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HomeMy WebLinkAbout020-1125-60-000n m p c :: ~ ~ ~ ~ ~ ~ ~ 3 I I w I ~, ~ ~, o ~ I ~ O ~ ~ ~ Q ~ ~ (~~ N ~- 7 d W W c_ 3 ~ O Q W O N N a j C~'1 ~ ~° ~ ~ ` I m p ~ ~ m 3 I H N w y ~ cn I ~ cn Z D ~ ~- ~ I u? -< D m ~n D ~' a ~ ~ u~i ~.. ~ C Q I W ~ co P O a - .r i p V ~ I O N N O O O c y n o I ' - O O O ~ z o' ; ~ ~°°~ I ~ ~ ~ ~ ~• ~ I r ~ ~ .. m O I - o N ~ C ~ M y z Z ~ Z D ~ O I O o ~ m cn ~ I m' S m ~ ~, m y C CD N O (D C ( p ~ C . ' W ~ a ~ Q ~ 7 ~ z ~ ~ j i ~ N to C v~ a I ~~ I ~ ~ I o. 3 I c r: I N ~ W < fD ~ D 7 m I ='o D ~ ~ ~. ~ ~ I o r. f ~ °~ TI , S d ~ m sv_ c ~ v_ o a I < m o ~ ~ I ~ ~ ~ o °' I .~ > y ~ I ~ O ~ fD I 3 -' OD a I x ~ W W fD Q i O ~ a I ~ I ' K O O m I m p p ~ ~ n cn p 3~ n d ~ d f 3 ~ 3 ~ d c ~ ~ 3 A ~ 1 ~ I ~ d ~ ~ ^ ~ ~ ~ ~ ` 1 ;.• i ~ 0 ^s W ~p N N 'O I~1 fA 7 J ~p N O ~ ~ ° ~ o ~ N Q ~ ~ O 7 N » ~ . p 3 C ~ ~ a ~ ~ o -+ O d ~ ~ _ O O C °' (~ N 3 3 ( O w w ~ y ~ !~i ~ 3 .. ~ O ` i l rn -1 ~ ~ w nmi l ` l N N fIl f° vvv, `° fD ~ ~ ~ ~ a o i .. m ~ N Z ~ Z ~ O D a ~ ~ ~ N i i ~ ~• d C N ~ d 7 ~ ~ Z N A C TT ~ N a? ~ n A ~ ~ Z ~ ~ W ~ ~ e o a ~ 2 -~ ° o s' cn B y m ~ _ W I T c a i i x A 'V` ' y A n w ti N O A A ~e+ G Q ` , ~ O ~`+ A y ti y Parcel #: 020-1125-60-000 03/31/2005 04:00 PM PAGE 1 OF 1 Alt. Parcel #: 07.29.19.572 020 -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 *REIDENBACH, JAMES J & BETH C JAMES J & BETH C REIDENBACH 355 MILLER RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 355 MILLER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.780 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 43 Block/Condo Bldg: LOT 43 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 755/385 07/23/1997 677/219 9(Ifld CI IMMARY Bill #: Fair Market Value: Assessed with: 48662 224,100 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.780 37,100 136,300 173,400 NO Totals for 2004: General Property 1.780 37,100 136,300 173,400 Woodland 0.000 0 0 Totals for 2003: General Property 1.780 37,100 136,300 173,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 312 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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and'Building Divis'bn ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Riedenbach, Jim City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM DISTRIBUTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 23 State Plan ID No: Parcel Tax No: 020-1125-60-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER Y Procenro Cvc4omc Anly YY Mnimrl [)r At-Grade SvStemS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedtrrench Center BedlTrench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: ! !- Location: 355 M[Iler Road Hudson, WI 54016 (NW 1/4 SE 1/4 7 T29N R19W) Eagle Ridge Lot 43 Parcel No: 07.29.19.572 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [] Yes ^ No ~ Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER ! _ ~i~ i i _ +'e1~ [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016-7710 f f J v (715)386-4680 Fax (715)386-4686 Attach complete plans for the s alter less than 8-1/2 x 11 inches in size. County Sanitary Permit # `flg v'Isioa(t ~t~e ' us application OO 23 a~~ I. Application Information -Please Print all Informatio '~+ .. ~ Location: Property Owner Name '~°•. ;'' ^~ --t , 1/4 ~ 1/4, Sec, ` i 'e ~C, ~ G`am' s ~ .~ ~~ I{ 1 ~ ~Qb~ ~w T Z N, R Jam( E (or) W Address zy~ ~~ Property Owner's Mailing ~ ~" Lot Number Block Number ` ~^ 1r~~ .~ 3 S J 1 ` `~, t~„`-~, r.-'\. ZOIVFNGOFFtCE ,f,r~ ' City, State Zip Code C fe,IJumberl~~, / + ~ Subdivision Name or CSM Number ~. 