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• Parcel 038-1097-70-000 12/04/2006 01:41 PM
PAGE 1 OF 1
Alt. Parcel 23.31.18.404E 038 - TOWN OF STAR PRAIRIE
Current XI 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 - BEARTH, GENE W & TAMARA JO
GENE W & TAMARA JO BEARTH
2006 CTY RD CC
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2006 CTY RD CC
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE
SEC 23 T31 N R1 8W 1.503A IN SE SE LOT 4 Block/Condo Bldg:
OF CSM IN VOL II PAGE 333
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/21/2001 662649 1767/369 WD
07/23/1997 520/546
2006 SUMMARY Bill Fair Market Value: Assessed with:
175497 178,700
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 28,500 129,400 157,900 NO
Totals for 2006:
General Property 1.500 28,500 129,400 157,900
Woodland 0.000 0 0
Totals for 2005:
General Property 1.500 28,500 129,400 157,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
*Parcel 038-1097-40-000 12/04/2006 01:37 PM
PAGE 1OF1
Alt. Parcel 23.31.18.404B 038 - TOWN OF STAR PRAIRIE
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
THEODORE H & JUDITH ARONSON O - ARONSON, THEODORE H & JUDITH
4932 BRITENI WAY #77
ZEPHRYHILLS FL 33541-7312
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
I
II
Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE
SEC 23 T31 N R1 8W S 20OFT OF E 870 FT OF Block/Condo Bldg:
SE SE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 573/437
2006 SUMMARY Bill Fair Market Value: Assessed with:
175494 11,300
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
UNDEVELOPED G5 4.000 10,000 0 10,000 NO
Totals for 2006:
General Property 4.000 10,000 0 10,000
Woodland 0.000 0 0
Totals for 2005:
General Property 4.000 10,000 0 10,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
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 :2~~jdrr1 TOWNSHIP i SEC. T N-R W
ADDRESS k 42 ST. CROIX COUNTY, WISCONSIN
JJ
SUBDIVISION LOT /J LOT SIZE `4
-r-
PLAN VIEW
Distances and dimensions to meet requirements of I•1,HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Y
IT- A
\a Sr r t ~►Y1=
l
~ilk,
RT
r
t
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /00 Proposed slope at site:
SEPTIC TANK: Manufacturer: y Liquid Capacity:
Number of rings used: A4--Tank manhole cover elevation:
Tank Inlet Elevation: U~--,-Tank Outlet Elevation:
Number of feet from nea est Road: Front A i
de 0 Rear, _ feet
~F6
f
From nearest property line Front ,-Side,O Rear, O feet
f
Number of feet from: well 56 , building: a G I .11
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE STDR
PUMP CHAMBER
6
Manufacturer: Liquid Ca ity:
Pump Model: - Pump/Siphon Ma acturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation, Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of fee rom nearest property line: Front, O Side, O Rear, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
(.2- ) r s
Width: Lenifh: -5 Number of Lines: .2 Area Built: -7Fill depth to top of piper
Number of feet from nearest property line: Front, O Side, Rear,0 Pt. ~
r
Number of feet from well:
Number of feet from building:
(Include distances on pl plan).
SEEPAGE PIT
Size: umber of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Bu
Has eit a drop box O or distribution box been used on any of the above soil
abso tion sytems? (Check one).
LDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inle
Number of fee from nearest property line: Front, O Side, O Rear, 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 :
k
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 5370,7
e CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
El Holding Tank E] In-Ground Pressure ❑ Mound (if assigned)
NAME OF PERMIT HOLDER: rDDRESS OF PERMIT HOLDER: INSPECTION DATTEn` ~ ~J
Ted Aronson 2, New Richmond, WI 54017
fJ •_~V I~ v
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SE SE, Section 23, T31N-R18W, Town of Star Prairie
Name of Plumber MP/MPRSW No.. 7's"t. Sanitary Permit NumberGar L. Steel 3254 Croix 79128
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER
f PROVIDED. PROVIDED:
' ! s; ~u,-:•`',, t DYES ONO DYES ONO
BEDDING: VENT ENT MATE. HIGH WATER NUMBER OF ROAD: Y : O FRESH
LINEEWELL JBUILDING: JVENTT
ALARM FEET FROM IPROPERT
AIR INLET: Millifilill DYES NO DYES NO NEAREST f', ` / ! v
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. -LwAfMING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: N ER F PROPERTY WELL. BUILDING. VENTTOFRESH
(DIFFERENCE BETWEEN ET F M LINE 1 AIR INLET
PUMP ON AND OFF) DYES ONO NEAR T
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JDIAMETER 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 jNO,OF JDISTR. PIPE SPACING COVER [NIIDE DIA .PITS LIQUID
DIMENSIONS S 7 TRENCHES p. ~f. M y7ERIAL PIT DEPTH
GRAVEL DEPTH FI H DISTR. PIPE D TR. PIPE DISTR. PIPE MATERIAL. NO. DI n R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES. A E COVER. ELEV. INLET ELE EN PIPES LI: AIFj,JNLET:
g/ NE
FEET FROM '
7, 4 ( a I ! NEAREST-s f r
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-
DYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS.
DYES ONO OYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED: MULCHED.
CENTER EDGES:
DYES ONO DYES ONO DYES ONO
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. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.. DIA.. ELEV.. PIPES. DIA.:
ELEVATION AND
❑'STRIBUTION
INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES ONO NEAREST
1
Sketch System on county file for audit.
Reverse Side.
SIGNATI ,K: TITLE
DI LHR SBD 6710 (R.01/82)
Wisconsin APPLICATION FOR SANITARY PERMIT
'~!DILHR (PLB 67) COUNTY
OEPRRTTYIEnT OF UNIFORM SANI ARY PERMIT #
MEMMO~M In0USTRM;LRB0R&HUMRn RELRT10n5
-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 WN R MAILING DRESS
/J lT Y l ` l
_S PiJ /
l~✓ c7 ~ 1. p
PROPER CATION CITY:
VILLA : i~
1/4 07 1/4, S 23 , T , 3 / , N, R (or) W WN OF l
LOT N MBER BLOCK N(IMBIR JS
N ARE T ROAD, LAKE OR LANDMARK STATE PLA D. NUMBER
L'V IVA
dr
TYPE OF BUILDING OR USE SERVED `Q 7..
&1 or 2 Family Number of Bedrooms. Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
I Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ 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 Eer
/ -5, 17 &(9 r)
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
r
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):
/19 7✓O 17 _ Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installatio of he private sewage system shown on the attached plans.
Name lumber (Print): Signature fWMPRSW No.: Phone Number:
(=5 1
s . 3
Plumber's A ress: Name of Designer: 10 COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
/~S m~ CJ1~ Approved El Owner Given Initial
Adverse Determination
Reason for Di pprov :
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
- s,
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.
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 J(y S~ S
Location of Property - ;4, Section 3 , T N - R W
Township = e -
Mailing Address i
r
lx? 41-~
Subdivision Name 4
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created - v? - 7:5
Are all corners and lot lines identifiable? f~ Yes No
Is this property being developed for resale (spec house) ? Yes y/ No
Volume ~v2 and Page Number S~1-4 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract .r~
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.
PROPERTV OWNER CERTIFICATION
I (We) eeAti6y that att e.tatementA on xhiA 6onm ane .true to the beat o6 my (oun)
knowledge; that 1 (we) am (ane) the owneA(d) o6 the pnopehty de c&i.bed in xh A
in6o4ma ion 6onm, by vi tue o6 a wakAanty deed neeonded in the 066ice o6 the
County RegiA ten o g Dee6 ae Document No. and that I (we)
pnee enemy own the pn.opoe ed site bon the d ewage d-iApozat a y.6 tem (on I (we) have
obtained an easement, to nun with the above debeni.bed pnopen.ty, bon the
construction o6 said system, and the same has been duty xeconded in the 066.iee
o6 the County RegiAten o6 Deeds, as Document No. ) .
