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HomeMy WebLinkAbout020-1158-10-000 n cn O v n d r~ to r/1 C 3 7 ~ i v n 3 ~ o N cNn O W W orl N °C • m ? O CC D N W z E: CO 0 W CD 3 0 W M M N cn ?C.0 O n W ~z CL 03 0 = (D CD co co WN~ CD 00 ° o NNCOD o n r, C O v CD T O W rr H m A CD CL . !y p H C (a N W a rJ (D G N O o co V C) 0 O H. ~ m C/~ cn o C: o co CO o n r r V U n C cn cn ° a co w t~ ~.o rt 6D W Ul OD o o O O O cn A 4- 0 ON ((D o 0 0 0 w m CD `may N N v ?c 3 O O O. 5. a O O aC Cl) (D 77 N CD Z. a D N z CL t7 t;1 j ° z oo z a - - 10 t cam.. n~ p n D o' k4k ti (D CD (n Oo (D m Ul - H (n C: CD m U) N ~o n N n F? N I Cs7 Z ~ , ~ cn r U) V. rt jam. 'd C- C E (D v a A 7 (D rt Z) C CA O O W-0 N W rt (D 9 ~ A Q a z a r N o 3 ;o ^ ! w o c) m CD A W CL N p_ ill Q G O ~ = C 7 o a N n N N I n. j A fi I O V N O O Q A pQ O o * w c) (D Parcel 020-1158-10-000 06/07/2006 08:11 AM PAGE 1 OF 1 Alt. Parcel 23.29.19.888 020 - 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): O = Current Owner, C = Current Co-Owner O - SITTLOW, BRENT L BRENT L SITTLOW 803 KELLY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 803 KELLY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.020 Plat: 1903-DEL'S WESTVIEW ADDITION SEC 23 T29N R19W DELS WESTVIEW ADD LOT 1 Block/Condo Bldg: LOT 01 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/03/2000 616315 1481/272 QC 07/23/1997 1139/81 WD 07/23/1997 703/365 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 2.020 85,100 127,300 212,400 NO Totals for 2006: General Property 2.020 85,100 127,300 212,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.020 85,100 127,300 212,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 127 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1062-85-000 06/07/2006 07:39 AM PAGE 1 OF 1 Alt. Parcel 23.29.19.240A 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): O = Current Owner, C = Current Co-Owner O - DEL'S WESTVIEW ADD DEL'S WESTVIEW ADD Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 23 T29N R19W SW SW THIS IS KNOWN AS Block/Condo Bldg: DEL'S WESTVIEW ADD FORMERLY KNOWN AS LOT 1 OF CSM 2/347 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/19/1993 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 Farm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Vl v~ J~.j SEC. c~ J i o_N-R ~W ADDRESS i s hr ST. CROIX COUNTY, WISCONSIN SUBDIVISION Lk S I _V1 LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requtrenients of -CLIEIL 83 SHOt,I EVERYTHING WITHIN 100 FEET OF SYSTEM 31' * R ~kj i Keli INDICATE NORTH ARROW BENCHt1ARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer:_° Liquid Capacity: __~OdV C Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,o Side, Rear, feet From nearest property line Front,0Side,®Rear,0 ~ feet w.imber of feet from: well bt_i7_ld:int (-lio-Iiide th.i information of the above plot r,lr~rz}( 2 reference dimensions to septic trmi:) SEE REVERSE SIDE Cw:+;8/~ : aagwnN asuaoTZ oC uo aagwnTa ^ 1 :pa:l uQ :aolaadsul v , Ir :aaznjaujnuvW wauTV :puoa isoauau woaj iaaj jo aagwnN :SuFpLTnq woaj :jaaj jo aagwnN :TTaM woz3 :iaaj jo zagwnN •:I30 `auaH Q `apFS O `woa3 :auTT ~t3aadoad isaauau woz3 iaaj jo aogwnN :IaTul jo uoTIunaTg :-~Luvj jo wolloq jo uoT2unaTg :pasn s9uTZ jo aagwnN :~~TouduO :aaanjoujnuuyq NNVI ONIQ•IOH •(auo xaatl,~) ZswalXs uoTigaosqu TT os anoqu aqi