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Parcel 020-1172-20-000 06/07/2006 08:43 AM
PAGE 1 OF 1
Alt. Parcel 17.29.19.1075 020 - TOWN OF HUDSON
Current Ix 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 - CAMPBELL, STEVEN W & DEBRA A
STEVEN W & DEBRA A CAMPBELL
914 RIDGE PASS
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 914 RIDGE PASS
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.004 Plat: 2627-WILLOW RIDGE EAST
SEC 17 T29N R19W LOT 76 WILLOW RIDGE Block/Condo Bldg: LOT 76
EAST
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/02/2002 683303 1921/357 WD
07/23/1997 772/190
07/23/1997 760/426
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.004 53,000 238,400 291,400 NO
Totals for 2006:
General Property 1.004 53,000 238,400 291,400
Woodland 0.000 0 0
Totals for 2005:
General Property 1.004 53,000 238,400 291,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 220
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 020-1172-20-000 08/29/2006 04:37 PM
PAGE 1 OF 1
Alt. Parcel M 17.29.19.1075 020 - TOWN OF HUDSON
Current 1-X-1! 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 - CAMPBELL, STEVEN W & DEBRA A
STEVEN W & DEBRA A CAMPBELL
914 RIDGE PASS
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 914 RIDGE PASS
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.004 Plat: 2627-WILLOW RIDGE EAST
SEC 17 T29N R19W LOT 76 WILLOW RIDGE Block/Condo Bldg: LOT 76
EAST
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/02/2002 683303 1921/357 WD
07/23/1997 772/190
07/23/1997 760/426
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.004 53,000 238,400 291,400 NO
Totals for 2006:
General Property 1.004 53,000 238,400 291,400
Woodland 0.000 0 0
Totals for 2005:
General Property 1.004 53,000 238,400 291,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 ' Certification Date: Batch 220
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form-STC- 104
' AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP u { i SEC. T 9N-R/9 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I111R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ai• /8x S3 eA
d
IN, JAI
Bokpoom Home
INDICATE NORTH ARR
BENCHM,*K: Describe the vertical reference point used
Elevation of vertical reference point:
V Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: Ip~ 0~
1 i
Number of rings used: Tank manhole cover elevation: V
-IQ
Tank Inlet Elevation: QV. Tank Outlet Elevation: 100-A
of feet from nearest Road: Front A7\ Side
Rear, O
~Q!
10 feet
From nearest property line Front 10 Side,Q Rear, O feet
Number of feet from: well
building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
f
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 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan). SIN Q ' V05 _79,05
v ~7 pp
Be NC~ MAK 40
SOIL ABSORPTION SYSTEM i- 3V "NID
VR-104 00 ~t - /Bed: Trench: Sit C'-* 3p" i1~M (~•~10
53 Num er of Lines:_ Area Built: 96 y
Width: Length:
Fill depth to top of pipe: Q0
Number of feet from nearest property line: Front, O Side, O Rear, Ft.~
Number of feet from well: 1~Q,
Number of feet from building: I,
(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).
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: ~1
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: ;2 Plumber on job:
~
License Number: J
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR 14UMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.Q. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
WCONVENTIONAL E] ALTERNATIVE State Plan I.D. Number:
D Holding Tank D In-Ground Pressure r7 Mound r' assigned)
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Wayne Moser 627 Fairfax, Altoona, WI 54720 / -J,2-,Q 7 ,I
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SW SW, Section 17, T29N-R19W, Town of Hudson, Lot 76, Willow Rdg. E.
