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HomeMy WebLinkAbout020-1168-80-000 { Q °c ' i 3 'o C 3 '* `D d m I 3 � I n a ° Cl) O 00 c Z) y , P c � 800 U0) o o co -0 � O CD 3 c ° C CD C cn CD ° � I CD C4 y N d N A N Q CL -< CD 0000 _ ' HOC . a 3 N .N. T T j K Z O O O O n 3 o to cn rn cn cn N p 7 o C ? rn o _ CD o 7 d N °- I w 3 m Z ° C 07 Z O :3 ° ? o in c� F co m 0 N CD N C CD CC N c N w � a Z m co � CO) m n a A Z O m 0 C v m � m CL Z � A � 3 .. Z m �! Z CD w � I N. D C CD a 0 I •< v c =, o F' m N N I y y i a o 3 i b =r j C o m 3 CD Qb m ti o_ C I m 0 ( b I o tA o (D Parcel #: 020-1168-80-000 12/14/2004 04:15 PM PAGE 1 OF 1 Alt.Parcel M 07.29.19.1046 020-TOWN OF HUDSON Current ❑ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner "MCARTHUR,ANDREW D ANDREW D MCARTHUR 306 WINDOLFF LA HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description `306 W INDOLFF LN SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 1.030 Plat: 2362-RANCHWOOD SEC 7 T29N R19W SW NW LOTS 15& 16 PLAT Block/Condo Bldg: LOT 15 RANCHWOOD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/10/2003 729439 2307/328 WD 05/30/2001 646805 1648/603 WD 07/23/1997 826/230 2004 SUMMARY Bill M Fair Market Value: Assessed with: 49086 284,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.030 32,500 187,500 220,000 NO Totals for 2004: General Property 1.030 32,500 187,500 220,000 Woodland 0.000 0 0 Totals for 2003: General Property 1.030 32,500 187,500 220,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 116 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 * Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �L�I'f7 / N-4CI TOWNSHIP 111C110501-1( SEC. T -R W ADDRESS ST. CROIX COUNTY, WISCONSIN �a V6 SUBDIVISION �ff}`(1�,k2�Ga 'f� LOT /�� �p LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM P4 Vol 41 Ilk lye/$'X' 3 ScPaGf- Ep f 13' ©t13� c..� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used f.�j 5j,4J(��6F Elevation of vertical reference point: /00, o Proposed slope at site: za SEPTIC TANK: Manufacturer: -Z Liquid Capacity: Number of rings used: �_ Tank manhole cover elevation: ClU, Tank Inlet Elevation: Tank Outlet Elevation: /O®s 9D Number of feet from nearest Road: Front Side feet Rear 10 , O From nearest property line Front,O Side,Rear,O 5-1-1 feet Number of feet from: well , building: 13 (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE P CHAMBER Manu urer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from n est property line: Front, O Side, O Rear, Ft. umber of feet from well: Number of feet from building: Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: )c Trench: Width: /Z Length: 5'3 Number of Lines: J Area Built Fill depth to top of pipe: �D Number of feet from nearest property line: Front, O Side, ® Rear,O Ft .� Number of feet from well: Number of feet from building: '30 (Include distances on plot plan). SEEPAGE PIT e: Number of pits: Diameter: Liquid the Bottom of seepage pit elevation: Area Built: Has either a drop box O distribution box O been used on y of the above soil absorbtion sytems? (Check one HOLDING TANK Manufacturer: Capacity: Number of rings used: evation f bottom of tank: Elevation of inlet: Number of feet from arest property ling: Front, Side, 0 Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: p Inspector: Dated: 1L// Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS I F�'O.BOX+�969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLIICATON MADISON,WI 53707 1 fir,'W4- State Plan I.D.Number: SEA N , ,S/9,T29N-R 19W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o6 Hudson Holding Tank ❑ In-Ground Pressure ❑ Mound Lo A F R ADDRESS OF PERMIT HOLDER: INSPECTION ATE. Robert Mouchet Route 1, Box 219-M, 0.6ceota, W1 54020 /.%I/ - BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 7F.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Donavin Schmitt 3205 St. Ckoix 119361 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /VG LJ�� G PROVIDED: PROVIDED: 1 �1 1 DYES ❑NO ❑YES 19 NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH 0) ALARM: FEET FROM LIN AIR INLET: ❑YES M NO -4 C ❑YE NO NEAREST--- to DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑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---11110� 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: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID ,� TRENCHES: (V i MATERIAL: PIT DEPTH: DIMENSIONS s A� GRAVEL DEPTH FILL DEPTH DISTR.PIPE FDISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH # B PIPES: ABOV COVER: /E.V.INLET: /E-V./END: Imo^ PIP S: LINE, AI INLET:FROM FEET r' �P r ID /D1 NEAREST----- O/- MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; [::]YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES :O: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 I 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: 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: G 110 ❑YES ❑NO ❑YES E]NO NEAREST ) 6 -01 a Sketch System on Retain in county file for audit. Reverse Side. SIGNAT E: TITLE: SBD-6710(R.06/88) ILHR SANITARY PERMIT APPLICATION CO""/ C(/(�p/ X In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# E ME # //9,36/ —Attach complete 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 �p� 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ONO PROPERTY OWNER PROPERTY LOCATION '/4 IVW%4, S TZ , N, R / E (Or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME , S CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK 13 VILLAGE : 11. TYPE OF BUILDING OR USE SERVED: at&. NJ , Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. VN 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. VNConventional 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. XSeepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION (�.'WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): f�1 83 Feet j�Private ❑Joint ❑ Public VI. TANK CAPACITY Site INFORMATION in oa ons Total #of Prefab. Fiber- Exper. New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber LI ❑ I ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system how2,2pJbe<fl ached plans. Plumber's Name(Print): Plumb Signature:(No to s) M /MPRSW N Business Phone Number: r Plumber's Address(Street,C ity,State,Zip Code)O Name of Designer: �, ► VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# G CST's ADDRESS(Street,City,S ate,Zip Code) f Phone Number: 2/1) 164- 6131 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Is ding Agent Signature(No Stamps) KApproved ❑ Owner Given Initial �p� �harCge Fee Q� �,\ _may � `�\k Adverse Determination � 126 6 � D��•� /� �o° C�J(,J tMn/l`'�-/1h X. COMMENTS/REASONS FOR DISAPPROVAL: I 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 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, 608-266-381,. 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; III. Purpose of application: Check only one in ##1:Complete ##2 if permit is for tank replacement, reconnection or repai r; 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; 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 andspecifications 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 atBr included the creation of surcharges (fees) for a number of regulated practices which Wisco il 'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reast�re' is used in your building is returned to the groundwater through your soil absorption u 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 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property ; Location of property r 1/4 X1/4, Section , T N-R-- -U W Township Mailing address PI Li/ © _ Address of site �3� A Subdivision name Lot number El f�, Previous owner of property ! 1 . 4. t ajcni Total size of parcel AGE Date parcel was created — L ' 0 Are all corners and lot lines identifiable? �es No 1 Is this property being developed for resale (spec house)? Yes No Volume _and Page Numberc::T130, 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 warranty.deed recorded in the Office of the County Register of Deeds as Document No. ' ; 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 Regi r of Deeds, as Document NQ. ) . Signature of Owne7m Signature of Co-Owner (If Applicable) Date of Signature Date of Signature I! I. i I' DQCUMENT No. STATE BAR OF WISCONSIN FORM 1-1983 li i THIS SPACE RESERVED FOR RECORDING DATA II Ii WARRANTY DEED I 442'710 Boa r�,u[ 30 i _- �� - REGISTER'S OFFICE Mar Ann X CO., W, I This Deed, made between ..._--_-.-.X -.._._..._Windolff, a Recd for Record �f sing e_-person' ------ --------------------- ----------•--------.....-------•--_..---•••----•--•-•-----•-- .._ at OCT 3 111986 ----------------- --• ._.__--- Grantor, M and..... oert A. Mouchet, and Doris F. Mouchet,......... �I -- ------- - huja► sand wife as suiorship_-marital 1e I) •� -------------------------------------- property., Roo Of Deeds -------------••-----•-•---••-•----....--•---•-----.........---•--•...