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Parcel #: 040-1184-50-000 12/15/2008 02:20 PM
PAGE 1 OF 1
Alt. Parcel#: 13.28.20.751 040-TOWN OF TROY
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O- MURPHY, ANDREW C
ANDREW C MURPHY C-CARLSON NANCY L
ON NANCY L
326 N
326 N COVE RD
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description '326 N COVE RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.700 Plat: 03-079-BOMAR HEIGHTS 040-77
SEC 13 T28N R20W LOT 5 BOMAR HEIGHTS Block/Condo Bldg: LOT 05
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-28N-20W
Notes: Parcel History:
Date Doc# Vol/Page Type
04/01/1999 600438 1415/264 WD
07/23/1997 428/42
2008 SUMMARY Bill#: Fair Market Value: Assessed with:
260647 685,500
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.700 315,000 300,400 615,400 NO
Totals for 2008:
General Property 0.700 315,000 300,400 615,400
Woodland 0.000 0 0
Totals for 2007:
General Property 0.700 315,000 300,400 615,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
' I
PUMP CHAMBER „� r
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, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Length: Number of Lines: Area Built:
Fill depth to top of pipe:
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).
I
SEEPAGE PIT
Size: J �(b qaL Number of pits: Diameter: /
p � i
Liquid depth: Bottom of seepage pit elevation: 7212
Area Built: L-D 171
Has either a drop box O or distribution boxeleen used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
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:
g
Number of feet from nearest road:
Alarm Manufacturer:
Inspector•
Dated: Plumber on job: /
-
License Number:
3/84:mj
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT le
OWNER �jt a d, �Ll TOWNSHIP o SEC. T _L_N-RO_W
ADDRESS Al? � �pX ��` ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
��I
,cJRIV6W,4 Y
I
'L/
We
13.r►�--�QS �� I
i
o.
- -------
o
yo
- -
_ I
33" �
5wufW pRdPER?Y L.vE INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used /"ono a< �JEGL
Elevation of vertical reference point: /00' Proposed slope at site: /b
SEPTIC TANK: Manufacturer: (,J�,Es�y� Liquid Capacity: /000 CAI—
Number of rings used: -3 Tank manhole cover elevation: 91/_ 341
Tank Inlet Elevation: Q9 91' Tank Outlet Elevation: , y$'
Number of feet from nearest Road: Front,O Side, Rear, C feet
From nearest property line Front 10 Side,aRear,O a-'5 I feet
Number of feet from: well s(� buildin
g: Sao
(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
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX'7969 BUREAU OF PLUMBING
MA6ISON,VIM 53707
SW SW, 13, 28, 20,Govt.Lot MCONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number:
(lf assigned)
Town of Troy El Holding Tank F-1 In-Ground Pressure El Mound
Lot #4
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E:
Dr. Joseph Kelly Rt. 3, Box 85, Hudson, WI 54016 s 8 a
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
L oT S 3e�-►�ah�-I
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Gary Zapppa I3300 St. Croix 92471
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIOUI C T TANK NLET ELEV.: TANK OUTLET LEV.: WARNING LABEL LOCKING COVER
Ci PR ED: PROVIDED:
'V' I C�1 YES ONO ❑YES EKNO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL B VENT LE FRESH
ALARM' FEET FROM /n LIN AIR INLET:
OYES NO
DYES NO NEAREST '�-
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARN I NG LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ❑NO IOYES ONO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION AL: NUMBER OF PROPERTY WELL BUILDING VER TOE FRESH
(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: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE IA. SPITS LIOUI
BED/TRENCH TRENCHES: MATERIAL: PIT - DEPTH.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH IDISTR,IPIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF ROPERTY WELL: BUILDING: V NT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV. NLET ELEV.END: PIPES. FEET FROM LINE: AIR INLET.
NEAREST--I
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.
OYES 1:1 NO
OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES -]NO DYES -]NO
DEPTH OVER TRENCH IBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER: EDGES:
OYES El NO ❑YES. ONO ❑YES ❑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
ELEVATION AND . DISTR.PIPE UISTHIBU TION PIPE MATERIAL&MARKING
ELEV.: ELEV.: DIA,'. ELEV.. PIPES DIA.'.
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED
❑YES E1 NO OYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE OFTOPERT WELL: BUILDING:
OYES El NO ❑YES 0 N NEARESOM
Sketch System on county file for audit.
Reverse Side.
SIGNATURE.4
DILHR SBD 6710(R.01/82)
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every�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 project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/s 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 ater
included the creation of surcharges (fees) for a number of regulated practices which Wisco to
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rP3sUfe
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.
c
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
w ate,; groundwater contamination investigations and establishment of standards. Ground-ater,
i° s worth protecting.
