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HomeMy WebLinkAbout020-1171-50-000 St. Croix County Zoning Wednesday, December 15, 2004 at 7:56:14 AM Detail Sanitary Information page 1 off Computer 020.1171-50.000 Sub/Plat: Edgewood Estates III Section: 7 Parcel 07.29.19.1070 Lot: 110&111 TNIRNG: T29N R19W Municipality: Hudson Township ,ZZ 7 CSM: 114114: SW 114 NW 114 Owner: Christensen, Mark & MaryA@*Edgewood Drive Hudson, WI 54016 State Permit: 83860 Issued: 09/0511986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 12/2611986 POWTS Detail: Trench (seepage) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson Yes Timm, Roger $000 Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 91512005 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r 12/15/2004 07:45 AM PAGE 1 OF 1 Parcel 020-1171-50-000 020 -TOWN OF HUDSON Alt. Parcel 7.29.19.1070 ST. CROIX COUNTY, WISCONSIN Current Sales Area Application # Permit # Permit Type Creation Date Historical Date M 00 # 0 Owner(s): * = Current Owner Tax Address: * CHAMBERS, FREDRICK E & ANTOINETTE FREDRICK E & ANTOINETTE CHAMBERS 332 EDGEWOOD DR HUDSON WI 54016 Property Address(es): Primary Districts: SC =School SP =Special * 334 EDGEWOOD DR Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 W ITC Acres: 1.180 Plat: 1932-EDGEWOOD ESTATES III Legal Description: Block/Condo Bldg: SEC 7 T29N R1 9W LOTS 110 & 111 EDGEWOOD ESTATESIII Tract(s): Sec-Twn-Rng 40 1/4 1601/4) 07-29N-19W Parcel History: Type Notes: Date Doc # Vol/Page WD 08/19/2002 687492 736 /382 07123/1997 2004 SUMMARY Bill Fair Market Value: Assessed with: 491111 306,100 Last Changed: 10/29/2001 Valuations: Land Improve Total State Reason Class Acres Description G1 1.180 29,300 207,500 236,800 NO RESIDENTIAL Totals for 2004: 1.180 29,300 207,500 236,8000 erty Genera WProp land 0.000 0 Totals for 2003: 1.180 29,300 207,500 236,800 General Property 0 0 Woodland 0.000 Batch 1127 Lottery Credit: Claim Count: 1 Certification Date: Specials: Category Amount User Special Code 27.00 SPECIAL ASSESSMENT 018-RECYCLING Special Assessments Special Chargeess Delinquent Charge0s Total 27.00 60 U0 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ~g dYl TOWNSHIP SEC. T OWNER ADDRESS Z ST. CROIX COUNTY, WISCONSIN 020 -//7/-;D-6aJ SUBDIVISION C+ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1.14R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM AAell 71 j~4/ie v"% /aw s ~v I 1 2b ,I ~ o r- 4 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~Q Elevation of vertical reference point : j o0 - Proposed slope at site: l~ S /mod t> SEPTIC TANK: Manufacturer: Sp/ Liquid Capacity: iQ Number of rings used: o Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: /Sa / Number of feet from nearest Road: Front,O Side, Rear, O feet feet .From nearest property line Front,OSide 10Rear , Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensio~s to REVERSE SIDE septic tant PUMP CHAMBER Manufacturer: Liquid Capacity: V 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, Rear O , 0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:_ Len `th: i"Z ~ Number of Lines: Z Area Built: Fill depth to top of pipe: 2- N umber of feet from nearest property line: Front 0Side, Rear, Ol►t . Number of feet from well: aC./ 4. Number of feet from building: oZ~ . (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 bo or distribution box been used on any of the above soil absorbtion sytems? (C'heecck one). o 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, 0 Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ~ Z J Z fir' - f%~ ~ Plumber on job: ~r License Number : 3/84:mj SAFETY & BUILUIN%J* DEPARTMENT OF I,NDU$TRY, INSPECTION