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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 - GOODING, ERROL F & HILDA IRENE ERROL F & HILDA IRENE GOODING 1188 192ND ST - BALDWIN WI 54002 Districts: SC = School SP = Special -Property Addre _ es): * = Primary Type Dist # Description * 1188 192ND ST SC 0231 BALDWIN-WOODVILLE AREA /V SP 1700 WITC ,t Ac Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 02 T29N R1 7W 40A SE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 06/15/2001 648339 1660/289 WD 07/23/1997 1216/470 LC 07/23/1997 1216/458 WD 07/23/1997 610/387 LC 2006 SUMMARY Bill M Fair Market Value: Assessed with: 171869 Use Value Assessment Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 4,200 0 4,200 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 13,000 108,600 121,600 NO Totals for 2006: General Property 40.000 17,300 108,600 125,900 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 17,300 108,600 125,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 SL Croix County Planning and Zoning GULLIXSQN,-XEN--_ NE SE, Section 16 R. R. 1 T29N-R17W Hammond, WI 54015 Town of Hammond San.Permit#74967 10-23-85 P. Cudd Conventional, Replacement INSTALLED - 11-7-85 o c, O c c 3 3 h. m o v v • -0 ~ xt v m m m 3 = ~ y CD 0) I 0~ N N N o 0 00 m a' o o m o 3 Q a N o o 1 o c W W 0 N w Q $1 N N N a IV C70 00 N N n n O A~ O CA 3 O O O CT 3 N 7 O N (A ' O 'rs' I J O CD (n m I (D ~ m N a N ~ O O O o 0 CD 0 CL v CD co Cb a O c N C/J 0 0 9 "41• O O O lZ a Cp a CD o v v v"I N CD lD N CC CJ (D CD < CS O N O C \ (D N O C1 y CCDD o O a 7 CD CD m S • O N !W F v N N C N (D f1 cn N m W CD CL a 00 a C*" O A W N I ~ N O CA CD CD y11 W ^ ? O 41 CC 7 S Z3 T C) o ? O (n O D Z) c v - D N O N O N O a N Q. O N r0 SN O. CD (Q O A, v CD N 7r N (O N n 01 O y 7 p. fD a CD D) =5 O Q ~ N N y N Cn :3 O O; I O ~CDO ~ °o m rn3 3 CL C/) N 1 O co CA O N v O < p O. 41 ~ N CIO CD I E» O a o CD b 0 CL ti I o Parcel 018-1004-00-000 11/07/2008 09:19 AM PAGE 1 OF 1 Alt. Parcel 02.29.17.24 018 - TOWN OF HAMMOND 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 - GOODING, ERROL F & HILDA IRENE ERROL F & HILDA IRENE GOODING 1188 192ND ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ''192ND ST SC 0231 BALDWIN-WOODVILLE AREA 7 SP 1700 WITC PS 7 / 17 z M-F. Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 02 T29N R17W 40A SE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 871/466 2008 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 11/04/2008 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 3.000 16,000 37,200 53,200 NO 05 AGRICULTURAL G4 18.000 2,900 0 2,900 NO 05 UNDEVELOPED G5 18.000 25,600 0 25,600 NO 05 AGRICULTURAL FOREST G5M 1.000 2,000 0 2,000 NO 05 Totals for 2008: General Property 40.000 46,500 37,200 83,700 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 15,350 28,100 43,450 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 HAMMOND T 3 .29 N._ R. 17 W. 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T 0 C h t~ • • Pefe~so c ~ ~s ~ 41 ~ ~ Otl ^ Vl \ Ncbc.,Y' Lew s ~ f~~: /3G.2 Ue /SS Eo/wo d~ ,60 ✓ ,P o% fao ~ soi7 l \ (~V~ ~ d ~.E/m cc. ~ 63 .Bernice ff.E~e~ d /6 0 a Tu nei^ .E: .E/>e A:e sow ° c. c. o 34Ri tlu n ~F^ f~° O/97z .Poc ono/ /~J¢/o [>6/s/ 1i7c. • i //sz SEE PAGE 19 no>_ FARMERS Proudly Serves You And Offers These Services FERTILIZER: BULK AND BAGGED - TRUCK OR TRACTOR SPREAD BULK FEED - GRINDING - MIXING CHEMICALS - CUSTOM WEED SPRAYING - COMPLETE LINE OF HOMIX FEEDS - SEED CLEANING & TREATING GARDEN TRACTORS - SNO TRAVELERS - CAMPING EQUIP. PHONE: 684-3371 BALDWIN, WISCONSIN ' Form -STC - 10 AS BUILT SANITARY SYSTEM REPORT OWNER SEC. T N-R 1;7 W ADDRESS ,e/ ST. CROIX COUNTY, WISCONSIN T SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~S, Q 30 i . gel IX C3 /UD Az' sns No, 2X' we , INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ~JIaSG' o /~9~ _ /00 d Proposed slope at site: . z °70 SEPTIC TANK: Manufacturer: l~~ee7l~: Liquid Capacity: Number of rings used: Tank manhole cover elevation: /d~Ql7` Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, 0 //p feet -From nearest property line Front,OSide,ORear,/C\ ~Q feet Number of feet from: well building: 30~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liqui Capacity: Pump Model: Pump/Sipho Ma u4Glons er: Pump Size Elevation of inlet: Bo to ank elevation: Pump off switch elevation: 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: Ye.S Trench i Width: l.Z Length: Number of Lines: Area Built: 4<& Z7 Fill depth to top of pipe: s~ Number of feet from nearest property line: Front, /O Side, O Rear,© Pt..Z Number of feet from well: Number of feet from building: 1-7 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom eepag it 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 prop/builtdin r t, O Side, O Rear, OFt. Number of feet : Number of feet fro : Number offeet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ,'~~"w lY License Number : X47 7 3/84:mj PUMP CHAMBER Manufacturer: Liqui Capacity: Pump Model: Pump/Sipho Ma ufac er: Pump Size Elevation of inlet: Bo to tank elevation: Pump off switch elevation: G llons 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 ABSORPTION SYSTEM Bed: l ~ Trench: Width: 1, ~ Length: Number of Lines: Area Built: G 1 Fill depth to top of pipe: 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). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom eelevation: 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: 1111A1 A n r t, O Side, O Rear, O Ft. Number of feet from nearest prop/buildind// Number of feet 11: Number of feet fro 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 & FtUMAN RELATIONS P.O. BOX 7969, 969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, WI 53707 XXXONVENTIONAL ❑ALTERNATIVE State Plan ID, Number: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Nolan Anderson R. R. 2, Baldwin, WI 54002 _ d o_-? BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SE SW, Section 2, T29N-R17W, Town of Hammond Name of Plumber MP/MiWW County: Sanitary Permit Number Dale E. Hudson 6St. Croix 64901 SEPTIC TANK/HOLDING TANK: • H MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. /ONO YES ❑NO ❑YES ❑NO BEDDING: tDIA.. VENT MATLHIGH WATER NUMBER ROADPROPERT WELLUILDING: VENT TO FRESH ALARM: FEET FROM LINE 'f BIqIR INLET: YES ❑NO ❑YES ❑NO NEAREST JJ/J DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL. IBUILDING:I VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE~jU ~ AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST ~ f'? _ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IL cvGTH 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 jNO,OF IDISTR PIPE SPACING: COVER INSIDE DIA #PITS LIQUID TREN S. / MA RIAL: PIT DEPTH: DIMENSIONS C/Y~ GRAVEL DEPTH FILL DEPTH IDISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL: TR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES. 0 ABO WER: El-V~NLET ELE END. PI FEET FROM LINE / AIR INLET: ' F U ~v NEAREST-~ !O~ 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH;BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑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 DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV., ELE V.. DIA.. ELEV.: PIPES: MIA,: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS' ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on in in county file for audit. Reverse Side. SI N U E: TITLE. DILHR SBD 6710 (R. 01/82) Ujisconsm APPLICATION FOR SANITARY PERMIT COUNTY ILHR, (PLB 67) ~1~ oeg11W7m6n T OF UNIFORM SANITARY PERMIT # ~ M'TOIJ$T Rb+'. LraepR SHUmF1/1/gEyRTKXiB. -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Y2 x 11 inches in size. -See reverse side for instructions' for completing this application. PLEASE PRINT PROPERTY OWNER / MAILING ADDRESS PROPERTY LOCATION .S'F 1/45&A/4, S ,0 , T29, N R/7 (or G TOWN OF } /TAX