S D-6398(R.03/86)
�ILHi� SANITARY PERMIT APPLICATION cou Y
nQ� y In accord with ILHR 83.05,Wis.Adm.Code 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
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO
PROPERTY OWNER PNff5TY LOCATION
Sf 3 T It, N, R 40 E (or W
PROPERTY OWNER'S MAILING DRESS LOT NUMBER BLOC NUMBER SUBDIVISION NAME _ox ,S
CITY,STATE CODE PHONE NUMBER 7 CITY NEAREST ROAD,LAKE R LANDMARK
Z / R ❑ VILLAGE : RO
II. TYPE 61F BUILDING OR USE SERVED:
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.X Replacement c. 1:1 Replacement of d.El 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. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. X Conventional b. ❑Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ 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): J
V� ! Feet ®Private ❑Joint ❑ Public
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 or Holding Tank Dnks
Lift Pump Tank/Siphon Chamber ❑ 1 ❑ ❑ ❑
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:
-?3 o v _ so
Plumbe s Address fStrtet,City,State,Zip Code): Name of Designer:
iw r>Aa Y 0460A
Vill. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
,1VqAL"gV
CST's ADDRESS(Straret,City,State,Zip Code) Phone Number:
o ' v/1 / S
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
IV JZW Approved ❑ Owner Given Initial ` � v S r harge Fee a (} Q�7
Adverse Determination �2.5 J�7 0 /
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 < O S e P
Location of Property , Section , T N-R W
Township
Mailing Address
_--� <<LL
LG
Address of Site � 2
..Subdivision Name
-Lot Number
Previous Owner of Property _
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume _L�. and Page Number 5-*&6 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) centi.6y that att btatement6 on thins 6onm ane true to the bebt o6 my (oun)
knowtedge; that I (we) am (cute) the owner(z) o6 the pupen ty du ch i.bed in th,i.6
.in6o4mati,on 6onm, by viAtue o6 a waAAanty deed neSSonded in the 066.ice o6 the
County Regi6teA o6 Deed6a6 Document No, > 1 , k- ; and that I (We) ptesentty
own the ptopobed .bite bon the 6ewage dizpozat bys em (on I (we) have obtained an
ea6ement, to nun with the above ducA bed phopenty, bon the con6tnuction o6 baid
.6ydtem, and the tame hab been d y recorded in the 066.ice o6 the County Reg.i6ten o6
Deede, a.a Document No. _3(, -; ) .
r
Si GNATRE OV OW14ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
V 14L /F
DATE SIGNED DATE SIGNED
A^ '
..nnnyy
tt'lVt4 r F� t r►►a,wN► I"Man MM
�o.'lW. Nnrrunl!' Detdc=fo Husband and W Jo t �'i
a 9409"1
307486
TIjiz Indenture, Made this 22nd day of October ,1971 ,
f
i
between David C. B,yrarn and Ann R. Byram, son and mother, both now ►
single,
• part ies of the first part, and
Joseph R. Kelly and Joan Kelly, '
husband and wife, as joint tenants, parties of the second part.
Wftntagttry, That the said part ies of the first part, for art, in consideration of the sum of
One Dollar and other valuable consideration --------------------)ollerft
to them in hand paid by the said parties of the second part, the receipt whereof is hereby
confessed and acknowledged, haVe given, granted, bargained, sold,remised,released,aliened,conveyed
and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and
confirm unto the said parties of the second part, as joint tenants, the following described real estate
situated in the County of St. Croix , Wisconsin, to-wit:
Lot Five (5) , Plat of Bomar Heights, Township II
of Troy, aceordini7 to the plat thereof on
file and of record in the office of the
Register of Deeds.
Subject to easements and restrictions, if any,
of record.
II
'1'� F'►iJ ;i'LR
LLhl.
I�
IIZogtt_gtt, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise
II appertaining, and all the estate, right, title, interest, claim or demand whatsoever,of the said part
II� of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained I,II
i
�i premises,and their hereditaments and appurtenances.
Zo 4abt anb to Polb, the said premises as above described with the hereditaments and appurtenances. III
unto the said parties of the second part, as joint tenants.
