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Parcel#: 26.29.19.290C 020-TOWN OF HUDSON Current [X] ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner STEVEN J DIAZ 0-DIAZ,STEVEN J 732 KINNEY RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description 732 KINNEY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N R19W NE SE LOT 2 CERT SURVEY Block/Condo Bldg: MAP IN VOL III PAGE 731 ORD EASEMENT- ALSO THE SLY 15'OF LOT 3 C.S.M. 3/731 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) PER 831/295 26-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 04/16/1999 601434 1419/326 QC 11/24/1997 568939 1278/514 WD 07/23/1997 831/295 07/23/1997 826/465 more 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 I Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 75,000 134,100 209,100 NO Totals for 2006: General Property 2.000 75,000 134,100 209,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 75,000 134,100 209,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. TN-R/ W en ADDRESS 1869- QW ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �e 158 319 INDICATE NORTH ARROW 4 BENCHMARK: Describe the vertical reference point used �y ��. � �r� 1511� i Elevation of vertical reference point: Proposed slope at site: _ SEPTIC TANK: Manufacturer: ale44 Liquid Capacity: �B/y Number of rings used: ,L_ Tank manhole cover elevation: Tank Inlet Elevation:_?�i 5_2 Tank Outlet Elevation: rf'6y� Q Number of feet from nearest Road: Front,O Side,O Rear, © feet From nearest property line ' Front,0 Side,0 Rear,O feet Number of feet from: well -��7�''—' building: R5, (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ,/ Trench: Width:_ �,� Length: s 7 . Number of Lines:-;� Area Built: Fill depth to top of pipe: _?g Number of feet from nearest property line: Front, O Side, &Rear,0 Ft .�/ Number of feet from well: Number of feet from building:. SS (Include distances on plot plan). SEEPAGE PIT T Size: Number of pits: Diameter: 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 s tems? Check one). Y ( HOLDING TANK i Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: /1/ Plumber on job: License Number: �'1►d'9 3/84:mj i DERAFUTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BO)G7969 ' ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NE�'4,SU4-,S26,T29N-R19W © CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o6 Hud6on ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound E SF - ADDRESS OF PERMIT HOLDER: INSPE TI N A E: Lance 8 Salty Otsan 1 1015 Oak) Hudson, X11 54016 12-5-88 3:30 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: David B. FageAty 3289 St. ctoix 119389 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST---111110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST---11111- MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES :0:jNO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: 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: iAREST- Sketch MBER OF PROPERTY WELL: BUILDING: COMMENTS: ET FROM LINE: ❑YES ❑NO ❑YES [::]NO System on Retain in county file for audit. Reverse Side. sIGNATURE: TITLE: Zoning A&njnj tU totc SBD-6710(R.06/88) r- TU�� SANITARY PERMIT APPLICATION Co NTY ILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# / / 93e9' -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 NO PROPERTY OWNER PROPERTY LOCATION A �' ex- '/4 %, S A6—T-? , N, R E (or PROPERTY OWNER'S MAILING J<DDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 9 A � e CITY,STATE ZIP CODE I PHONE NUMBER Q CITY NEAREST ROAD, El VILLAGE: s0,` II. TYPE OF BUILDING OR USE SERVED: " 107a ?0"00 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. [J 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 Ownersh.ip Agreement to County Copy. a IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. PConventional 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. See a e Bed b. ❑seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): i 6� 5" s Feet rivate ❑Joint ❑ Public CAPACITY Site I VI. INFORMATION Manufacturer' in allons Total #of Prefab. Fiber- Exper. N New xisting Gallons Tanks s Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1,eww L Lj _H_FH_. ift 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): Plumber's Signature:(No Stamps) 'MWMPRSW No.: Business Phone Number: � Address(Street,City,Stafg,Zip Cod d): I Name of Designer: en- 16 K40.2_3 V 11. 