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HomeMy WebLinkAbout020-1184-30-000 �Y o m ° ~ 0 o o w C Y O O N T c N b � p.0�0 E d C ~ o C _ O d s a a) y a $ E vai 0 � U N n U L L � SF4 C Z 3 c m c c � LL CO _ O 3 a>0 CL a y C a m a� 3 Cl) v o Z E rn w O � c Z d d O N W d m N H Z c O U O Z •r 0' r N o CO H r rn � Z C E N Cl) N 0) N N •IV dN L_ U O O N Q w Z m Z Q a N N z O) d N E O d }y > d W +`. c v rn G IL C-4 ommrn c X000 •LV m IL m a CF ro � rnrn z° 2 co cD E o m a p m Q Z (T) m C CM') N y N O 00 C O C� Oi N C N N O O O LO M O O C O C -p O N f0 0i ~ p O U N cp LO 1ry)' L0 C N U Z d "00 O �V•0 y„ 6 O O 0-4 N N ' U — C E O O 0 O N2 z O O cL U n v � d •�v a it a L: IL • e0 o d .2 d �1 A ciao . ovO) ci r ' Parcel #: 020-1184-30-000 01/07/2005 01:23 PM PAGE 1 OF 1 Alt. Parcel#: 20.29.19.1162 020-TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner VA&CHIA LEE VUE *VUE,VA&CHIA LEE 493 LASSIE LA HUDSON WI 54016 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *493 LASSIE LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.340 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R19W NE SE LOT 22 PINEGROVE Block/Condo Bldg: LOT 22 HEIGHTS 1ST ADDITION TOWN HUDSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 08/31/2000 629127 1539/91 WD 07/23/1997 866/126 07/23/1997 808/529 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49202 201,800 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.340 23,400 132,700 156,100 NO Totals for 2004: General Property 1.340 23,400 132,700 156,100 Woodland 0.000 0 0 Totals for 2003: General Property 1.340 23,400 132,700 156,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 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 M C- ly Sao `ta9ti k ►�� -- a Z teA-e �ie VL " 1 I ,- 96 i 9Y't, (;ellz Oon/ Fr _ �CGL OM bC2 nI _ N t s'� DErRTM NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE!4,SE4,S20,T29N—R19W L CONVENTIONAL ❑ALTERNATIVE StatePI11LD.Number: (lf assigned) Town of Hudson E-1 Holding Tank El In-Ground Pressure El Mound Lot 22 Pinegrove Heights 1st Addition NAME OF PERMIT HOLDER: JADDRESSOF PERMIT HOLDER: INSPEC O D E. Daniel L. Bracht 126 2nd Street, Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN n REF.PT.ELEV.: 7EF.PT.ELEV.. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: Gordon A. Stromberg 5861 St. Croix 106112 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ❑NO DYES ONO BEDDING. VENT DIA. VENT MATL: IHOYES IGH WATER NUMBER OF ROAD: PROPERTY WELL: JBUILD�NG.JVENTTOFRESH ALARM FEET FROM LINE'. AIR INL ET ❑YES ONO ONO NEAREST CL DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO D YES ENO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR wLEr PUMP ON AND OFF) DYES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depthOfplOwing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA 1 ZITS LIQUID BED/TRENCH TRENCHES MATERIAL! PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END. PIPES FEET FROM LINE AIR INLET NEARESTi MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS OATION WE LLS DYES ❑NO YES 0 N DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES El NO DYES 1-1 NO DYES El NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERALSPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL.&MARKING ELEVATION AND ELEV.. ELEV.. CIA.. ELEV.. PIPES DI A.