Anb tbt %atb, David C. B•yra.rn and Ann }3 . Byrarn, son and mother,
part ie-, of the first part, for themselves , their heirs, executors and administrators,
iI
do covenant, grant, bargain and agree to and with the said parties of the second part,and to and III
with the survivor of them, his or her heirs and assigns,that at the time of the ensea ling and delivery of
these presents they are well seized of the premises above described,
s
AI
as of a good, sure, perfect absolute and indefeasible estate of inheritance in the law, in fee simple,and
that the same are free and clear from all incumbrances whatever.
and that the above bargained premises, in the quiet and peaceable possession of the said parties of the
second part,as joint tenants, against all and every person or persons lawfully claiming the whole or any
part thereof will forever WARRANT AND DEFEND.
7n Riitntoo Wbtrtot,the said part ieS of the first ha Vehereunto set their hands and
seals this 22nd day of i �-Qeto . 1971 .
L a G' lk� f.LY1C1 (Seal)
j Signed,Sealed and Delivered in Presence of
,� .• �, Lam-- �..�y'!'�'.�---=�.- ... .../....`�6c�••.t1...._(Seal)
1 ----•--- ..__.._ .....�..� __�._1 Ann Hvra_m
R E. Low — —(Seal)
_(Sea!)
A. Kueppers, Jr.
®left oUaWtllcOaxl�3lX
L ss.
Ramsey County.
On this the 22nd day of October . 1971 ,before
me, R. E. Low the undersigned officer, personally
s appeared David C. B ram a d An R. Byram, known (or satisfactorily proven) to be the
Un an� mother
person S whom name S subscribed to the within ins'rument and acknowledged that they executed
the same for the purposes therein contained.
Ia—thw s whereof 1 hereunto set my hand 7r 'al :eal "
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tanesota '
Notary Public, Ramsey Counly; D�G7QR•
i My Commission expires
March 7 ...I�• 7#:�,,
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SEPTIC TANK MAINTENANCE AGREEMENT p
St . Croix County x
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OWNER/BUYER V M
ROUTE/BOX NUMBERS �� Fire Number_ZLL�_
CITY/STATE ZIP
PROPERTY LOCATION: (,� ;c, 14, Section s T2 N, R_q�2_W,
Town of �� St . Croix County,
Subdivision Lot number .
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper. What you pdt into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. y
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I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
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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.
SIGNED / le e
DATE G 7 7-Z/ U
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 .
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LAi30R AND PERCOLATION TESTS Lam P.O. BOX 7969
HUMAN RELATIONS Z) MA/D/ISON,WI 53707
6wT.LINT``� (H63.09(1)& Chapter 145.045) �—'V A Ge/Z.1'l
L A I N: SECTION: p �dl TOWNSH-I�/MyUNICIPALITY: OT NO.:BLK.NO.: UBDIVISION NAME: 1.
C,! 4 �/ �/ i3 T�� N/1lZb�llorlw j I��C�� 4- — Mf c • insP•iP
COUNTY: WNER' BUYER'S NAME: MA L N A D SS:
SrGRoI>< �osu I��ct`Y 3 Co P 4o/6
USE __ DATES OBSERVATIONS MADE
IVNO.BEDRMS.: COMM R AL DESCRIPTION S
Residence -- ,� —- ❑New Replace I �6 /9Fs!7MxA<A
I rn t �MlhEt�"�
RATING:S=Site suitable for system U_-Site unsuitable for system )L �M G - i
ONV NTI NAL MOUND: IN-GROUND-PRESSURE:roso—ur,M-INF LL RECOMMENDED SY�T M:(optional)
o s D :uo s � ❑s
!l ev WELL_S
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the `//�
under s.1-163.09115)(b),indicate: �L�4:,S / Floodplain, indicate Floodplain elevation: A/
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROU ND ATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH-TIf, ELEVATION OBSERVED EST.HIG TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- 1 17.E .47 /7.o0 ;7N-ALSLTS -Z+-& S', St6tMlkl:), /K3��T BeNC MS
B- Z 17,00 `�S. �} �o t I7,00 73"&scrs 2-z"&qS S*Gk I3'�M GA 96 NLT&N St,:i t'.
B- 3 16 oll 94.5 o > �6•o� 33 &S is$eNStL tGe 12"6aN 6R1214T�aN sr�R
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B-
B. _
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES, RATE MINUTES
NUMBER RtlQlli'S AFTER SWELLING INTERVAL-MIN. PERIQD_t _PF
_81002 PER INCH
P. 91;A0! .
P_ I 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 B/•SO
SrTF ta"rionr pH I�cvdlR
Q/11 LWra_y-
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I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NA print TESTS WERE COMPLETED ON:
A .-
CERT FI AT NUMBER: P�IONE NUMBER(optional):
-
— CST SI ATURE:
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DISTRIBUTION:Original vnd one copy to Local Authority,Pinr KIV Owner and Sail Teslei.
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