501 G ~ . ^-' ~ `~7~ 5 II T pe of Building: (check one) ^City Village C~Tow o 1 or 2 Family Dwelling - No. of Bedrooms: ^ Public/Commercial (describe use): .,. ~ 'ilo ^ State-owned Nearest Road Check box on line B if applicable) pe of Permit: (Check only one box on line A II T ~ . . y Parcel Tax Number(s) A) 1~iRepair 2. ^ Reconnection 3.^Non-plumbin 4.~Rejuvenation Sanitation ~Z ~ ' - bOCl B) Permit Number Date Issued ^ State Sanitary Permit was previously issued 7. a1 q ~ ~ ~ ' S7 IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other . Dispersalfl'reatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation y ~' . 9 . zz I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks o ^ ^ ^ ^ ^ ^ ^ ^ ^ 11. Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Name (print) ignature (no stamps): rtdFPfIV1F'R'3-td~ Business Phone Number ,R a ~~ Tl~-3~6-Z/3o Address (Street, City, State, Zip Code) III. County Use Only Disapproved Sanitary Permit Fee Oate Issued Issuin Agent Sign lure (No stamps) Approved Owner Given Initial Adverse ~ ~ d~L~ 2'S ~ ~' Determination IX. Conditions of Approval/Reasons for Disapproval: (~ /' r_ I -~p ~ f9-~-Ccsx L~ ~"~ is ~. Ba (~/ 0~2.*.eMllst~8'V~ ~J~ ~ ~ ~ S`y ~.~pM+~, ' ~ l w ~1~, v~. L.b~ 4~y 0 ~: ~ '~tl I ~- ~Y. ~ S 1 S ~ Y~uc-a bC ~~ ., ~ • Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County < include, but not limited to: vertical and horizontal reference point (BM), direction and ` percent slope, sale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ~, o. Please print all informat/an. a awed , by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Prnne.h. n......_ n ... . Page of Z ~! zs • ~o • oao ~ Date j~ Property Location - ! ~ `~ ~I M ~ t E D~~ ~+ ~ ~ Govt. Lot N~ 1/4 5 ~1/4 S ~ T ~'/ N R 19 Property Owner's Mailing Address E (or) W 3 SS /~'f%~~~Q,. pD • lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ~~ ~~~~ /e~•Di~~- - r7V ~.S'~~ ~/. SYo~~ (~~) ~~~ . 7SS ~ ^ City ^ Village ®Town Nearest Road vOSo,rJ ~Ii//~ ~~ • [] New Construction Use; ~ Residential / Number of bedrooms /~ ._~_ Code derived design flow rate _ 7 _ ~Q GPD ^ Replacement ^ Pubitc or commercial -Describe: Parent material DU vv Flood Plain elevation if applicable _ ~(/ ~ ~_ R General comments and recommendations: ~ SJ T~ ~ SO%L ~-(fA~U ~ Cowrl ~i',¢,v ~ ~ii~' ~f'~Tvviv,~-rlov ~o~~ss - `7t-~~, ~4 'G~' /,v ~. ,tr ~- Ground surtace elev. ~v ~Z~t, Boring # ^ Boring ^ Pit Ground surface elev. ry. n Depth Dominant Color Redox Description in. Munseli Qu. Sz. Cont. Color 'Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L Please Print) ~~ R E R r ~~~ ~,~ ~ ~ Signatw Ulbricht 8 Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ©Boring # ^ Boring Pit Depth to limiting factor, ~< 0 l~ Effluent #2 = BODs < Date Evaluation Conduct !`~A-13/-~-00 ...J and TSS < 30 mg/L CST Number 22Cc3~S ~is•3~~•~l~~ i '~ Depth to limiting factor in. Horizo Soil AppNption Rate Texture Structure Consistence Boundary Roots GPD/fl~ Gr. Sz. Sh. 'Eff#1 ~ •Eff#2 r_ t i1 3 1~~~' >~ ~.. 0 I I~ ~~~- . a~ M ~ S ~ '~ ooa~ r9,~y~ l 3L sso~lstes Itanta Ulbtlcht$e s0e ~0nsu pryvate ell Rd• 665 ~ N Wls. 5401b Hudson, I ~z~3 MP~~ , of nn l 0~ ~~ ?~,2~"' ~-- . i .------ 3 a --~. i~ •x 3~ ,aoo L CO~~ Cd,.~~ ~i ~,~ T /~it'~if5' T S. T • l ~.e sv~~ ~~- 3 ~' ~s F ~ ~ ~ o g8.sz ~ ,~.~ Tyr ~~ Y ~.~. v..e~,~f G~. ~~•o' ~~ IS ., ,. i1 >~ ~~- p. o~ n on k l ~ t 1~L gspciate$ Ulbtlcht 8e 9e Oonsultanta a ptlvata •N Rd. 540~8 855 O N Wls Hudson, ~'~~ ~ zzC~3 MP~~ , of ~~tGr~'~ ~I 1~.ti2" r- .--- 3 a - iQ '~ 3C~ ,aoo L /~~~.