961L TEST INFORMATION ified Soil Tester(CST)Name CST# � I� CST's ADDRESS(Street,City,St e,Zip de) Phone Number: 06e.► w� p23 II IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) NLI Approved Given Initial /� urch�ar(g�e'Fee fV Adverse Determination 2,0, 06 'a G�,(0,_-) X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 1 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, 608-266-381,5. 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 'lank 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 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served, B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco ihl" can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure' a is used in your building is returned to the groundwater through your soil absorption o 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) rn n lit to a 7, ti ` it Th Nw d v u RR� f fi T a s ` Cam` "* V I� P lr• i ¢:. l �. r _....TM. �� /I�I fft' P' r i� / �i A .6i m ��` r. v -- ._ '�` 1 l �•'" �',: �'.- `i �ir 1 I �� �......_ � _..�- ,. ��.--i,. �,, _ S' m � ,�. �, - .. � l'. �� �� -�� �. }<,. •.t - � a = , - __; j � �' . ,` :.f-1;� .... ; �,,.,' IA ,..Y' � i ft --' � , y,�ysy— .,_. r 1 + t �� .>�''� J 4 � 4 ►� \ � �cry�w� r OR ft. $a 0 1� I�oo } i I Fj LV 999E-6qL au04d £ZObS NISNOOSIM 'SJ�a3808 peon s34819H Ave o j 68Z£# ££Z£# 'i aagwnld V jalsol �1aad P asuaol auo4a WMd �ja390A 300 eO la 6v �ti�3 �N 959E SIM S o OVS NISN08 aN ��a8 EVE# £ Pe0�Z£sal,\aaa �s�^�a aagwnwnld e5�35$�0 523 OP�ersed#etty �SGrON36 6 Rog Ph e�49' 959£'6 M laso11 Yw�bel Zp��a�s40.3s%S!a£Za#S oasva'u%1 �24,9�°�� Z3 ONG IA �N eP -rv` All .6'v 4 avo S 11o9ob 9N�SN0o aN Sv�� u • Z a 6Z�peo6 Z£a Say�?9 ��ndO ,lop bel �.�� 00��'Ses�ec289 1111 3 V� Pe(K is Ro y4p2 Vp�e�sed#ey�SGnON�,6 6 Fog.�S,Y'1 149' R082�'pr°�a auoua ®Ob 959 ND�SIM� aoa EZpi�S N\slu�+'•aH 62£# suaoll peo6 ZE*sai� 08 pa ,, JaN s<e� '�NI� pVF �0p rk�e #g2$9oad 3 0 ce�SO 4323 Ne�grtss N 5gg2 �� o e�yW\SCO 3656 VOZ PhOre 49' 955ti'61�L auoSo 8011 EZO8zo8I 4 %a ££#pasuaol'1 0,3 �agu►nld '�?alsol 'II A 3ndQ i t ras Q t W y� 9 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Z-A N C Q. t- S ©L S d A) ROUTE/BOX NUMBER' ' FIRE NO. CITY/STATE /A &SU 0✓ / S ZIP Wo rZ S( 1/4, 2 PROPERTY LOCATION: 1 4 L Section Lr� T N R � � W Town of C v( 0,S6 A) , St. Croix County, Subdivision 13 V_2fq — U�y('sn7 0" -)At , Lot No. 2 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. S I G1,}E$" .'"`'� � 45 DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address ,I gu it A MdjWr* 4UMMI- Gran ........... -...... .... ......................... ..... 77, ....................... ......... .............. .. .......................... ....................... ........... . ................ 3 . ............. d t. an . ........... 01 ..........­*............... rs ..4#._.jt;trvivq h..p ............. "If................... .........I.......... �A.................. ............. . ................................... ..... ........ ...................!......... .......................... ...... .... .. ..... ... .......................... ...... ... ........ ....... WtTu*pv To :7A ................... .............. ... . ........... ........................... .......0=11ty. 46— Tw Pawned No:...... . 77 �Oz,*E-1/4 of SE-114- of Section 26-29-19 described as Lot 2 Of Certified Survey Map filed November 1,7,- 30* Page 731' ta vations, reattl —14.7 an y (is aso T_� F=ZR ' KU8M Xk, ACKNOW i-," M AT OF WISCONSgN 7� ................. 