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HomeMy WebLinkAbout020-1150-60-000 0 _ $ g o 2 K E , , � K JD � � CL � m j �0 )) � I &—_ 7 { // Z / § � M� LL c ■ k \k < o \ P z \ % j @ § $ a c ( z 2 /q t $ \ o g ■ _ f § { k / a Is c 0 \ } m \ m ) ) ) k ) 3 % E o 04 fCL Cc ( - - ■ & e % ° \ U2 � _k \ \ a. / r � � k K k ® cn ) G t ' \ a a a 0. U \ \ ƒ k § § t 2 � } k @ C ) 2 A / § � © ° ■ 2 � k � 04 a t @ @ g o 7 -� 2 3 j ] / } 2 { c 2 a G m 2 2 E o 2 / / \ 2 i � k m L., S a) k / $ c c a § / J a i0 & 3 & . . ... : Parcel #: 020-1150-60-000 12/15/2004 08:49 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.814 020-TOWN OF HUDSON Current [A] ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): ' =Current Owner HUBBARD,JEFFREY B&JANET K JEFFREY B&JANET K HUBBARD 712 GLENNA DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "712 GLENNA DR SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 1.010 Plat: 2356-PRESIDENTIAL ESTATES SEC 29 T29N R19W PRESIDENTIAL ESTATES Block/Condo Bldg: LOT 5 LOT 5 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 799/441 07/23/1997 799/278 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 48900 214,800 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.010 27,100 139,100 166,200 NO Totals for 2004: General Property 1.010 27,100 139,100 166,200 Woodland 0.000 0 0 Totals for 2003: General Property 1.010 27,100 139,100 166,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 102 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Cha 0 00 Total 27.00 0.00 PUMP CHAMBER A Li Manufacturer: /U • quid 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: �m h ��-f,��, / Trench Width: / 4' ' Length: 540 11 Number of Lines: 3 Area Built: Fill depth to top of pipe: y a Number of feet from nearest property line: Front, O Side, Rear,O Ft .ZV Number of feet from well: 2 Z Number ©f eet from building: y , (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). t HOLDING TANK �J 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: Plumber on job: �,- �, �ie •cr License Number: - 3/84:mj TS Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S�-/ir I �lf�/� TOWNSHIP /-//&/ L� SEC. T N-R� ADDRESS JL / Y 2$ Z ST. CROIX COUNTY, WISCONSIN —T SUBDIVISION,�'��� f¢s LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Syst Iv zy'Xz✓' pr:j d- Nos Sc 2Y kSo• �D �. �z 0, 2`► a 3� Q g.W,Cov�o✓ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 'r loft ,lam $ GtJ, Zo7eoirw r © Elevation of vertical reference point: Proposed slope at site: D D ?p SEPTIC TANK: Manufacturer: lfld "5 ee / Liquid Capacity: /00�4 ,, Number of rings used: Z Tank manhole cover elevation: !21/-D S� Tank Inlet Elevation: Qo2` Tank Outlet Elevation: 90, /S�, Number of feet from nearest Road: Front,O Side, Rear, O 12- feet From nearest property line Front,O Side,ORear,� _ 2� feet Number of feet from: well 5�$� building: �7r c}' 027 �6on• 5F�o„ar (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE RE DE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS DIVISION PRIVATE SEWAGE SYSTEMS P.O.3OX 7969 BUREAU OF PLUMBING MA&tSON;-M_ 53707 S 4, SA, S29,T29N—R19W XC ONVENTIONAL 1:1 ALTERNATIVE State assigned)D.Numbers Town of Hudson ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 5 Presidential Estates NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Route 1, Box 282, Hudson, WI 54016 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 i5432 St. Croix 99044 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 1�` \\'' PROVIDED: PROVIDED \.L� Cc). k� �tbo �ES ONO DYES ZNO BEDDING: VENT DIA.: I VENT MATL.: HIGH WATER NUMBER OF ROAD: JL ROPERTY WELL BUILDING: VENT TO FRESH ALARM I NE LAIR INLET:FEET DYES �O - CZ OYES �NO NEAREST Sd DOSING CHAMBER: MANUFACTURER. BEDDING: UOUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL ILOCKNG COVER PROVIDED: DED: ❑YES ONO DYES ONO ONO 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) OYES 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. N A]DI IPE SPACING. COVER JINIIDE DIA.. #PITS: LIQUID TRENCHES. MATERIAL: PIT DEPTH.lmeiii 1oks GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: No. TR NUMBEft''.OF PROPERTY WELL: BG: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV.INLET ELEV.END: PIPES AIR INLET: ILO'' +- a �5,-,�1 4, a�a FEET �, 3 + MO UND 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 1:1 NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS. DYES 1:1 NO ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =F TOPSOIL. SODDED. SEEDED-. MULCHED. CENTER. EDGES. 