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HomeMy WebLinkAbout030-1057-20-000 Z o am o o -4 O °� en c d rY o 2 o ° o I E U) c i V 5 � )a w N m I i m m I � � m � 3 o C z w LL = my o L L Q z m 3 Cl) v � I rn Z E Z = ° v o ° a m N H Z O O Z :!t C) .0 r III 0 - Z d = O m a) z c E -2 (6 N M C O) _ E o CD o a •� � L I 'i p cu �O z co z w N ate, co 4.; z �i E N V .. L a N a _ co C) 2 m ° ° G D a bap zr >° � o 0 o z •►v Na (L a CL E ` 3 p (� 0 0 ° cn W J L) 00 rn cu T O N o r M E m O a 7 N n 0 tl] N C O z 0 N j m E r/ O LO 4r O (n � O +% N "' a M M 7 7 M N = N ~ ° M O p fn f0 R • �' O N (n In .M- O z C r2 cn s. R a xt a L: a • ca a d rIWAj ++ E i C C 3 r A V a O m V a Parcel #: 030-1057-20-000 02/24/2005 04:52 PM Alt. Parcel#: 23.30.19.201A PAGE 1 OF 1 Current 030-TOWN OF SAINT JOSEPH [X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner DOUGLAS G&THERESA M STONE STONE, DOUGLAS G&THERESA M 1494 N BAY RD SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1492 N BAY RD SC 5432 SCH D OF SOMERSET SP 1700 WITC () ( (XJ 1 Legal Description: Acres: 3.750 Plat: N/A-NOT AVAILABLE SEC 23 T30N R19W NW NW 3.75 AC PT OF Block/Condo Bldg: G.L. 5 LOT 1 OF CSM 6/1738 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 870/442 07/23/1997 808/241 07/23/1997 572/10 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 5209 262,800 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.750 67,400 191,100 258,500 NO Totals for 2004: General Property 3.750 67,400 191,100 258,500 Woodland 0.000 0 0 Totals for 2003: General Property 3.750 39,700 148,700 188,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 211 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 FOR P F I i t'Lr-D " IP ,�i AaFS o'cO�yMCtc ''1 C E R T I F1 ED SURVEY MAP !�' g*Vhfer of ')Old., , GOVT LOT 5 S G 23 T30 N R 19W s,. aorx count ' C w1'conein UNPLATTED - LAND S66°-13'-23'W S89°-41'-40"E o NORTH LINE 73.62' IE S 89P-41-40 E 748.69' SEC. 23 \ N.W.COR. 1317.87' SEC.23 % " I"I.P FD. 60 `u� /" 1,4q-04'-57' 4°_04 -57 P., � (� S380-10=5 f'W / LOT 1 114.12 UNpLA-- fat� 4.3 ACRES h o 38" ' � „ 6I 8.26' 218°-2i"56 S 8 9°-41'-40° E S 88°-13'-14'W N890-41-40W -- -174.61 - - �-- _ 106.30' i N51°-55'-24"E 511.96! 00. got 67,25 A 56 PRIVATE row,-�, s�o 51°-55=24'E �'i a� EASE- ��� � � �� 33.62' MENT ti/ -1i "� .�,�` 1� LOT 2 � 9,61 ' ; /a / _ `ti ��N 3.0 ACRES � 30 r of N w 6 s' N 1° i D �t i 2 — Q P o 159° -26'-56" S 89°-41'-40"E ro _ � I BASS O 556.62' -- -- - / - 1 3.35' - o' 93.2d 1 L'� 3 ,o-�i- `\®157°- _58., LOT 3 oM _L A K-E CD - 11 3.0 ACRES °`a / (D157 0-15'-59„ 805 yam"+" S 890-41'-4 0"E � 498.55' 9 ;;- S630-03'-47"E 66'PRIVATE ` ` �'� �56, ?9p,9E` \ 120.81' EASEMENT FROM C.T.H . I TO LOT 4 50' CUL-DE-SAC A� 0A �? 3.0 ACRES S 32°-45'-09"E c \ 109.44' `0�� All + PRIVATE >po 68 S19°-30'-50"E %EASEMENT `�� 66 - �' -/0', 50.38' LEGEND `o--- - - S°'' 65'= 88.52' N 89 0-41'-40°W 505.74' I"X 24"IRON PI PE SET UNPLATTED LAND WT. L68LBS./LIN.FT. --' "- ----- ---- tit-----I"X30"IRON PIPE SET ,N�Ns�ttt�jjN�i WT. 1.68 LBS./LIN.FT. CURVE I- 2 DATA �0! C,0 fV�f�!'�'' RADIUS---=-- 80.0' N CHORD-----.108.92' CHORD S GENE C. BEARING---N18°-44'-55"W SHAFFER Q ASSUMED BEARINGS CENTRAL to S-1 25 v A ANGLE---- o " LONG THE NORTH 85 48-29 LINE OF SEC..23 � < C +' 200 150' 100' 50' O 15 p' IVO APPROVAL NOR SUBDIVIS THIS INSTRUMENT WAS SCALE IN FEET DOES NOT MEAN APPROVAL FO DRAFTED BY GCS BUILDING SITE OR SEPTIC SYSTEM, JOB NO.78-49 VOL- 3 PA�i L� 1 REFER TO H62.20. SHEET I OF 2 ST. CROIX COi NTf, wr. c 7 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �t C_ TOWNSHIP SEC. 2 :?�, T�N-RW ADDRESS C 4b ST. CROIX COUNTY, WISCONSIN RuA6jaw �401(!==, �5_ /Ulf SUBDIVISION �p, `7 3 g LOT LOT SIZE Ck.0 V- y PLAN VIEW C IM (� �('� 3 d Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A hI rr'4,'',� � r � INDICATE NORTH ARROW Oai } 4 �u� 9i- BENCHMARK: Describe the vertical reference Kint used Elevation of vertical reference oint: p _100 � 99 5"Proposed slope at site: �—Z= SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: g �Z Tank manhole cover elevation: -sae �us F vd�r- ' Tank Inlet Elevation: 1u,s, ank Outlet Elevation. S ° ef- r _ +us re�t�r Number of feet from nearest Road: Front,®Side 10 Rear, O � d' feet From nearest• property line : Front,O Side Rear,ADl / feet Number of feet from: well building: � (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE X . PUMP CHAMBER Manufacturer: _ Liquid Capacity: " pump Size pump Model: Pump/Siphon Manufacturer: Elevation of inlet: Bottom of tank elevation: PUMP off switch elevation: Gallons per cycle: Alarm Switch Type: Alarm Manufacturer: Front, O Side, Rear, Number of feet from nearest roperty line: O t �• Number of feet from well. : Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: �. `3 Area Built:��_ 1 g? Length: Width: Number of Lines: Fill depth to top of pipe: 3� Zi ZJ H property line: Front, O Side, Rear, Pt •� Number of feet from nearest prop y BW Number of feet from well: � Number of feet from building: d g (Include distances on plot plan). SEEPAGE PIT � Number of pits: Diameter: Size: 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 IV/+ Manufacturer: Capacity: Number of rings used: _ Elevation of bottom of tank: Elevation of inlet: Front, O Side, O Rear, OFt. Number of feet from nearest property line: Number of feet from wells Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: : ��Zf� D Plumber on job: Dated License Number: 'Z �' 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING .LABOR&HUMAN RELATIONS P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS DIVISION N&DI$Qfy3Wl 3707 OFFICE OF DIVISION CODES&APPLICATION 4,I��WW 4, ec 23,T30-R19 Sia assigned) 'Number: Town of St. JO s eph ❑ CONVENTIONAL ❑ ALTERATIVE C. T.H. I Lot 1 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ERt . 2 ,RESS OF PERMIT HOLDER: INSPECTION DATE: q9/�/• Richard 0. Stout Box C 40 Hudson, WI ✓IJ�/ — [�V ��d BENCHMARK(Permanent referen a point)DESCRIBE IF DIFFEREN FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name o Plu ber: MP/MPRSW No.: County: Sanitary Permit Number: John P. Sykora III 3212 St Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET EJLEV.: TANK OUTLET ELEV.: WARNIN ABEL LOCKING COVER �D l�—'U /D I tp PROV�_�D:: PROVIDED: r� �,z t d Z �"" LJ YES ❑NO ❑YES LINO BEDDING: VENT DIA.: VENT MATL.: HIGH WATEH NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ,���� r ALARM: �O -5 l � > AIR INLET: ❑YES I0NO �� C_C. ❑YES IB'�10 NEAREST—♦ L�E g DOSING CHAMBER: MANUFACTURER I BEDDING: LIQUID CAPACITY: U P MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PU D TROLS 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 t e depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction Shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.�O�F// DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID DIMENSIONS I '3 S TR# ES / ATERIAL: PIT / DEPTH: GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: EV.INLET: E t 30 � v U g MOUND SYSTEM: =0YESplowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM urrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. TEXTURE: PERMANENT MARKERS: OBSE=WELLS;❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: CENTER: EDGES: MULCHED: ❑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: DIMENSIONS TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: INFORMATION COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO DYES APPROVED PLANS ❑NO ❑YES ❑NO COMMENTS: PFRMANENTMARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 1 Nt ❑YES ❑NO ❑YES ❑NO NEAREST—� 101 - r 1 } I _ j Sketch System on, Retain in county file for audit. Reverse Side. s NATUR TITLE: SBD-6710(R.06/88) , Al -fib 1L RE SANITARY PERMIT APPLICATION 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. c � vl n to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Rc.�P,rok c). NE Y4 Aly) Y4, S 23 Tad, N, R /9 E( )W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# tv/A CITY,STATE ZIP CODE PHONE NUMBER SUB VISION NAME OR CSM NUMBER , r4atl0 7f5 lo��l _ 7 3 �j CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE' Jo C.T. I�. `�I ❑ Public ®1 or 2 Fam.Dwelling-#of bedrooms Z PAR EL TAX NUMBER( ) III. BUILDING USE: (If building type is public,check all that apply) e—O l A 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. UO New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ in-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2,ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE 5� REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) p ELEVATION G 1 S (0 3® •77Z. 9 94' 7 Feet 98.�` Feet VII. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Se tic Tank or Holdin Tank dm 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): v S er's Signature:(No Stamps) MPWfPSw c Busines s ss Phone Number: Plu `7�S Plumber's Address(.11,obt,City,State,Zip Code); PW 79' /Wu,'LQat' ,.," 617 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial [j i 1//--3-W Surcharge Fee) Adverse Determination / ` 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 A 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. Ill. 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 R1 c4 ok 0 Sfo 4, Location of property NE 1/4 .KkA3 1/4, Section T 3D_N-R_L_�,_W Township Mailing address I� `z 901K CqQ j)" .. 5'`E o Co Address of site cS es C 8ubdivislon name iV,/A- Lot number Previous owner of property Q�r,,- Si 8cn Total miss of parcel `J Ct G S Date parcel was created Are all corners and lot lines identifiable? on No Is this property being developed for resale (spec house)?--.L—Yes No Volume and 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 I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty dead rec r ed in the Office of the County Register of Deeds as Document No. 43�3 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to tun with the above described property, for the construction of sald system, and the same has been d�l recorded in the Office of the Count Re is r of Deeds, as Document No. _� ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature "Imovaleft Palm ftr a WW of .a b k �►.c .�... .... ...... .... ....................... ,. ,,, . .....t .! .. ............................................... !j .......... •............................................................ » t', .........•.tii41.1 ............................................................. ................». •. .......................................................... K 4W .. 7 "�►1M1` � r .�wwre. M .� ..............................1, +, ��'�ili��►4M'#�'+MM�r�.111��dMrl�r�Yn.. .r. � `�'�< 4.. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER '�rcL&., ck Qt �TVwy" ROUTE/BOX NUMBER 10*2 gppc C140 FIRE NO. CITY/STATE S00 Ld J(. ZIP 6410140 PROPERTY LOCATION: NE 1/4 1)&J 1/4, Section 2 3 , T30 N, R_ a W, Town of SP-t _"e, se/a , St. Croix County, Subdivision N/Ar , Lot No. I 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 /z(0a9 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 ET &B� N IIV DUST F��(; � I t9 N LABOR AND PERCOLATION TESTS (115) �' �949k," �° 9 HUMAN RELATIONS 7 (H63.09(1)& Chapter 145.045) F o LOCATION: SE TI C ON. TOWNSHIP/ LOT NO.:BLK.NO.: SU IS10 A/Iff 114kY ?3 /T3,DN/R/q 1 (or)W 5r. �~ COUNTY: OWNER'S BUY R'S NAME: MAILING ADDRESS: ST L/'oIX c �cxr• S`rpvT O USE DATES OBSERVATION MADE NO.BEDRMS.:1COMMERCIAL DESCRIPTION: PR FI E NS: PERCOLATION TESTS: Residence New ❑Replace L,r -3 FLI S-`y 9�'-&'7 3 RATING:S-Site suitable for system U=Site unsuitable for system rnsou • MOUND:©S DU IN-GROUND PQ U : SDSTEM-IN�-FILLHO[--Is MU RECOMMENDED SYS�T cwlIptional) If Percolation Tests are NOT reqZe DESIGV RATE: If any portion of the tested area is in the A/under s.H63.09(5)(b),indicate: /� / Floodplain, indicate Floodplain elevation: %A i c PROFILE DESCRIPTIONS S BORING TOTALM DEPTH TO GROU NDWATE 4Nll11 6 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH 1 ELEVATION OBSERVED H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 7.4- u � /',/D -� �2 � o 7 61 , p - r , 2 �B A � l ox fin r 4 4, �> , B3 , / _ B- / r 1G. 9' yo r-7, r B-5 ° � N 1) - 0- d,dai/- 14 3 ,Is B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PFRIOD 3 PER INCH P- 1 V P y 5 P- 34 , 3 0 1� 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 `� `��• k ,l Ax, t X 1,vc:�,7C1anrF S.i7'e:, _ . t, ,.. --i '�+le r T— -�L f`, � T*N� sue. ,P a c, e— ; � tom,. e , 3 t , , h N Sic, J. ZNu � , / I 5 Vp i , I,th4 lundersigned, 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 Admilistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. I NAME(prigtli _ TESTS WERE COMPLETED ON: ,//// w a LZI to �- -Z C✓ ADDRESS: CERTIFICA ION NUMBER: PHONE NUMBER(optional): � I I t o k i W O 1 2 1 $'/ CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — l- 7TP-1,"(0) c.]T-py.`�' 3 Qet7►ifoc�w� �v`u�- tJ/t7/89 N�V4 z3 �J� 1 6C�lil 'S Gc&C,.ed P -75 ?o g-1 r '° ° ?- ' ,r. +e L CG6,03 A ut gM '15- il a6 14 Jnb' Sak a= Bay-i•.� R s-RbtS SP��r�� -75 s f F-C.S M t, weeL IS S.7 T — !Sd' x 3 5 da-aiw die 6y ,, 'a`r Ctr4le-