0 t.QIM . .. ........ .................. -Roger,W. Kub;6r'&_ ,", ' 1 . J J •��j�l�n� i 4 ,,,� l F n 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 L 4A)CIL 1plsp o Location of property 11! ,i 1/4 /- 1/4, Section Z U , T—N-R ( W Township l*149-sd A) Mailing address Address of site l 07- 9 Z y Subdivision name t/D/yp" Lot number C T Z Previous owner of property _ IC t7 ur2 -i ` C4 A I T 14 Q ri iZ la Total size of parcel 4- Date parcel was created / ��/ 7 e7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes X _No Volume 3 and Page Number ? 3 1 as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- 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.� y Z 8 4// ; 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* (4C12 �Y Signature of Owner Signature o Co-Owner (If Applicable) l yr 8/Z1 6j Date of Si nature Date of Signature #4WI- 7i11 I.t a%l `l4nks, 7 no� `to^ why ,tio f �6le 719 44 sn. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDU$'$�+', .. G DIVISION C4BOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LOCATION- SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.]SUBDIVISION NAME: III & '/l./ G /V9 N/R E (o ,Z — COUNT�(r+ NER'S B fR'S-GAME: MAILING ADDRESS: O P / Ail wi /VL USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: Qflesidence 7 1 �Y RATING:S=Site suitable for system U=Site unsuitable for system r OENRVENTIONAL: M OUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optionas aU [as ❑U as aU Es ❑U 2s ❑U Z . If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: -- l Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- `/-7 ' B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- Y' 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 7_4 o ' I I : : tN i 3 1 I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): RT TESTS WERE COMPLETED ON: DAVE EOGEY PLUMBING !� ADDRESS: b#3233 #3289 CERTIFIC TION MBER: PHONE NUMBER(optional): Fogerty Heights Road C N Phone 749-3656 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER- DEPARTMENT OF REPORT 0'N 'SOIL DO RINGS AND SAFETY& BUILDINGS I * Ndl��wi'RY, DIVISION LA P.O. BOX 7969 Hl,°M'Ag REDA"IONS PERCOLATION '7ESTS (115) MADISON WI 53707 (H63,090)& Chapter 145.045) LOCATION: SE TION: OWNS IP/ t7tQtCW*tM-1— OT NO.:BLK.NO.: SUBDIVISION NAME: ��S�� /R9N/R/ b(or o,�1 -r` I /t'1e.aa�ocu COU TY: OW R'S BUYE 'S NA E: MAILING ADD _SS: USE ATES OBSERVATIONS MADE NO.BEDRMS.: COMMER AL ES R PTION: PR FI ONS: ESTS: esidence ;.Q'ew ❑ ieplace s—. a RATING:S=Site suitable for system U=Site unsuitable for system t> ONVENTI NAL: MOUND: IN- GROUN EM-I FIL LHOLDING TANK:REC MEN ED YSTEM: o ti na 1 0 EKsou 0-sou KS au ❑s XU os l p If Percolation Tests are NOT required DESIGN RATEE- IIf any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: y. ffi P OFI E GESCLLRiwT10NS h s('•°•II`Ir Tr AL r^Tli TO R UNDViA T E'n4ir� J ;,AiiAL En OF SOiL Wi 1 H 1-HIUKNESS,COLOR, iEX U ,AND DEPTH NUMBER DEPTH LEVATION BSERVED I HE 70 BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) i1 B- a 7 0 ' s , s' s 3 B3 IF z ye An 77 ; J- B- PERCOLATION TESTS i . TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WA ER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. I PER INCH P o f 0 P- /(,lt, ( _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 plant Show the surface elleevation at all borings and the direction anndd percent of land slope. P•? r �'�•� 9 7.9 • A/I Al!15 - Y OA S4'�/`w $YSTEM ELEVATION 9s• 7 v���-,� y, _ �j ra CO ___ f ` _. tN ' 1 L (- ( ! i 64� I 1 . 4, Tl -I I&f- Coru&- MArIE BY Skc/ 4-4w-/asf-er�%O I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): // TESTS WERE COMPLETED ON: -5 -2,1-e ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): Q. d! / A U E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•SBD-6395 (R.02/82) -OVER - r � a 1. '