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Parcel 161-1062-95-000 08/17/2007 03:17
PAGE 1 OF 1
F 1
Alt. Parcel 13.29.20.530C 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 - HIGGINS, TIMOTHY P
TIMOTHY P HIGGINS
355 STATION LA N
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 355 STATION LN N
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 0952-CSM 04/0952
PT OL 89 VIL NH 1.09A LOT 2 CSM VOL Block/Condo Bldg:
4/952
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Typa
07/23/1997 1085/150 VVD
07/23/1997 889/449
07/23/1997 812/321
07/23/1997 726/496
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 110,400 200,900 311,300 NO
Totals for 2007:
General Property 0.000 110,400 200,900 311,300
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 110,400 200,900 311,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
IMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227 c:i::; OC
L iwi fall tiL;U;i 1'f RER OR i IAA t E. 10/2",
IMURTHOUSE DATF R=F,(VVEr14
luDSON4 4!I
(ez
Cl
'q Z-~h l
jenP i n
1uE OF SAMPLE. Kifatee.
FORM: 0 /100 m
NTERPRETATION. Bactei
s3TRATE-N: 2
oF.,NDEGEN,
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isiL df: t _ PROFESSIONAL LABORATORY SERVICES SINCE 1952
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ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
~?c Hudson, WI 54016
Telephone - (715)386--4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the prO~ert~can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING -----------------------------FEE: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $175.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection)
Property owner's name'
Property owner's address
Legal Description 1/4 of the /,I kl 1/4 of Section TL. N-R
of /V/cLot Number - Subdivision Name
02
14 FIRE NUMBER LOCK BOX NU14BEIZ ~C C', ' ~
Color of house ,,e-.-Realty sign by house? If so, lis firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:_ 4
Telephone Number 3 9,;?
REPORT TO BE SENT TO:_
Closing date
Signature ' -
x
1~, 1
ST. CROIX COUNTY
t
WISCONSIN
e 4 ~5Y "]c9~: Y v~'7
_ (¢k ZONING OFFICE
' Yc~yFJ~ ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Oct. 24, 1990
Carrie Johnson
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Ms. Johnson:
An inspection of the septic system on the
located at 355 Station Circle N. property
, Hudson, WI was conducted on
Oct. 18, 1990. At the same time a
water sample was obtained for
testing. The results of that testing will sent to you as soon as
we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve an
Accordin 1 Y excavating or chemical analysis.
g y, there is the possibility of hidden defects in the
system not discoverable by this inspection. This not not in any
way warrant or guarantee the continued proper functioning or
operations of this system. It is recommended that the system
should be pumped once every three ears.
prolonged life of this system is totally dependent ruP p on p the
maintenance of the system. roper
Should you have any questions regarding this subject, please feel
free to contact me.
Sincerely
,
Mary J. Jenkins
Assistant Zoning Administrator
cj
,rte
FORM 985-A
364518
CERTIFIED SURVEY iIAP
ST.~ CROIX STATION North Dine of Section 13 UNPLAT-LD L.'-DS
1 i Point of Beginning
31 I 561.19' N 80-41W N88°34 l
,90 202.20 126.5 2332.43' 400.16
2
400 . 1' R~Nl 4
328.76 corner
6
~~x Section 13
T29N, /R20W
1.121 Acres 1.092 Acres ti /r
sz -
Jli S7 b S 1 ~)n
0 00 r 9o o 10 v i~ ~L /l
301 1 71
ene 65
I
rl .1 S 74 02s
1T~D L °f hra~~1 `A,A(,6 2~ ~G 1
ey L
~'~DS _ ane
Scale in Feet ` ~--TR
] E-NW / /C)~-' BEARING
0 r/
65 ~
r
LEGEND
• EXISTING 2" PIPE, WEIGHING 3.65#/LINEAL FOOT
O 1" IRON PIPE, SET, WEIGHING 1.681-1t/LINEAL FOOT 44
JUN 8 1900
JARES O' CONKEa
9*91stw of Dasdi
OWNER 0 SUBDIVIDER so, CVOiX Covnty, C,
NORBERT KOCH 4 9 y
METRO SQUARE BUILDING
SUITE 742
121 E. 7th ST. Z- ~57
ST. PAUL 5 INN. S5101
Volume 4 Page 952
'his instrument drafted by Wade Hartenstein.