jo !uu uo pasn uaoq O xoq uozIngTIISTP ao O xoq doap u zagjTa suH : ITTng uaaV :uoT:IunaTa :Fd 99udaas 3o uio~log :gjdap pTnb-l :aa~awuFQ :said jo aagwnN :azTS lid 3Ovd3HS •(neLd -joLd uo saouu19-Fp opnToul) :9uTpTz11cl wozj laaj jo aagwnN : T Tam woaj iaa:l jo aagwnN ~I - • `z nu o `apFS _auoz3 :auF L ~Cizacload 1sazuau woaj jo aagwnN - :ad-Fd jo doh of il~dop TTT3 : IlTng uazV sauT7 jo zagwnN 11 .9,U, TI PT M : tlouazs : pag WRIS7kS NOIlaXOSgV BIOS •(uuld iotd uo saouu:js-Fp apnTz)ul) s11 r1'1_[Ii(I imu-tf jo =raquinl~~ ;I tarp. ~~i~,.i r 1•~:; ;o .~agwnl~ •13 `zeaH(~ `ap-FS 0 1woz3 :auT-L 4iaadozd isaauau woa3 iaaj jo aagwnN - :ad4L goITMg wauTy :aazn:IoujnuvN wzuTV : a p4D zad suoTTUD : UOT:jUna1a qo-3zMS j jo dwrid :uozzunOj@ >Iuuq jo woaIog _ :aalu7 jo uOTIunaTg @ZTS dwn3 :aaanjaujnuull uogdTS/dwn3 :Tapolq dwnd - : fI:IzJUduO pTnbF'l : zaanjoujnuejq 2I.IgI•d6FIO dhttld I DEPARTIOENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS DIVISION _PRIVATE SEWAGE SYSTEMS P.G. BOX 7969 BUREAU OF PLUMBING MADISON, 1'9,53707 iJ CONVENTIONAL ❑ALTERNATIVE State Plan liO Numb.,: ~ • Ul,..~unw ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 1764 !NAME OF PERMIT HOLDER: OORESS OF PERMIT HOLDER: INSPEC O DATE' Steve Vieter A1407 Prosperity Ave., St. Paul, MN 55106-//-ifs' X r i BENCH MARK IPmmananl relevance pmml DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. I SW-4 SW4, Section 23, T29N-R19W, Town of Hudson, Lot#l,Del'S West View Add. IName of Plumber. MP/MPRSW No. County, S.-.1.1V P.-I Numb- ; Richard W. Hopkins 11059 St. Croix 58933 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACIT TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. YE ~ S ONO 1 1~ 7 YES ONO ❑ BEDDING VENT DIA VENT MATL . HIGH WA NUMBER OF ROAD j PROPERTY WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LINE AIR INLET 06YES ONO ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ONO ❑YES ONCE ❑YES ONO 'GALLON PERS PERS CYCLE: PUMP AN CON R L OPERATIONAL NUMBER OF PROPERTY WELL BUILDING V N TO RE .(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing t E W H UTAME TCH 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: WIDTH LEN TH NO DISTR PIPC SPACING COVER INSIDFiDIA SE PITS LIQUID i BED/TRENCH / TRENCHES MA~jCHIAL: / DEPTH DIMENSIONS PIT / Gf 4V L DEPTH- FILL DEPTH UIS II 1 DISTR PIPE IS I MA IAL NO ISTR NUMBER OF WELL BUILDINGV NT TO FRESH N/O Plptii jPHoPERlY itiELOW PIPE' ABOVE COVER ELEV INLF I ELEVEC FEET OM AIR 1 L,E(T ~G O V F NEAREST v V 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- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO ❑YES ONO uAPTH OVER TRENCH/BED DEPTH OVER TR N H/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ONO ❑YES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPAGNG rHAVEL DEPTH BELOW PIPE FILL DEPTH AB V COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MA EHIAL NO I/1STH DISTR. 1 DISTHI8UIION PIPE MATEHIAL& MARKING ELEV ELEV UTA ELEV PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE Silf HOLE SPACING DRILL[ U COHHf C I L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ _~C YES L_~NO YES ONO COMMENTS: pERMAN N MA K OBSERVATION WELLS INUMB ROF PROPERTY WELLEEL FRLINE NO DYES L]N0 EAREST ;ketch System on Retain in county file for audit. leverse Side. SR~NATVIHI TITLE )ILHR SBD 6710 (R. 01/82) /1 > ! q-' ZE wlsc n n APPLICATION FOR SANITARY PERMIT D I L H R COUNTY TTT1EnT OF (P~B 67) UNIFrOr.