Loading...
HomeMy WebLinkAbout020-1137-70-000 n CO) p g v n tz r~ I o d f c~ c M -0 7! m • M ? O ~n~ 0 ED o~ ° CAw r ° =r 3 5. o C a N o a= z n N ED) O CO ^ w a- _ CO w ` 1 N Q O O J (D O OD -4 Cl " O C W 01 7 3 V O oo to N ~ p i (D O m a CD W a -p :3 3 CO W r C CD 6~_ i two. 0rCh 0) 0) 0 r! cr 0 000 0 G) 0 'a Oro 7c 3 'a (a ca C4 =r a C 07 N O N N a S, it Q IN m N n O1 ' N OD. = 3 D1 O. N a a M O z 0o z O I~ D a ~ 3 CD N N • y N IIVV CD N c CAD N CD I w o- n 3 o CD =3 o z y c A z o v a G) o ! (A N ! Ill N CD co CD CO CL B z °o » z N z F w Wo, D Cn~C5 n ~ o v CO 'D D v c am CD o a ~ 75 6 N n f/i N O lG Q r y I m- 6 W O 3 C (D 0) 3 O O. Q A (d 07 CL O ;L C_ O S G 0 w p N NO O O A O_ b ;r O 6q a p 0 V I ~ a Parcel 020-1137-70-000 05/23/2005 11:38 AM PAGE 1OF1 Alt. Parcel M 29.29.19.688 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner HAMBLIN, PAUL W & KATHERINE R PAUL W & KATHERINE R HAMBLIN 756 GHERTY LA HUDSON WI 54016 * = Districts: SC School SP Special Property Address(es): Primary Type Dist # Description * 756 GHERTY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.244 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERYT'S ADD LOT 3 BLK Block/Condo Bldg: 2 LOT 3 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.244 31,200 255,000 286,200 NO Totals for 2005: General Property 2.244 31,200 255,000 286,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.244 31,200 255,000 286,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 204 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1137-80-000 05/23/2005 11:38 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.689 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HAMBLIN, PAUL W & KATHERINE R PAUL W & KATHERINE R HAMBLIN 756 GHERTY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 758 GHERTY LN l SC 2611 SCH D OF HUDSON / - I SP 1700 WITC J" Legal Description: Acres: 3.145 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 4 BLK Block/Condo Bldg: 2 LOT 4 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: L st Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.145 35,800 0 5,800 NO Totals for 2005: General Property 3.145 35,800 0 35,800 Woodland 0.000 0 0 Totals for 2004: General Property 3.145 35,800 0 35,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 nnw~~ Form- STC - 104 AS BUILT SANITARY SYSTEM REPORT Iv` OWNER ~(-1UHJRM j N TOWNSHIP ~ i) SEC. T 1N-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 Cad Kc~~ ~ - - r O (000 g,4 I N INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 3 s 1 p~y . Elevation of vertical reference point: too '0 Proposed slope at site: SEPTIC TANK: Manufacturer: ~Qe Liquid Capacity: Woo ~A.) Numb#r of r.ngs used: _ Tank manhole cover elevation: Tankjnlet llevation: Tank Outlet Elevation: Numb(r of foet from nearest Road: Front,0 Side,O Rear, (D 50 feet From :iearest property line Front,OSide,0Rear,0 feet Number of feet from: well , building: 7' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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 ABSORBTION SYSTEM, Bed Trench: Width: Length:~ Number of Lines: 3 Area Built: Fill depth to top of pipe; Q f` I Number of feet from nearest property line: Front, iO Side, O Rear,(7\Ft . y Number of feet from weld.: 4J15 Number of feet from building: (Include uistances on plot piau), 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, 0Rear, 0Ft. Number of feet from well; Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector Dated Plumber on job: License Number 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7968 BUREAU OF PLUMBING