~' T s, 7-, 3~~ ~s i F I i ~ g' ~ / . ~ ~ ~ s ~s,~~ ~5. yo ~ ~ o ~g.5 Z y ~ . ~. U..ei~f `~~' ~e~•o' ,, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .~ , Tr ~Zre- ~~ ~+~h Mailing Address ~ S'am' ~~ ~ ~ l.u ~_ Property Address ~- (Verification required from Planning Department for new construction) City/State ~~ v.C.So c.3 , W s , Parcel Identification Number V 2 C~ - 17 z 5 ' ~ y ' ~ LEGAL DESCRIPTION Property Location ~~ '/a, ~ '/,, Sec. _Z, T Z ei N-R 1 ~,W, Town of ~~.. c~ So ~ 1 Subdivision ~ ~ ~ 1~ ~ ~~ ~ ,Lot # ,~_. Certified Survey Map # ,Volume ,Page # Warranty Deed # `~ ~ ~ S °1 G ,Volume ~ ~~ ,Page # ~ ~~ ~ Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification fortri, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wasteRraterdisposalaystem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the about requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ,~-days o~ the three y xpiration date. ~ ~ A OF PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property des e, by virtue of a warranty deed recorded in Register of Deeds Office. ~/ ~ 7/ .~/d /' SIGNATURE APP ICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~0 ~ ~~ 1 i NAGE 4~c~ Title St. Croix County Affidavit of System Rejuvenation ~J~ht~S ~l , ~Ef.DE,J,asFC,~{ Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following arcel of land located in St. Croix County, Wisconsin, recorded in Volume 7 5~~ Page ~ g~ Document Numbed 175 9 St. Croix County Register of Deeds Office: A parcel of land located in the~~ ~/, of theme %, of Section ~, T Z~_ N - R ~~ W, Town of ~-(y~l .y,,,~y , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): (.. c~ fi ~ ~ t E`aSl-~ `R'~ ~b-'~-i (v~..~ c: ~ E-1..,1so.-'t s^i . C ~a ~ 74 CU~a~~ (/ l.iJ'~S Co•~S'~1 _ 65077 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI f~CEII~D FOR RECORD 47-10-2001 9:15 AM AFFIDAVIT EXEMPT # CERT COY FEE: COPY FEE: TRANSFER FEE• R~E~DING FEE: 14.40 Name and Return Aatd:es J a,~-~ 5 Z :~c ~c.~~o o.~h ass rr.',11ar '1Z~. vZo' IlaS-Go-ooo ~ Parcel Identification Number (PIN) As owner of the above described property, i acknowledge that the septic system serving this residence (is I~t) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. I also acknowledge that I will make this information available to any future parties interested in pruchasing this property. ed thi Z ~ ay a.~~lL 2~ I AU ENTICATIO ' Signature(s) ~ f T+1-t t~ ~ ~ I~ t ~ ~ ~~+ b4t this TITLE: MEMBE AR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY ~.,,~.~~ \~~r ~ ~ ~er`cb~.~.~, ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County. ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter. document title. name & return address. and ~ (if required). Ofher information such as the granting Causes, leagal description, etc. maybe placed on this first page of the document or may be placed on addiGona/ pages of The document. Note: Use of this cover page adds one page to your document and 52.00 to the recordino fee. Wisconsin Statutes, 59.517. M i DCN:SJR?ENT NO. ~ STAT& BAR OF RISCONSIN FORM 1-19A; ,I~ *"'• slACa Rp[RYLO 1011 MCORDINe DATA WARRANTY GEED ~~ ~ig'7~ , ~~ REiiSTBtS OfF1C! ~~i~ t~1/~ CCam/ . .,. --_~ RELQ 111L_i..._~~~J_/-. ... 7-. _ __.. .: Ut1ti;- -r ~r11UL~~., _- 1i $T1 C.ROIX O~ nhl/ ESCROW NO: EC$6~6[~. -BJM Recd. fix Reoord !Ns 1st This Deed, made between ..-DAVID.•M.•.-~!IALONE~-•JR-.••-AND ...--.--..-.CYNTHIA.-J-,--.MALONE,~.-.HUSBAND.---AND.-WIFE-~__-AS-_---_ ay 01` Qct,,, A.Q 19$6 ........... ...........•-- ----...-•------..._...-.....---.... --_...------•----..-..---•--....., Grantor, rnd ...JAIL ~ ._~r.~~..~'i.:._.R~~+~1------------------ :AI`1R..