~R+yv~~M~~ffff SANITARY PERMIT # InOUSTRV,LRBOR 6 HUMRn RELRTIOns J V ; 3 -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 OWNER L MAILING ADDRESS -5/ PROPERTY LOCATION CITY: VILLAGE: S 1tf1 /4•5Iv1 /4, S ~ j , T N, R E (or) s_v / " N 0F:) - i - 5 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME A EST ROA , LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED /ZV da~ --~G 1 or 2 Family Number of Bedrooms. j Public (Specify): 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 G^rl~~ 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: / 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 ABSORPTL(Square EA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED Feet): +f L Private ❑ Join t ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: - I*SP,/MPRS,VV No.: Phone Number: / 1 r f / r Plumber's Address: J Name,c)f Designer: X t~ i< li J COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ..J~ I / n / l~Z / //~Gg ^ ❑ Owner Given Initial K / J Approved Adverse Determination Reason 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 e 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. Fo rm - S T C 100 Uwuer of i'ropcrty ,~~~.UI {it T h >rtt; Vll ~ Location of Property Section 1 N R 1`J W Township Mailing Address Subdivleion Name 1'25 W&15-«,;-W AaiTic N Lot Number Previous Owner of Property 13ieCr--Z4 1 Total Size of Parcel - Z t4c 7-S Date Parcel was Createdcl'T 2NQ Are all cornera identifiabie? Yes No Include with this application one of the iollowing: .Certified Survey Map .Deed .Land Cu.ntract, or .Other legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. _z`i L i Z Z- ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easament, to run with the above described property, for the construction of said system, end the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 3`i `I ) SICIN TUBE OF OWNS SIGNATURE OF CO-CIVN ER (IF APPLICABLE) DATE SIG ED DATE INGNED L 00"C A QED I KI aPA R OF F H E NrS°L~,S`, V °5.=0' + IL UNPLA_=C I L(_ Y w_ST LINE OF THE t Pl87°45'49"E ca q 33.02' ro N 00° 27' 50" W (24! to IT - -210.00' 210.OQ' -255.00'- q POINT OF 'B'EGINNING of ;,jcjNT DRIVEWAY 20, CURVE OATA V) A O 1 6~g' t R = 24E5.67' f I L-308.4I TA 1`14 = N254'1!°'v' S87°G5'49"W 041 i < I ol ol LLJ ai 87,9l4 SQ.FT.87,844 SQ. FT. el 1 2 C2 C =S 2.02 ACRE S co / C. C r r S` v 160,303 SQ. F T. 1 3.63 ACRES ZI ~ ti O N r;j n 221-40' 210.00' N00022'3-3W CV 431.40' v- 92,601 SQ. FT. 0 2.13 ACRES e co z - .450.51' 255.00' { S 0 22'33" E~ 1271.. ' r T _ `1 LOT 2 CERTIFIED ::•~r `i t ` n tit r ALt:- BEARINGS; ARE: REFERENCED' TO' 1 n M>- WEST. LINE OF: TNi~- SW 1/4 OF SECT1t - 1 -WHICH BE-A-RS A TRUE BEARING OF F f , . J 41V %J }i r~o 3 rf_ it: it_ o - n a oil W I 1 I ~n l-~ v~ J e) w 7 v, n= v ; j C °`t i. 7 r 3 5 co v n n -3 Z Z } h r, Rat 14 ~7 ~7 (n 41 m V y""0_1 ,~4 , J z7 Z yr . _ Z, -3) f) Tj J-1 I ~'~js ` v~ ~ Q" iu 1 m ro 1T p I A cm i CD Sl to qtr Co tJ • fit; .k„S H am, 3 ) C ' Of'r ~ F • ,.n..1 t " Y44]711 lY""'J i t i ' H r~ W S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT Sc. Croix County d y OWNER/BUYER ROUTE/BOX NUMBER: i4i- rfio i i1'IL:', --Hire Number-- rmu- CITY/STATE f~✓~Sc~! ~lv,$c.nt51N LLP PROPERTY LOCAT ION OAV i Sac t ion - R W , Town u1_ ~~`~c St Croix County, Subdivision- .