HomeMy WebLinkAbout020-1120-90-000
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Parcel '020-1120-90-000 03/24/2006 09:19 AM
PAGE 1 OF 1
Alt. Parcel 17.29.19.526 020 - 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): 0 = Current Owner, C = Current Co-Owner
O - PORTER, JOEL D & KAREN J
JOEL D & KAREN J PORTER
388 BROOKWOOD DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 388 BROOKWOOD DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.110 Plat: 2553-TROUT BROOK WOODS ADDITION
SEC 17 & 18 T29N R1 9W TROUT BROOK WOODS Block/Condo Bldg: LOT 23
ADDITION LOT 23
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 703/323
07/23/1997 696/609
2005 SUMMARY Bill Fair Market Value: Assessed with:
92396 269,000
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.110 77,400 197,000 274,400 NO 05
Totals for 2005:
General Property 2.110 77,400 197,000 274,400
Woodland 0.000 0 0
Totals for 2004:
General Property 2.110 40,700 198,200 238,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 113
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
Form - S T C - 104
~t AS BUILT SANITARY SYSTEM REPORT
Y
OWNER O~ E )P, rf TOWNSHIP SEC. T o~ l N-R (W
ADDRESS lI2UU B900K t~Ork15 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION 1Z Olt 1 (Z4O C 0o T N0 LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IJHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
cl'
IS' ~
o
y
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used IRON Po d
Elevation of vertical reference point: J0V 01 r7o
Proposed slope at site:
SEPTIC TANK: Manufacturer: ee S Liquid Capacity: WOO ~ i
Number of rings used:
~ Tank manhole cover elevation:
Tank Inlet.Elevation Tank Outlet Elevation:
Number of feet from:nearest~ Road.: t °
Front 10 Side, Rear, O 1 j feet
From 'nearest, property line _;',Front,0Side 0Rear, 0 feet
Number of feet from: well , building:
(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, Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
r"
SOIL ABSORPTION SYSTEM r. { <YJ q
y~
Bed Trench:
Width:, Length: Number of Lines: Area Built: ) 0
Fill depth to top of pipe:
! 5.,
~t
Number of feet from nearest property line: Front,, O Side, Rear,0 Ft.
Number of feet from well:
Number of feet from building: 3
(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, O Ft.
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: f'
3/84:m3
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969
MADISON, VIII 53707 BUREAU OF PLUMBING
„CONVENTIONAL DALTERNATIVE
Ld State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound III -iq%dl
>a
NAME OF PERM, HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Joel Porter 421 Monroe St. N., Hudson, WT 54016-Iff
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: C5T REF PT. ELEV.-
NE SW, Section 17, T29N-R19W, Town of HudsonVotl#~13 out Brood Wood
Name of PlumberMP/MPRSW Nu.Sanitary Perm,, Number:
Richard Hopkins 1059 ix 74986
SEPTIC TANK/HOLDING TANK:t
MANUFACTURER. LIQUID CAPACITY . TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER
PROVIDED PROVIDED:
/ ~.7! ` OYES ONO OYES ONO
BEDDING. VENT DIA.: VENT MATT H1A11 NUMBER OF "ROAD PROPERTY WELL. BUILDING: NT TO FRESH
/ r 1(ALARM
0 J Ci~ G{ FEET FROM LINE/ IAIIER INLET.
ZYES ONO / 1 DYES LINO NEAREST_ l
DOSING CHAMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP; SIPHON MANUf ACTIIHEH WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
OYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CON TROLSOPERAT IONAL NUMBER OF PH OPEH7V WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM NE AIR INLET'
PUMP ON AND OFF) DYES ONO _ NEAREST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing DIAME rEFt MATF RIAL 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 DISTH PIPE SPACIN(, COVER NSIDE )IA SPITS LIQUID
L( THE NCF (lj[in ti AL PIT DEPTH.