~'iZk~,..:AS..SIJRV~~R,4FI~P..MP~Z~AL..Pl~JPk~----------- o..r~ V1Titnesseth, That file said Grantor, for a valuable consideration-...._ Oc>~..Ao7..l.ax.._.(.5~..-Q0.)...and..s>'.t~het..good-..and..val.uab.Xe.._corls~der~tio~n _ __ - ~ R[TURN TO conveys to Grantee the following described real estate in ..._ST,...CROIX-..-... Couniy, State of Wiacon~in: LOT 43 EAGLE RIDGE, TOWN OF HUDSON, Ta: Parcel No : ................................... ST. OUNTY, WISCONSIN. :-,f~'V1JF~ ~~ y_ 7~TJ 0 This --.-----• ..............•__-. 6omeatesd property. (ia) (ia not) Together with all and singular the hereditamenta and appurtenances thereunto belonging; And...DAYZD..M,_-.MALONE.,...JR..._AI`tD_.CXIITHIA..~I~._14SgLONE-------------- ---------------------•.--.-----..._ warrants that the title is good, indefeasible is fee simple and free and clear of encumbrances except and will warrant and defend the acme. -•---•-••--•--• .....................• 19 ~~.. '' Dated this --••------...---•---- -------•------3~--~- day of _52DlEm~~.-- i .(SEAL) ........(SEAL) ~. ~ --- }~~- -r-•------•-••-•-•- i~ D ID M._ MA ONE __ li r ------------------•-------••---•-------•-•-------•---•-------------(SEAL) x--- --- . ...__.ar _c-- i~e"4S:C.E:.~-Q~-----(SEAL) CY HIA J.LONE ,,. ~ .. ii AIITSSNTICATION ACHNOWLSD(iMSIt'r ~~C~~ ~ :_ 1 ~ ._~ Signature(s) STATE OF WISCONSIN .~; d ~ .,.,- ~ : i~ ~ ~ ~ ®~ •~~~ti antheahcated this ______._day of___________________________ 19__..._ Personally came before me this .:!if_ ~tt••` ---~?~_'(!'-'-~'-r------•----.., 19.$b.._ tpe ~>'iboSDed TITLE: MEMBER STATE BAR OF WISCONSIN (If not, --------•-•--•---••---•---•------------•-------------_..... -•--•----.....-°------------------------•-•--••---•--- authorized by ~ 708.06, Wie. Stata.) to me known to be the persoa S___.____ who ezecuted the .'~regoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ~i~~ N ~ - Vim( i11~~~,~^ V. "PREPARED SY ANTHONY ZOM80LAS' - --/---•-----__-•-~" _ --•••-------•-----------------------•----------- '~ - ----- Notary Public __.-..___ ST.C1~0/X o y ra~~.IRn,>•P,~ nIAV hP AI/t}IPnNPA}P(I nr APirnnmlodewi_ Rnt6 My Commission is permanent. (if not, state expiration . .:.....:...:.:_..: ~--- , t ~~ " ; .- - ,~ ~ i .... . ,ti ~, \~ Wisconsin Department of Commerce ~~~•EVAL~ ION R Division of Safety and Buildings ~ EPORT Q ta~1 `,-- in a1'~' rdance~wit~i Otimm ~5, Wis. Code Page of Z `° " County ~,[ , ~! Attach complete site plan on paper not les t 8 1/ x 11,' c u , 1~ ?~( 1n(sizp. P n ust include, but not limited to: vertical and horiz Ck~ference p f ~~1~FeciiQn nd percent slope, scale or dimensions, north arr Parcel I.D. . ~-d, Iota ' istance C- crest road. ~ 0 . ~~ZS • ~Q • 00 Please print all fn~rmation. , ` R iewed by Date ~. ~~ ~ .~; Personal information you provide may be used for seconds * '` ~' Peres-(P_iivacy Law, s. 15.04 (1) (m)). / ~ Property Owner (~ j~ ~ / Property Location ~j ~~ M 1~ t E D~~ h.~ ~ v~l/ Govt. Lot /~/~ 1/4 5 ~1/4 S ~ T Z'/ N R l9 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 ss .~-li/172- ~I~ ' y3 E'~G-!~ ~i v~-~"" - Clty State Zip Code Phone Number ffUDSO~ ~/, SyO!/ (~~) ~ `~ . 7SS, ^City ^ Village ®Town Nearest Road ^ New Construction Use: (,~ Residential / Number of bedrooms - ~ Code derived design flow rate Q ^ Replacement GPD ^ Public or commercial -Describe: Parent material O(J Q~J Flood Plain elevation if applicable __~~~- General comments ft• and recommendations: ~ s~ T~ ~ SOS L ~'Uj~~vf.