MADISON, WI 63707 CONVENTIONAL ❑ALTERNATIVE State Planl,D.Numb er: is li (It assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER' INSPECTION DATE: Paul Hamblin 1064 - 10th St. N., Hudson, WI 54016 ` i 3 C~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELE V.. SE NW, Section 29,T29N-R19W, Town of Hudson,Lot#4,Blk#2,Gherty Addn. Name of Plumber: jP/MPRSW No.. County - San,try Permit Number: Richard Hopkins 1059 St. Croix 75027 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER " PROM ED. PROVIDED: 00 0 07 Ii"j18~ AYES ❑NO ❑YES NO BEDDING. VENT DIA.: VENT MATL JHIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: IV ENT TO FRESH n ALARM FEET FROM 5 LINE AIR INLET 17 ❑YES NO ❑YES ❑NO NEAREST- GO ~C) DOSING CHAMBER: MANUFACTURER . r~YINCITY JPUMP MCOEL PUMP; SIPHON MANUF ACi1HEH WARNING LABEL LOCKING COVER P OVIDEDPROVIDED ES ❑NO YES ❑NO ❑YES .❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF P OP T ELL BUILDING VENTTO FRESH (DIFFERENCE BETWEEN FEET FROM N I AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing s ~I ~,,A IFTEH 11MATIHIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until LORCE the soil is dry enough to continue.) AIN CO NVENTIONAL SYSTEM: BED/TRENCH WIDTH. LENGTH NO. OF DISTR PIPE SPACIN(V COVERNSIUE UTA -PITS LIQUID ' TRENCHES MHIAL' PIT DEPTH: DIMENSIONS GR~'VEL DFPTH FILL DEPTH UIST H. PIPF OISTH PIPE DISTR PIPE MATERIAL NO DV H NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV END ® PIPES LINE AIR INLET. t 4 I I FEET FR / lyt 12 Z 2.q NEARESTO SO S q5 1" ~I f MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PFH IANf NT MARKERS [',SFE:1YES VATTON WELLS ❑ NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BE[) D❑ YES FIND ,)I)OED SECUFD MULCHED CENTER EDGES 5 ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL INC_ DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES CIA.; ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: 1OBSERVATION WELLS NUMBER OF PROPERTY WELL: EET FROM LINE❑YES ❑NO ❑YES ❑NEAREST Sketch System on Retain in county file for audit. Reverse Side. ' SIGNATURES - TITLE DILHR SBD 6710 (R. 01/82) "r L _1(~~ - I - '`mmmi6m ujisconsln APPLICATION FOR SANITARY PERMIT j/' / DILHR COUNTY ~b DEPrigTm6rlT OF (PLB 67) UNIFORM SANITARY PERMIT # mmommon Ir101/5TR4, LRBOR 6 NUTRfI RELRTIOr15 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNT HIM i MAILING ADDRESS PROPERTY LOCATION CITY VILL ~ 114414114, S 2- 21T,3 , N, R E (or) TOWN OF LOT N MBER JBLOCK NUMBER JSNEAREST 6DAD LAKE OR LANDMARK ST T P AN I.D. NUMBER ~IA TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: 5' New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. U Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: p K!; INc IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 410 615 Gq ~ U Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (P int►: Signa e: /MPRSW No.: Phone Number: kr C'l~a,r f7~o P~~ n.5 Plum is Address: Nam f Designer: 91 r b/ COUNTY/DEPARTMENT USE ONLY Signatu a of Issuing Agent: - Fee: Date: ❑ Disapproved t d~ ❑ Owner Given Initial t5- Approved Adverse Determination on for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i APPI,ICA11011 I`HR ;;ANITARY PIMM'IT T C loll This appl.lcation inl ll! I11 I it In- romp nl ,.I lit I ill I and sil;ned by the owner(s) of the property being duvol(11)od. Any Iwidu n,ir lun wH I. only result in delays of the permit issuance. Should thfii d(tvelopment'bi! I. icendcd for.resale by owner/contractclr, ( spec house"), then a second form shon.ld bu iotnlned and completed when the property is sold and submiLLUd Ln lllln OIJI(:u wlch 1110 ul)propriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property. _ Lr_ 9= 1/ Location of Property ~--'~4 I~lw St„ Section 2' , T N - R 19 W Township Mailing Address 7711 7~41 Subdivision Name ._.....