DIMENSIONS \/j z
GR',VEL DEFIiI FILL EPTH DISTH PIPE DISTH PIPE DISTR PIPE MATERIAL NO D T NUMBER OF PgOPERTV WELL BUILDING: VENT TO FRESH
BELOW PIP S ABOVE OVER EIEV INLFi ELE'V L TO PIPE' - LINE -4-
AIRI T
~j ,I,° "?t{ /y/ pj FEET FROM 91 S3 y I °f I ld iJ NEARESTr
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-
OYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMAN OfNYT MES ARKERS ONO OBSERVATION WELLS
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPS(11L SODDED SEEDFO MULCHED O NO
CENTER EDGES
OYES. ONO OYES CNO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BE VIOTH 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 ELEVATION AND MATERIAL 9MARKING
ELEV.. ELEV. DIA. ELEV. PIPES CIA
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING LHILLED CORRECT LY
_____j COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPq OVED
PLANS
OYES ONO _ OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PR OPERTV ~WELL BUILDING:
FEET FROM LINE'
DYES ONO OYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNAT RE TITLE
DILHR SBD 6710 (R. 01/82)
M7
wlsconsln APPLICATION. FOR SANITARY PERMIT _
DILHR pLB 67 COUNTY
- OEPRRTmEnTOF ( ) UNIFORM SANITARY PERMIT #
InOUSTR4, LRBOR 6 MU;Rn RELRTIOnS qfH~
9 ?4
-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
PROP ~TYO NER MAI ING ADDRES
2 / / 'o N 1?de ",5f 4/,v#fP7
PROP TY L ATION /
CITY:
E 1 /4.5/4, S l T;7N, R Cor) W OWN OF: 1Ad SQ~
LOT NUM BLOCK NUMBER SUBDIVISION NAME N
B
ST R AD, LAKE O LA ARK STATE PLAN D. NUMBER
4 W WO0J" o 0d1
TY70 LDING OR USE SERVED
1 or 2 Family Number of Bedrooms: Public (Specify): C NV N~(rSR~N
THIS PERMIT IS FOR A:
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.
X 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
Gallons Tanks Con ete Constructed Steel Fiberglass Plastic
Septic Tank Capacity /2Op
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: e4
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes ~p)er inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Zo I? Z X Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na of Plumber (Print): Sign re: fRP/MPRSW No.: Phone Number:
1
41 J-1-10
r S / 0 S
Plumber's Address: Nam of Designer: ~
COUNTY/DEPARTMENT USE ONLY
Signatur of~lssuing Agent: Fee: Date:
OO ❑ Disapproved
❑ Owner Given Initial
Approved
Henson for Disapproval: Adverse Determination
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: t
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
S' 1' C- 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/contractc?z,("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 t7 U PDtKreFg, 4'
Location of Property 5v~.. 14 ->b Section T ~Z_ N - R W
Township 0250 N
Mailing; Address 4-Z.~ MDrvQOC% STET ~ o
1-~U42~20/y W1 674016
Subdivision Name 770 61 t~ D 410 ~6
Lot Number Z3
Previous Owner of Property t,~ cop, `
Total Size. of Parcel PRO)(,
Date Parcel was Created AN ZND ~q S5 ~ co AM
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes _ No
Volume 7p3 and Page Number 3Z3 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.
PROPERTY OWNER CERTIFICATION
l pct ?
7 (we) c cti6y lzat a" b azemenia on it,vs ~o%un ~vLe cue to the- bat o, p, I
knowledge; 'hat 7 (we) am (ane') the o~~rleh{~) o6 the pnope~cty desmibed in this
It n6onmati,on;6onm, by v.vLtue o6 a waAAanty deed seconded in tAe 066ice o6 the
County Reg-i.6-ten o6 Deeds a.6 Docwner►t Nv.8 Z and that T (we)
ne~sentty oun the pnopoaed .bite bon the 6uuage c cepaa b ybtem (on 7 (we) have
p
obtained an , to nun with the above de6etu.bed pno))enty, bon the
constAu '0 6 b ' s--elm and the -same It" been duty neeonded in the 066.iee
06 e C R o6 Deeds, occurrent No. 3q S$q Z J
SIGNATURE OF OWNER SI NATURE OF CO-OWNER (IF APPLICABLE)
/0Z3/Z0
10131106
DATE SIGNED DATE: SIGNED
"
• H
r
S T C - 105 r
H
SEPTIC TANK MAINTENANCE A(;REE'MLNT
0
St. Croix County
r
OWNER/BUYER M
ROUTE/BOX NUMBER Z T 5 13o)( 8-7 A Fire Number N
CITY/STATE ~U%oQ WL66
- ----LLf'- 474ol4o
PROPERTY LOCATION: 6W'-4, /7(~ `4> R_W,
Town of 7j St. Croix Co Z
Subdivision Thu'` eO , Lot number Z3
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance cun-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank Lumber. What you put into
the system can affect the function of the sL'ptic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents maw be eligible to receive a grunt 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 thL'ir 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 requireiu s and agree
the-standards set forth, herein, as set by the iDepart-
to maintain the private sewage disposal system i 9,IA5-
ment-of Natural Resources. Certification form m leted
and returned to the St. Croix County Zoni, Of 0
St. e with x
of the three year expiration date.
