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HomeMy WebLinkAbout020-1123-30-000 CD N p 6s d M SO M N ti M v ° � a i0 M C X Y C y � � y O C Z 7 c _ LL c N O_ m I, Q O 3 Cl) v 0) Z y rnW E Z'% = 0 Z °' W am z j 0 c t7 0 cu 0 Z a c c zp 0 01 r O` .y. Z O N F- T a Z c E n N (D N y •1V i d fn s o p co O O z w Z [o Z o N co Z cm �l V E 0 N N O Om r.. N c 4 0 N a) 0 O N G G a a) L N W N N N N O w d 65 O O 000 zo •N aan. 0 CL to V o coo 000 y y O O } 2 0 N .-. O O O N O f� � N O N N d N J co y C I O) N d Q } (n (0 'd — 10 O O O Y N C E c N ] N 0 O O 3 c Q a. o °O 0) m y £ O c a N N N 4 C U) O' N d 7 - N N W U CJ • N n O O C O O OT.� 0 0 = CA d m € n 3ik a ` ate A V a O U) v -, Parcel #: 020-1123-30-000 03/31/2005 03:23 PM PAGE 1 OF 1 Alt. Parcel#: 07.29.19.550 020-TOWN OF HUDSON Current i X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): "=Current Owner STRAND,ALICE B, &R D STRAND ALICE B,&R D STRAND STRAND 421 KRATTLEY LA HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description *421 KRATTLEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.880 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 21 Block/Condo Bldg: LOT 21 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1110/150 WD 07/23/1997 806/473 07/23/1997 790/506 07/23/1997 705/348 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 48639 287,100 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.880 38,400 183,700 222,100 NO Totals for 2004: General Property 1.880 38,400 183,700 222,100 Woodland 0.000 0 0 Totals for 2003: General Property 1.880 38,400 183,700 222,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 116 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 PUMP CHAMBER Manufacturer: /V A— 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,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). -- -- SOIL ABSORPTION SYSTEM Bed: Vw'f;0. 0.\ Trench: Width: ( rf Length: 3 G Number of Lines: Area Built:_y� Fill depth to top of pipe: '( '2- /e Number of feet from nearest property line: Front, O Side, ® Rear,O Ft . e{O i Number of feet from well: `r'7 Number of feet from building: 3 (Include distances on plot plan). SEEPAGE PIT ' Size: ` Number of pits: Diameter: Liquid depth: Bottom of'seepage pit elevation: .. 1 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 ,(/ Manufacturer: 'V 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: Plumber on job: License Number: 3/84:mj - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Saz /P 211;11a4' TOWNSHIP�4�S ca< i SEC. a` / TO-�7 N-R(/? ADDRESS ede OOH z$Z ST. CROIX COUNTY, WISCONSIN / C_ SUBDIVISION A ��.. �.d S cL LOT Z/ LOT SIZE �•70 ��a ri PLAN VIEW Distances and dimensions to meet requirements of IjHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 'AT.$. i 1 1 � It o 97 ya Tow I• = I Oo.o " 5� o�♦` 8�' L qV HoKs�- al X Sa N 3 to S.E.lort Cor v�F r .� TT , YDIAIVI 1 N �fQ•r A 7 W_V JT INDICATE NORTH ARROW r BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: (�•�� Proposed slope at site: AS. 1 SEPTIC TANK: Manufacturer: Liquid Capacity: 1Q Number of rings used: 2. Tank manhole cover elevation: Tank Inlet Elevation:?-`6S. 1(04Klank Outlet Elevation: SS.I0 0 Number of feet from nearest Road: Front 10 Side 0Rear, v1p0 feet From nearest- property line : Front,0Side,®Rear,0 Jr�, feet Number of feet from: well 8s' , building: af,i"."