REPORT FOR DIVISION LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7969 MAD ISON, W 153707 ~I,pn N V E NT I O N A L D ALTERNATIVE Steta Ple^ I.D. Number: "1s1pned1 D Holding Tank E In-Ground Pressure E Mound t INSPECTION ATE: + 6 NAME Of PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Mark Christensen Rt. 2, Hudson, WI 54016 ~;`e a REF. T! ?6V.: CSTREF. PT.ELEV BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. T29N-R19W, Town of Hudson,Lots110-111, Edgewood Est. SE NW, Section 7, Cou Iy Samlary Perm.t Number: Name Of Plumber MPIMPRSW Nn.. p 30 G O 3224 St. Croix O OV NING Roger Timm , ( LIOUI CAPACIT ANK INLE ELEV. TANK OUTLE~T/ELEV. PROVIOEDLAB L LOCKINGC SEPTIC TANK/HOLDING NK: PROVIDED MANUFACTURER,: / YES ENO EYES ENO / PROPERT WELL BUILDING: V NT TO FRESH LLLilllllll HIGH WATER NUMBER OF ROAD' LIN AIR ONE. BEDDING: VENT MAT , ALARM FEET FROM µ EYES ENO NEAREST ` f EYES EN DOSING CHAMBER: pUMP.SIPHON MANUI ACIOHE" WARNING LABEL LOCKING COVER PROVIDED PROVIDED' MANUFACTURER BEDDING. LIQUID CAPACI Iy Pt1MV MOIIEE ONO EYES ENO YES R OF OPE HTV WE L L BVILDING AIR H V NT TO FEE INLET, EYES ENO PUMP AND CONTROLS OPERATIONAL NUMBE LINE L GALLONS PER CYCLE: FEET FROM (DIFFERENCE BETWEEN EYES ENO NEAREST--1• AND OFF) f plowi I F Nl~nl UTAMF TC11 AtA1f HIAI AND MARKING PUMP SOIL ON ABSORPTION SYSTEM. Check the soil moisture at the depth plowing FORGE or excavation. (If soil can be rolled into a wire, construction Shall cease until MAIN the soil is dry enough to continue.) uoulD CONVENTIONAL SYSTEM: INSIDE ()IA SPITS DEPTH WIDT w EN iH/ NO OF UISTN PIPE $V A(:IN(. COVE N IAL' PIT BED/TRENCH THENy)NfS DIMENSIONS O~ NUMBER OF LINE PROPE Ty WELL BUILDING V AIRNT(/Q_TO FRESH Iy~E L D TN 'IL DEPTH UI 1H IPf EL jjT PIP DISTN _PIPF MATERIAL P P ~H FEET FROM BELOW PIP LS ABOVE COVER E DfII NEAREST MOUND SYSTEM: Mound site plowed perpen iCLE ar o slope Check th t xtuof the fill material for PROVIDE A DIAGRAM OF SYSTEM MEASURED, SHOW ELEVA- and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. meets the criteria for medium sand. TIONS EYES ENO PF 111114Nf NI MAHKf HS OBSEHVATIONWELLS OIL COVER TEXTURE EYES ENO EYES. ONO 6fFUFD MULCHED E OVER TRENCH NEU UT PTH Of TOPSOIL SM)Df 1) []YES ENO EYES ENO DEPTH OVER TRENCH BED DEPTH CENTER EYES. ENO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOV COVER WIDTH LENGTH NO.OF LATERAL SPACING GHAVEL DEPTH BELOW PIPE BEDfTRENCH TRENCHES DIMENSIONS MANIFOLD MATERIAL NO DISTH DISTN PIP DISTItIBU 11ON PIPE MAT EHIAL & MARKING MANIFOLD P MI OLU DISTR. PIPE PIPIs DIA ELEV. ELLEV. DIA ELEV. ELEVATION AND COVER TENIAL VERTICAL LtiT CORRESPONDS?O APPRUVEO DISTRIBUTION HOLE SPACING DRILLED COHHFCI LY PLANS INFORMATION HOLE SIZE DYES ENO OYES ENO PROPERTY WELL. BUILDING: OBSERV ATI E LS. NUMBER OF LINE COMMENTS: PERMANENT MARKERS. FEET FROM DYES ENO EYES NO NEAREST r B O .0 I 1 .7 ! R in county f i le for audit. Sketch System on •O TITLE RBVerSe Side. /3 GI SIGNATURE DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUN Y (~tDILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # 3 0 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I,D. NUMBER 8% ox 11 inches in size. -See reverse side for instructions for completing this application. FFORITVARIANCE ION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ❑ YES ❑ NO PROPERTY OWNER / I / - ~F?% RTY LOCATION P1 LcIY I- ehe i N?' c j/ '7 T a , N, R /9 E (or W PROPER ;OWN 'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ' r Z %i r 1 I cJ CITYLtATELL. ZIP C, ODDE / PHONE NUM ER CITY NEA T ROAD, LAKE OR LANDMARK " 1 7' ~i ' A/ O VILLAGE : SCf7 ~ 'j )~.