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Parcel 020-1085-00-100 02/04/2005 07:46 AM
PAGE 1 OF 1
Alt. Parcel 29.29.19.3408 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
HOGBERG, KATHERINE LEE
KATHERINE LEE HOGBERG
716 COUNTRY VIEW CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 716 COUNTRY VIEW CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.040 Plat: N/A-NOT AVAILABLE
SEC 29 T29N R19W SW SE LOT 1 OF C.S.M. Block/Condo Bldg:
5/1500
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/08/1999 604602 1432/546 QC
07/23/1997 706/110
2004 SUMMARY Bill Fair Market Value: Assessed with:
48309 253,900
Valuations: Last Changed: 11/27/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.040 30,500 165,900 196,400 NO
Totals for 2004:
General Property 2.040 30,500 165,900 196,400
Woodland 0.000 0 0
Totals for 2003:
General Property 2.040 30,500 165,900 196,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 140
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
r!'
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SW 1/4 OF THE SE 1/4 AND PART OF THE NW 1/4 OF THE SE 1/4
ALL IN SECTION 29, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN.
CENTER SECTION 29
2" IRON PIPE
N89°06'51"E
522.00'
SOUTH LINE NW1/4 - SE1/4
N89006' 51" E 1
3
wi CD
133,732 sq.ft. 4-)
sr 3.07 acres ro
LOT 3 N
fl GLI o 0
z o
LLJ
ppo4~
v~ '7 1
LLj
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0
~I v N It LOT 2 LOT 4 ~ L W W
o i~ zsI
Hi 90,930 sq.ft. v 0 2i W N
~i rn 132,481 sq.ft. o -1 a
E_I x 2.09 acres
U) I E_ 3.04 acres ai
wl O
~ l U)
H i I 22` 438.61' full m
-
E+i 41• 4`~~ 4
wl N 2 0 S87046'58"W
A i o 0 56l
wi z z° 3 6 0
C o
LOT ] N
ai 88,832 sq.ft. w 66 o
2.04 acres C. o w
0 0
SCALE IN FEET
o m - p p
~ - N
w 2
66' ROAD 100 0 200
- '
DEDICATED TO - 7 S87°46'58"W OWNER
THE PUBLIC. 1 ~ - -
23.00
- SAM MILLER
8 TROUT BROOK ROAD
unplatted-lands owned bX_platter HUDSON, WI. 54016
S
v LEGEND
N N • 1" IRON PIPE FOUND.
0 It 1" x 24" IRON PIPE
c WEIGHING 1.68 LBS/ LIN.FT,
z
SET.
S 1/4 CORNER
SECTION 29
COUNTY MONUMENT 0 IV
CURVE LOT CENTRAL RADIUS CURVE CHORD CHORD ALLEN C. Fs
NO. NO. ANGLE LENGTH LENGTH LENGTH BEARING
~^E
NYHAGEN s
1-2 1 22021'13" 929.13' 362.49' 360.20' N73057'12.511E
3-4 1 27°48'34" 137.00' 66.50' 65.84' N16°07'19"W : 5-1407 j
4-5 310°01'31" 80.00' 432.88' 67.59' N44047'09.511E F, HUDSON, i
Wis. `
1 87°33'40" 122.26' 110.70' N66026'46"W 0
2 82°33'39" 115.28' 105.56' N18°36'53.5"E ~
3 52050'59" 73.79' 71.20' N8 °1 '
6 9 12.5"E
i~i$0L~ ~1
0
4 4600812611 64.42 62.70- S03o16t18nE
4-5 cul-de-sac 40°54i47n 57.13 55.92' S46047154.511E
5-6 32048'48" 203.00' 116.26' 114.68' S18037'2611E
4 15023'06" 54.51' 54.35' S27020'17"E
road 17025'42" 61.75' 61.51' S10055'5311E
7-8 27°14'38" 863.13' 410.41' 406.56' S74009'3911W
THIS INSTRUMENT DRAFTED BY DOUGLAS ZAHLER JOB NO. 84-12
e r
Form- S T C - 104
BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP j SEC. T N-R jam)
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION r--. "~s' LOT LOT SIZE e "
E i JtfC SCr
F i=
PLAN VIEW
Distances and dimensions to meet requirements of ILH.R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~ cam
r
N
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used L1f
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: _Liquid Capacity: Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation:Olt7. if r Tank Outlet Elevation:
Number of feet from nearest Road?' Frolit.(\7 Si.?e ( Rear, feet
.From nearest property line Front, Side,kWRear,O
feet
Number of feet from: well building,yr'~.
