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Parcel #: 036-1044-20-000 02i22i2007 09:58 AM
PAGE10F1
Alt. Parcel#: 19.31.17.277B 036-TOWN OF STANTON
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-TAPPE,WM P&JACKIE M KUNZE
WM P&JACKIE M KUNZE TAPPE
1485 210TH AVE
NEW RICHMOND WI 54017
Districts: SC =School SP=Special Property Address(es): *=Primary
Type Dist# Description " 1485 210TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE
SEC 19 T31 N R1 7W 1.50A IN NE NE COM Block/Condo Bldg:
812.25'W OF NE COR, S 261.36'W250' N
261.36'TH E 250'TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
19-31 N-1 7W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1200/315 WD
07/23/1997 488/348
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/05/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 18,000 156,600 174,600 NO
Totals for 2007:
General Property 1.500 18,000 156,600 174,600
Woodland 0.000 0 0
Totals for 2006:
General Property 1.500 18,000 156,600 174,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 220
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent q Charges
Total 0.00 0.00 0.00
1
1
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
T
Width: / Length: , Number of Lines: Area Built: G__L
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, ® Rear,O
Number of feet from well: // 0
Number of feet from building: S
(Include distances on plot plan).
SEEPAGE PIT I%
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 i
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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
i
Alarm Manufacturer:
Inspector:
Dated• Lj—r6` Plumber on job:
License Number:
3/84:mj
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER �Y dell/05�t TOWNSHIP _S/ 1-i d '7 SEC. _ T N-R 7W
ADDRESS�'c ',r /„? j ST. CROIX COUNTY, WISCONSIN
SUBDIVISION i LOTW LOT SSST E
PLAN VIEW
Distances and dimensions to meet requirements of I•I.,HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1
VLJ
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /C'=G'' Proposed slope at site:
SEPTIC TANK: Manufacturer: 11451lz Liquid Capacity:
Number of rings used: 6;( Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: Q�
Number of feet from nearest Road:
Front,0 Sideo Rear,0 /60 feet
From nearest property line Front,O Side,®Rear,O feet
Number of feet from: well /� ( , building: 6S f
(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&B DIVISION OR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
P.O.Bbx 7369
BUREAU OF PLUMBING
MAbISON,WI 53707
NE!4,NE4,S19,T31N—R17W 7EN CONVENTIONAL 1:1 ALTERNATIVE State PlanLD.Number:
Town of Stanton El Holding Tank ❑In-Ground Pressure ❑Mound
4 210th Avenue
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Arnell Kunze Rt. 3, Box 129M, New Richmond, WI 5401
BENCH MARK(Permanent reference pant)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Byron Bird, Jr. 3318 St. Croix 92489
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES —]NO —]YES ONO
BEDDING: VENT DIA.: VENT MAT_.: HIGH WATE NUMBER PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET
OYES ONO ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
OYES ONO ❑YES ONO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL BUILDING.jVeNTTOFRE5H R INLET
(DIFFERENCE BETWEEN FEET FROM LINE
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: LEN TH IN O.OF DISTR.PIPE SPACING. COV R INSIDE DIA. #PITS LIQUID
BED/TRENCH /P/— TRENCHES: MATERIAL: PIT DEPTH
DIMENSIONS rte( `/
RAVEL DEPTH FILL DEPTH IDISTR.PIPF IDISTIT PIPE IDISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL. BUILDING V N7 TO FRESH
BELOW PIPES: ABOVE COVER: ELEV.INLET IEIEV,END: PIPES: FEET FROM LINE. AIR INLET.
NEAREST---o-
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
OIL COVER ITEXTURE PERMANENT MARKERS JOBSERV WELLS
❑YES ONO : YES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED
CENTER. EDGES:
❑YES ❑NO DYES ONO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. 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.: CIA.. ELEV.. PIPES DIA.,
ELEVATION AND
DISTRIBUTION VERT
INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL PLAN SCAL LIFT CORRESPONDS TO APPROVED
❑YES El NO ❑YES 1:1 NO
MENTS: PERMANENT MARKERS: OBSERVATION WELLS: INUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE:
,9 ?0 EYES ❑NO : YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE.
DILHR SBD 6710(R.01/82) Zoning Administrator
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 maintaine&The septic tank(s) should be pumped by a licensed
pumpeF 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;
ll. 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 protect
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 8Yz 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 fff ;
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground wer.-
included the creation of surcharges (fees) for a number of regulated practices which Wisco inns a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried resure
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
a
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
�'L R SANITARY PERMIT APPLICATION COUNTY Gro/�
In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT#
. ,a.o ....,.�.�
–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
1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO
PROPERTY WNER PROPERTY LOCATION
r,4-e � '/a '/a, S If T , N, R 1,7 E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
p J� h) iC p 4OL40
CITY,STATE _ ZIP CODE PHONE NUMBER VILLAGE: NEARE T ROA LAKE OR LANDMARK
a/ 7 fah rv� /a� /�(� t.