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 88445
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LAB L LOCKING COVEfl
/ ` (g/~ P OVIDED: PROVIDED:
V U V, YES ❑NO DYES NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: j VENT TO FRESH
ALARM. FEET FROM LINE (AIR INL T
DYES NO DYES NO NEAREST 7 -S %
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO ! DYES ❑NO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUM ROF PROPERTY WELL BUILDING. JVENTTOFRESH
(DIFFERENCE BETWEEN FE FROM LINE AIR INLET
PUMP ON AND OFF) DYES ❑NO N REST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L GTH 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:
BED/TRENCH WIDTH LENGTH NO OF JDISTR. PIPE SPACING COVER =SIDE DIA #PITS JLIQUID
S TRENCHES / l MDEPTH
DIMENSIONS / Jl
GRAVEL DEPTH FILL DEPTH UISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPET ABOVE COVER JILIV. INLET. E V. END(~ PIPE LI G~
NE/ ANLE
EET FR
a-- G •I~ /v NEARESTO-s oC / / C~
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.
DYES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED DYES ❑ NO D YES ❑NO
SEEDED MULCHED.
CENTER: EDGES.
DYES ❑NO DYES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR
ELEVATION AND . DISTR. PIPE pISTHIBU TION PIPE MATERIAL & MARKING
ELEV.: ELEV.: CIA.: ELEV.: PIPES DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF
- 1 J j
PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ❑NO DYES ❑NO NEAREST
Sketch System on etain in county file for audit.
Reverse Side.
SIGNATURES TITLE DILHR SBD 6710 (R. 01/82)
[:E: DI~.HF~ SANITARY PERMIT APPLICATION COUNTY
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.
rF TITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. R V ARIANCE ❑ YES 9 NO
PROPER Y OWNEFj PROPERTY LOCATION
%a W%a,S T2_ N,R
19
E(or W
PROPERTY OWNER'S MAI IN,3 AD ESS LOT N MBER BLOCK NUMBER SUBDIV SIGN NAME
1R A
CITY, STATE ZIP CODE PHONE NUMBER CITY NE EST ROAD, L R LANDMARK
ILLAGE
ooN
Q 1
rC • 5YZ ao VTOWN OR AuAgnk)
-1 DA SS
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family? OR ❑ Public (Specify): C G~ I
III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable)
1. a. XrNew b. ❑ Replacement c. ❑ Replacement of d. E1 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. [ 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. See a e 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): REQU
,7q5 linj IRED (Square Feet): PROPOSED Square Feet): ~f
95 T /.0()Feet Private ❑Joint ❑Public
B-3
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
Tans Tanks structed
Septic Tank or Holding Tank Ia60 We-, S, 0 ❑ El I El ❑
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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
w
Plum Ws A dress Street, it , e, ip ode): r Name % Designer.
f, i i.
VIII. SOIL TEST INFORMATION SAO
Certified S '1 Tester (CST) Name E7/-J-) ST
,e .3X/yc
CST's ADDRESS (Street, Staatee,Z' Code) oneNumber: '306--
IX. -7
COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa
ry Permit Fee Groundwater ate Issuing Agent Signature (No Stamps
41
S rcharee~
Approved ❑ Owner Given Initial IQ~2
Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL: 7 eel
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
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 permitrmay be needed
if there is a Change in your building plans, system location, estimated wastewater flow (number @ -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, 608-266-3815.
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;
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'/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 dimensigns, 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
r 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 (lees) for a number of regulated practices which Wiscori~in's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure
is used in your building is returned t_~- the groundwater through your soil absorption ,o
system or the disposal site used by your holding tank pumper.
L- 4
The monies collected through these surcharges are credited to ti ha graur xwale.,- f.r:d adminis-
3d by the Department of Natural R~ sources. These funds are used for r-non coring ground- ~f
er, groundwater contamin~tr: =F in estigations and establishment of standards. Groundwater,
worth protecting.