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWN HD!IP SEC. T N-R Z y W
ADDRESS GL~C ST. CROIX COUNTY, WISCONSIN
SUBDIVISION (..a_u~/ LOT" LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~rj✓~-ems f~
A/C
i
~A
1
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
f ✓
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: ty'(IU4 Liquid Capacity: le~00 Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest- Road: Front,0 Side,O Rear, O 1_5 feet
From nearest property line Front, 0Side, 0Rear,,Q 26, 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, O Side, O Rear Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Lengfth: Number of Lines: 5' Area Built: C G'~
Cc:='
Fill depth to top of pipe: `
Number of feet from nearest property line: Front, O Side Rear,O Ft. /Z
Number of feet from well: c<J
Number of feet from building: r y'
(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 1
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 :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
. CONVENTIONAL ❑ALTERNATIVE stare Planl.D.Num
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERM HOLDER' INSPECTION DATE
Ronald Clausen Plaza 94, Hudson, WI
_
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV. CST REF. PT ELEV
NE NW, Section 13, T29N-R20W, Village of N. Hudson,LOt#2,St. Croix St tion
Name o! Plumher: MPLMPRSW Nr, C"u ,ty ,i. dr,Perm.,; N~.mna~
Roger Timm 3224 St. Croix 75010
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIOUID CAPACITY TANK INLEl ELEV_ TANK OUT LET LEV IWARNING LABEL JLOCKING COVER
s P v DE D. PROVIDED.
> y YES ❑NO ❑YES [XNO
BEDDING. VENT DIA.. VENT MATT JHI( ;H WATER NUMB -R"C~'F'- 'ROAD PROPER iV WELL HUILDING (VENT TO FRESH
ALARM FEET FROM L INE AIR INLET
❑YES NO C ❑YES ❑NO NEAREST
DOSING C AMBER: ~
MANUFACTURER BEDDING[ CnPA('I Iy PUMP MIJ()F L Ill l.tj".SIVH ()IV ^.A r1l1f ~~t:i 11HE H WARNING LABEL LOCKING COVER
PROVIDED PROVIDED.
❑YES ❑NO ❑YES L ENO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION L NUMBER OF PHOPEHTY WELL BuILDEN(, (VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES L! INO NEAREST10
SOIL ABSORPTION SYSTEM. Check the soil rnoistureat the depth of plowing :TEI+ 111,111HIAL AN;, %IAHKIN,;
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:
WIDIH LENGTH NC lff DISTH PIPE SPACINI, btlt 1t.51U1 )IA =PIT' LIQUID
BED/TRENCH rHEacHF +eH PIT DFPTH
DIMENSIONS,
GRAY L DEPTH Fit L DEPTH DISTH PIPE DISTH IF E DISTR PIPE MATERIAL I`;I NUMBER OF PH OPERTV WELL BUILDING VENT TO FRESH
BT 1.OW PIPES ABO E„COVER ELEV IN-f! T ELL V N f E LINE ' AIR INLET
t , r l FEET FROM
) l \ 2 / 7 NEAREST O_ Ict
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 (t ON REVERSE SIDE. SHOW ELEVA-
I❑YES L❑ me is the criteria for medium sand. TIONS MEASURED.
NO:
SOIL COVER TExTURe - HMANL NT MAHkI Ies Al A if
R A Ir,N wt LLs
r I L_~Y S ❑N0 d ` ❑ AYES ❑NO
DEPTH OVER TRENCH B D DEP N OVER TRENCH HFU PTE/ of TOE'S( IL [mof I) } SEEDED MULCHED
CENTER E CJ,CE 5 ' J
~1' t OYES. _JN ❑YES ❑NO ❑YES ❑NO
.
PRESSURIZED DISTRIBUTION SYSTEM: `
WIIITH LENGTH NO. OF LAT RA SPAC C. [HAVE. L DFP H HE I Pl Ell L DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIF,---OLD DI TR. P E MANIFOLD MATE IA NO DISTH DISTH PIPE ,.r DIS 11. UT N PIPE MATERIAL & MARKING
ELEVATION ANDEIEV. ELEV DIA .F / ELEV. PIPES DIA
DISTRIBUTION
INFORMATION J" S.E HOLF SPACING DILL D R R I Ly COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
f PLANS
AYES ❑NO _ ❑YES ❑NO
COMMENTS: PERMANENT MA ERS'. OBSERVATION WELLS. f ❑ ❑ UMBER OF PROPERTY WELL.
4FEET FROM LINE -1' NO ❑ YES LINd NEAREST- BUILDING.