11. TYPE OF BUILDING OR USE SERVED: dLO. &8('0 — l`
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. ❑ New b.;40 Replacement c. ❑ Replacement of d.El 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. Xconventional 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. C9 Seepage Bed b. ❑Seepage Trench c. ❑ See a e 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): 1.-6 �o S Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed I El
Septic Tank or Holding Tank o
Lift Pump Tank/Siphon Chamber ❑ I El
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 Si nature:(No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber' Address(Street,City,State,Zip Code): Name of Designer: /
va v�G.fo� J1'0` r
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name / CST#by ?
1 !�'D X, `
CST's AD,PAESS(Street,City,State,Zip Code) Phone Number:
dx n-�' �/�� oo /o -26
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
®Approved ❑ Owner Given Initial charge Fee p
Adverse Determination 4l loo•06 ly°Vs•v6 �///�
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
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 Property N F_ N 14, Section , T .��� N-R //__/W
Township �3 �O A/
Mailing Address x 9
Address of Site
S M F
Subdivision Name Nip
. Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created fiu 191
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes _X_ No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) cer.ti.6y that ate statements on this /
Lm ace true to the best o6 my (ouA)
knowledge; that I (we) am (ace) the owners o6 the pnopeAty descni.bed in this
.in6o4mati.on 6o4m, by viAtue o6 a waAanty deed neconded in the 066.ice o6 the
County Re9iAten o6 Veeds as Document No. I OeyS ; and that I (We) preaentty
own the proposed site bon the sewage cVspos sys em (on I (we) have obtained an
easement, to run with the above deachibed property, 6or the construction o6 said
system, and the same has been duty neconded in the 066.ice o6 the County Register o6
Deeds, as Voe meat No. ) .
SIGNATURE Old OWNER �IGNATURE OF CO-OWNER (I APPLICABLE)
00
DATE SIGNED DATE SIGNED
r
DOCUMENT NO. / �i,}' STATE BAR OF WISCONSIN-FORM 2
9OOi4, '188 PlIGE348 WARRANTY DEED li
S SPACE RESERVED FOR RECORDING DATA
h
3 '_ 2(10i'�
BY THIS DEED, Charles Kunze and Viola Kunze, tREGISTERS OFFICE
husband and wifls, ST. CROIX Co., WIS.
Recd for RRcord this_25t_n_
day of A1t1 _5 ----A.D.19_12
ii
is Grantor conveys and warrants to Arnel L J. Kunze and Linda L.
Kunze, husband i�nd wife as joint tenants, at------x,3.0___-'1 M.
Reg tar of eeds
r
Grantee S
f for a valuable consideration RETURN TO !'
I
the following described real estate in__J?t. Croix County,State of Wisconsin:
it
Tax Key #
This is homestead property.
A parcel of land in the Northeast Quarter (NE4) of the �
,
Northeast Quarter (NE4) of Section Nineteen (19) , Township
Thirty-one (31) North, Range Seventeen (17) West described j
as follows: Commencing at the Northeast corner of said
Section Ninetee. 19 h
thence West a distance
of
812.25 feet
i z
along the North line of the Northeast Quarter (rdEk) of the ,
Northeast QuartlBr (NE4) of said Section Nineteen (19) to
the point of be!
z
H
a
• r
STC - 105 a
. H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
tj
a
I H
OWNER/BUYER , 'L / i� I1 V —
i
ROUTE/BOX NUMBER /� Fire Number
CITY/STATE ZIP
i
PROPERTY LOCATION : /K _ IVE 14, Section , T N , R_ W,
Town of S7f41.[kA/ , St . Croix County ,
Subdivision , Lot number
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper . What you put into f!
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system .
St . Croix . County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping ( if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration . H
0
F
I/WE, the undersigned,, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein , as set by the Wisconsin Depart- 'v
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 .
llA'f E 171(p//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 .
INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 6395
To be a complete and accurate soil test,your report must include:
1. Complete legal description;
2, Tha use section must clearly indicate whether this is a residence or commercial project;
1 MAXIMUM number of bedrooms or commercial use planned;
4. Is this a nevv 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;
B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
J. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
0. 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 riot apply, place N.A. in the appropriate box;
1 1. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as redUired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10„) BR - Bedrock
cob Cobble (3- 10") SS - Sandstone
gr - Gravel (under 3") LS -- Limestone
*s - Sand HGW - High Groundwater
cs Coarse Sand Pere - Percolation Rate
med s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
is Loamy Sand > - Greater Than
�sl Sandy Loam < - Less Than
I - Loarn Bn -- Brown
*sil - 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
ss; - Sandy Clay wt' -- vvith
sic - Silty Clay fff - few, tine, faint
x.