-6398 l1?.03/861
APPLICATIOV ANITARY PERMIT
• - 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/contractQZ,("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. 1S'U/Z T' )✓~,1~E ` "war,
81 -
Location of Property c, 2Lk Section 1:2, T - N - R
Township } ~jy 6 0f
Mailing Address
_f44- b.A/14 w/ y a
Subdivision Name W I LJU /Z A 96A OAVT
Lot Number -76,
Previous Owner of Property
Total Size of Parcel /4 C,46-4
Date Parcel was Created /6
Are all corners and lot lines identifiable? Yes No
1s this property being developed for resale (spec house) ? Yes f No
Volume 60 and Page Number Y_24'e as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
Warra_a.ry Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of 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
I (Ole) eeAti.6y .that aU Statementz on .th.i,a 60~un cute .thue to the but o6 my (ouA)
h..nowtedge; fha.t I (we) am (au,) the owraeh(s) 06 the phopehty debcAubed in .thin
in6o,unati.on ;6o4m, by vi)Ltue o~ a waJvtartty deed n.eeo/cded in .the 066ice o6 the
County Regia'ten o6 Deeds as Document No. / , and that I (we)
pAuen,t!'y oun tMe paoposed site bo4 the selvage dizposat system (on I (we) have
obtained an easement, to tun with the above de,6mbed p&openty, bon. ,the
con6tAucti.or, o6 said system, and .the scune has been dwey aeeonded in the 066ice
o6 .the CounA y Regis-tea o6 Deeds, as Document No. ) .
/ ~ j ~~✓C mil)
C
SIGNATURE OF OWNER S A U[: OF CO-OWNER (IF APPLICABLE)
Z/_ i~-j - Z E,
'
DATE SIGN L /1 DATE SIGNED
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SEPTIC 'LANK MAfNTENANCE AUR1ElEMENT o
St. Croix County
. v
y
OWNER/BUYER /ICJ fi Ile' lNG.1~ Ll1i9L/l7,e ~55'er ~
ROUTE/BOX NUMBER S 16 (d7 Fine Number
C I T Y/ S T A T E _ ~ ( , 7 ' ~ U / ✓ f ~ i b e ! / S ' 2 L4 Z I P
PROPERTY LOCATION: SCA/ ` Section L2 '1'_ N, R_~
Town of dy)oc'0~.~ St. Croix County, 1
Subdivision WlLL,.► A10jf- 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 evory three years or sooner,
if needed, by a licensed sultic tank piter. What 'YOU put into
the system can affect the function of the svhtic tank as a treat-
meat 'stage in the waste disposal system.
St. Croix County residents w_,:jj be eligible `to receive a grant f.or
a maximum of 60% of the cost of replacement '.of_a falling system,
which was in operation -prior to July 1,- 197$.` St,.-C.ro,ix County
accepted this program in 'August of 1980,.wit4',the~.requ.lrement that
owners of all new systems agree to_keeli thutr systems properly
maintained,
The pr.uperty owner agrees to submit to St. Croix County Zonin.g 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 bf sludge and scum.
Certification form will be sent approximately 30 drys prior to
three year expiration. y
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- ro
u►ent-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. ,
S I C N E U
DATE it n
St. Ct,oix C.,unty 'Coning Office LA-1
ll
P.-O. E' o x 98 I / lyj
Nammor d, WI 54015
715-7S:6-223q or 715-425-8363
NPUST DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INnUSTRY, DIVISION
LABOR AND P.O. BOX 7969
HUMAN RELATIONS,ff RCOLATION TESTS ( \115) MADISON, WI 53707
' (H63.09(1) & Chapter 146.045)
LOCATION: 5 SECTIO T MUNICIPALITY: T IIJO.J.BLK NO.: SUBDIVISION NAME: .
