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HomeMy WebLinkAbout020-1137-50-000 CD & � o ® . P k = ; 0 2 \ $ co cm � g c b . # I ) / � ] a i k � ) %�$ � cow z #�j ) 7k0 0 E] e \ \ /ƒ) f » n z § . . i § , o m § $ I ) z k k k \ z = k o / m / ) f J § ' 3 u Q j z k z / § j t = # k E 7 C 2 0 CL ) \ E 0 \ � © 2 § ƒ }CD § § § z Z 2 ■ § = m 2 ] L) .! § § co z % k § a \ M § S « ° E $ c 2 § § k ) f � \ - - \ k LO C) c » � e o $ i § ; $ } \ 2 2 a e LO ) I § 7 § § ■ _ a k c - % z - 6@ _ E S a E . w@ g 2 / $ ) \ � ■ � 2 i EL j ) . . 2 cx 0 ] c a § . / 3 a § 0 2 v Parcel #: 020-1137-50-000 05/23/2005 12:22 PM PAGE 1 OF 1 Alt. Parcel#: 29.29.19.686 020-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 * HAROLD W&JULIA S TRUST RICHARDSON RICHARDSON, HAROLD W&JULIA S TRUST 752 GHERTY LA HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *752 GHERTY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.198 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 1 BLK Block/Condo Bldg: 2 LOT 1 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 08/05/2003 733944 2349/17 WD 1176/05 QC 1122/044 QC 858/249 more 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.198 31,000 172,300 203,300 NO Totals for 2005: General Property 2.198 31,000 172,300 203,300 Woodland 0.000 0 0 Totals for 2004: General Property 2.198 31,000 172,300 203,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 112 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � kU- - TOWNSHIP q QYN SEC.,;2-5 T !N-R /9 W ADDRESS ? ST. CROIX COUNTY, WISCONSIN a z 3 7- 5--0-0eD� SUBDIVISION LOT .CJL LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J >>c � ` j 3y �` / � I � © .k i INDICATE NORTH ARROW ?NCHMARK: Describe the vertical reference point used ovation of vertical reference point: Proposed slope at site: 7:7�c) IC TANK: Manufacturer: l�(./..�Q•, Liquid Capacity: ember of rings used: Tank manhole cover elevation: ik Inlet Elevation: Tank Outlet Elevation: ,er of feet from nearest Road: Front,O Side,W Rear, O 16YO 7 feet From nearest property line Front,O Side,(3 Rear,O 3 feet (Inc of feet from: well gOI , building: Is information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER 3 K f 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: Lenith: a Number of Lines: -2— Area Built:�� Fill depth to top of pipe: d �� Number of feet from nearest property line: Front, O Side 00 Rear,0 Pt .o�J� Number of feet from well: qy� Number of feet from building: 7 Z (Include distances on plot plan). SEEPAGE PIT /`�� Size: 1 4 Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: �o ' Z I Plumber on job: clw License Number: 3/84:mj • SAFETY&BUILDINGS DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LAtOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON W153707 SEk,M, S29,T29N—R19W KRCONVENTIONAL ❑ALTERNATIVE State Plan 1.0.Number: (11 assigned) Town of Hudson ❑Holding Tank El In-Ground Pressure El Mound Lot 1, Block 1 Gherty's Addition NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT A E: John Wegner Route 5 Hudson W i 54016 �, "a/— gF, </'f Ud 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: Roger Timm 3224 St. Croix 106045 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER q // PROVIDED. PROVIDED 0 J . l .S DYES ONO ❑YES 1:1 NO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: I'LIN ROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM E: AIR INLET. DYES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER JBIDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. 