~o~ ? lf~`~~~~'O~T fO n.1 e~ CO~`C- ~,~rr /~'~,v t'e, ~vi2 ~t'~`~ vviv~f-rlov ~O,ep~ss - _ `Tt-~~ •~ • ~i~'Tiv~- ,. ©Boring # ^ Boring ~~ Z~ ~ ~,,,pi( .Ground surface elev. h, Horizon Depth Dominant Color Redox Description in• Munsell Qu. Sz. Cont. Color ~ o•Z3 Hoye 2 -- fig - n ~~ O /N ~' ~ e`D 2 L 7, S --~ 7. s ._-., ~--- ~-- Boring # ^ Boring ^ Pit Ground surface elev .6 Private~Sewage Consultants 655 O'Nell Rd. Hudson, Wis. 54018 Depth to limiting factor ~` D in. Texture Structure Consistence Boundary Roots Gr. Sz. Sh. SL / S ,~ n'r-fiQ 2~G Zf _ se ~ .S. /f ~ a 2 ~- a-Fsb i+-~fi' ~s D_ _ca ./ 0 _ ft- Depth to limiting factor i., Soil Application Rale GPD/ft~ 'Eff#1 'Eff#2 .y . 7 .~ /, Z, .s .8 . ~ ~. Z r... -~ Property Owner Parcel ID # ^ Boring # ^ Boring page of ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ~ 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. fl. Depth to limiting factor Horizon Depth Dominant Color Redo D i ti in. Munsell x escr p on Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence ' Effluent #1 =BODY > 30 < 220 mg/L and TSS >30 < 150 mg/L in. ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L The Departrnent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. r " r • ~~ O (~ ~/ i~ cow G~. , ley ~ ~i D vn~ 9l 3L ~~'X3f~ boo ~ 3 a _____r Ass a ~onsultanta I Vlbtlcht ~ wa9 1 pdvataNell Rd• H Win, Wls. 54p18 ~ CODS Cd,yt,J G/ i'I'~/ T O ~~ ~ 3 ,~v~~ ~~ MPS , o/ ~ nn l 3~1 ~s . D~ ~ F i ~ i ~ . ~~ ~ ~Ssvw~ ?~ ~ ~ ( ~~'aC3<o ~ ~ ~ 1 ~ o ~. ~ .~, U..eN~f G~ ~o~•o' a .. ~ 'COMMERCIAL TESTING LABORATORY, INC. 514.Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 -962 - 5227 ,, .. 'I ST. CROIX Z[~lING REF~2T NO.: 14991/41 PAGE 1 ST. CROIX COI~l1'Y RFF~tT DATE: 9/18/91 G(~JRTHOUSE DATE fiECEIi/EDI 9/17/91 ~: HUDS~l, WI 54016 ATTN. THOMAS C. NELStk! ',' l~'Z ~ -~' / 2~~ ~ ~ U~b '' - - G t~INER2 James 6 Beth Reidenbach ~~ ~"/, j ~' ~ " LOCATIONS 355 Miller Rd., Hudson COL.LECTi~'ti M. Jenkins SOI.~iCE ~ SAMPLES Kitchen faucet COLIfORFii 4 /140 mt INTERPRETATI{]NS Bacteriologically SAFE NITRATE-NS < 1 ppm Above 14 ppln exceeds the reco~erwied Pub L i c Drinking Water Standard. Cotifarm Bacteriafi00 ml Nitrate-Nitrogen, mg/L ~. ~pDEOENpE Ft pt q.~G C ~` LOp Vi y AO ~~~ SA ~~` 9 1p LAB TECHNICIANS Pae~ Gane ~ 1> WI Approved lab No. 19 ~ E.t"c~ ~~ ~ t, ' o,~ T T ,,~ V C~ ~~ < Means "LESS THAN" Detectable Level Approved by•. ~ .PROFESSIONAL LABORATORY SERVICES SINCE 1952 a .._ • . q !~-9l ~ lo~~( ~~. ST. CROIX COUNTY ZONING OFFICE l0~ „J _ St. Croix County Courthouse ,~1~~j 911 4th Street /~ ~-" Hudson, WI 54016 Telephone - (715)386-4680 The St. Groix County Zoning Office offers the and water inspections to Lending Institutions, private individuals. service of septic Realty Firms, and Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. XX XX time of Property owner's name James J. Reidenbach and Beth C. Reidenbach (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00_ (Determines if system is properly functioning at inspection) WATER TESTING FEE: $127.00 WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) Property owner's address 355 Miller Road, Hudson, Wi 54016 Legal Description 1/4 of the 1/4 of Section , T N-R Town of Hudson Lot Number 43 Subdivision Name Eagle Ridge FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? no If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh.. Tf the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: The First National Bank of Hudson Telephone Number Peg or Jeff 386-5511 ~ .REPORT TO ~ $~N; TO • The First National Bank of Hudson ~\ff •„ 307 Second Street, Hudson, Wi 54016 Closing ~ Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Sept. 17, 1991 First National Bank/Hudson Attn: Peg 307 2nd St. Hudson., WI 54016 Dear Peg: An inspection