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Parcel #: 040-1173-70-000 02/10/2005 09:46 AM
PAGE 1OF1
Alt. Parcel M 24.28.20.663 040-TOWN OF TROY
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
*
DR JOSEPH L TRUST SPRAFKA SPRAFKA, DR JOSEPH L TRUST
515 S LEXINGTON PKWY 505
ST PAUL MN 55105
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description *298 COVE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.600 Plat: 2490-ST CROIX COVE
SEC 24 T28N R20W ST.CROIX COVE LOT 6 Block/Condo Bldg: LOT 06
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc# Vol/Page Type
08/20/2002 687575 1953/152 QC
08/20/2002 687574 1953/150 TI
259184 361/46 WD
2004 SUMMARY Bill M Fair Market Value: Assessed with:
27479 546,400
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.600 369,000 178,500 547,500 NO
Totals for 2004:
General Property 0.600 369,000 178,500 547,500
Woodland 0.000 0 0
Totals for 2003:
General Property 0.600 352,000 164,900 516,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
I
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP a SEC. TN-RC W 0o &4
ADDRESS , ST. CROIX COUNTY, WISCONSIN
SUBDIVISION - - ,;"�,r �y� LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
NmR�'H PRdP�*l7'tY
,b U; N. WrcL
L \ J
C
Z X/g T/.0& i
V +o f(er O
'- -
SD u t/-f �k'v PERTY L,/rvE
INDICATE NORTH ARROW
/✓o SCAI
BENCHMARK: Describe the vertical reference point used 5f)K4' ,a?" 40 At TdE
Elevation of vertical reference point: ,/00 , Proposed slope at site:
SEPTIC TANK: Manufacturer: U-)/-' S C4 Liquid Capacity:
Number of rings used: O Tank manhole cover elevation:
Tank Inlet Elevation:. �9C,. 93 Tank Outlet Elevation:
Number of feet from nearest Road:
Front,O Side,ORear, �/gg� feet
From nearest property line Front,O Side,elear,O / feet
Number of feet from: well �'� , building:
(Include this information of the above lan ot l
P P ) (. 2 reference dimensions to .septic tank)
PUMP CHAMBER - 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,O Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: �9 .� CLE✓ Trench:
Width: �� Length: �` Number of Lines:
a Area Built {
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, (Rear,0 Pt .
Number of feet from well: (2
rear,
of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
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 sytems? (Check one).
HOLDING TANK
x
Manufacturer: Ca aci
c
t
P Y:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector•
Dated: �°, Plumber on job:
License Number: rjogZj` ?cam
3/84:mj
'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
4ABOR&AUMAN RELATIONS DIVISION
P.O.BOX 7969+ ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
NE%,NA-,S24,T28N-R20(U State(it umber:
assgned)
Town a� Thay � CONVENTIONAL ❑ ALTERATIVE
L ❑ Holding Tank ❑ In-Ground Pressure El Mound
NAME OF PERMIT L : ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Joseph Spy La�k.a 298 Cave Road, Hudson, W1 54016 )a a1 416 9��
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
I i
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Gutty ZaPpa 3300 St. CAOix 119395
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
f r� � PROVIDED: PROVIDED:
YES ❑NO ❑YES XN O
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑YES XNO ( .L ❑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 111 YES ❑NO NEAREST-�
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: /— MATERIAL: ` PIT DEPTH:
DIMENSIONS (?
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.141 TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BE OW/PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: ,'�r�i,•,:r PIP : FEET FROM LINE: AIR NLET:
NEAREST-]► 31
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 ❑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 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
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM
❑YES ❑NO ❑YES ❑NO N ►
Sketch System on Retain in county file for audit.
Reverse Side. SIGNATURE: TITLE:
SBD-6710(R.06/88)
Zoning Adminizfitc.crton
SANITARY PERMIT APPLICATION COUNT
�
TA po�
•DILHR
In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT#
/ /9L395
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8'h x 11 inches in size.
—See reverse side for instructions for completing this application. [FORI TION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. VARI ANCE ❑YES ®NO
PRO ERTY OWNER PROPERTY LOCATION
'/ %'S A' T , N, R E (or W
PROPE OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CJ
CITY,STATE ZIP CODE PHONE NUMBER p CIT GE: NEAREST ROAD,LAKE OR LANDMARK
Cc
II. TYPE OF BUILDING OR USE SERVED: 61q0`1173—7U
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. ❑ New b.X 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. X 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. N 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): REQUIRED(Square Feet): PROPOSED(Square Feet): p�
611 , .� Feet X Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total #of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank i� L> A ❑ 1:1 ❑ ❑ ❑
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) W/MPRSW No.: Business Phone Number:
4444 a l l
Plu s Address(Street,City,State,Zip Code): Name of Designer:
VIII. SOIL TEST INFORMATION
Ce'tirtified Soil Tester`(C T)Name CST#
CST's ADD SS(Street,City,State,Zip Code) Phone Number:
a
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Issuing ;entSigna�tur;(No St s)
(Approved ❑ Owner Given Initial I� rl� F [ate
��3�$ /h C Adverse Determination I GU CJ pL> (r
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
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 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 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 atr-�
included the creation of surcharges (fees) for a number of regulated practices which Wisconjah.s
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reAks:, ° a
is used in your building is returned to the groundwater through your soil absorption o
I'
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-
water, groundwater contamination investigations and establishment of standards. Groundwater, t
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
Location of proper 1/9 /U� 1/9, Section �, T �� N-R W
Township
MaIlIn,9 address
Address of site 4
Subdivision name
Lot number
Previous owner of property
Total size of parcel p p.