SIGNATURE OF OWNER SI ATU OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
cn
H
. y
ST C- 105 r
H
SEPTIC TANK MAINTENANCE AGREEMEN'P o
St. Croix County V,
d
OWN E B U Y E R----- -
ROUTE/BOX NUMBER/l/o,2 Fire Number--
CITY/STATE__~C~ ~,Z21~;✓1--T(~r/r_~GIP~ti~?i~!~~-
PROPERTY LOCATION:S6- _-4, Section-23 T,31 N, R W,
Town ofSt. Croix County,
Subdivision Lot number 4 .
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 se tic tank ui~_per. What you put 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. yo
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- by
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.~
a SIGNED U
t DATE
St. Croix County Zoning Office
P.O. 3ox 96
Hammo id , WW 54 015
715-7 0-2239 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
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS 1 / MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: S SECTION: TOWNSHIP/NI11UL6FRA4_ ITY: LOT NO.:BLK. NO.: SUBDIVISIO NAME:
'1 2 Dj N/RMS (or) W , fti
COU TY. NER'S UYER'S N ME: MAILING ADDRESS.
/
19 1-)
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: ICOMMERCI L DESCRIPTIONf~,. PROFILE IPTIONS:
IPERC
LATION TESesidence New ta~teplace g c-,
RATING: S- Site suitable for system U= Site unsuitable for system
CONVENT NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
OS [:]U ®-S E QS DU 0 S 00 [IS 9U
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1/77- ] I f PROFILE DESCRIPTIONS J•
BORING TOTAL ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL 'WITH -THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
17
/ y 7
B- Cd 7'~ 9 r~ 1 G > / . ? W r •7 P J q%r,.,
113
~
B-
r.
B-
B
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -PERIOD 1 PERIOD PER INCH
P-
P
P-I/V
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 hor
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 percer
of land slope.
SYSTEM ELEVATION
J_ of 51 )F- P4- loo
S"ec. z3 ~
u
No a,.$ .
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 th 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 (pin C TESTS WERE COMPLETED ON:
~
`J ~l
ADDRESS; fj CERTIFICATION NUMBER: PHONE NUMBER (optional):
~ ~ Y~ r Z Z_~j /,5 -ZF-G=lam a
CST SIGNA
1
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
12,1 ge-'I)
31
of, 17 /
Imo/ 50
"DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
HUMAN RELATIONS
N WI 53707
HUMAN
(1-163.090) & Chapter 145.045)
LOCATION: SECTION: JTLITY: OT ►4O.:BLK. NO.: SUBDIVISIO NAME:
S'/ 1 T31 N/11/61(or)W
COU TY. NER'S UYER'S N ME: MAILING ADDRESS:
'
USE DATES OBSERVATIONS WADE
NO. BEDRMS.: COMM R zI- D S R PTION: R N TESTS:
Residence O New 151$ep►ace
RATING: S- Site suitable for system U- Site unsuitable for system
ONVEN NAL: MOUN~`D: E IN-G(R~OUN~`D ESSU : S STE~`M-IN-FILLHOLDI(N~G TANK: RECOMMENDED SYSTEM: (optional)
0If Percolation Tests are NOT required DESIGN RATE: If any porsau
tion of the tested area is in the
under s,1-163.09(5)(b), indicate: SC Floodplain, indicate Floodplain elevation: 14 )Ijq
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL ITH -THICKNESS. COLOR, TEXTURE, AND DEPTH
NUMBER OBSERVED S I HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ~191 yZlj 4/ X75 Zt: vet 83
od os~c. L, I.3 t.&.s.
7
B- to U '_3 q1y61
C;aftl 17-1.
B- j
B-
B-'
B-
PERCOLATION TESTS
TEST
NUMBER INCHES AFTER SWELOLING INTERVAL-MIN. P I D DROP IN W PEER LEVEL-INCHES RAPER INCH ES
P-
P
P- V.
P-
P.
PLOT PLAN: Show locations of percolation tests, so►l.borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hor
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 percer
of land slope.
SYSTEM ELEVATION 9~ v
_464 79
M f
m 'A). 6 - , .
Of 54-0 f) F_ P4- loo
T ,
• o
81,
140 UI ~f
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 th 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 (grin C G f TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
• CST SIGNA
l
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R, 02/82) - OVER -
• ' G u -7-7
31'
LAI
S KI a+ too'
17 , 8 i
r0