of the septic system on the property of James Reidenbach located at 355 Miller Rd., Hudson, WI was conducted on Sept.. 16, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the;laboratory... At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any-way warrant or guarantee the continued proper functioning or opteration of this system. It is recommended that the system sh~ltid be pumped once every three years. Therefore, the pr~ionged life of this system may be dependent upon proper >Yta~.ntenance of the system. Si erely, P Ma J enk ns Assistant Zoning Administrator cj AS BUILT SANITARY SYSTEM REPORT 1 OWNER TOWNSHIP ~ S SEC. T /N -R~~W ADDRESS /j''~'^~ ~/'~~'~ ~~ ST. CROIX COUNTY, WISCONSIN. ~~~~So~- 1~/i5 ~'`f~ 1~ SUBDIVISION ~u~l ~ 1 < <~~j (` LOT ~ 3 LOT SIZE ~' -~ PLAN VIEW Distances and dimensions to meet requirements of H63 ' . { SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 i I di at N r h rr w ... .~ ~ '. c `~ / BENCHMARK: (Permanent reference Point) Describe: 1 ~r v ~' ~ ~ f"/"` ~ "- Lvf Go`f'ff'~' ~ ~ G Elevation of v~.ertical reference point: ~~D'6G Slope at site: y -r SEPTIC TANK: Manufacturer: Number of rings on covex Tank Inlet Elevation: I/l/i: Ser Liquid Capacity: ~ O O Tank manhol0 cover elevation: Tank Outlet Elevation: c~~. PUMP CHAMBER A~ nn Manufacturer: ~ /v 'T Number of gallons Number of gal. pump set for a cycle___1t//~ gallons; Total capacity of distribution lines 1y~ gallon: .size of pump /~- head; gallon per minute /t//f horsepower ,/V ;brand name of puc and model number ~(//1- Type of warning device ~/~- T HOLDING TANK: Manufacturer /l/ /~' Number of gallons ~~- Elevation of manhole cover ///~ Type of warning deva.ce ,/1~ ~ SEEPAGE PIT SIZE; ~//} Number of pits /y~" feet diameter /V feeC liquid depth- /~/~ seepage pit inlet pipe-elevation /t/~- bottom of seepage p~.t elevation /I//~ feet. r •3 ti. c.,~ C v c.. ~ ~ ~ ~ `~i ~ ~ `~ \` '~. R' i ~ ~i~" ~ G \ C.~ ~~ 0 ~i;: `ti_ ,~ ~~ ,~_~: l- :~ ~~ ~~ ~~ ~. ~ ~~ ~~ d ~~ -- _~_ ~~ . t .~ n ~- o N b ~~' ~~ 0 s ~~ F .. AS BUILT SANITARY SYSTEM REPORT OWNER~i4~ ~~~e~-- TOWNSHIP G/d a,(~ _SEC.~T,~N-R/q W ADDRESS r~QOCIT ~QDOK Rd~• S`l. CROIX COUNTY, WISCONSIN. SUBDIVISION ~ 14~~E«/~j(sE` LOT 'j~i~ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - ._ . _ . . l _ I di at N r h rr w i BENCHMARK: (Permanent reference Point) Describe: Slo e at site: ~ Elevation of vtertical reference point:~OJ- (~ P SEPTIC TANK: Manufacturer: ~ZlS e r Liquid Capacity:_~ D 4 Number of rings on cover ~ Tank manhole cover elevation:9",_sS" Tank Inlet Elevation• 9 y,z,r Tank Outlet Elevation:C~ y,p z PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pur and model number __ Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. t DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslo P.O. BOX 7969 BUREAU OF PLUMBIN MADISON,iN,I 53707 ~, C~CONVENTIONAL ^ALTERNATIVE State Planl.D.Number: ^ Holding Tank ^ In-Ground Pressure ^ Mound (lf assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: } ' ~ D 3 ~ Sam Miller Trout Brook Rd. , Hudson, WI - ,- d J ~l~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. SW SE,Sec.7,T29N-R19W, Lot 43,Eagle Ridge,Town of Hudson ~'~~.~ Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 38535 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ~ LIQUID CAPACITY: TANK INLET ELEV.: TANK OUT LET ELE V.: WARNING LABEL LOCKING COVER ` PROVIDED: PROVIDED: ~„?