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HomeMy WebLinkAbout161-1057-30-000 o cn o 3 -0 n ~1 o - c w o3 -1 c ? 0 1 C) m vy o n j w rn • m D co N (L] CO ~ r~ CD 7 O O q::= a C a CL y w ~ N~ ~ A ~ W W~ y O o J O ` 1\ N Q 6 (D 0 N 00 r~ O 0 cu (017 S O K 7 y N = O C y y Z'l 0- (n cn G D a o (D n 3 0- C 0 cao O C CD CD ca co R n r cn CD co 00 cn N CrJ y m C J cn Z 0 CD ~ rr • N '-d G 7~ O O O v rt r'i U1 C cn O N i_j `L v G A Z hr~ H. Fl O (D c u) ti (n o D v O H• G n v v Q 0 0= o ~J rt CD C: co W H N `2 y N (D w Ul CD Z H O C Z CD z CD O H n D m o rn a 0 ~ ~ jayy • ~ o N d rt C oo c m ° c CD N O - F-- CD n I I N F-] V] Z -I cn (9 CD W 00 J N CrJ O N ;o q O In C" l0 Y I Z U) CL A O C, ~d C N (D C) t fD W m w G7 r m G Z H• rr C N a C H• rn o W fD H• O H ~j y d N F-+ ~ H• W w v C o (D F-h D 3 \ Z a j r - G no~i c a - 3 o a (D CA N i w ti 0 0 a a o b ti ~ A O W Efl O ti O :E p yb 6 (D O O~ Parcel 161-1057-30-000 06/23/2006 12:00 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.522D 161 - VILLAGE OF NORTH 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 - RABENS, GARY & PAULA GARY & PAULA RABENS 1511 RIVERSIDE DR N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1511 RIVERSIDE DR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.430 Plat: 2219-CSM 08/2219 PT OL 81 VIL N HUDSON BEING LOT 4 CSM Block/Condo Bldg: 8/2219 1.43AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 872/222 07/23/1997 741/111 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 318,800 184,600 503,400 NO Totals for 2006: General Property 0.000 318,800 184,600 503,400 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 318,800 184,600 503,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 113 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 06/23/2006 12:03 PM Parcel 161-1057-30-110 PAGE 1 OF 1 Alt. Parcel 13.29.20.522D-10 161 - VILLAGE OF NORTH HUDSON ST. CROIX COUNTY, WISCONSIN Current X 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 - WHALEN, SHAWN M & SANDRA A SHAWN M & SANDRA A WHALEN 5625 CHOWEN AVE S EDINA MN 55410 * =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.140 Plat: 2219-CSM 08/2219 PT OL 81 VIL N HUDSON BEING LOT 1 CSM Block/Condo Bldg: 8/2219.14AC ASSESS WITH P522-1 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/25/2000 626948 1529/76 WD 07/23/1997 888/497 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2006: 0 0 General Property 0.000 0 0 Woodland 0.000 0 Totals for 2005: 0 0 0 General Property 0.000 0 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Charges 00 0.00 0.00 Total Parcel 161-1057-30-120 06/23/2006 12:03 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.522D-20 161 - VILLAGE OF NORTH 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 - ADAMS, ROGER J & SUZANNE M ROGER J & SUZANNE M ADAMS 502 HELEN ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.140 Plat: 2219-CSM 08/2219 PT OL 81 VIL N HUDSON BEING LOT 2 CSM Block/Condo Bldg: 8/2219.14AC ASSESSED WITH P 522J PER 881/617 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 881/617 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 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 Parcel 161-1057-30-130 06/23/2006 12:04 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.522D-30 161 - VILLAGE OF NORTH 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 - HALLORAN, JOHN W & DIANNE W JOHN W & DIANNE W HALLORAN 1419 RIVERSIDE DR N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.500 Plat: 2219-CSM 08/2219 PT OL 81 VIL N HUDSON BEING LOT 3 CSM Block/Condo Bldg: 8/2219.5AC ASSESSED WITH P521F Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 872/327 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/17/1991 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 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP - , /v. .1✓<a, SEC. T / N-R i W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILH,R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i OL1;~ ~S /TD G✓! ~/Z ; rJ L: 1 L i tXZS 71'.N [Iivt LL. _'_~r~ kX*snr~G L X1~ --N! G ~AC' rz~~Sot.,~ r_ r ~ L;Ht .