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes y No
Volumerl-V9 f and Page Number 7 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 reco ded in the Office of
the County Register of Deeds as Document No. c�� 1� ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easeme t, t :and un w' h the above described property, for the
construction of s d sys e , h same has been duly recorded in the Office
o t e Coun Re i er Dees, s Document No. ) .
Si nature of Owner Signa a of Co-Owner f A icable)
cF
Date o f/11 ignat#a Date of Signature
No.607. Warranty nd«i—staiutery Form—Win. State.-236.06. RIEGIsTEMM OFFICE
PO �.
,2 9,18 4 BOOK `���� PAGE 46 Recd for Rrcord thie_-AM
WARRANTY DEED By of...August__ao.19_,59
at--- A--°-� M'
>` WINFORD, INC. f _, David
- -M ii'2p�ter of Des dT a corporation duly org:�nized and existing under the laws of Wisconsin, hav ng its pre$ n
"` the. City of Hudson, St. Croix County, Wisconsin,grantor, hereby x
conbego anb wattantO to Joseph L. Sprafka and Virginia L. Sprafka, husband and .
wife,
Of Ramsey County, Wisconsin,grantee' 'ftlr'tfieium of
,One Dollar ($1.00).;nd other valuable consideration-------------- Dollars-the following
tract of land in St. Croix County,in the State of Wisconsin. R
Lot Six (6), St. Croix Cove, according to the plat thereof
on file and of record in the office of the Register of Deeds
in and for St. Croix County, Wisconsin. Subject to restrictions
and protective covenants of record and further subject to the
Declaration of Winford, Inc., to the Public, dated April 24,
1957, acknowledged May 31, 1957, and recorded June 7, 1957
in Book 339 at page 325, in the office of the Register of
Deeds in and for St. Croix County, Wisconsin, and the
conditions contained therein.
1
I Wttntoo Wbtrect, the said grantor has caused this deed to be signed by its president,countersigned by
its secretary, and its corporate seal hereunto affixed this 8th day of let
July
In Pre nce of �
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».«....»\\..,«.�`....`.�...««.«. .«p..« ... ; • .
...........«...._«........................... .h.�resid�r�t'► �,,
Kirk M. Stauf _ « »«« William.D. C1 'p
Countersig ed
.......... .................... »» «.«
...... ... .. .... (C
Assistant Se tary.
Edward D. Clapp
( Cornorate
1 Seal
INNESOTA
M
%tate of �iQe�clpaoc
County.} ss.
Personally came before me this 8th day of July ,19 59 the above named
William D. Clapp President and Edward D. Clapp, Assistant Secretesy#i:.o
of the Winford, Inc. to me known to be the jiersons
who executed the foregoing instrument and acknowledged that they executed nd delivered the ~`as k
and for the act and deed of said corporation. ( , :•�� ! `
/�.........-».............
R EAr:OR S. DODDS
«_......««..._..«..........
«««»....»_....«...•rotary�ub�ic;Itamsey�eunty, lrll�in�» ��;
My t;c„rims sn Expires April 21,1965.
...._..«.«.....,....................
......«..«.«....
My Commission expires». «.-.... ««. ..«« . , .. _._«_ _« , 19
(To be filled in if sinned by a Notary Public.)
(N.11—Ch.60 Win.State provides that all instruments to be recorded shall have plainly printed or typewritten thereon the
names of the granters, Kranteee,witnesses and notary.)
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• S & N LAND SURVEYING •
HUDSON , WISCONSIN 54016
715) 386-2007
Nome Dr. Joseph Sprafka
Address 1833 Cove Road
Hudson, Wi . 54016
Description Southerly line of Lot 6, St. Croix Cove, Town of Troy,
St. Croix County, Wisconsin.
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STC - 105
SEPTIC TANK MAI ENANCE AGRE ENT
ix County
OWNER/BUYER
ROUTE/BOX NI BER 9161 W FIRE NO. 9
CITY/STATE ZIP
PROPERTY LOCATION: ��' 1/4 I/1/4 1/4, Section , T_C;r N, R W,
Town of -TAN N , St. Croix County,
Subdivision 11' .0 r� y4 , Lot No.
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. tification
form must be completed and returned to the St. ix County in Of is hin
30 days of the three year expiration date.
SIG r
DATE C_
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
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUIL O
DIVISION
,INDUSTRY,AND P.O. BOX 71)69
LABOR HUMAN RELATIONS 1,163.090) TESTS (115) MADISON,WI 53707
H63.090)&Chapter 145.045)
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COUNTY: ME: MAILING A S:
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DATES 013SERVATIONS MADE
T ON: TS:
Residence �N� ❑New;W: Replaco�ILS �k at S r~c � (4tnti"11 L�
RATING:SR Site sukabla for tt�ystem U-Site unsuitable for system
�t N -FILL OLDI G TANK:RE/CO�MMENDED SYSTEM:(o�tionnal)
S a S DY S ❑U INS ❑U ❑S L-ONV� TIOhf 4L F1`�
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
Under s.t163.09(6)(b),indicate: Floodplain,indicate Floodplain elevation: N A
bALPt' PROFILE DESCRIPTIONS
BORING A GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NLMER yam, ELEVATION -O! \r TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B" 6,33 Q7.Z� •Yi7A/ /0.?
z 9.83 ()3.44 r4oNV. 9.IR _ 1_7' LIC s7-- 14"90-SS
B& rz.7S 99.oy Ne r /Z.-75 3.:8tsc 3r''8aN 6S 3Z �-,��.�Fs hst,�-,L 55 , ANC dC
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B- _
B- -
B-
PERCOLATION TESTS
H WATER 1 N HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
FP DER AFTERS LLiN INTERVAL-MIN. _ I PER INCH
3.bo Y. 10 1' 4 �' 174
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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 89.3
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1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and nwilimis soficilied 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:
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DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
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