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES 1:1 NO DYES 1-1 NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ONO DYES ❑NO NEAREST b t ,Q ) Sketch System on _� Retain in county file for audit. Reverse Side. i SIGNATURES. TITLE. �t Zoning Administrator DILHR SBD 6710(R.01/82) i t (� DJLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# -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 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES CS�/NO PROPERTY OWNER PROPERTY LOCATION DPrw, L_ 1.. 6 PA-C14-7- F' '/4 -C '/4, S �,a T cl, N, R 19 E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME I r, :9, Lam- aA P'Nc ui NTH I � A CITY,STATE ZIP CODE PHONE NUMBER CITY NEAR MT ROAD,LAK OR LANDMARK u y01 (P 1 — E] VILLAGE: k DSt►� �W i II. TYPE OF BUILDING OR USE SERVED: - • 0,X)` M Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. �0 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. r%Conventional b. ❑Alternative c. ❑ Experimental 2. a. W 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. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUI RED(Square Feet): PROPOSED(Square Feet): 3- 1 t//o is- tQ 9�, Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank I F i ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): PI ber's Signature: o Stamps) P MPRSW No.: Business Phone Number: 2 N A-. -Tev g-A4 ( 7/S X166- 6d Plumber's Address(Street,City,State,Zio Code): Name of Designer: Rt A I LJC S c�R r VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 41+e_U eq Q70 j+jjSO t.J 3L18Y CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) -Approved ❑ Owner Given Initial 12 rc ar a Fee r7 Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: �1. BD-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, 608-266-3815. 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; 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 8h 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 ttBF included the creation of surcharges (fees) for a number of regulated practices which Wisco iiz can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Ts1t1TQ 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, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY P4RMLT STC - 100 . i This application form is to be completed in full and signed by the owner(s) of tike prul,el•Ly bring developed. Any inadequacies will only result in delays of the permit lstiva«ce. Should this development be intended for resale by owner/contractor, ("spec lujuse") , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - T - - - - - - - - - - - - - - - - - - - - - - - - - - - - r (� )weer of Property "-- LUCat Luu of Property ) 1. �' r k, Section � T (�I;, 9 N - R W l'uwuship fling Address w Subdivision Name Lur Nuiuber - - - --- - -- -'D L4 Previous Owner of Property _ Tucal Size of Parcel Dale Parcel was Created f 9'x'7 Are all corners and lot lines identifiable? L------�Yes No lb LhLb property being developed for resale (spec house) ? --L=ies _ No vulunw and Page Number Sad as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: I. Warranty Deed 1. Land .Contract ; 3. Other recordings filed with the Register of Deeds Office in addLtion, a certified survey, if available, would be helpful so as to avoid delays ,11 Lhe reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eetti6y tAat aZZ a.tatementa on t1 .a 6o4m arse .tAue to the beat 06 my (uuA) k►iuwt dge; tAat I (we) am (aa.e) the owneA(a) o6 the pnuper+,ty de,6c/L bed in .ilia c►I6uunat.iun 6orun, by viAtue 06 a wanAanty deed neeoaded in the 066.iee o6 .the Cuwi ty Regi-6 teA o6 Deeds as Document No. ; and tJtat I (we I pneae,i.Uy own .the,pnopoaed 4ite bon ti►e aewage poaaZ Aya,tem (un I (we) have ub.ta.i.ned an eaaemen.t, to nun kith the above deaa bed pkopeAty, bon .tile eino tAucti.un o6 aa.id 6y.6 te►n, and .the name W been duty aeeonded in the 066.ice u6 .ttie County RegiA ten o6 Deeda, as Doeumu No. 1 . i 51GNATURE OF OWNER SIGNATURE OF CU-UWNER (IF APPLICABLE) l z— t� LA'Z'E SIGNGD DATL•' SIGNED !. ..'