\ mwc.,V%cV �- �����p'►-�" "1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS L'''ABOR&'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P:O."B'OX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE1,4,SE,jS7—T29N—R19W UCONVENTIONAL El ALTERNATIVE State Plan l.D.Number: • i (If assigned) Town of Hudson P Holding Tank ❑ In-Ground Pressure ❑Mound Lot 21 Eagle Ridge � ! NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Sam Miller Route 1, Box 282, Hudson, WI 54016 ae6u � � � S 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: Douglas Strohbeen 5432 St. Croix 99113 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: D �Cp I V YES S 1:1 NO DYES XNO BEDDING: VENT DIA.. VENT MATLL. I'TJYES H WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH d ARM r/���y� LINE: A AIR INLET:FEET DYES �O / CL KENO NE REST 1/00 O �rJ /Q DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES 0 N p DYES ONO EYES ❑NO GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL NUMBER PROPERTY WELL. BUILDING:JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES 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: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIUE CIA.. #PITS. LIQUID 80/TFt0NCH, (� TRENCHES 1 MATERIAL' PIT DEPTH: 'IMENSiONS I Y/ _ `- GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO. ISTR NUMBER�F PR OPERTV WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER ELEV.INLET ELEV.END. PIPES: 'LINE: AIR INLET: 11 4- 9� Q3 9i,49 a��� NEAREST ' qo 4 -�3 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. DYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED :EF TOPSOIL SODDED. SEEDED. MULCHED. CENTER. EDGES. 1:1 YES El NO 1 1:1 YES ❑NO El YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: .BL^3./TF#FrNCI'I WIDTH: LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. E'��M�N�FCINS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.. DIA.. ELEV.: PIPES. DT: ELEVATION AND DIS'F .ITION NF©Jq'MATFON HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ❑YES NO 1:1 YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMSER OF PROPERTY WELL: BUILDING: SFEET FRk1'M LINE O ED ❑NO DYES ❑NO NEAR '� A a�� of 13.1 O �-1 + 13 '3 13 �� Sketch System on I '3 Retain in county file for audit. Reverse Side. SIGNATURE: 3 TLE: Zoning Administrator DILHR SBD 6710(R.01/82) 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; Il. 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 meter—! included the creation of surcharges (fees) for a number of regulated practices which WisCO iri=s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TeaSt!#B! a is used in your building is returned to the groundwater through your soil absorption system or the disposal site used b ° Y p y 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) SANITARY PERMIT APPLICATION °OUN I .HR In accord with ILHR 83.05,Wis.Adm.Code STA 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. [FOR ETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. VARIANCE ❑YES L� NO PROPERTY OWNER PROPERTY LOCATION i �� '/a S 1 S TZ , N, R/ E(o W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,ST TE ZIP CODE / PHONE NUM2BER CITY N/E.A EST ROAD,�L�K R LANDMARK S��I�o 7IS jj4.7769 ❑ VILLAGE : D rf 4 �!/!��FZ TOWN 11. TYPE OF BUILDING OR USE SERVED: 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. X 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. 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. ❑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): (.o(S -7 7— 4,410 S -7 T 8' Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in gallons Total #of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New xisting Gallons Tanks structed::F Tanks Tanks Septic Tank or Holding Tank I Y Ll 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: � .5 l icy 4 g Plumber' Address(Street,City,State,Zip Code): Name of Designer: St/ ti � cc Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# g D 6 Phone Number CST's ADDRESS(S reef, ity, tate,Zip Code) IX. COUNTY/DEPARTMENT USE ONLY I gent Signature(No Stamps) IHDoiwsapproved S nitary Permit Fee Groundwater ate S rcharge Fee Approved ner Given Initial I a. k) � `� /04_9�.�..$ Adverse Determination O� C/V V X. OMMENTS/REASONS FOR DISAPPROVAL: ICU, a.v�Lij-d b� rc�c� j .