c Clay cc ._ common, coarse
pt - Peat rnrn - Many, rrredium
rn Muck ci -- 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 securing a san;tary permit. The county orthe Department may ro luest
v r i ic:ation of this soil test in the field Prior to {permit issuance, A cornplete set of plans for the private
se va(y-, sysi:em and a permit application must he submitted lo 'the aowopriat:e local authority in order to
obtain a permit. The sanitary perrnit must be ohiained and posted trim to the start of any construction,
l
r— -
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS 115 P.O.MADI WI 3707
HUMAN RE CATIONS
(H63.09(1)& Chapter 145.045)
LOCATION: SECTION: NSHI MUNICIPALITY: LOT NO.:E
/V4' 1/44Y/ / /T,,3 N/R 47 E (o
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
f�Ya
ix 3 ex
la Q� C,
USE DATES
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI
Residence ❑New Replace �' _
RATING:S=Site suitable for system U=Site unsuitable for system EJU CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)E]S 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 I Floodplain,indicate Floodplain elevation: // D
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 2 c d 0 !o- ��, 57'
B- 3 9V
B-
B-
B-
PERCOLATION TESTS
TEST EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD-1 PERIOD2 P R PERINCH
P- / �•7 '
P 2 /
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
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I,the undersigned, hereby certify that the soil test\re or ted on this form were made by me in accord with the procedur a methLIDI�� iified�,�FielNVisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and b
NAME(print): TESTS WERE COMPLETED
jgvy-& n Id, J
ADDRESS: / CERTIFICATION NUMBER: PHONE NUMBER(optional):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
1VIr 1 CJ 1 7 �11:�) MADISON,WI 53707
HUMAN RELATIONS (1-163.090)&Chapter 145.045) i
I
iV . NO. BLK NO. SUBDIVISION NAME:
SE LOCATION. T H R47E o t
COUNTY: ' OW ER'S BUYER'S NAME: MAILING ADDRESS:
5 D
USE DATES OBSERVATIONS MADE
NO.BEDRMS.:1COMMERCAL DESCRIPTION: OR-OFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ❑New RReplace
1
RATING:S=Site suitable for system U=Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
S ❑U 0S ❑U S ❑U ❑S ®U ❑S U
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n�
under s.H63.09(5)(b),indicate: , I Floodplain,indicate Floodplain elevation: /! D
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED ES I HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- C 702 �. 46 7a
B- d
B- %' 21 woote—
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B_
B-
PERCOLATIO TESTS
TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PER INCH
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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
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1,the unddr � ,herlfy that tfi �oil tests re
s►g orted on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative de,a the data"roc rded and the location of the tests are correct to the best of my knowledge and belief.
NAME(print):
— TESTS WERE COMPLETED ON:
r•
ADDRESS: 3yoo�CERTIFICATION NUMBER: PHONE NUMBERIoptionaq:
t9 0 3 Y �6 7c!
CST SIGNATURE:
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
DIVISION
INDUSTRY,
LA80i AND PERCOLATION TESTS (115) MADISON WI 53707
HLR, _N RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATION: SECTION:, NSHI MUNICIPALITY: OT NO.:BLK.NO.:ISUBDIVISION NAME:
N� 1/N�/ / /T2 N/R i7 E to
COUNTY: OW ER'S BUYER'S NAME: MAILING ADDRESS:
f Cre iX f 3 oZ Q�J - s 634 O
USE DATES OBSERVATIONS MADE
NO.BEDRMS : COMMERC AL DESCRIPTION: PROFILE T NS: A TS
N TES :
Residence New Replace
RATING:S=Site suitable for system U-Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)
S ❑U 0 S ❑� S ❑U D S ®U ❑$ U 6/� �-
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: , Floodplain,indicate Floodplain elevation: /!
PROFILE DESCRIPTIONS
BORING TOTAL =ELEVATION ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN, D ES I HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 3
B-
B- I
B-
PERCOLATION TESTS
TEST jj��EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 118 AFTERSWELLING INTERVAL-MIN. P E RI D PER INCH
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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 0, °5 Qoof 4.
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1,the undersigned,hereby certify that the soil test\r. orted 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:
Azlnen
/v//' /'
ADDRESS: r- CERTIFICATION NUMBER: PHONE NUMBER(optional):
SG .Sy°d� t� 03 ? y 11 -cl
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
1
PLOT PLAN
PROJECT roc///fin ADDRESS
IW 1/4 1Vf- . 1141Se7/T,3/ N/R W TOWN a o COUNTY
MPRS Byron Bird Jr. 3318 DATE —
BEDROOM CLASS PERC___CONVENTIONALXN-GROUND ESS(JRE
CONVENTIONAL LIFT_ MOUND_HOLDING'TANK
SEPTIC TANK SIZE ze-0 LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA d v"z PERC RATE �, BED SIZE 3 5
► Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
* H.R.P. /V.,A)_ 4..� c oa/o >,-4 ,o 4e-4 _
D Borehole Well Scale --- — _ �D / Feet
O Perc Hole System Elevation'. S
TYPAR COVERING
2"
12" 3- 0 6' 0 3' 3' 3'
I 6" Sewer Rock
i 12' 18'
—0 Pit
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