LOT NUMBER BLOCK NUMBER ISUBDIVI$ION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ,0 TYPE OF BUILDING OR USE SERVED dl 10051_ 761-62"J X 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 U 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 C~c'JCD Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer. ' 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 SO TIDN AR WATER SUPPLY: (Minutes par inch): REQUIRED (Square Feet): P POS D (Squar eetl i v- Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: IMP/MPRSW No.: Phone Number: Da le ~so~'I f ,4' ~iS168~1~337 Plumber's Address: Name of Designer: Iva" ";7 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Cf ❑ Disapproved ,t,~ f~! Approved Owner Given Initial Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBp 6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 3 1 r s ' ti oc~ IZNI y a'~~`~s 3 V l:a e~ t ~ to - n 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 4L n C I l ijji /lAde s (1[2 Location of Property , Section T N - R 1"7 W Township 44 X Jf) r n Mailing Address 0 Subdivision Name I I Lot Number n N _ Previous Owner of Property 1 ~ CL r 11 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 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. 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. PROPERTV OWNER CERTIFICATION I (We) eenti.6y that att statements on this 6onm ane true to the but o6 my (ou-0 knowP.e.dge; that I (we) am (oAe) the owneA (6) o6 the pnopen t y des end bed in th.i,a .in6o4mation 6onm, by viAtue of a wannanty deed neconded in the 066.ice of the County RegiAteA o6 Deeds as Document No. ; and that I (we) pnesentty own the proposed 6.cte bon the sewage diApo,-6-Z-6yAtem (on I (we) have obtained an easement, to nun with the above deseni.bed pnopenty, bon the eonstnucti.on of said system, and the same has been duty neconded in the Ojb<iee o6 the County Re9.c.6ten o6 Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) -f7 14 - 9-11191:!L DATE SIGNED DATE SIGNED ~,r ~bAlt ACKX y DCK n?T STATE OF WISCQ vSIN ) J ss, COUNTY OF St. Croix ~ On this 12th day of April 19 80___., r~11110 rlr~rrlrlrwMrr•~ r rte: before me Eric J. Lundell a Notary Public in and for said county, personally appeared Nels P. Anderson and Norma Anderson to me known to be the person(s) named in and who executed the foregoing instrument9 and acknowledged that they e3mcuted the same as their voluntary act and deed. (he! they) his, their) (SEAL) Notary Publi in and for said County My commission ampiraa~k is pernment. This instm-cent was drafted by the V. S. Department of Agriculture. ~.:..,...*w.+x..m.,.-.._...._,.....:-...,..:ti.....,~...,,.....,.~.~,.:: .-...wr.~yrayWtrglcwwy. ~,..,...--........y..Forri FHA-Wis. 127-3 United States Department of Agriculture Farmers Home Administration AGRFZ1 DTTT WITH LAND (00ITMIRACT FOLDER Date April 12, 1980 In consideration of a loan to be made or insured by the United States of .America, acting by and through the Administrator of the Farmers Home Admin- istration (Hereinafter referred to as the "Government")., pursuant to the Consolidated Farmers Home Administration Act of 1901 (7 U.S.C. 1921), or Title V of the Housing Act of 1949 (;42 U.S.C. 1171), to Nolan E Anderson and Ruth Ann Anderson hereinafter referred to as the "Borrowers ' , which loan is to be secured wholly or partly by a real estate mortgage granted by the borrower tothe Government on the following described real estate in the County of Croix State of Wisconsin, to wit: The SA, of the Mk, except commencing 2 rods W of the NE corner of said SW, of l Ek, thence E 2 rods, thence S 2 rods, thence NWJly to the point of beginning; E. of the SW-',, NVA, of the SE,-, ALL in Section 2-29-17. The Wk of the NW, of Section 11-29-17. The undersigned for themselves, their heirs, executors, administrators, and assigns, hereby agree that in the event the borrower shall make a default undo his