(Include this information of the above plot plan)( 2 reference dimensions to sep*_ic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Y
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 1_ine: Front, 0 Side, o Rear Ft. _
{
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
'
Bed: ~ Trench:
,J Number of Lines: Area Built:
1~, y
j Length
Width: •
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side,( Rear,O Ft f X~✓
Number of feet from well: %
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT r
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:
4
L icer ce Number :
I
3/84:mj
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DEPARTMENT OF INDUSTRY, a e INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RE% LATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969
BUREAU OF PLUMBING
MADISON, 141 53707
[XkONVENTIONAL 1:1 ALTERNATIVE
Ilf assigned)
Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DATE:
Sam MiUvL Tuut Bnook Rd. Box 282, HuAon, W1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT RE . PT. ECE V.. CST REF. PT. ELEV..
SW SE, Section 29, T29N-R19W, o~ Hudson, Lot# 1, Foramen Beh..P,i-n pup. IW f V
Name of Plumber. MP/MPRSW No. Count
V Sanitary Permit Number.
Dougtals StGvcobeen 5432 St. cuix 58908
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
f ;'~F 1 PROVIDED. PROVIDED.
YES ONO OYES ONO
BEDDING. VENT DIA VENT MAT L. HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING. VENT TO FRESH
ALARM FEET FROM I LIN LAIR INLET
YES ONO OYES ONO NEAREST l~
DO ING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP ;SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
OYES NO EYES ONO EYES ONO
GALLONS PER CYCLE: PUMP ANDCONTROOISOPEBRAT IfONAL NUMBER OF PROPERTY WELL JBUILDING (DIFFERENCE BETWEEN FEET FROM LINE JVENTTOFRESH
AIR INLET'
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nc;n1 IDIAMITIR JMATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until =FORCE the s
oil is dry enough to continue.) CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER NSIUE CIA =PITS LIQUID
JI TRENCHES. MATERIAL' PIT DEPTH.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR PIPk MATERIAL. NO. DISTH NUMBER OF PROPERTY WELL. BUILDIN VENT TO FRESH
BELOW PIPES ABOVE,COVER ELE;. INLET ELEV. END Y /
PIPES FEET FROM LINE. AIR IN~LgE T.
NEAR
EST-► C 4!
MOUND SYSTEM: r
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-
O YES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
OYES ONO OYES ONO
DEPTH OVER TRENCH: BED DEPTH OVER TRENC H;BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER
EDGES
DYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. fSTR
MANIFOLD PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVELEVDIA. ELEVPIPESA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
OYES ONO EYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE RTV WELL. BUILDING.
FEET FROM LINE
EYES ONO OYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE:
DILHR SBD 6710 (R. 01/82) / . I
Wisconsin APPLICATION FOR SANITARY PERMIT
D.~ L H n COUNTY
(PLB 67)
-~%OEPRRTfT1EnTOF UNIFORM SANITARY PERMIT #
1"OUSTRV,LRBOR GHUTRn RELRTIOnS 90 /~I
-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 MAILING ADDRESS
S, ' //1t 4 /3,oa .PA X
PROPERTY LOCATION CITY: f'~ S h
Si~Y_J 1/4S~ 1/4, S , T29, N, R (or Try F:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ry/ NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
dUr'Ya+a✓~~s . rl /Z~ ~G/fC6 LG. ~x .~4 1
TYPE OF BUILDING OR USE SERVED
Y 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
N 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 U Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: (lea ; 5 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 j
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
/ S ❑ 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: f MP/MPRSW No.: Phone Number:
Plumbe s Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
&VI. ❑ Owner Given Initial
r -17" J ((I(1 l / 4 7
/ [,~6 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
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.