~ i YES ^NO ^YES NO BEDDIN G: VENT DIA.: VENT MAT L.. HIGH W ATER NUM BER OF ROAD: PROPERTY WELL: BU ILDING: L VEN TO F ES ^ /) /- ALARM. FEET FROM LINE: _ jl Q ~ ~ AIR 1 ET~ YES NO 1~.. ^YES ^NO NEAR EST ~/ v DOSING CHAMBER : n ~% 1V~ ~ % ~ r3` MANU FACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUF ACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTRO LS OPERATION AL NUMBER OF PROPERTY WELL: BU ILDING. VENT TO FR ES (DIFFERENCE BETWEEN FEET FROM LINE. AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE I FNt,TH UTAM ETER MATERIAL ANO MARK wG or excavation. (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN Cfl1UVFIUTI[IIUAI CVSTFMr BED/TRENCH DIMENSIONS WIDTH: LENGTH: ~ NO. OF ~ TRENC DISTR. PIPE SPACING: / (/f/ COVER M PIT INSIDE DIA.. St PITS. LIQUID DEPTH: GRAVEL DEPTH FILL DEP H DISTR. PIPE D R. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRES BELOW PIPES ~ ABOV~VER. ELEV. INLET. ELEV. END. ~ PIPES' FEET FROM NEAREST--~ LINE: ~ ~ AIR INLET: MOUND SYSTEM: Mound site plowed perpendicular to slope Check t'f,etexture 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. 7'IONS MEASURED. ^YES ^NO SOIL COVER TEXTURE. PERMANENT MARKERS'. OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED. CENTER. EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: LATERAL SPACING: GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.: DIA: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECT LV COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS : OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^NO ^YES ^NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DI LHR SBD 6710 IR. 01 /82) DEPARTMENT OF ` APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANRARY DIVISION LABOR A1VD PERMIT P.O, BOX 7969 HItMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/Z x 11 inches in size. lnctude a plot plan that is dimensioned or drawn to scale. Horizontal and vertical. elevation reference points-must be shown. Ali appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown.. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: ~~ ~ I / !P/ Mailing Addres1s: oo ~/~~ ! ~~ ~ !mod sfik (~ lS ~~~G b Property Location: 5~/4 S~'/4S 7 iT~ N/Rl or)W [~ i~u~~o ~~ Township: t 4a~Su+1 S County: ~ ~.tQi,(~ LotQNu/mjber: / J Blk No.: Subdivision Name: J~ J ~Q ~C~ I Y I Q ~p Nearest Road, Lake or Landmark: ~~ q-t+{t ! a ~ F. State Plan hD. N_ umber: (lf assigned) ,~ ,g- Number of Public* ^ Variance* ^ Other (specify-* Bedroom ~1 or 2 Family *State Approval Required. TOTAL GALLONS NUMBER OF TANKS PREFAB CONCRETE POURED-IN PLACE STEEL FIBERGLASS NEW INSTALLATION REPLACE- MENT OTHER (Specify) SEPTIC TANK CAPACITY O d U . ( l/ I% HOLDING TANK CAPACITY ~'/ LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch: PROPOSED (Square feetl: .New ^ Replacement ^ Experimental. ~epage Bed ^ Seepage Pit f ~ ~( ^ Alternative (specify) ^ Seepage Trench Water Su ly: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ^ Joint ^Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signat e: MP/MPRSW No.: Phone Number: vu tro cch ~1P-s~321~9~>--~,i3 Plumber's Address: Name of Designer: ~}- ~4w I~(~h rnan~ 'ors ~~ar7 ,S frv~Gcen COUNTY/DEPARTMENT .USE ONLY 'gnat re of Issuing Ag t: Fee: ~ Date: APPROVED Sanitary Permit Number: ~~~~~ DISAPPROVED S Reason for Disapproval Alternate course(s) of Action Available: Change of ownership,. building use or plumber requires a .Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DI LHRSBD-6398 18.07/81) Form - S T C 100 E`' Owner of Property S r1 ~ '~!~ ~,`ct,j' Location of PropertY~~t~_~, Section~_,T~~N R is Township. ~~ ~ ~ ~; c~ raj 1(~ Mailing Address ~^~_~~~~ ~~ ~ ~ ~~ ~~~ ~ . ~ ~ s ~ ~ o ,.. tav ~1 S ~~•~~~ Subdivision Name .~ -• .. Lot. Nutuber_ ~'~?, Previous Owner of Property ~• ~}~ 1~ K.