1-1 YES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 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: BED/TRENCH WIDTH LENGTH IN RENGIQES DISTR PIPE ry107ER1AL PIT JINIIDE OIA -PITS LIQUID DIMENSIONS S /�t�J L� Ir GRAVEL DEPTH FILL DEPTH IDISoTR PIPF DISTR PIPE DISTR.PIPE MA TERIAL. NO.OIS NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES AEDVE COVER ELE V.INLET ELE V.END'. PIPES FEET FROM LINE AIR INLET �pt (o( 2 7 2 NEAREST-1 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE PERMANENT MARKERS 1011SIRVATION WE IIS 1:1 YES ONO OYES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ❑NO ❑YES ONO 1:1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING (TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE IMANIFOLDMATIRIA1 NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.' ELEV.. CIA.. ELEV.. PIPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES 1:1 NO DYES ONO COMMENTS: t PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL. JIIUILF5NG l ❑YES ❑NO FEET FROM LINE: r {� ❑YES ❑NO NEAREST I. 39 s. 73 0 6 (Ol Sketch System on p b J� Retain in county file for audit. Reverse Side. I a' SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710(R.01/82) t as �'""m" SANITARY PERMIT APPLICATION COU TY �MLHR 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%)t 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES L)f.VO PROPE NER ` PROPERTY LOCATION '�1 U ►1 jf 011 ,�,' a �I1144, S ;Z j T,2-�, N, R 1 (or)W PROPERTY OWNER'S MAILING OFDDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISIQN AME ,,!� I .;2- lerl Al �s CITY,STATE ZIP CODE PHONE NUMBE CITY. NEAREST ROAD,LAKE OR LANDMARK t W� VILLAGE: II. TYPE OF BUILDING OR USE SERVED: `1157 _003 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. �q 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. YU Conventional 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. ❑ seepage Bed b. tgSee a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): I I 1.2. (/,/- -151-6 7Z 91, Z4, Feet Private ❑Joint ❑ Public CAPACITY VI. TANK Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank )C� ,J2�L,L� ❑ ❑ ❑ 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): Plumber's Signature:(No Stamps) MP/MPRSW No_ Business Phone Number: v.5' 72, Plumb s A dres (Street,City,Stq e,;ir p,Coode): Name of Designer: VIII. SOIL TEST INFORMATION Certified S it Tester(CST) ame CST# z CST's ADDRESS(Street,City,Stat ,Zip Code) Phone Number: / IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Iss 'ng Agent Signature(No Stamps) Approved ❑ Owner Given initial % 120 �� urcharge Fee — Adverse Determination co '/ A 0 /o 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 L 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 ne:ded 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 sea* 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 (-a.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'f2 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 Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco {o a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure 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. 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 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 V d tvd &'L ' Location of Property l� / W , Section a /c , T__C7 7N-R W Township Hailing Address y� Address of Site Subdivision Name � J . Lot Number /�. Previous Amer of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I IWeI cehti6y that a t 6.tatement6 on thus ohm alce �Jcue to the but o6 my (oun) know£edge; that I (we) am (ane) the owneA(e� 06 the phopen.ty de�scAi.bed in .thiA .in6o4mdtlon boron, by viAtue 06 a waAAanty deed neeonded in the 066ice o6 the County RegiAteh o6 Vee6 ah Voeument No. t,� �3 and that I (We) pneeentty aun the p4opo6ed site 6on the eewage diApoAaZ aye em (on I (we) have obtained an easement, to nun with the above de cAA,.bed ptopeA ty, 6o& the eon.6tAuc ti.on o6 said ay6.tem, and the name hae been duty kecotded to the 066.iee o6 the County Re9•i,6.teA o6 Veed6, ad Voement No. ) . IGNATURE OP OWN SIGNATURE OF CO-OWNER (IF APPLICABLE) IGNED DATE SIGNED _DOCUMENT NO. i WARRANTY DEU I HIS SPACE RESERVED FOR RECORDING DATA (I STATE BAR OF WISCONSIN FORM 2-1982 I i 43263E �~ 79SPAGE14 _ 'S OFFICE gT. ato1X Co., VA Claude Patrick Chatterton i(v Record i! .