~t II. TYPE OF BUILDING OR USE SERVED: d Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specity): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a./31 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of ell Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a- Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. See a e 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): 7~ Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. Con- INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank ~uF Lift Pump Tank/Si hon Chamber, ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plume Signature: (No Sta s) MP/AdeEsw-wo.: Business Phone Number: E/ ,j•►r<rat,J 71-5 72-- z Plumber' Ad ress (Stye t, City, State, Zip Code : Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil T ster (CST) Name CST # r e.,, 1 CST's ADDRESS (Stree ity, State, Zip Code) Phone Number:~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial S~ch~Fee r Adverse Determination ,~V ~•CJ 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 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION a 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 revisiorfs trp this permit must,be approved by tlf.0;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 Oy:,a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's e can effect groundwater. The surcharge! took effect on July 1, 1984. All of the water that b,,;ried ~reasuts ~I is used in your building is returned tc: the groundwater through your soil absorption sy-stem.or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund admirds- tered by the Department of Natural Resources. These funds are used for monitorirq ground- _1 groundwater contamination in,,estigations and establishment of standards. Groundwater, ~Y it's worth protecting. SBD-6398 (R.03/86) a I I 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 i4s uance. Should this development be intended for resale by owner/contractgr,("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 41 Location of Property /f/14 k, Section - 7_--, T '90 N - R Z_ W Township /7.6 077 Mulling Address Subdivision Name , . _ _ _ - Luc Number Previous Owner of Property 'Dotal Size of Parcel fG2~ Y'- Date Parcel was Created Are all corners and lot lines identifiable? - X Yes No Is this property being developed for resale (spec house) ? Yes x No Volume (0 and Page Number y'- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 1. Land Contract J. Other recordings filed with the Register of Deeds Office lit addition, a certified survey, if available, would be helpful so as to avoid delays 01 the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 iw(,) eenti6y that at 6tatement6 on thiA 6onm ane true to the but o6 my (oun) knuw&dge; that I (we) am (ane) the owner(6) o6 the pnopen.ty de cAibed in -th.i6 ( . ji6utunatiun 6onm. by viAtue o6 a wama.nty deed aecoaded in the 066ice o6 Vie County Regi4ten o6 Deed6 ab Document No. 4110(5 ; and that I (we) pn"L,.►4txy own the pnopoaed 6,ite bon the sewage di.epaba~by6,tem (on I (we) have ob'ta'ined an ea6ement, to nun with the above de c ibed pnopenty, bon .the eoa6tnuc Lion o6 6ai.d 6y6tem, and the Game ha6 been duty %econded in the 066.iee u6 .the County RegiAten. o6 Deed6, as Document No. yi0 5"41 ) SIGNATURE OF OWNER SIGNATU E OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIG'NE'D H a ' r S T C`- 105 r a rl SEPTIC TANK MAINTENANCE AGREEMENT o \ St. Croix County a OWNER/B`UYER t - ROUTE/BoX NUMBER Fire Number • CITY/STATEi Q~1 ZIP PROPERTY LOCATION: SE /UW , Section T_aq N, Rl_W, Town of St. Croix County, Subdivision lam, 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 litrve years or sourer, uu►~4~ ._.