SIGNED
DATE Croix County Zoning Office
P.O. f- o x 98
Hammor d, WI 54015
715-7S'6-2239 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 \ / MADISON, WI 53707
(H63.0911) & Chapter 145.045)
LOCATION: SECTION: TOWN IP/ /UNICIPALITY: LOT3NO.:BLK4O.: SU~~kVIOIyU~M
C NTY: OW E 'S BUYER'S NAME MAILING ADD ESS: fs+
t~l Y e a e ! < 7//
USE DATES 04SIfFIVATIONS4 DE
NO,BEDRMS.: COMMERCIA ESCRIPTION: K/PeIN ~T" ✓ SRS LATION TESTS:
~esidence ? ,!?L1.New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
C NVENTIONAL: MOUND: I-GEND-IIIE:ISYSTiEM-IN-FILLIHOLDING TANK: RECOMMEND D SYST option )
s ou S ❑u S ❑u o S ~u ❑ S a coy°o~.a"1~'
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:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OB ERVED (SEE ABBRV. ON BACK.)
B- Q✓ 11lI ryt ; a ~HPc~
B- Z An V
/ S
B- Q
B-,5 , gL
B- 0
PERCOLATION TESTS
TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P-
P_ , r
P a'IGJ 7-/ YJ
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 ~4/, 0
i i
_ ...w. _ .._.T f
S4
X-d
I ( E
E
E 3 ~ l
N
1 i I
I
t
s
i
3 ;
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 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)' STS WERE COMPLETED
r eel
_I A14X, S/
ADDRE ERTIFICATION NUMBER. PHONE U ER(optiopall:
j, r q. -39
A'r 3 S_3 /
A lJ " CS 6 G Fr 3
CST SIG T
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
D I LHR-SBD-6395 (R. 02/82) OVER -
INSTRUCTIONS FOR COMPLETING FOIE 116 - S BD - 6396
To be - c arnplete 'a( ;gate soil test, your report must include:
1. Cg
2. C rly indicate whether this is a residence or commercial project;
3. M, = rooms or commercial use planned;
6. -es. A SITE 11 TAPI E POP A HOLDING TANK nNLY IF ALL.
OUT . C___ IONS;
6. in he t, le plan;
_ A
lnent;
9 bo> st exemp-
10. I as flood -in, elevation) does n A. in the appropriate box;
11. 1,e, dour --r - " address and your cer_5 i --jer;
1 e t " require . ALL SOIL TLr_ MUST BE FILED WITH THE
LOCAL AU HORI 'ITHIN, ) DAYS OF 'L ;TICIN.
ABBREVIATIONS FOR CERTIFIED SOIL TESTES
- (us :ler 3")
*s _ S id
cs f 1
med s
fs -
id
si -
cl Y
am i
m not
wi
pl.
p
HWL-I1
TO THE Y
! _ ty request
private
'der to
f
JI
J
E11-1i 115. Rev. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS 1
_ , . WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
e ; }
LOCATION: I I t' S l Section / T '22 N,R i9 E' (or) W, Township or Municipality r~~~ fr ci #4
` ~QtI~J 13 { ook ~CfVf,+ 51 'y 1 J /
Lot No. Block No. County
1
u ivision Name. r
Owner's/Buyers Name: `V,41V/VC W,4 ~'N 4-x~ {l
Mailing Address:
TYPE OF OCCUPANCY:. Residence k No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
3 n -7 11r•'
DATES OBSERVATIONS MAD_ E SOIL BORINGS Pr CD r +V /7-7 PERCOLATION TESTS 'Zfi'
SOIL MAP SHEET t fS~I NAME OF SOIL MAP UNITS 4
PERCOLATION TESTS.