-----•-•----••... -•.............•--.._.... ---------------------------------------------------------------------------- --- DEC 2 1987 -------------------------------------- -------- ---------- --- ------------------------------------------ at /o: 00 ,q M conveys and warrants to John ... [aegri..r . I •-'............ ..•----•---.....--•-----• --...••• .....__.... ROOMNofDo$& ' --- .........•••-•-••••---•-••-•--•--•-•••-•-•-•••---•-•----••--•----••---------•-•----•----•--•-.....•----•- ......................._...__...._.._....._...._......_.__._...._ ............................................... RETURN TO .. ............... ...................................................... ........ ................... ..... _ -- --- - ... St.---Cr01X---------.------•----------------- I, the following described real estate in ................................................County, Ij State of Wisconsin: I! Tax Parcel No: .............................. �! Lot 1, Block "2" , Gherty ' s Addition to the Ij Town of Hudson. I i I I I I III I t kA i v ' •'�� i FEE ! I Ii This 1S riOt homestead property. (is) (is not) j Exception to warranties I Dated this -----....... 3.' -. ----•---••-••---•---•---••-- day of ...... ..p.y�'.h e..-'-- ..... -------.... 19.8...... I+ ' --------------------------------------------------------------(SEAL) -•---------- -- --------- -------------_-_--------....---------(SEAL) CL UDE P CK CH T E N �! ----------- --------------------------------------------------(SEAL) l --- .(SEAL) I i A T ENTICATION ACKNOWLEDGMENT Signature(s) ?67�e1 STATE OF WISCONSIN I' SS. --------•--- ------------- ------ 1 —County. authenticated this . "'"✓P a --•_ ay of.___..._._ Personally came before me this ................day of .......................................... 19-------- the above named II ............... ---------------•---------------•-•---••......-----•---•-----•••- I ii • ITL : ME B S TE BAR OF WISCONSIN (If not, •----- -----•-------•-------•--------------------------- -- •-- - -• --- -- --- ---• -------- - •... -- . authorized b y § 706.06, Wis. Stats.) to me known to be the person................ who executed the i foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY II •---Mark J. C;herty --------------------------------------------------------------------------- - - ----------•---------- •--------------•---------------------•-----•••••- --•-HUdSOri --- ----- - WiSCOnSl-- 5 4 0 1 6 --------------•---- Notary Public ............__---------------------------Count Y. Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) date: , 19......... I� I "Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN H.CMiIlarComprry� FORM No. 2— 1982 Stock No. 13002 Y•I....w,w�..MN. H z H . 9 r ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER 0-oh y LV ugh e e ROUTE/BOX NUMBER Fire Number / CITY/STATE �4 � ZIP ,7lol6 —o PROPERTY LOCATION : �41 14, Section T 2� N , R /2 -W, Town of /X/ St . Croix County , Subdivision �s Lot number 94 I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into I! the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , 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 . 