~,~tv> _KW1 IC0, Lot number I 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 heeded, by a licensed septic tank kymLer. Whet you put into the system can affect the function of the .opL is tank as a treat- ment Stage in Chu waste disposal SyStem. St. Croix County residents ma_- be eligible to rccuive a grant for a maximum of bOY of the cost of replacement of a failing; system, which was in operation prior to July 1, 1918. St. Croix County accepted this program in Aul;,ust of 1980, with Chu requirement that owners of all new s}~sCeius agree to keep their systems properly maintainud. The property owner agrees to submit to 5L. 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) Clue on-site wastewater disposal system iS in proper operating condition and (2) after inspuction and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sunt 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 H the standards set forth, herein, as set by the Wisconsin Depart- 1n ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office wi Iin 30 days of the three year expiration data. S I G N E D Gc ~ T_- 1 1)AT E St. C,'oix County Zoning Office P.O. Fox 98 Hammond, W1 54015 715-7~ 6-2239 or 715-425-8363 Sign, date and return to above address.,. v ~ r x m d v ~ cn w ~ ~ O CD ~ ~ << O O 44 D Go 0 ~ m a3 ~~c. co Q O c O W~ 3 3 ccoco o 0 FD -o CD CD 0 J" 113, Cl to N D - to cD O 70c g CD w w A i_ - 0) 'a CD m w ~v~ N 8 r ID I N o3n o°°w o m c o w o W 0 _ c 0 W W C j f~D F 7 W ~ w w c :3 p, (D cj8 a ~ CD M _ Co CD w ° ~ D D D < CN (n ~O CD cn O D C CD 0 = w 0 ° ~~°c co a 0 c"D (OD O f O m w^.mco m sa° uwi C m 0PN CD U, Z D N-4 ~~0 z C w - K j w \,n (n ~ cu cu c,=m am 0 3 N~ ~.a D Er ; as ?w ~c w 0 v, w ac 0 g cD C m m 3 c '0 a v m v? m m m 0 CD U) _ °o cn<C=c~ D p c _ c <p 3 ~ vi JVcr w m o Cow Q 'cc o cawo R1 v Cal n CD CL n Q3 * a~N c co M. ~ c O co O 0 vi 0 (p 0 c noa caw mcc~D m ~p p a vc p, -o f~ av3 03 O°3 jai av' am o CD CD tO 0 r c Lc/iu jfie %FST lp,VDrTi~rlS Svuvy~ 1 9 ° ~C .Vo f/pOST . DEP MENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUST ',Y, DIVISION LABOR AND J PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME: s~ /4 Z 3 /T:17 N/R 9 E (or W f/voso,~/ 1 .DES s wEsT l/~~w ,qvv; 77 COUNTY: /BUYER'S NAME: MAILING ADDRESS: S Ci,O l1( STtvF j/ic Ta /yo7 /vPos;P.6 oei T' Xv~- 4'03 ~1 w~ • Ss -/o USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ISPERCOLATION TESTS: XResidence ~ A/~ ANew ❑Replace I V- °/~G.9ti i c RATING: S= Site suitable for system U= Site unsuitable for system Yc y ,f'O%L r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) os ❑u ©s ❑u ©s ❑u ❑s au ❑s au ~o~~~N,,~,~~G %~£ti If Percolation Tests are NOT required DESIGN RATE: If an /J y portion of the tested area is in the /1~-- under s.H63.09(5)(b), indicate: ~'GASS -L Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS iN ~.2c;r~eQ Frsi BORING TOTAI ELEVATION DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) S /yL' N. S a 5 B / p' I/~..f5~ .7 ,q /.S• 13/ . s ,67 Q.v. S/ /.a Bu. s d N. B-J 7.0 ff ?ter 9 d rA,v Cs o ' as 0 131i. B- o f b~.C~ y > a a .r. B ~~.o' ~~/•3d >~O •33"lq/--.5~ 7' -6Y. . 3 3 Z Z. (3. . S/ J-. 17 ' N v C'~S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER , AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIO 3 PER INCH P- 7.35 L o IU.F Z PAOII ~-O /,v .r- < P- d2 vvT~ La.