~C::).0sL-~S ,C, 114 Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Creatud J~, L 5:~- Are all corners and Iml, 11nes ident.11 li1ble? ✓ Yes No is this property be lql, developecl f'017 Posit.! e (spec hous(2) ? Yes ✓ No Volume 57 area Page Number 2 t ~ r as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: V4. Warranty 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 (tile) ceAti.6y that aU e,tatementb on this 604M ane tiLue to the best o6 my (ouA) knowledge; Biat I (we.) am (aAel the owner (,s) o6 the pnopenty duuLibed in .t6t,i s ,in6o~unati.on i6onm, by v,uctue o~ a wcvvta)Ity deed )tecatded in the 066.ice 06 tjte County RegiA teA o6 De uts " Document No. 3 23 1's C ; and that I (we) pn.Umtey oun .the, p4opobed e.ift bon .thv, 6ewage capoe ey'stem (on I (we.) have obtained an eaae.meot, to nun with the above deecnibed p~topeAty, 6o t the conltl(UlItt.or, 06 dai(1 <,IlStetn, mid -Ow 1(Inlt! has been dt,.ey'neconded in the 066ice 06 the Cotln4y Rc:d-f-.')1`.C'1 U6 [)v(,d.t,, (11 I)ootimollt tit). / 147 -7--=- SIGNATURE: (IF OWW-Jt WHATURL: OF CO-OWNER (IF APPLICABLE) DATE SIGNED I)ATE SIGNED h-i cn S T C - 105 r - r • SEPTIC TANK MAIN'T'ENANCE A(;kEl-I'MENT H St. Croix County 0 y OWNER/BUYER ~p~y` ~~~Mgt rat ~i ROUTE/BOX NUMBER Z() _7W ,j Fire Number CITY/STATE ~,LI~7s Cs a/ hJ/ s- ~C!f~ _Z 113 _ F PROPERTY LOCATION: Section Zl, T ZI M R_ _-W, Town of St'. Croix County, Subdivision 60r,rr-f 5 Lot number Improper use and maintenance of your suptic 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 LmLer. What you put into the system can affect trie function of the svI)tiC tank as a treat went stage in rh= way _ disposal system. St- Croix C,,iuntz r s=r zay be eligible lu receivu a grant for a maximum or 60Z of._ e; east of replacement of a failing system, which was in operaz. n prior to-July 1, 1978. St. Croix County- aecep,ed this prv`_az - august of 1080, with the ruquirumenC that owners of :ail new a:.~ree to keep their systems properly waintained The pruperty owner :L submit to St. Croix County Zoning a certification Tura., ,y the- owner and by a master plumber, journeyman plumber, r~s_riced plumber or a licensed pumper veri- fying that (1) tiie :>r.-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. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x Elie-standards set forth, herein, as set by'the,Wisconsin Depart- 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. Ct,oix County Zoning Office P..0. f-ox 98 Hammond,-WI .`54015...-. y 715-75'6-2239 >or ;715-425-8363 , r Sign, date and return to above:iddr~ss . vi. . t4 • ~ 0 4. q ~ a µ 1r a. f+ ti+r sk fr s e Za r t 7 s J, "AIN % r ( r 0' rw yVi % ` ~ • ~ ''CIS?•~' iK--"` ; 11~ ~(ri, 1r~ r 10 1 - t a J~4 74 ~ ~ d t lp. + t~ ice, b f - t d ' -P B.L. 6 7 PLOT OSS SEC:JTION PROJECT - _PLUM ''I. NAME A ; 1'1 tj NAME 916 L 0 C A T 10 (_IC ENS E-t as I? L U T k/1 A_P 2~ Q~ K-NC k MARK- € L = 100.0 ` illy eye 00) 0 yfl I8X3G Bed P3 7 0 131 1000 9R~ 3 BeAkoom N N~rn~ FRESH AIR :C 1 L".1'S AND OBSERVATI()N PIPE C.1.11OSS SECTION Approved Vent Cap Minimum 12" Above I 1"1I){j ~R~~ Final GracG,~____..•r'_._.j W 4" Cast Iron Above p Vent Pipe To Final Grada-___-_._ Marsh Hay Or Synthetic Cove,-i~ng Min. .2" Agg i- eq!rii f a _ Over Pipe Dis tr.bution Tee Pipe Aggregate I Perforated Pipe Below Bene- th Pipe TerminaL-.i.ng At I of tom of System O 2 n _ w~ w= C C 3 O r 1 o C (Q S S w 7 ~L~r J/ d+ O 3 p C (p O ~ W m Z O 0 _O 3 C O 7c G o ~m '0 C =Dr CD Zo a CD CD O A N CA D O lD N (D O yi c N a A* . 