~'04TN 4~7--Pz~~L2TY l3 XZ-~7'2r✓ G AF-~'~ /~7 =lUo. r~r 1 !i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used I >l-L LG; L Elevation of vertical reference point: %r Proposed slope at site: 'Al", SEPTIC TANK: Manufacturer: Liquid Capacity: ) , Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,o Rear' (D S j feet i From nearest property line Front,0 Side,® Rear, O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) j SEE REVERSE SIDE r s 4 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, 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: yiJ Trench: Width: Length: Number of Lines: Area Built: 0/W Fill depth to top of pipe: Number of feet from nearest property line: Front, K7NSide, O Rear,O 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 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: ~ t Inspector •`'C Dated:' o Plumber on job: License Number: 3/84:mj i DEPARTMENT GIF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 7kONVENTIONAL ❑ALTERNATIVE state Pla LD Number (lf ass19nedl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE Martha Edwards 276 Riverside Drive,NHudson, WI 54016 /V - BENCH MARK (Permanent reference P-0 DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.- CST REF PT. ELEV SE SE Section 13, T29N-R20W, Vill.of N. Hudson - 276 Riverside Dr. Ins Name of PI,rilbe,. MP,MPHSW Nn Cr~.i t~ arritar Perm,l Number. Gar Za a 3300 St. Croix 69683 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY ']-~ANK ELEV TANK OUTL F?ELEV WARNING LABEL LOCKING COVER % _ PROVIDED. PROVIDED E T YES LINO ❑YES LINO BEDDING'. VENT DIA.. VEN ATI ALARM TEF2 NUMBER OF ROAD PHOPERT WELL BUILDING IVENTTOFRESH ALARM _ FEET FROM- uNe AIR INLET YES LINO r ❑YES LINO N__E_A___R_ES_T_ DOSING CHAMBER: 1MANUFACTURFR JBEDDING IIOUID (:OPA(, ITY PUMI MC)i)El P)l~9P SIPlrf l^:".^ANUI Fit WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF F'HOPEHTV WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE ' AIR INLET PUMP ON AND OFF) LJYES DNO INEAREST _-0. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 11,1I TI H 111,1ATI HIAt AND MAHKINCI 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 LENGTH IND OF DISTH P PL 11,111, 1111, '1'VI H 11,;5!I3 F. ()IA =PI1S LIQUID BED/TRENCH T11 FS DEPTH DIMENSIONS 1~R / P17 GRAVEL RCPTH FILL EPTH DISTH PIPE DISTH PIPE DISTR PIPE MATERIAL NO TI; NUMBER OF PHOPERTV WELL BUILDING VENT 'TO FRESH EELOW PIPES L ABOVE COVER FIE IN I T ELE ENU PIPE LINE AIR IN ET L v FEET FROM i NEAREST f 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- ❑ meets the criteria for medium sand. TIONS MEASURED. YES LINO SOIL COVER TEXTURE P[ .%1111 NT MAHK I Its off SE HVA T IrrN WF L LS ❑YES LINO ES LINO DEPTH OVER THENCII BED DEPTH OVER THENCII HFD DrPTH nF TO PSI IIL s )DI)f f) JF' OF Il MULCHED CENTER - (EDGES ❑YES LINO ❑YES LINO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH _NO OF LATFIPAL SPACING GRAVEL DEPTH BE I OW PIP( FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATEHIAI NO DISTH DISTH PIPE DISTRIBUTION PIPE MATERIAL & MARKING ILFV. Et EV DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION "OLESIZE HOLF SPACING DIIILLFU COHHECTI V CMATERIAL VEHTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO DYES LINO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE ❑YES LINO ❑YES LINO _ NEAREST- Sketch System on Retain in county file for audit. Reverse Side. SI( NATUH TITLE ~~i rf?