-jx -ff P- 1 S r,v Pew;; e S ST rf S < P- ~ P- /!o 2- 2-- 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. 77 SYSTEM ELEVATION ~c:~ s~ 7F AGTE,P,tTio,v %•z . m l~ 'wr ~ L/-7 .Sfir'1 !/jV C 2r •7/ 3 fT. 70/d SDiz- 6-'- a„~Q W k- !!1 T6 p P4 = /00, D f r use' of fr 9 /Po c /~e ~E,r¢4 /~r f Roe IS A ~ VC-P r ?3 s/o REF-F` L07" 4 / 8 T% 160 site APPROVEt) to C"rtireo of 13 y P, fora conventional septic systep. 113 °lo SEco~O Y S/% a z . ~1 VEoe r- kf- Pr y6 301 OV i S x xO Top RA& /3 P3 ~ ,~~EC FE,~c~ 13 PoS 1 . e \ /of 13.3 I, the undersigned, hereby certify that thr 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 recc ded and the location of the tests are correct to the best of my knowledge and belief, 11-MIRESITE SEPTIC PLUMBING CO NAME (print): TESTS WERE COMPLETED ON: RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ~D III _ / f ROBERT ULBRICHT ADDRESS: WIS. MASTER PLUMBER LIC. NO. 3307 M.R.R.S7 CERTIFICATION NUMBER: PHONE NUMBER (optional): MINN. INSTALLER & DESIGNER LIC. NO. 00663 S f OL'~~1- '3049(o CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. I DILHR-SBD-6395 (R. 02/82) OVER - - ftba. i 1 N LF # $"s e # P°°" ~ $ L,A Y V. ael F10113' CO €M I-L 8 N G ~ „s° ~`e. t 3°R ill C,f If iLtn €ofv€ , du c., , ,s. lij, IVIA HVIiY"Ill rIF(m §i I„t .OE + f QCs ` ,F C,.te)M F, a-f sa q rt2IS c@ it t)?' € I E "',-1'rIt syste, t;-, Con, lct,, ,.I suit abilo at€r,;,- bo A, SITE IS SUITA1Io- d _ PLE AS €i.,, th,' a,bIu ~i<,.,<v €s sht Y,r. hwI , for .,u X1.3 ,,:e dF,a r fpuons and cc r1lpic;t=nq the pet IVIA E I. EC"IB E ikiw€ l Yt seC t.i it loo"Iti 1 yf:;m t"I iOca €o ns, t ,v i C"7{ E? Sca C . tl't: ,-.tj s ,_.tr uf,( ` tl If aE € g0 PY,$E s"l0St -I., at"d€,z€t.f e' .,7p U, 4° r€ t.°, illid ,s. ;€:ri'i.c. A W i€..a-I ola. n I.~~ )°t". o 1 a t { in (:FCk Ct ?C i i3 , roes nol In 3, he p n)i S .:3 , ~ in ti p! ~ cr v, IF i en? zic,ttt .s.i F3 rt i ~,'<;i.t l' C, 1' ,1 10" : y +,o { m G t. 4`s csF'is` f?.t_i s F? F - g F:,13 z.. l i ~In - I €.bs ri ~r € tstp,3 ,a,r - f' f- 'v iifW, CC C ,vea t,r i'al Hiuh v, t i s r 3 I~;i' I'ii S ,x: e=i = € P t. f :±t., s h ,~f th_ L)€ ImI TI. rI l;,y. ,.;$t.iP;S( r . t,t 31.3 T01, -lie I"I ate r ~.r= F_ =s e- > -.~C~ `C', CJ , ~t3€ «UI:z= taaE -'I C3 d' to ~ / ~ ~ ~ _ _ ~ NOMESITE SEPTt - t V~. 1 _ C PLUMBING CO. L v RT. 3 O'NEIL RD.; ' HUL,SON W(S. 54016 WIS. MA ROBERT ULBRICHT STER PLUMBER LIC. NO. 3307 M. P, R.S. & DESIGNER LIC. N0. 00663 H i 5.^0' i UNP:~_= LAS'^S-0'.' ~ F ` r ~ ' yr - _ST LINE T~_ N°7°4549 - <D rr) C 33.02 N 00' 27~ 50" W 124 V~ - -210`00' - 2! t m i - 255.00' ° `POINT OF BEGINNINu ~ JQlNT DRlV ~qY _~r: E~~ _ L_ E N 1w ~J 20'C 2~' - i IU; ~-'_P'Jc D_T r ,0 10~ ~ ^ J t 7'S' L=303.41' -_i 3S''45~4'9 W f i I of ~ ( 1 ! - 9t4 SO-=T. e 87.3c4 SQ.=T. _ ) ~ ! { \ ~ , ✓ mac`'`-- ~ ~ = I C. ~j I J 1.3 303 ji. r T. V! z i ~ ;ti _ - O rv - trj 221.40' 2!0.00` = N00°22'33'W _ _ 43!.40'. _ - - O O G- 92,60( S0. ~T.= c - O 2. (3 Ac'R s a z _ E - 450- 5(' - 2~5.00~ s -c I - r _ Z E - - _ Y/. c Yr. k ' f d l s ; _ =YJ~ t `~f OT CERT(F1E r 4 ~j i7..:- C'' rte" .c ~ A _ ~ _ - - c e i - 4 ~ ,?i` { t - -rr .f >s~ t3c r'ttHGS ARE-REF R - (N _ . _ WEST:' L '":>SY~- t/4 _ - _ _ E Oro Fi O _ rti'riii:ij B S 'RU; 3~ARlN' ` 7L,- s°w~ Su'~ •5-~3 ~ is- s /S15 ' G 5" b - i 1-3 f3 L4~ yyl ~Q s i ~ f CA2 a _ ~ r. q l02• met/` ~ ~ ~