'� as �� ry Sketch System on elZ In In county file for audit, Reverse Side. SIONATUR TIT - SBD-6710(R.06/88) ®ILHR SANITARY PERMIT APPLICATION X01 In accord with ILHR 83.05,Wis.Adm.Code couN STATE SANITARY PERMIT –Attach complete plans(to the county copy only)for the system,on paper not less than ❑ � � 8%x 11 inches in size. Ch - et if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFO A ION–PLEA E PRINT ALL IN RMATION. PROPERTY OWNER PROP RTY L C TION ' C�L-�'/a /a,S �' TZ , N, R E(or PROPERTY OWNER'S MAILING ADDRf, �//� r LOT# � � BLOCK# 3 I W-^ CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY — NEAREST ROAD a II. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE �ti �(aJS� S (J!� ❑ Public 01 or 2 Fam. Dwelling#of bedrooms EL A NUM ER( ) III. BUILDING USE: (If building type is public,check all that apply) 1 ❑ Apt/Condo �d �f 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 E9 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) //,� .ELEVATION Q r 7� 33 Feet J 33 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank O1D V `— .060 e. Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ignatur (No S mps) MON,PRSW No.: Business Phone Number: ae Plu er's Address(Street,City tats,Zip Cod dfti CAL /.S. S� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial I , j G ourcharge Fee) Adverse Deter ination /� J 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 J 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/contractot, (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 (f A IV f- - n ►� ., I Location of property 5 GU 1/4 /9, Section , T N-R Y Township r 1 I Mailing address �1 0.� cyC !F)+ , C eA S -k .Jqc/0a3 Address of site Subdivision name Lot number ) (( 11 Previous owner of property QAA] kid t ) eklC -rd"rrT Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ,_Yes No Is this property being developed for resale (spec house)?—AL—Yes _No Volums -8 e76and Page Number as recorded with the Register of Deeds. ---------------------------------------------------------=--------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND 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 1(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 warrantx deed record d in the Office of the County Register of Deeds as Document No. `i S3 ., Ej ; 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 Deeds, as Document No. ) . 0,1 Signature of Owner Signature of Co-Owner (If Applicable) Date of Sign tore Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 ; THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED !` 45325' .vc: 836 ME 69 This Deed, made between David J Waldroff and REGISTER'S OFFICE Julie A. Waldroff, husband and wife ST. CROIX CO. WI Recd for Record _ QQ .-- •--- -----•------------- -• ----- ------- --, Grantor, , V��� V �9P9 and.__-Calvin K. Burton rand Beverly K. Burton, husband and t wife as survivorsh>_p marital property ------------• --- --• a 3: 0 P. M ------ -------- ----- ------------------------------------ ---------------------------------------------_............................... ...................... ------------------------------------------------ Grantee Regl ro�DeA-N` witriGgSetn, That the said Grantor, for a valup.ble consLideration of dire dollar and other good and valuable consideration _.._ I! RETURN TO conveys to Grantee the following described real estate in .__Si .__Crnix_____________ County, State of Wisconsin: 4 Tax Parcel No- ----------------------------------- Lot 1 of Certified Survey Map recorded January 5, 1989 in Volume 117", page 2059 as Document No. 444380. This ---------is_not------- homestead property. CW (is not) UU EE�� h dd Together witaVlldansl. sWallQYO handlt uInts and ppa urTeon aces thereunto belonging; AndLD 11 W ----•---••-------•--•- ------W C-----------••----------•----•-----• --------•-----•------ --------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record. and will warrant and defend the same. Dated this 6th--- day of November ------- ---------- ------- -• --•-------------••--- ---- (SEAL) �i�""" (/ G'� ------- - ---------------(SEAL) * _ _ - d__J.._.Waldr_of£_____ ---------------------------------------------------------------------(SEAL) ---�- --- -- * * lie A. Waldroff �.