�rl•{Wt�: i L. �, �,bF„'�,f'y� Y5.'"`� �.9o-pk. n.'�' ' :. . tx; 7''gyx � ,;. s 4 k .. i (� SOO°49 40"E w wo \ L! DEDICATED .TO. THE PUBLIC S00°49'40' E 350.98' " Iv �(� 1< W lD N OD m '\ ,S I O m Ln O u - 1� lJ 1 � a) n iD I- Itn W � to m Irn 10 1"� ':s:i`.. -`�:.i'•�' •� � Ito •. \: c N 00° 52' 50"W 300.00' Soo° 52' 50' E 351 17 on 0 LA (v J a A m o m ° IIZn ;, 1l r) N a, N . n N ` Ul I O i ;i to o . 7. rn titer Q m (- m D O C O a Iu O ® rn ® t7 v ..`• •.•t : F1.. O ' o to 'n __-^- D M to rn f r. �, • �. - '1--- S00°58'28" E - © y 283.00'' " SOO°58'28"E `258.59`7 r. _ 295.00 fl(lgL D ® _ . ROAD L,. 295.00 �� �� 1 N 00° 58'28" - 275.10' 4 1' N 00°58'28"W—258.64= .Ico lD O 7- O �m w u O _ Z W o d U L4 cn N N C n N �' ;'J w , 1 , O to m •� 0 to Cc). ... �'. N v to m 1 :0 N m V v m 8 m W m O �. `•I'D f = 1. .n (�n O © \ N In i m t Z Im ` S02- 12'41" E 247. 35- (� I a 295.40' o I= o , ID Z 1 m '; W z Cr \ �� m D D - N _ 1 A m m �N y w A O D Q1 A 1 y n� O `1.iy m NmQ7 o N O m O It 5 Z Ln �4 C' _ `" _ O Cc) V - U F .•''. (D c V N O N W Lj q1 - D 1 �1 M N i t a tT m N W' n'• O �1 `''. mo l O N 1 m _ j •n t to :N I t � . N 5 l o S 00° 58' 43" E 736. 06' ' EAST LINE OF THE SE 1/4 ` POOR!go l- .4 • SEPTIC. TANK MAINTENA CE AGKEEMEN'r Sc . Croix pull kY � v � / l*1 EK/BUY1:K hire Number ."t/ gSo TE/BOX NUMBEK Y/ STATE EK'TY LuCATIUN : k. s._ -14 Section 1'.a � .. " • r SL • L:ruix Coullty . .17 . Town of 7 ion uL uuluber�, • ,Subd#vis � proper use• and maintenance of your septic bysL.lu could result In I prop ,er Inuincel►uucr cun- s pre►uature failure to handle wasted - Prul I ' bc, ul pumping out the Meptic tank every tl�r�•c yv:►rd or buuuo a licensed septic tank 2uljL)r• WIIJL YOU I,ut ll►► •, ded , . by ---1'-- tic Lank as a tr�at- e sybLem can affect the function o-f- o4w sep nc bt..be in the waste disposal system• _ L . Croix County residents ►"ubcpCttofra` faili�iligbsybtelu, r u►axllouul of 60X of Cho Cost of elacame St . Croix Co Lill Ly hick was in operation prig . � up tbat , l ccepted t1►is program in Aug o vners of all new sYsm ag ree t keep their systems properly - aintained. 1 /Jllll►b a 't►e property owner agrees to submit LO 5t . Cculu aubLeC I, luull,.:r . ertification for m. signed by tl►u uvn►sr a►►d by ,unl � ► V.:rl - uurntsyman plumber , restricted plumber or a licensed 1 p • ,rJ cr ng cl►at (1) the on-Pita wastewater disposal sye�teu► l.b in 1 p y i condition and (2) after inspecciol► and pul"Pillg' �1 'lee , perdting bsdry) , rile septic 'tank is less th130idsys pr1Jr LJ Yercification form will be sent approximately 0 0 three year expiration. undersigned, have read the above reyuirealents and agree v�l 11/WE, the u x osal system in accordance with to maintain the private sewage disp the Wisconsin Depart- 'the standards set forth, herein, as set by 'ment of Natural Resources . Certification form must withtnm3leted and returned to the St. Croix Coun;y g days of the three. year expiration date. t SIGNED n DATE St . Croix County Zoning Office Y .O . Box 98- Ilammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above uddreus . tai ned an eaaememt,' .to nun kcun me aouve uu c1Lt.ue.0 j.PWPV-/"V# ov6 -wtww )?lAtAUCti.an 06 aaid 6y,6ten, and the same has been duty %eeunded in the 066.