�.1-e�.Inc /o SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber M 1 j APPLICATION FOR SANITARY PERMIT STC - 100 his 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 _,S&,oW , ���✓ Location of Property l/ alt, Section ? , T_Zj N-R W Township Mailing Address / �O�r L$'Z-- Address of Site !a f/. ` '�- / ,�l - / �,r /� /L. z Subdivision lime 47d sc/�- d Lot dumber & 7- 1 Previous Amer of Property 99E9 /fi t Z c n ; a 7Lo S 96 Total Size of Parcel Date Parcel was Created Z. 4•---7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? /r Yes No volume �g0 _ and Page Number .5-O'(i as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq 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 1 IWO co-Ati.6y that dtt Atatement�s on thin ane thue .to .the best o6 my (ouh) hnowtedge; that 1 (we) am (ahe) the awnerc(,5for the pkopexty dezchi.bed in .this in6ohmati.on 6okm, by viAtue 06 a wamanty deed rcecokded in the 066.ice 06 the Cc mtyy RegiAten o6 Ueeds ah Document No. t ; and that I (We) pheAenttCy awn the p4opos¢d hite 6oh .the sewage d"004at eys em (OIL 1 (we) have obtained an Eaae„ent, to hun with the above deAcAi.bed property, 6oh the eonetnucti.on o6 said system, and the same has been du. y recorded in the 066.iee o6 .the County Re9UteL o6 Vttds, as Ooeument No. 41 r, pd Z 1 . SIGNATURE Op OWNER SIGNATURE OF CO-0 ER (IF APPLICABLE) Lb D - 1 AIE SIGNED DATE SIGNED } 1 y t ✓ d atc+w L• h? a' M i­114K v.� a vo � Deal �arik cif 3it. .i►aal, a _.; oas �. T 1 } w �� ... ,.. :. ..... .1... ................ ............ .....w. gY ...-.. -.: .x.•i .G......... ..... ......a............... ....... .. ............ .. .. k ........... ... x tti x Lot 71. Eagle .Ridge in the Town of sadson . a` e j k fr r ^'a Mzt�titiw I Rana"*Ming ordinspoet s � � alt iti s lMotbol adjacent to side and re1lr~ ; i la bus restrictions and counts a Awl G/Q 491CAL1 .. STA'1's OP *# $, .... ......�. ..... ..a I _...W..... ws oi .............. . ......... p ►xL Q�. R a e ii►s�ai'wiacxi x ............. H z . a I ST C - 105 r' a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 H OWNER/BUYER ROUTE/BOX NUMBER / l3aXf ? S 2_ Fire Number CITY/STATE !�� I � crr �i� S ZIP PROPERTY LOCATION : ,S 14. Section_, TAN , R� Town of . St . Croix County , Subdivision ,rL �9 _� Lot number 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 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 H three year expiration . o E z I/WE, the undersigned , have read the above requirements and agree C„ to maintain the private sewage disposal system in accordance with rx, the standards set forth, herein, as set by the Wisconsin Depart- 'b 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 . JL_ SIGNE DATE 7 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 . • • + n INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired;' 3. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; S. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. if the information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures tither Symbols s - Stone (over 10") BR - Bedrock coin Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS -- Limestone S - Sand HGW - High Groundwater cs - Coarse Sand Perc -- Percolation Rate coed s - Medium Sand W - Well fs Fine Sand Bldg - Building Is -- Loarny Sand > - Greater Than `sl - Sandy Loarn < Less Than { - Loarn Bn -- Brown �siI - Silt Loarn BI Black si -- Silt Gy -- Gray `cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl = Silty Clay Loam mot Mottles sc. Sandy Clay w% - with sic - Silty Clay fff - few, fine, faint Clay cc - common, coarse pi - Peat rnrn - Mally, medium rn - Murk d - distinct p -- prominent- HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP 'Vertical Reference Point TO THE OWNER; This soil test report is the first step in seccrrinq a sanitary permit.The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private serwaige system ar�cl a permit application must ire submitted to