~j{_ ~t_- ✓"~C/ DILHR SBD 6710 (R. 01/82) wlsconsin APPLICATION FOR SANITARY PERMIT y DILH R (PLB 67) COUNTY 0 ofRRRTTT1EnTOF UNIFORM SANITARY PERMIT # -OU5TRV,LR1BORGHUMRn RELRT1On5 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT _ PROPERTY nINNIFR MAILING ADDRESS 2 7 Co JOE i vc. S~ lam- .9~°'vF /Uo . ,y~D so c~ PROPERTY LOCATION /4 SE 1/4, S T ly N, R )-0 E (or) W LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, STATE PLAN I.D. NUMBER L__e_ 7G PIV-X, si12sz ?Jo• NUZ~s'oJ iuEKsia~ `lei t1~ ^J. I p TYPE OF BUILDING OR USE SERVED &I or 2 Family Number of Bedrooms. 2-- ❑ 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 # 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 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: /ESE CQ,V C ~7E" / ~.v oG 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): /PPROP?OSED (Square Feet): s /3 7~0 ~d XJ O Z,/,? Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: #P/MPRSW No.: Phone Number: 8300 (3Fs'~ Z~SG Plumber's Address: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature f Issuing Agent: Fee: Date: ❑ Disapproved o ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: 1 Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 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 M WZT-k R EtM(ArZ05 Location of Property ✓'E 14 S~ 34, Section 13 , T v~`? N - R o2~ W Township ~tL~ ~Cn Gc yk1c 2T1~ ur> s0 ,4 Mailing Address V `f:~ S l o c '~)2 1 V c-~, N c `ZTl-k Subdivision Name (D xr I-o°> l Lot Number Previous Owner of Property ZAP'pA CA'TNE:2tlvZ 2^PPA Total Size of Parcel Z ~7 AC~cS Date Parcel was Created Are all corners and lot lines identifiable? K Yes No Is this property being developed for resale (spec house) ? X_ Yes No Volume 2 &and Page Number G 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 1 (We) eenti.6y that a.t,t. dtatementb on this 6o4m are tkue to the bed.t o6 my (our) knowledge; that I (we) am (ane) the owner (6) o6 the pnopen ty deb en,i.bed in thiA in6onmati.on 6onm, by viAtue o6 a wannanty deed neeoKded in the 066iee o6 the County RegiAten o 6 Deeds a6 Document No . ;~Z 17 0 07 ; and that 1 (we) pobat .6ystem (on 1 (we) have dia pneaentty own the p4opobed bite bon the aewage obtained an easement, to hun with the above deben,i-bed pnopenty, bon the con6t4u.ction o6 bai.d 6ybtem, and the tame had been duty %eco&ded in the 066.iee o6 .the County Reg,i 6ten o6 Deeds , a6 Document No. 2 1 '7 l ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) i DATE SIGNED DATE SIGNED H z H . a ST C- 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d _ a OWNER/BUYER ~I Ali=Trig vV! r~~ S _ ROUTE/BOX NUMBER (21 u~LsC_ Fire Number CITY/STATE l~j~'.~Sa1J V~~ ZIP S / 0 PROPERTY LOCATION:, 4i Section 13 T o2? N, R ZLj _W, Town of NII}r-Th KXDSGi',J St. Croix County, Subdivision 0 1-kTI- 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 needed, by a licensed septic tank pumper. What you put into I the system can affect the function of ttie 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. 