------... Grantee, Witnesseth, That the said Grantor, for a valuable consideration.._.:_ of one dollar and other valuable consideration conv6ys to Grantee the following described real estate in .:..S . _C___r__o___1_X RETUIiN'TO County, State of Wisconsin: Tax Parcel No: ------------- -------- ----- II ! Lots 15 and 16 Ranc hwood Addition in the Town of Hudson, Wit. Croix County, Wisconsin. TRANS .1 SA o FEE This .... S_.IlOt.-________ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And--Mary---Ann_ Wind_ olff warrants that the title is - --- ---- ---" good, indefeasible in fee simple and free and clear of encumbrances except, • .•.-- easements, restrictions, and covenants of record, if any, and will warrant and defend the same. Dated this --.i .............. day of .............•---(,l� _--•-•----(SEAL) �QU ....(SEAL) �. * * Mary Ann Windolff -----------------•--------•-----(SEAL) ---------(SEAL) AUTHENTICATION ACKNOWLEDGMENT I Signature(a) ____________________•___.-________ STATE OF WISCONSIN I' ... .................................. ss. Sj., -Croix. ..... County. I� . authenticated this --------day of___________________________ 19__-.•_ Perso 11 came before me this ------3_]-----day of I� Y p --------------- ------- 19.A[�__ the above named II Mar Ann Windolt'f * Y ------------------------- TITLE: MEMBER ----------------------•----------------------------- --------------------- R STATE BAR OF WISCONSIN (If not, --•--•--•-----•---•.. •-• .....P.�. • , __....--_--_•--------_... , :authorized by § 706.06, Wis. Stats.J � t-----------• ---------------•---- I % -------------------------------------•------•� o me known to be the person ............ who executed the v0. pregoiinng instrument and ncknowledge the same. THIS INSTRUMENT WAS DRAFTED BYE�.• 'Z ' I' , Robert F. Wall -4� i f �A. L_,� (; a 4* -----------RICHAR}S WAhii & HARRI v __s522 Second Street -Hudson•,---W-I-•---54-01.i----•-------. `. vNotary Public __C__r_Ol__X __-_-_County, Wis. (Signatures may be authenticated or ackn ¢ M• Commission is p• are not necessary.) ,f�j6r.d•i,�Ath�-P�,�� 3 perms ent. (If not state expiration date: ............... -- -------------------, I� y 'Names of persons signing in an capacity should he typed or -� printed below their signatures. � II WARRANTY DEED STATE BAR OF WISCONSIN ,...- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER FIRE NO.- CITY/STATE $ ���, ZIP 'S do) > PROPERTY LOCATION: 1/9 1/9, Section T 2 N, R 20 W, Town of -ko(D 5 oa , St. Croix County, i Subdivisions , Lot No. L�?. 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 L` DATE lam % St. Croix County Zonin g Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INQUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 , HUMAN RkLATIONS ► 109(1)& Chapter 145.045) LOCATION: -SE Io KOT N`. BLK.NO. S r '140%/ jT2N/R �(or) MsA�S COUNTY: OW ER'S BUYER'S N E: AILING ADPR SS: J 6� —a1 a r ; c►/G USE _j DATES OBSEfIVATIONS I'm MADENO.BEDRMS.: COMM R SCRIPTIO : R I D S 1iIP R 1 TESTS: esidence � �ew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system NVFNTI —N IVI S.❑U IN GN S [:]U . :SQ S 4l M L a OLDINGTAN NK:RECOMMENDED C� �A/ S 11 Percolation Tests are NOT required DESIGN RATE: �� If any portion of the tested area is in the under s.1­163.09(5)(b),indicate: Q Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTA P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH.". ELEVATION OBSERVED EST7RTURE—sT TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) Cj% o � '4z �� .01 (jhs;/ �.f� Bh 5�9r, r Sl 3'b'hC S�ls >j� IJ ♦v �/' , B- v/ d B- ��l % 309 ah 3 B- 7 `92 AQ > 7r 9a ,V 0 i 13- PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. I D P t D 2 ERL PER INCH I .. P P- P__ f 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 relerencq 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 9S$ 3 A' jFh OWL i { I � I I �. f s' 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 � i TESTS OWER CO PLET D ON: L ADDRESS. CERTIFI ATI N NUMBER: PHONE NUMBER(optional): VCT G T Y OI TRIFAUTION- O,,yinal and-n„colry to Local Authority.Property Owner and Soil Tester. pl 1.HR S80-R325 IR.02!821 —OVER— r i I I i Y � I I j � , I I , I� ; I I I , i I Cry Ic 13� I � , I _ t - -- - I I JL I _ I r - I , I I i - 1% / i r _ I , I I I 1 air -pig. 1---+- j , I I I I I I I J I I i r i •- � - I r , I I I I I I 1 i I - 1. ---� D r� ' ' �) O r t j ,D Y /_! ; I �-- I I � { rtT ` 1 � IIi II Iii it iI 4 ii I l [ I ff : - I F , . i I I I i 1 I. I I i I � I I � 1 i 7 I L i I I I : � I f t � ' I r I { r t E I ' I ' I I , ' I ' i I i I I f f - I , I � I , i 1 ' I ±- I I__1 L