thy. appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS ,INDUSTR,Y, c DIVISION HUMAN PERCOLATION TESTS (115) MADISON W153707 HUMAN RELATIONS (H63.09(1)& Chapter 145.045) LOCA 1 10 e'-,/ SECTION: for TOWNSHIP/ FP�tty fY: OT NO.:BLK�r VISION NAME: oN COUNTY: OWNER'S BUYER'S NA/ME: MAILING ADDRESS: USE DATES OBSERVATfONS MADE NO.BEDRMS.: MMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: EFI O ATION TES CO TS: Residence 3 A/ .New ❑Replace I 9/ - s7-- d 7 S0"/tilA�O 4 6a / O RATING:S=Site suitable for system U=Site unsuitable for system c �`j,I f k6 c'-17'-/0.1 /� LOS CONVENTIONAL: MOUND:I )FRisou jI, -GROUND-PRESS SO RE: SYSTEM-IN-FILL OS GR]U TANK:RECOMMENDED; TEM:(optionpl)CalUVea If Percolation Tests are NOT required DESIGN RATE: [Floodplain,any portion of the tested areais in the under s.H63.09(5)(b),indicate: indicate Floodplain elevation: PR FI E DESCRIPTIONS tt BORING TOTAL/ DEPTH TO GROUNDWATER-1 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH4ft7 ELEVATION OBSERVED EST- IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / . / 1p�/Q v •7 B- d r D Q .6 ,8/-r,'/, �,6 Br S;/, .S Bv,S l� y.3 t3� c S r a 7 ome_ O , 9 r/�( �j 3 !/n S/,. -8�h /GS , 6 VA ex B- 8.0' L 3 a�, Wi/EU e- / O / h S B- y �O ' 9SS' � 7 . c�� .St3l S•`/, 3, 6 Bh s'11 CC, p�? B-J /d' V � / O f •S�'!/s.'� /.O ij si/� /� h QY.S � � /( ." &s� 7 ' IV, PERCOLATION TESTS i` �Q ��6 ►-► TEST DEPTH+, WATER IN HOLE TEST TIME DROP IN WATER LEVEL N111 HES ATE MINUTES NUMBER-4A1CJ3ES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH P 6 < 3 P- 9' o P-3 3,Of d .�3 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 (P ' f,a Gtr L +1 t t E . � 1 Q2 v i v. i __ ► _ � , - _ 4, _ v r d rt _._..._. a " � $•M. __.. _ _ 1�� 3 j i 3 -- © _�_ E i 3 � ► I I e � s 1 � s I I To MA.'-- 7-44A, &r6-44/O!� Xe44 cci`reM� 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: ADDRESS: E// / I� / /` / CERTIFICATION NUMBER: PHON NUMBER(optional): CST GNA URE: v DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS ,INDUSTRY, C DIVISION BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (1-163.090)& Chapter 145.045) q LOCATION:,(1/ SECTION:T�9N/R// �(or TOWNS��Nf6}PAtFTY: o02T%O.:BLK_ .NO.: SUBDIVISION NAME: Q_ d/ COUNTY: OWNER'S BUYER'S NAME: MAILIN9 ADDRESS: Ile 1;�Vaf droohr s/ ati ttjt's' 5-yalc v USE DATES OBSERVA ONS MADE I'll NO.BEDRM COMMERCIAL DE R PTIO �O f! - STS: esidence New ❑Replace� R �O d 7 — RATING:S=Site suitable for system U=Site unsuitable for system G �`6 o �•'/� /Q/g/`, CONVENTIONAL: MOUND: IN-GROUND-PR URE: SYSTEM-I -FILL O DING TANK:RECOMMENDED SYSTEM:(optional) ( p 1 $ ❑U $ O Z S OU ❑S .®U O S .®U 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: I Floodplain,indicate Floodplain elevation: 11(l//q PR FI E DESCRIPTIONS e BORING TOTAL/ PTH TO GR U DWATERINGIIES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH4.W ELEVATION OBSERVED E T. IGHE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) i B- pOi �' Alnue_ C)f '7 l3l S , /. P r `7, o t_ �, .GBls%/, 2.6l�rS%/, •SBnSI, y,3 On eS B- � ro 7 0 B- 3 •�' �.�� �lo,� 7 0 , /.3 d 5/, .80h /c- , • 6 Brat Gx s B- y o ' ,S S' 7 C7 ..rol s%// 3. 6 dot 9 r • B-...5 7BA PERCOLATION TESTS r. ?" i J a, L-3 DEPTH. WATER IN HOLE i OL TEST TIME DROP IN WATER -EVE CHES , RATE MINUTES NUMBER AFTERS EL I W LNG INTERVAL-MIN. P D 1 P RI PER INCH .O' 0 ,C .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 "? . 0 r v .� �l. ._ p3 ( _ __ . __ _l± _ U -J:___._ ^ ._._ t.. _ � X ` __ ,. ---.Pow _ _s _4 �✓ t Z__ {{-- oil ' i 6 0 de ; Q I O. tN e_ t% e o I I I o• ! cud_ o .__ �-` .0 _s.. To Mai•i� YAi N (/�I'f i`Ci4�0l� i �QcQ([t`ht 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: - -- if ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optional): A r ce C66A.4 Cl/,f /log S 7�j= C CST GNA URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. 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