~ -- C ----- Tota1 Size of Parcel Date Parcel Was Created_ Iv' •Are all corners identifiable? k~ Yes No Include with__this apulication one of the following: .Certified Survey Map .Deed .Land Contract, Qr .Other ~:egal Document which describes the property PROPERTY OWNER CERT)FICATIQN I (We) certify that all statements on this form are true to the best of m 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. ~--,1-~.-~-_ ;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. 3~~ / ~ ), 1 ~ ~ SIGNATURE OF oWNEA SIGNATURE of CO~OWNEA (IF APPLICABLE) /'~, - \ ~~ `~ _ ~' -- ,~ _, PATE SIQNEp DATE SIGNED BetE,raer2: Sam ~~,. l~i:tller, IiudsnuT i~rl and J«hn M. Pick, 'yTost Bend, T^T:L 12 !.: Lots ,8- J~"`~O^ LF].-°Z&~...~E 3..t~', 4~ ~;aglo Riche Subdz.vision, Iiuds.on, WI r i :~ k . ,; -..:. P~;y i. .'..: b Sat,i ~^!,. r-iil:Ier is bua.]_din~ a Woad tc~ servi_ca tho ab~>v~a lots.. P~ti_11er to pay for all e~.pense,s an ':his road and place ;72,000.00 per lot in escrow as they are sold to pay for blacittoppi.nd. ti~ Sam '~;'. IIi:Ller° to .pay all construct:ion casts _i.T, l'r]_1 :_: t no expel~se to :9ctin M. Pick. .Els Sam E. Ir1i11er p«~,~r~' for a lot, he is tc~ gati 1~~ ir:~terest on cacti lot from Oct. ?-j, 1.9~>2, 'to Closin~. .Price per "lot a.s v~`~, 000.00. Price c>rt lots valid through Dec.. ?:L, lei; . Iiuo e:r t;o pay l~)8~ and 1•~~-cer l,axes. Jotiii i~~i. P.i.c' i,o pay ].~$2 tu~ses due irr 153. Lsc:rotia to be placed in First Federal Savi.n,~s ~.. Loan Associa- Lion of LaOrosse, t~TI, Hudson off%ce, :ire tt:~e Warne of Suns E. ;idler. and John M. Fic'.c. In:,erest~ ~~~ t_;o 1;0 :<~cn E. ~1i1_ler. Ca 4 a `J~ ~.} yy. EE e ' l/' ~.ry _ _._. __._ - U.~ii~i ~;. I~iIL1 uZ _~, . ----- ~~OIiN i`i. L'1CI~ `~; Witnessed I3~~: _ • ..-- L].! • D1iV"ID ~' . AND:G:I~SC?I~~ ~= c ~~ Fiy~/~ o DEPARTMENT O~ REPORT ON SOIL BORINGS D a~p~~J'9~9t'FE BUILDINGS INDUSTRY, ~/N 983 ~~ DIVISION LABOR AND PERCOLATION TESTS (115 ~ °~~'~ '~' •O. BOX 7969 1-JUMAN RELATIONS SON, WI 53707 ` ' +~ Q;' LO ATION: Sd ~ ~/~E~/ SECTION: OWNSHIP/ ~ / N/R/9~1 OTNO.: 4/3 BLK. - ~ I AME: P `d c o ~ ~~ e ~ . COUNTY: OWNER'S BUYER'S NAME: MAILING ADDR SS: . I ISF ~esidence NO. BEDRMS.: ~ COMMER AL DESCRIPTION: ~ / ~lew ^ Repl RATING: S= Site suitable for system U= Site unsuitahlw fnr system /fir t/O DATES OBSERVATIONS MADE I S: A TESTS: ace 08 .,,,,~~~ s~/t- /~ CONVENTIONAL: ~.S ^ U MOUND: ~.$ ^ U IN-GROUND-PRESSURE: ~.S ^ U SYSTE -I -FILL ~ S ~ OLDING TANK: ^ S ~U RECOMMENDED SYSTEM:loptional) C'o.~ y~l~ah.~./ ~It~/il'~C3(', If Percolation Tests are NOT re wired DESIGN RATE: SYSTE E 4 ~ I If any portion of the lot is in the under s.H63.09(511b1, indicate: Floodplain, indicate Floodplain elevation: ~/~1 PF~QFI,kE DESCRIPTIONS BORING TOTAL N PTH TO ROUN DWATER~Mi9FFE6~ CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT f#' ELEVATIO OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-~- „~' ~.a' •(lo,,..~ 7 .S' 8~1 /314,/ / /s,~ ~`' .?, cs B- ~ .Sr . ~' /Llo.~.e. ? ~s' '~ s~ ~~ / ~/ k y dti S/ +~~ y~ 3 ' /, e_ B- PERCOLATION TESTS TEST DEPTH• WATER fN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER FP~6~IiS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH p_ / S. C'7' O ~ L P- ~- 02 L P- ~ O ~ ~ P- P- P- PLAN VIEW: 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 amt" all borings and the direction and perccent of land slop. P~ ~88~j ~i8 ~ ~J R~ /In ~`>ft-~sfSr.~ •~~~1 cS ~ SYSTEM ELEVATION /a~. ~' ,( ~t~~=~ e ~~~ P ~~ .~ _~_~ e _ ~,_. I € • w. ~. ~. .~~__ __ Y~R- ,,. sue: ;, ~~ F ~• ~'~~ ' may`' ; ~~ 7`~s~'" ~ ~o ei A ~ _: s ~ • 1. 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