contract with the undersigned for the purchase of the above described real estate, dated Aril 12,~ 1980„_, and recorded on April 14, 1980 in Book No. tp0_, Page 0' 7 - of the lase Records! St. Croix County, Wisconsin, the undersigned shall, at least 90 daya;prior to the exercise of their right of cancellation of said contract, give written notice by certified mail, to the Government, at the Office of-the State Director of the Farmers Home Administration, Stevens Point, Wis., in- I forming the Government of said default and of their intention to cancel said i caritract not less than 90 days thereafter, unless said default is removed prior to said date. It is also hereby agreed that in this event or in the event the Government exercises its right of foreclosure, the Government may pay in full the amount still due on said contract. Signed e e s Anderson i11~.M# ~I~i 11/I ill Norma Anderson H L N - H . a ST C- 105 r" • r a H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d a OWNER/BUYER /y®/qn ROUTE/BOX NUMBER ~q~LU~r17 Fire Number CITY/STATE PROPERTY LOCATION: Section T .2~ N, R 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 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. H 0 I/WE, the undersigned, have read 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- b 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 ~lt? DATE g 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. d Z L O e. 0 E c n.. c 10 O CL 0 0.- CU r_ e sv a~~oF- co 10 0 V 4 O 4) 0 L: 0 0 C p `O 7 0 m O U) C C v a) m (D OP c w W ~3>>~0 3010 eo ~0 10 EC h C CM O con (=j yy~yCN rnD° L~ Lc Fc- coo. w oo w~ 12 ca 3rn10t a7v_~ to C C V .(A y 10 ~ W °so:co~ c~ c 10 Q N o,y o C~ 10 c o o E 0 010 3 a) C 0 O N N C O Z Q c~ H V N ) a7 li Q 3 3 y Z to 4? L. a) y N c cNOCaawc 0vi0 10 0 = i 3 C 'C w 0= V O_ CD V U to Z. z Q 0 j V) N ~ Q aa~a~o c wrn-_ 0 .N co at ~ ~ ~ w w c X10.0 E o' crnZ._ 0 0 o w o~ t c c ccooc) m0co 10Ec0, 0) C (D r a~ L- cm qr CO .0 U) 4) -T co M cu 0 (D a cu a y 0 C co O L- 00 10 a a$ 16 v, . 3 m c V c O a) y C Q y t O' Q a o CM c)) c Y M" L.. m E c a`« z 1113" M== a E O a p0 a °f c O 0 a) -a Ecv vi ai w CU - N 3U) m ° « Cc* Q = J co O p/'~p AND 54AATMENT OF REPORT ON SOIL BORINGS SAFETY & L,- INDUSTRY, ~ DIVl51U LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N, W! 53709 HUMAN 4~ELATIONS (H$3.09(1) & Chapter 145.045) L ON:S&? SECTION: TOWNSHIP7PdIt71tl7Cti1'7T4: LOT NO.: BLK. NO.: SUBDIVISION NAME: % 14 al for Q~YI/!?!7/%f X /v14 COUNTY; OWN R SI 13 U Y E R'S AMEN MAILING ADDRESS: o ~r3p~ gel 1014 0 U E DATES OBSERVATIONS MADE MS.: Cf? fi L DESCRIPTION: P OFIL DESCRIPTIONS: ER OLA ION TESTS: fiesldence ❑New Replace RATING: S= Site suitable for system U~-$ite unsuitable for system V TONAL ]MOUND: IN, DPRE TE -IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) S []U 0S 2~ S ~U U H 0 S 0U CQ e,-.7 i I EIS in Percolation Tests ar required EICN ATE' If an If are NOT any portio of the tested area is in the under s.H63.09(5)(b), indicate: A*A Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BOR NG TOTAL OEM R WATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NIMABFR DEPTHS, ELEVATION B V I HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7,0 > 7, 0 B- 2 -1,67 .1 99,q0 7 a/ 32 'S 0.5 Ys B- 3 840` qq,9? /0-osd- '9 an sd; - :3 ' s B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME, DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 60IFS AFTERSWELLING INTERVAL-MIN. PERIOD I P RIO PER INCH P- 2- M2 P- 3 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' • 1 ; t ' f , ; f , i ; 3 , S c 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. NAME (Print'. TESTS WERE COMPLETED ON: ADDRESS; CERTIFICATION NUMBER: PHONE NUMBER (optional): 41/73 ZE 7 CS .3 CST SIGlTURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - J i ` •,x.11- ~ `~A / `b ~ ~ ~ 1 Ilk Y I'\ t. c r rJ ~ ~"GSA ~K, /O d ~/Q 1 C Ilk 1P Ila ~ - ° N o/ - ~ (`yam=y plo,K ke) J;i s_