«e -tile County Regiz ten. o6 Deeda, as Doeumer No. 1 'IGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) '11 S1GNL D UATL SIGNEU L x 99 y„�HtA ti.. z�^ � ri'� � �" � "✓e r w.a` .d a a ��'G�,rnf° "'a X3m.y+ 'd B erksh�re Ranch i z � , M ry a, 3Fa � 1'"FF.x w5R � lie �,mi - '4- �;;�`„ ,..:. �y�.�v ��Y�•,�.tr ��'i � s"t�`'�sr�,r�y.M., I�II� �I�Y , ,, ,� ��K��T ffA''� 1P�g�ydy •` }t�� �I IIIIt� x: Alk Affliv p q Alf El .t= S aaaaooa yy � x _^ w �r x d � j `�. .3.. J0., '• CR�`v� 9 6 16- 8 13- 10 1,238 SQ F ' z ;xz , 0V" 'a'� lei r sue" 1 DINING r GREAT ROOM BEDROOM O rrn awyf 1 i y L js sa �` �� � W3 KITCHE w FO JW ^-L x 4r K r4.,"xdx.{ ... Y-'`6 Y { k r AI'Ait 1� n ,•�� �-,Pm�s's 4ay.4 c 'r;` '�6 h,,F''t' rt�y Fi r LO BEDROOM 2 BEDROOM 3 o_ r d K 4-4 10-2 13- 10 The artist rendering shown above may 1 N C. contain optional or suggested ry The Moor plan is for design reference-not P.O.Box 37,Stratford,WI 54484,Phone 715/687-3133 lor c,,,at„,ct;o„purposes. "lasting Value Based on Honest Craftunanship" r' b.ta.ine.d an easement, to nun with the above descAi.bed pnopeAty, bon the 'on6 Aue.Uon o6 aa.i.d Aya.te n, and tthe name iota been duly aeconded in the 0661ee 6 the County Regiz teA o6 Veeda, as Docume, No. I . SIGNAI'UKE OF OWNER SIGNATURE OF CO-OWNER (IF APPL11CAULE) ATE S1GNU) UA"rE Sicm:u INDUSTRY, T OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, C DIVISION LA110a Af D PERCOLATION TESTS (115) MADISON WBOX I 3 07 HUMAN RELATIONS (H63,09(11&Chapter 145.045) A UNICIPALITY: OT NO. L-K.NO.: SUBDIVISION NAME: NE �� � Tz9 N/R19t(o o ZZ 4D COUNTY: AM : S-T Ceo Ix LAIIA 1 EL t4c USE DATES OWERVATIONS MADE f / Residence UNk New ❑Replace a�R1l SOILS le, �Gi= S8 .C�l� SI$�SxrrTRE ' RATING:So Site suitable for system U�-Site unsuitable for system - U tAx Pr A rffs CCU WT,MAL: C�i•S,L� N =S [I S- -F�L O�LDI G�K:R��OMMENDED SYSTEM:(optiona�f) 'l S If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the under s.1-163.09115)(b),indicate: CLASS M Floodplain,indicate Floodplein elevation: A PROFILE DESCRIPTIONS BBO�1RIIN�G TOTAL ELEVATION £R-INCH CHARACTER IL W THICKNESS,COLOR,TEXTURE,AND DEPTH V TO BEDROCK IF OBSERVED JSEE ABBRV.ON BACK.) i B- � S`� oz.2� 9.se tZ '�$c.l«7s �/"���,�9Z''g�N>�►s,K,rE; IN.LZ N 7, /0.67 UASC&LTS4Z">3QN&L El"AeBQN MS 42 n C-r$Q+vm6 /or zl Lt > 3(Dv-44-L.I'S )C"BRNL 4 9&BON MS SCNLTd04 AlS Sr 6 A > .�3 a3 ��tTS )�"$eNC, selaerims B- �oUU /0/•45 a N /0.00 36"D1;&sTS -0et 'NL S4 gahMSjrC,2 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME RA f U S NUMBER mINONE•S AFTERSWELLIN INTERVAL-MIN. PER INCH P- 1 6,56 a 10z 3 1> Z 7 Z .G P- ' S 190 ii: )oi.6v / 4 /' P- 3 S,bo 1.30 >Z > 2 < 3 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 4s,7 IT I : 1- ' t _ nl�T .� / rs isl d�- vlisl✓ //� i!�ilEi. IST' _ . _ ._ I M i ( f l- i 1 1 i ; i 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 end the location of the tests are correct to the best of my knowledge and belief. NAME( : TESTS WERE COMPLETED ON: �4'ZEY J e Sr Ap*,,L Z4 /9SK ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): At,,7 Scc.orvo Sr /�u1a��iv V�J 1 5`�o)G 34B'� G-4pg0 $'&/2'n ST SI TURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) -OVER - J-N aw azb� j' ,os f II 449 Vk m Z • J't M:7C Z 7- N� { �+aw3zd3 /IV'7 `7/4"q •j ���aaw arm ?did Nv��•.2 ��aWri�rv�� , � C�wlut:r?. l�Avi�L. aJLfICl-1-T ppl- T 40 .�+► c ti c is ►�yr 2 K a° r >J �:PC- '�Y S r$ /Y S 'T5 u L,Or si L-oT '� a ` ForpK Si ze i oo o 1�hcs 6 CD -S izes � a xIS-V �3eA-�0- D��v� Or Q a� Wc=�� loT ; 1 b-► sq � le b-1 � � I 371 b- `f u C-L6U IJ A O V O^a a' 11 M:N G2 RDa W /�. T RC1�`7 FiC 1