--.wliuC tank. if needed, by a licensed septic you put into the system can affect the function 4--the septic tank as a -treat- ment stage in the waste disposal system. - St. Croix County residents all be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation pr o,r7~"Co_.auly ^1-9-78...._. St. Cr-oix 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 scuia Certification form will be sent approximately 30 days prior to three year expiration. E z I/WE, the undersigned, have reao the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- PC 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 / DATE St. Croix County Zoning Office P. 0. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. fire-,, NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION_:_ I NTOWN$l- OT NO.' BLK. NO. SUBDIVISION NAME: 5 C 7 /"r 7-9 NIN /L) or tavq UASo N 1: rb-11 ! Eb(zEwOOb STATes COUNTY: W E AM : I MAILING ADDRESS: r Ccolx 8414 6 L. PM6N,- /N~• F36 SiCfarx'ST A101m /4uAS till 'S w6 USE DATES ONERVATIONS MADE CIAL O : ~Rasidence New ❑Reptace 26, f 9 G UNK ),j) L,. DOo< Ae L 49 SOtti' RATING: S- Site suitable for system U- Sita unsuitable for system Sq G Z -SAN?/A46 N A : IMOUND: IIPTG IISSLIRE: - -FI~~1LL rnS IING TAtt I K: RCOMMENDED SYSTEM:(optional) S ❑ S ❑u S CIU ❑S V C,OWI/6N710 AL, k~Q If Percolation Tests are NOT required DESIGN RATE:- If any portion of the tested area is in the A IA under s.H63.tJ9(51Ib), indicate: CL14 SS 3 • Floodplain, indicate Floodplain elevation: A A PROFILE DESCRIPTIONS --r BORING TOTAL T Q-I.NCHES7 A SOIL-WITH THICKNESS, C OR, T X RE, AN DEPTH NUMBER DEPTH M ELEVATION B TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) p-O.q' L LTS 0.4 - •'K Lr kt4 L .Z n.e To CMkVj_SAN B- / X0.10 /as.o© Npwc }lo,ro~ ~cah 9.z 8 t o rM :z- in.I 4s Vcdb B- Z 8.1 /03.20 l~/anl L T $ , % - - e d S C. R ~ co U-Lo Ajw.'S,L PS-2.7' S-SQLw cob 2,7- 8.3 B- /04,3o A(onl > 0~,SR+:e ~Uccobccn, ~.3-B.~s ~,QnSf4Q ~'cab• p.t7,6` t t I 0,8-7.O G-h,c w! Z.0- .b 4 5TT B. 4 q 0 boo.oo NoNL > 4'U T14KCS,/ Cltl>taNS 0- RA S,! ONiM Cti AT,j.?S Z"k3"GiYCCL 6t Al 'A& ! 0_0.% '184- L TS Q.$-2.0 99AJ r *Z.d- IA 'ON L B- 6 /0-511 o >r > IO S~ G G1, 'SA-/6,S p N S'46'e b 0 -0 6 19L 1_7S 0.& - / •7 I8,ie,4 I L .7- Z- s E+Pn;f 6 ~ f S L- B. L,, CoL+G Z•S ~•3 Q Gob Cow. PERCOLATION TESTS rtoTTUU4 rN 'uPmeft LAYeal - A-S o~ A tv t~IL tT. 99.%('3 NON > 9.0o uLiAC~t:IlTAdLt- ec TEST DEPTH WATER IN HOLE TEST TIM WATER DROP IN RA MINUTES Mt I ER W2LES AFTERSWELLING INTERVAL-MIN. PERIOD I Pf" 81002 PER PER INCH P. 1 16 .x()' AJ 8O 3© mix/ .0 I o b1p w o P Z 'vL 107,10 3 / q r't B I .1i3 f 1g .Z- P- P• P- _ S tc.c:.t;oris of Nr .o;ati.•n tests, wi;l d..%; -tile ditnwtoiwas of yuhdlra soil a,c,as. indlc,ntl bcaii or %fisttiooft. tVM*.b1r' „TM a.t. li+e nuli. 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 98 . ao , , 1 _ r~ ins Q'"~ en 1 13 41 LoT 1 ~ l a o B' z Settle" ~ ~ I 6, ~or it SAT I, the undersigned, her_eby certify that the soil two reported on this form were made I;ly me in accord,n;tflt the'-procadures 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: ~~d~'~r~7` 1%a1tt•!"~L'1~ F&MOAkY 7G /6386 ADD SS: / j ERTIFICs}T12N NUMBER: PHONE NUMBERInptional►: T I TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. t.In-Cnn a"zuaM rlv l - OVfFt - Timm, 1013--d ~tir[SkNser SHEET NO. OF_ xcavating Co. CALCULATED BY . D S R I, Box 192, Wilson, WI 54027 CHECKED BY DATE SCALE L.. .1..... 1 i f U l4LS ~"!0N l _ 3,33 ~~~y► Li I 5 ►IlOdlt" fOt. zinc. &*W NW 81471. Timm #k ~ OF - CALCULATED BY Co. SHEET NO. OF BY Amt., /I~►N1 /~JP~ 3~ 2y R I, Box 142, Wilson, WI 54027 CHECKED BY DATE SCALE i i.. /vo p-P .E ~ 98.+7 7ts / ~I /QI'7 o n 4... i P I ~ +F 1 1 1 N W arix+xY.