(SEAL) AUTHENTICATION ACKNOWLEDGMENT `iggar^atu�;��•s) - avid J. Waldroff__and STATE OF WISCONSIN J .•' Jul' - droff SS. )' -___.•------------------------------------------- ---------------------- -------------County.o O h of.. November icte h:a _-__ 19.89- Personally came before me this ________________day of G -----, 19-------. the above named Dougl�rs Zilz --------------------------------•-------------------------------------- 9�''- ------------------------------------------ ------•-------------------------------------------------------------.....- 'TTLr Mli1b� E]t STATE BAR OF WISCONSIN -----------------------------------------------=-------------------------------- (If•riot- -------------------------------------- ----------------- -- authorized by § 706.06, Wis. StatsJ ------- to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 4 Zilzand Estreen -----------•-------------------------------------------------------------------- 62-1--Be,"nd--- -t-reet--------------------------------------- `. i Hudson WI 54016 '----------------- ----------------------- ------------------------------ ' Notary Public ------------------------------------------County Wis. ---------------------------------------------- --- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ................... 19......... *Names of persons signing in any capacity should be typed or printed below their signatures. H.C.Mill rCompany M STATE BAR OF WISCONSIN .. w.,.•..�. ® FORM No. 1-1982 Stock No. 13 3 . r f k �'- �C' _ i� .� � ^ - �i tf4�'�4 �{ 5 }�u� .a n �. :.. ut + �a (• _ c, STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER P/1 �UI✓I ,� l.t V'�D ►1 ROUTE/BOX NUMBER_ �,�-( P(eCt,')(a.V\ St FIRE NO. CITY/STATE L 6C,,r 5 I - ZIP PROPERTY LOCATION: GV 1/4 /lJ tA-)__ l/4, Section, T _ _N, R_L_� W, Town of S%� ' ose/Jt-,( , St. Croix\Coun ,f Subdivision -T'4 , 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 (�O rte•-�Jl DATE Ab tl St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 ) HUMAN RELATIONS 1 / MADISON,WI 53707 OLHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOW SH P OT NO.BLK N .: SUB DI VI I NAME: WY4 Y4 / H/R (o , CQU T s LING A DRE S: USE DATES OBSERVATIONS MADE NO.BEDRNI : COMMER AL DE RIPTION: 1o�I A STS: l7Residence r�New ❑Replace / / d /O a r, RATING:S=Site suitable for system U-Site unsuitable for system D d ONVENTIONAL: MOU D: IN-GROUNDPRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED S S EM:loptio 1) ®s DU LAS ❑U ®S ❑U CJs Nu CJs ICU If Percolation Tests are NOT required DES N ATE: I If any portion of the tested area is in the /n under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPT//H IN, dd OBSERVED HET TO BE )ROC IF OBSERVED (SEE ABBRV.ON BACK.) B- l C� J.33 26 7 n s d Q&Z .r 115 It 313i7/S /5 e"?5/' ;e.� s S r B3 .r.3 49'7 s/, 9 nCs� �r > 9 o K en s , '� s "e"S/ -0165P rs B- 3, � � � O n s .� s .I s � s /J c 5 PERCOLATION TESTS TEST ii DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. -PERIOD 1 P 10D 2 P PER INCH P-e2 .3 C P- P- P- 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. SYSTEM ELEVATION 9 J, 3 3 r • _ 1 t I � _T .. f. . .I. x 4 J4, �8 oZ. a �Q .. © Cl 6-3 .35 "taeI haevsie I, the undersigned, hereby certify that th soil tests reported q���h��'-j form w levade�'me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded an;—the locatibn'oTThe test s"aF6�orieLR'tethe best of my knowledge and belief. NAME (print): , TESTS WERE MPLET ON: ADDRESS: CERTIFIC TION NUMBER: P//NE NUMB�on CST;�GN�A! al DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(RDILHR- (R. 10/83) 11 P �. A) Lv c rH--a•� � �Et.�o v� rpV acv ,.(js 41P gur->30"J, C.(JIS 6-�oo, S T, -1 o s 6:70,-1 fL0r"/3CAL yew R-0 2- 44 ado -I- R-� 6-1 E(; s Qj Y `3