APPLICATION FOR SANITARY PERMIT
S T 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/contractor,(",-;n(-
house"), then a second form should be retained and completed when the property
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of//Property,~ ~4 Section T Z~ N - R /
Township r/
Mailing Address -VV
e> ~-7 L~J> '
5~ca /
Subdivision Name
Lot Number -0-/
Previous Owner of Property
Total Size of Parcel Z 5 /~c e
Date Parcel was Created
Are all corners and lot lines identifiable?~ Yes No
Is this property being developed for resale (spec house) ? /r Yes No
Volume and Page Number 3T`'7 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
I (We) eeAti6y that a" statements on this 6onm atee PLue to the best o6 my (oun)
knowledge; that 1 (we) am (a Le) the owneAW ob the pnopen.ty danibed in this
-nbonmati.on bonm, by viAtue ob a wahAanty deed hteeortded in the Obbice ob the
County Reg-iusteA ob Deeds as Document No. .7 ; and that I (we)
pneJsentty own the ptopo6ed site bon the sewage dis-p-oTa 6yatem (on I (we) have.
obtained an easement, to nun with the above de~scA bed ptopenty, bon the
eonsthuction ob said system, and the /same has been duly neeotded in the Obb,i.ce
o6 the County Regizte4 o6 Deeds, as Document No. 3 ! ) 3 7 Z. )
SIGNATURE OF OWNS SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
`r
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S T C - 105 r
` H
SEP'T'IC TANK MAINTENANCE AGREEMENT
0
St. Croix County z
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y
_SIiyI7,'~~+~ - rv
OWNER/BUYER
ROUTE/BOX NUMBER K-~ z_ Fire Number _
C ITY/ STATE iiU•c Z III `Y(
PROPERTY LOCATION:, Cc/ %4, S~ ]%4, Section 2_1 T N, R L~
Town of St. Croix County,
Subdivision-c'- 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 x
H
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
DATE -
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.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDl9STRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN *RELATIONS \ / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNS IP/ LOT NO.:BLK. NO.: SUBDIVISION NAME:
/U7 N/R/7 !(or
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
C o,' -SAM 1qi L e T" r r~alE Rc( `s s el C
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL ESCRIPTION: PROFILE DESCRIPTIONS: P RCOLATION TESTS:
Residence .New
/K ❑ Replace Z -Cr
13
n
RATING: S= Site suitable for system U= Site unsuitable for system 4 K.4;14 t'e C", /
` / e,
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-I -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
If Percolation Tests are NOT required DESIGN RATE- If an
' any portion of the tested area is in the
under s.H63.09(5)(bl, indicate: A Floodplain, indicate Floodplain elevation: A
PROFIL DESCRIPTIONS
G
BORING TOTAL/ ELEVATION DEPTH TO GROUNDWATER- r uGC CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND DEPTH
NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- Aj
/ ra auee ? `o° •~/3.v AS'% 3,
-4 0.
B "S ` ,r,(c' 07110/5 . 78/+ ~j • YI A0 S / q. Sir-fit. ",6
B- V I r/r & e / V11 ~ A/49;? 5 V`✓-Af x "L ec f.~-s
B 7•,r l f& (L r v r S% . 45A Y-3 s-r r-p 4- 01, S h C s
B , c'~ /X At 481-5 A/ cA UnCS
B-
PERCOLATION TESTS
TEST DEPTH/ WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER TMPµ AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- / ' /~l0 3 G 3
P- ' ,~O 3 6' t 3
P- -9 -3
P-
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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 percen-
of land slope.
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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 best of my knowledge and belief.
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NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: RTIFy`I~CATION NUMBER: PHONE NUMBER (optional):
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner i C s
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