1:1 YES 0 N 1:1 YES 1:1 No DYES El NO PRESSURIZED DISTRIBUTION SYSTEM: bTENCI'I WIDTH. LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. ' 11MIE IONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. EVA ELEV.: ELEV.. DIA.. ELEV.: PIPES. DIA.: L LION AMO JE C)ISRU ION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 1NIORMATIpN ` PLANS DYES ❑NO OYES ❑NO COMMENTS: PERMANENT MARKERS: BSERVATION WELLS: NB "RO��t"," LRIOE ERTY WELL: BUILDING: Q FEET FROM ❑ O 3 t7 DYES NO OYES ❑NO NEARES� r t � � 0� Sketch System on 1 Retain in county file for audit. Reverse Side. SI RE: TITLE: DILHR SBD 6710 (R.01/82) \', Zoning Administrator f � INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow(number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained.The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-381.5. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and 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 V/2 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 stet included the creation of surcharges (fees) for a number of regulated practices which WisCO Era can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rt'asum. is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY— D (� DILHR In accord with ILHR 83.05,Wis.Adm.Code 1 ° 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%x 11 inches in size. –See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES X NO PROPERTY OWNER PROPERTY LOCATION 51E 1/4 5 101/4, S d2 T , N, R / E (Oro PROPERTY OWNER'S MAILING ADDRESS LOT UMBER BLOCK NUMBER S BDIVISI N NAME 2 � o z� s ��,�H-r� Q �s CITY,ST TE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK VILLAGE : cc Soh !v D/ 7�S G'865Z A &/S /4ss a /�'d� II. 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. New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.El 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. 0 The System i s shared by more than one owner/building. Attach Common Ownership Agreement reement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Z 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): Joint ❑ Public G �G / S a 7— 6, T V S q 7— Sq-S Feet Private ❑ VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank orHoldin Tank x QDO We-; a.-►- ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ 1 Li I ❑ 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: qobu 165 S I ro4 ,veil /14r 2 �- 7 3 2 � Plu be ' Address(Street,City,State,Zip Code): Name of Designer: loe lop Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# �� G CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 4, La r Cf,/ �Ql�e., &_,160 Alt O/+!O /, 31(4- IX. COUNTY/DEPARTMENT USE ONLY ❑ isapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) v SVcharge Fe�Approved Given Initial �,D ,'``�';' n�-. Adverse Determination � 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 I� 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 a7- Location of Property 4&,) , Section a , T N-R q W Township /-/u d ,S�vi ?Sailing Address -w- / 'a V Z AKO/son Address of Site /Y4 d5my, !i2! _ Subdivision flame _ Ar e Lot Number . Previous Amer of Property La-,.c,7 ; S Total Size of Parcel 1. 3 Date Parcel was Created 7- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No volume _? and Page Number 3 7 9 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 (We) ceA.ti,6y that att statements on this foAm ake tAue to the best o6 my (ouA) hnowtedge; that 1 (we) am (ane) the owneA(s 06 the pnopenty ducAibed in this .i.n604mation 6o4m, by vi tue o6 a waAAanty deed keeo4ded in the 066ice o the Count Reg4,sten o6 Veed�s as Vocument No. ) f� and that I (We) pnesentCy own .the pnopoaed site 60A the sewage di�sp04 sys em (oA I (we) have obtained an easement, to nun with the above deAcA bed pAopehty, bon the conatnucti.on o6 said aya.tem, and the same has been duty teco&ded in the 066.tce o6 the County Reg.cateA o6 Veede, ab Voemnent No. �'2 SIGNATURE' OIL ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 0QCUM9P,T NO. Wff 09AM SM MATE 8"OF WisCassaim—posm, a 3 8718 voi 671 PA079 T"66 0^4" M"N"o Fee amema"am& MG 616RS OFFICE ................................................................ ST. Citax Co., wa ................... ... ........ ...................I.... ...................................................... Wd., for Reawd ft 23rd quit-claim" to -R . .....!JEWIS day oL_±!!_A.C. IV ................................................... 83 ................... ...... .. ................................................................................ of 8:30 A —............... .....-.... ...........-.......................................... ..................•..• 2 ........................... .. ..... ...I................. ................................................. - 1h ..................... I ......I.. ..... ....... .I.. ..... ........ ...... ...............I............... the following described row estate in .........5.t.4.X"iA.................... County, State of Wisconsin: may'"`:P,A2 21st, WO&A19#Of 44q=WISP TaxKey No. . .................................... Lot #10r, Presidential Estates, a subdivision located in SE4 of SW;4- of Section 29, T. 29 N. R 19 W, Town of Hudson, St. Croix County, Wisconsin. FFS This .........t�..PQt....... homestead property. (is) (in nut) Dated this ..........................1.21*............. day of .............4au it-ft .... .. . . .......... .83 ........ (SFAL) .................... ... ..... .......... . .. .............(SEAL) ........... ......... ......... ...................—....................... ... . ........ ......... (SEAL) ........ .............. ... .. . ... .... . ........ .........ISEAL) ....................... ................................ ......... • . ....... ... . .. ..... ................ AUTHENTICATION ACKNO LRDOMENT Signatures authenticated this ....... . ...... . day of STATE OF ...............................I................. 19-.. .. ) .......1;6 . . .....County. ersonally cargo f9re me. this /-:I. day of • WiLwvt named �... .................. ... ........ ........... .................. ....... Af -i ......ire, TITLE: MEMBER STATE BAR OF WISCONSIN AOSEPH..PALLA and, LOIS.-PALLA................. (If not,.................. ... ..... ... ................. .. ....... . . .......... ...................... authorized by § 706.041. Wis. Stats.) .. ........ ........ . .......I....... ............ .................... THIS INSTRUMENT WAS DRAFTEU my to..me, ,known, to'be'the''person' ' .......w*ho,e,zee*u,t,ad,th,a Closi_ng_.$Prvi.ces foregoing instrument and acknowledge the same. 1300 France Ave.. So. Edina, Minn t_•_ 5435 ... .. ........ 5. (Signatures may be authenticated or acknowledged. Both Notary Public Co.unty. I& are'lot necessary.) My rommin..4ion is per nen (if rot, state expiration The use 44 witnesses is optional date: 19L P c,L-'l R. Richardson 7�- QUIT CLAM "So STAT BAR or WISCONSIN roam w F e. 3—1977 r""k C. Im. L H z cn H a ST C - 105 r r a I H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Oee Fire Number CITY/STATE y4l,Sor� �i ZIP PROPERTY LOCATION : ,5F 4, 5L4,) 14, Sectiona5 , T ?. IN , R / 7 W Town of #�c�3py , St . Croix County , Subdivision?,-2 s:J�r1"o�cl �SfifQ{ Lot numbers . 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 requiremeint 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 , restr cted 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. H 0 E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x 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 . SIGN DATE - - 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 DIVISION INDUSTRY, LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHIP/ o1.9A61;F* LOT NO.:BLK.NO: Kid,VISION.NAME: ��wS r, 1/ /T Z9N/R/` 1 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: .S d ..,(11 7-7.011L USE DATES OBSERVA IONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: Residence . New ❑Replace I Z-/_y �]_ MAP Bx �L (A .�,[._ RATING:S=Site suitable for system U=Site unsuitable for system (s/- SIB ` O /EX CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMM DED SYSTEM:(optional) M 0U SS ❑U 1S ❑U El S ®.0 ❑S au Co,�0,4 .� If Percolation Tests are NOT re wired DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate Q iFloodplain, indicate Floodplain elevation: O(JIA PR FI DESCRIPTIONS cc BORING TOTAL# DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH NUMBER DEPTHAN- ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 8,� ' 9 . Q 7 fcl ' . B s si , 9cdn cfWB� s B- Z F,L ' .).8 jt4av > j'• � ' S /, 3 /3n r s/ .6 An /S B- 3 .C'I' 5, d e- /• 0 8 2. 3 en S,-,e Co r S B- �' (.6 ' /Via e <7 % sl of Aft s. 3, C�H S B-- e,40 Y ' �lQ� 7 ���' .33 6 1 s l 1,--�_ is . / CoAlAt r,/+.[ n: B- Q• ' /y '' AIJA/t,— 7 $e r , l S/ o 6 ALM S` PERCOLATION TIFSTS TEST DEPTH4 WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER IINCH ES NUMBER bPl6+1,9 AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERIOD 3 P- 3 3' AJO .9c. 3 P- G,o' v f— ' L_ ' 3 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION `/- /•e 6- 3 rA1ler,uplE�� �3 l 1 -,,Q Y gores l� Pars 7`es1' B�rdAj ` �3, cwff ra oL MA`e- o. &,A*l I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the WisconsiP Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COM�PLLETED sO/�N: ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): v s =� CS TU E: c DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — yv\" sy ` L nd D 13• Yh. ,'S -IA#. Yo-rf Hori z F&r P. Kt at f In a... s. L o'f e--o r vl)a_Y o A 't'o� d F a I�r Lot Ass L, &. t.1V. = �o.o D Bo✓d d. lLio-ck Aoe-1 D Pc rc s l tc.sT Q, ft-z, Su, �Qb 14, W r�� vo uj �wrt to b �b�� aiou d' B %%t.r f$ /41 I w AVorth /of' i w ,I 1 ZD 64iagc Dr, ✓a w ��/ i R a- t 8x14 d C v {� no d o \ ��I A�f�rnt7Qi � Z 13, 1 a to ZE d ,.,, 0 ) Iz i e OL — L7( vi =1V�t ._ . i • o J M cd am. I I I ♦ ,� .��ia� M r ♦! 4`i-tN v ♦ d