0 E 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- 10 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 A Ix-0 DATE ~ ILA b ( °l i 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. v r ~ = m m N C -I W N N `33 O v N w c c = m a m co n n 'CD ° 0- 3 Q p c O w w~~ w F Z ?V S O 3~ 0 G p~ ui '0 C (D N (D a (D N O i _ N D p wa w ? i CO) * CD - CD _ ~p m = m cD n 3mw0av~Nf ° 3 a (D ° (D (D 00 0 CD c: "0:1 =r 0 o 0 C- c w Zc° 0S3oao 3 c~Q° o h s V• m w w N N - ca D CD co 4. c: C G) c -0 0 o D w°° o ~c -4 =r O a O (U`~ w c w o :aQ° w =rR O p~ CCD N. Z D CD (D 2 a(Do 3`-Dmm=a D N N D va ~w=°~o If1 a ~ a CD w CL Ic -NT o c m m° f C m 3 CD CD 00 CL CD =r (A CD N CD OO " a~ r, ° m w - cp a 0 p~ 0~ p !A p CD 0=0U, 37 ao F N c c f w G) w w aaam CA 171 a c L7 Y< ~ N N. ° N p C N (D , 3 H 0 m n C (p 7 p N n m O 7 C a c O w (D (D c p m o C a ~c w -7, OL ,fir 3 O j (D p m t w a _3' _a m ° o 3 ° a O ~r co 0 v o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAT. ¢ DTI, NGN LABOO INDUSTRY, P. HUMAN AND P PERCOLATION TESTS (115) HUMAN RELATIONS MAC~~17 ,T. (H63.090) & Chapter 145.045) LOCATION: SECTION: T7"Z UNICIPALITY: LOT NO.: BLK. SUBDI IS ON NA 5C ~ / 3 /T ly N/R `0E (or) ,%v~So,tJ ~vf r- NO e~ . V 7'. COUNTY: OWNER'St~6 NAME: MAILING ADDRESS: 27 G 12i UA_ S ice- N , eta USE DATES OBSERVATIONS MAD \ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: P R I STS: &Residence .2- i11/f_ ❑ New Replace L fl` ~js 1 y h C RATING: S= Site suitable for system U= Site unsuitable for system F NVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ES ❑ S ❑U ❑S a]U ❑S ©U ~O.v~f-tljiDc>¢L If Percolation Tests are NOT required DESIGN RATE: V C,G9ss If any portion of the tested area is in the ' under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS /N 2)_0C1'A1a_Q_ -F4 . BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SE ABBRV. ON BACK.) ~ ~3 ' a, coo s, z.~ ~ • o~- a . B- Z 7. p' 77 OY' - >,70 B- O p '7_4,c, 057A C.s. B- , B-3. 7S y7.Sz > 75 I s.o 'T'u v cs' B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P- 2-- .2- P_ P_ P-_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensi- ,-.s I s. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on V. urface elevation at all borings and the direction and percent of land slope. 93.0' ' TO S n. z5 SYSTEM ELEVATION Ba-710 M _ Df //OmE` tf\ • - Qi4c~i/a~ pits / $ 33' ---a► x = PAC 5' f ouv8~trkr✓ , ~ CvE_!/ ~'t ~gi~rFv { o,~ 3 _ UST ~T Nod( S ipE or ffokE > 5 o f f~ /y ~it~0.~1 % ~"ST ~l~'~~f • Y X oN fi! f T r .4 it 8 ~'/~V• = ' ti6 _ . _ good tN Ste' s - tQ~ a ' 9 r r Gc' (l, = r yA • J ,evccud/QOo L~v1, _ _ ) s L~~f M411i eu W*tt e 6Rd-E V4 E%v. WATER 3'VAI E, Y.0,0 , 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): TESTS E R E COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. T 2 Y- RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ADDRESS: ROBEHI CERT ICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S s,S = D Z y 4L 3 ~6 pl~ MINN. tNSTALLER & DESIGNER LIC NQ U0663 CST NATURE: Q DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ,,~ttxAtjt-~ and ac', rnuj "'4±P, ~t..E-..F Fi'~.Y tea ' t.I"HaER, SI(S',-" .ter§HE P"i)luA ts~7OU F ti,FDO m Ni ` 10", iz„ uxj_F. ¢F ,a i, -Y?o.us ~ te'r IjCx tam arcut-t,,: #~carf~r~>. tom. ....1 .'J,"J ~Ix:a1 f~ x<. 3..~,t i_c.€.; '3t?~t L•1 t. f,,?r; we o2E "i?'° r w aa. = ,,V ?tJertzzEa.ei Lti)id,ta. ~.l81 £ _ e Hfr OJ a ~ce ,t ze 1i uct . n" ;ae void c en S, r+ z 3 . t-. ~t E sn ' .t::t,,, - rat? - t l-v ta tairt,E "J v t~~~rtrr;t tt,at eiixt~ 1~, k Ms's etas;.. t x:ounav ortw Dopartn-mntt`T1 may tcques` h ? F °3te r ~s.e.m ~l =,o nlr.t. soi ~ r fLr h p i at 3r. <<Da' a to srsTe g po,j 1Jo ~d-~ l'4UDSo~ w'~SIi~EE o W i S f1~+'`'E o >2Sr~. `1 ~ r cJ D Rr" ~ X ?~~K 2 >rl`isri,~ ~ y rn -ro II SySTEh 111-30 ~ SITE • ~ - do O X33 ~ v U N0 l ~ . o / 1A 2!0' t 35~ puc ~ Ev 9S. 5 N,~tiFSr eV060A) Fr. v Fresh Air Inlets And Observation Pipe ~ h 0 Approved Vent Cap Minimum 12" Above Final Grade C-- f N is- _ 3 " Above Pipe 4" Cast Iron - i o Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2" AggrAe] Over Pipe PA S6;/ Distribution Tee BEST Pipe 0 0 0 AggregaPerforated Pipe Below Beneath PipCoupling Terminating At 2 Bottom Of System (3