0 < E I/WE, the undersigned , have read the above requirements and agree CA to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- ro ment 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 . DATE /� 0 0 St . Croix County Zoning Office P .O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, owv��2/ DIVISION LABOR AND PERCOLATION TESTS 115 l P.O. BOX 7969 HUMAN RELATIONS C1,1uf�� / MADISON,WI 5371117 (1-163.090)&Chapter 145.045) Z , I A&Lt S LOG"ATION:N SECTION: TOWNS HIP/A411A1164RALI. y. OT NO.:BLK.NO.: SUBDIVISION NAME: SF 1/ 1/ 2 9 /T�9 N/R I I E (o t+uvso to I Z GHER ry s hvo%r. COUNTY: 'S BUYER'S NAME: MAILING ADDRESS: �5f.CROI)( TO 4(,j Q)E:&0E-P, 21 Z o M>~i Jso a {auk. Low, tAko_ /4iAjv• s S 3S G USE 01x— 1473— 003 ? DATES OBSERVATIONS MADE LN) NO.BEDRMS,: DESCRIPTION: IPR FI NS: ESTS: Residence 3 , LLYNew ❑Re place t No V 2I—8 7 ND U .22 -�7 RATING:S=Site suitable for system U=Site unsuitable for system SJ•S C0� F M M r R t 3 V R 7- ONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:loptional) os ❑u as ❑u os ❑u ❑s ©u ❑s NA -�eN&w S �1) S- x so' wl�k. 'DP-op ox I'SrR)'@�rfoN If Percolation Tests are NOT required DESIGN RATE: [Floodplain,any portion of the tested area is in the under s.H63.09(5)(b),indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS !v �ECiM}L BORING TOTAL ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, OBSERVED EST.HIGHEST— TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) . 0k 3.4 . 51 st > �,zs ' B- �l 0 ?X,24 7,� > d 751 -0 rz , B-Z 7, S' 7s2�� — > 7Si IS ) 1.33 ' TN . S/ S. t ' Trw wad—S. B. 7. 0' > 7 S" -Rik. S, 2,0 ' '3,3, S G a � .5 T1tAv cs 3 GR� / q �/d ' 71fN 44DCD -F;rv,- B- 7 � � I /�'�� / > �.Q , 5 ` -Dk'. 131-1 . 5� , 2. O r a�N SIB ►.� � �k 6,P N U&P- cS 1 Is0- B- � O 9�2Gi > - v ` . 5 � �K• $�•. 51 I-$' 73a, 5 6 ,0 , -NAJ CS B- SUP-1'4 62- 6'16,7UArion)S o f PegCS PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS ELLING INTERVAL-MIN. PERIOD 1 PE I D 2 PER INCH P- 10' y 2 Z % /% L P- P- Z P- P- 6.2 L 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 directions and percent of land slope. /Ow Teewe ._ SYSTEM ELEVATION AE` s site tes epti�c sY t 5o jot a In ►- - Nr r'wTtt r ES T ,S I S f Tt 53 1 C,ovD/f/ovf -- e i I I o rxVS r. uepdr. Rr:�.. Pt y8f ' � tk �3 �..P3 s /R rM-S0 R pip Too r lr� _� _ __ I'�s r r I 1_ �y . /QO; i &¢{ y' l � i 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures cified 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: !iCMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 V7 ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER(optional):: WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. IPA— 31(,—if/40S r i AN.INSTALL CST SIGNATURE DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DIL.HR•SBD-6395 (R,02/82) ER _ JOB Timm • SHEET NO. � T OF Z Excavating Co. CALCULATED BY ^,,.' r ' DATE 177f)R5 '3� R.I, BOX 192, Wilson. WI v'!V`7 CHEQKED BY DATE__ 3-fib�kA!D SCALE f � _ Pv. ._ q......... . ...... _. _. ..... I I s 3 1 1 yo i i I °7 shop¢, 13 2 WIQM rv� a ;set( >> � 5610r I a Trews k4S ee r/ 9Z.yq 40 i............ b .....4..... i., /CL'YJ GC .. pl�t Ci. 1i�.2e �CS G f? ................. ... , J .... .... ...........: ... Timm i JOB A *. a Z SHEET NO. OF + • Excavating Co. I CALCULATED BY 42 e h`IZ DATE ' S R 1, BOX 192, Wilson, WI 667 CHEQKED BY DATE SCALE i;. ...i ..1..... ...... .. .b. ..... .. ..�....... ... .. ... ..... .... ..... �l- �ii6•Z L .__ < ✓ender --� EC�L.y4 v C .. .;......... t , ....... }..... `..._ .......... ..... i .. ..t.... ............. . _. .........:...... ......� t....._. .. s .... ! ...._ � ...... j. ... 4 1 f i i .I.. ' d. .. ..:.. ..........d ........... I............. ... :.. ..... .._ I ...; ., ..d.. .. .�....... _.. ...�...... +.... , ! ! .............., .....1...........d. .... .... .......�.... 4.... I w ; i I �.... i... , ..... :... .:..........:...... .... .... arch,M-01411.