1 p er E CD 0 CO w -0 6 CD "Z' CD CL CD W co ID ° 3 a O 6 CD CD 0. r O CD c coo G' O w O cp j w 3 ° C° C- c m m 0 -C: w C l< ~ C1 0 A~ CD O ° a CAD O O in = CD Cb~ 7c70 D O T CD C , a cp Q O 6110 CD0 0Dc~.~~ O C C=_ w A O a w n w CD CCDD 0 f CD0 0 ao.= w O 0 (n CD -0 w~( C O~W Nf0 cc o a Cn CD CD C' CD 0 U) co C CD (D - CD n 3 `CD CD m? a 0 w a° ^w-TO ?o m QN a N.s> j w 'C En w ::r OL (a cn F C m m 3 m° O O w Al m CD c ::r CD _-x R CD CD N - CD CO Q pMt = \ O CL w O CD a, o o v, o TC: CD_ 3y oa C :3 CD n M N O A_ ~I C1 O* c cr O C 1 w3w CL L ID 0m m cr cn ° r f a = cn M, 0 G) C CD n C T) 0 << m CD 3 (D a 0 a O O 1 n M O O ti o a C C O Y o~ 40 i 'f aC_3 0CC 00 l~ CD a~ 0-CD 0 3 Q ~ ca - CD ~ z 0 © DUST M€I*T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR ~AND PERCOLATION TESTS (1151 P.O. BOX 7969 'HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHL /MU ICIPALITY: LOT NO.: B -K. NO.: S/U~BDIV ISION NAME: J n J E '/41W/4 a /Ta9N/R (or &SQn o~ EJ eH /~ddi'l-ioi1 COUNTY: OWNER'S BUYER'S NAME: MAILING ADD ESS: / C ro i fa v_ ~ 4a m b ( i h Duo Id /VGG~sz l(~~ ri/u/~ 41 USE DATES OBSERVATIONS MADE NO. BEDRMS : FCOMMERCI L DESCRIPTION: P OFI E DESCRIPTIONS: IPERCOLATION TESTS: Residence New ❑Replace Q RATING: S= Site suitable for system U= Site unsuitable for system r CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: REC MM ENDED SYSTEM: (optional) S ❑U S ❑U $ ❑ $ ❑ S U n I` na und,r7,'.H63.09(5)(b), Perlation Tests are NOT required DESIGN R7: If any portion of the tested area is in the indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I 7 01 , b01 N n~ 1 . OI 1'r0 61 f~ .9;t 61 1.0 Ibn 6 ) 3. 68 n 4 f r-.7 A'Q B- id, l 91.x0 no ' •"75' 81 l~ j.93 6A1) 117 6n Cs J V, s'3 i5n;Ps B- 3 $,5$ q`~•~$ hones 7 9,58' 1 g1 1) ,1413r,10 .0 6n 15*rar, Q.57 ghs 6 s v 6r B- Ll .IolW l ,olo` hbr2 7 9 ~ 1,$3 611) 3.92 Bn 1, a,I7 6n 15) 1,75- BhSrf-6r B- J Ib.q~ q~,$~~ hOln~' 1C3,~a 1 , 1-781 1) 1.83 Bh Id #616 n/5 On S' 6•-- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME D 130P IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTE S ELLING INTERVAL-MIN. PERIOD 1 - PERIOD 2 PERIOD PER INCH P 0: 6 y e < 3 P- AD Ps 3 sue'' `,k~ Z Z , 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 l 3 A -I i 16 6 F_ 16o f i t 1 _ F J IN ~'N ' 8M I ~ ~ I n s i = 1, 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. I M), NAME (print): TESTS ERE CO PLETED ON: ae n W!~ ( a n 8l~ ADDR S: CERTIF CATION NUMBER: PHONE NUMBER (optional►: 3 60k 3~ n l DI s 3 5-3 - 8I CST 1 A E- 1: Original and one copy to Local Authority, Property Owner and Soil Tester. .195 (R. 02/82) - OVER - t I STRUC, JNS FOR COMPLETING FORM 115 - SBD - CS35 To I„' a complete and aec..._._e soil test, your report must include: } 1. -1-- legal description- 2. >ction must clew cate whether this is a residence M numk er - commercial use planned; 4 r n am; oxe-. A ' 15 SUITABLE FOR A DING TANK ONLY IF ALL. -DO( i - OIL SOIL CON 6 L 0 ar writir and completing the plot plan; 7 3 to scale is preferre A own, an ` E 0 C i r ~s as to . tes, =rr 1p- 10 god plain, elevation) does r a appropriate box; _ ur current address an-' ,,,,'s. r distribute as require '-L FILED WITH THE Lr a1.' IITHIN30DAYSC. -VIA-a, CERTIFIED SOIL TESTERS So - e 3., I *s cs Co _ 1d med s - ,r,A f rt I: - 1d *s_... L irn an ss s - *cl 1- I Sal - L p dt3 - iv...a,E~ - ix ge f o -e Point & C rrtment may request for the private in order to ic ion,