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL,! INCHES
DEPTH C A ACTE O S01 RATE
NUM- n ~ KN R ~'';h'^~ L*s'~ SIN(E1iOLE H PL E ~ NTERVA
E INCHES THICKNESS IN INCHES IiSTWrTTED Q~" ~ PERIOD 1 PERIOD 2 ^PE (OD'~'3 I41tIV11N
I B R SWE LNG i4N*MiI4UTE§ R
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SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
(TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST Q ! IF OBSERVED IN INCHES
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colation t pit bor h les nd I 'table soil area Indicate a lar)R atio and srt ,arg f t f,sulfablg areas.
dlic to r umbe~ofte uare feet of r tion area need "ef ~,or bui)'in. :.,+.s w+It*uaa $F J
~c c~ type and oecu n c, , ' Ind'acatg scale o, distances.
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Give horizonta and vertical reference points. Indicate slope. $ •.L .i %f r , w _
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I, the undersigend, 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 location of test holes are correct to the best of my
knowledge and belief.
_ZIIA,eic A 7- L2
Name (print) A-6 op r Certification No.
Address "'d" }~~'~!1/f/e~1 ~s" }~~•rlJrt.~ =1.7~
Name of installer if known `
yr.
CST Signature y(~ CGx ,
Copy C -Property Owner
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i t4'. Ot' HEAL'ir"I A'I'J 1
riCr; i IC)fd: Section ! T 2;y N,Fi ' E (or) 1V, Township or pality~
; y'i{'L~ i~ ~'r : t~.: ~ LE.J Ga(>,~:tr,~ St~"• ~s
, t,i•ock I O. x
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u ivislon Name County
wne-'s/Buyers Name: tZ i
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Mailing Address:
1i
TYPE OF OCCUPANCY:- Residence 'No. of Bedrooms LCOMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM - OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS SEp r t,' ~y7 PERCOLATION TESTS ~I-dr 7 ~I 7
SOIL MAP SHEET NAME OF SOIL MAP UNIT Cr/t' I" E R T C'c /Lj
PERCOLATION TESTS
1 WATER IN TEST TIME DROP IN WATER LEVELINCHE BADE
TEST DEPTH HOURS
;C° .
E~r_.& rCE': tioL
Hbt'~" . fiA v~
NUM. INCHES THICKNESS IN INCHES'"' + :.:.Q IST 1= WETTED SWEI_CING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
BER
P- Q- To
P-
P-
P- i
",SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES (CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVEDESTIMATED HIGHEST IF OBSERVED IN INCHES Ii
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B 2. / I' (fl ` UN~ > 32 13N• S , l9 f .2 " ( 3
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1:. rPLAN VIEW_(Locatp-pp
Ecoia a I k) l a anc~;pPae.fPeZ u~table meas. ,
Indicate number of square feef'o absorptlori area nee ed for building type and occupancy Indica a tale or distances.
Give horizontal and vertical reference points, indicate iope, PAL Al q; ]E RVF 1) L AV
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1. the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedur~e,t► and methods
specified in the Wisconsin Administrative Code, and that the data recorded and locatlon of test holes are correct to the te$ and e st of my
knowledge and belief,
Name (print) ::ertificat;on No._
o't.' Zee i -
Address ^rl 1 ? I,If. i~✓ !t ' .._.__.,I. A ~j 3 f fName of installer if known
COPY C - Property Owner CST Signature
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R E3.LI, 67 PLOT DOSS
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s~°~es ` y t p° $ I'rl = 100'
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N oRt Slope Figs J NI Ra
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FRESH ATP -I[~T "PS AND OBSERVATION PIPE
c I'll SECTION
r Approved Vent Cap
Minimum 12" AlDove
Final Grad
4" Ca:>L- Iron
Above Pipe
Dent Pipe
T0 Final Grade-----------
Marsh Hay Or Synthetic Cover.ipg
Min. 2" Agg.r_ ecJ!a
Over Pipe J
Distribution - Tee
Pipe l
Aggregate Per.Carated Pipe Below
Beneath Pipe < -----Coupl i_ng Terminating At
V Bot Lom of. System