SW 1/ r,/1/ 17 /Tz9 N/R~ ~(or W UIISSOrf 1L
7G - it-LOW 44C E~4ST
COUNTY: WNER'S S AM : MAILING i '
STCP-6IA $rt/4 4EdELoPM1cNT /Nc. $36 5-rCso)x ST*E rr`t4krN %utscN iNI S4o/6
USE DATES OBSERVATIONS MADE
F NCX BEDRMS.: M
Residence (J),j< - ®New ❑Replace OCT xs
P( I
SotLS K-A44C STS ~stS Uut<t4m41AT
RATING; S- Site suitable for for system OU. U- Site V unsuitable for "am BKCZ
S ❑U
ONVENTIONAL: Mt_J ou . s - - u L [IS I'M I T RCECOMM ENDED OIVVEATKoNIIL fSE& I'
PUS If Percolation Tosts are NOT r wired DESIGN RATE:
squired If any portion of the tested area is in the ~
under s.H63.09(5) (b), Indicate CLASS Z F16odplain,,inclicato Ftoodplain elevation: 14A
"
PROFILE DESCRIPTIONS
BORING TOTAL DEPT A E -1 CH CHARACTER O SOIL-WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHmf ELEVATION QB5ER V TO BEDROCK IF OS ERVED SEE ABBRV. ON BACK.)
B I //"&0, , i 2"16WS, C 40k /0" &AJ 'S1 G R Z8''"&4 C-M S
/647 /0/.37 le8 4A CS464fir.f1'0s.1's "SS"LrtQf-4 MS
B- Z Sb /03.6c f4oNcr >16.SO g1"13 cTZr W-i: tbl, 47&k.4MS44,t ?A"g N cS-EbR
W6L4.TS ie9eNs,L 23 t><v5L 41g&fv/IS vi B- 3 a 33 /c~o•6~ 1fofJLr > /o• 33 /"~s=$R~l S tAghm 24"Lr&N M S
B- 4 /6.47Z9T-3C) r4c,NIE >10.4Z. 17"8LLTSZ-7"&kNS,L 'i4"$NSL re1_T9#o M5 1"44*_
B- S S /00.4(, p > 9 •/1,%tLT•S26""eaNS-L 7&"gkX ~S /'"A"Az or t*&N S
B-
PERCOLATION. TESTS
TEST DEPTH WATER IN HOLE TEST TI RAT , MINUTES
NUMBER I>S AFTERSWELLIN INTERVAL-MIN. PS R 100 2 PE RA 00- PER INCH
/w
P_ I 3.4C Norg 6 11 vo.4(. 10
P- Z. 3.6-11 Novi"( 11 6O.6'S 10 y / .4
P- 3 6- G ; oNb( bbl.66 i > Z ? < Z
P- ELL)(d ,oN c *c-
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. PKIMJQPY - 97~
SYSTEM ELEVATION ALT. - q4• 3c~)
i - , , /a EL F - +t 1
i
I ~ LaT 6►4~~5-
r
L p-r 4~ S 1
I I B 3
d
i ~ ca • i i•
1
'A-Z_ -
i ` r L.^,~ j 30
I ..PI V_ i xr. TRPC
i f II u; t 'ao I G/
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T 7
i I ~ ~ i •
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1, the undersigned, her 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, an that the date recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME print : TESTS WERE COMPLETED ON:
I~AkV1zy Jold,1JsoN C1c-roBe+R 2S /9W(3
ADDRESS: l/ CERTIFICATION NUMBER: PHONE NUMBER (optional):
467 Sc r-oiv & l /o&c-a 'S4016 3484 3-66 4.0 0
T SIG URE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
nil WR_SRn-6395 tR o?/R?) -OVER -
(?_B.L. 67
PL CST ANROSS SECTION
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L I C E N S E =f t- ! o si ,
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FRESH All! INI:I:TS AND OBSERVATI(}Cd I LPE
CROSS SECTION
App v_r,ved Vent Cap
101.50
Minimum 12" Above
Final Graj._
4" Cast Iron
Above Pipe - Vent Pipe
To Final Grad:------
Marsh Flay Or Synthetic Cover:i.ng
Min. 2" Aggreg"
Over Pipe ~V '.1
Distribution Tee
Pipe
Aggregate Perforated Pipe Below
9 I, oo Beneath Pipe c-- -Coupling Terminating At
Bottom of System
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