7
C I o' I/
d i`7 ~f r
D '
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNAT E TITLE
D I L H R S B D 6710 (R. 01/82) C % s-",~
wlsconsln APPLICATION FOR SANITARY PERMIT//'' /j y
~ COUNTY
'Z~Dl LHR (PLB 67) UNIFORM SANITARY PERMIT #
OEPAR"nrnEnT of
InOUSTRV, LABOR 6 NLIMAn RELRTIO;
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Yzx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPERTY LOCATION CITY:
1 /4 /la Yf ~t~ll
To
(9 OF:
TN, R 2,) X (or)
/4, S
j„-
LOT NUMBER BLOCK NUMB ER SUBDIVISION NAME , NEAR/E~ST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER A/9
TYPE OF BUILDING OR USE SERVED
' 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
Y-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.
❑
;K Seepage Bed ❑ Seepage Trench ❑ Seepage Pit Holding Tank
❑ Vault Privy ❑ Pit Privy
EJ System-In-Fill ❑ In-Ground Pressure
❑ 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 6~b
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 ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
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: MP/MPRSWT1tn.r Phone Number:
Name of Designer
Plumber13 Address:
COUNTY/ DEPARTMENT USE ONLY
Signatyre of Issuing Agent: Fe Date: ❑ Disapproved
ry ~p C' ❑ Owner Given Initial
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
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 4"mq o t CL~ ,"y _
Location of Property k A)tj k, Section W
Mailing Address
Address of Site
Subdivision Name
Lot Number
Previous Owner of property
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being develop/ed~ for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warrant Deed which includes a Document number, volume .and _page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) centi6y that a t statements on this 6oAm ahe tAue to the best o6 my (out)
knowledge; that I (we) am fate) the owneA (,s) o6 the ptopetty dens ctt i.bed in the
in6otmation 6otm, by virtue o6 a waAAanty deed Aecotded in the 066ice o6 the
County RegizteA o4 Deeds ass Document No. and that I (We) pies entty
own the ptopo~sed site ite 6oA the sewage duspoz yztem (o)L I (we) have obtained an
easement, to tun with the above de6cAibed ptopWy, 6oA the con/stkuction o6 said
.system, and the same has been duty AecoAded in the 046ice o6 the County RegisteA o6
Deeds, as Document No.
✓
SIGN URE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
z
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ST C- 105 r'
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SEPTIC TANK MAINTENANCE: AGREEMENT o
St. Croix County z
t7
H
OWNER/BUYER ~
ROUTE/BOX NUMBERf Fire Number
CITY/STATE {15'cr? ZIP
PROPERTY LOCATION: Section T~ N, R W,
f ~ Town of ~ St. Croix County,
Subdivision ~f: _ Svi✓✓. d( 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 I{
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 H
three year expiration. °
z
I/WE, the undersigned, have read the above requirements and agree
x
to maintain the private sewage disposal system in accordance with r,
the standards set forth, herein, as set by the Wisconsin Depart- 'v
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 ✓---[>'c-
St. Croix County Zoning Office
P.O. Box W
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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n, O- $SOIL BORINGS AND SAFETY & 13
Di S! J',
' 1,,~TION TESTS (115) BOX 37jr
n~AD)sor~. ~n i 57,3,
(r4c?,C&'1) &_-Chapter 145.645)
- LOT NO.:BLK. NO.: SUBDIVISION NAME:
~--i1P.~NICIPALIl~%'
J cJ ~v .A-~
X04 QSa~j 2 T,
- A`yr` R' Jr: S NAME. MAILING ADDRESS: VOL, 41 P. 95z
o l~EAtJ E 6,~,* rJ
DATES OBSERVATIONS MADE
PdC.BEDRK/S,: COMMER ALDESCRIPTILN _ PROFI D RIP. IONS: ATIONTESTS
~tJew ~.Ji=teplace t(IJ3(////BS" , 4-,`:~~
S`CSTSM 2EQjIQ-°S k. ~tz7 ?~utn'L~iZ Lcu~.e✓
!NG S- Site suitable for system U' Site unsuitable for system e~ Yy' i'F? aSLL) L:~-Lw Dc51iei rJ A L-sn•
ff,I N GROUND-PRE. JRE~SYSTEM !n rill{NrLDiNC NK jP.COMMEIJ ED SYSTEM iopt!onal~r,fy,~~D tS
r~ 4L MO' ND: l
S U QU S CU I Z S In14 sr-'3 P n xis _oOZ.__~ - '
!or. Tests are NOT required DESIGN RATE ASS Z ) • an. C for c~' he tesud arer, is n the
e, s,H63.091Ei)W, indicate: ; F o a air, cate F!oodP air•. °lev,t,or N , A .
i caCa tom- P. 7 rR ; PROHL E DESCRIPTIONS SC1LS, qtr J'g L r~Y t rsrr:
^i?!NG TOTAL DEPTH T GR UN DVk'ATER-INCNE3 CHARACTER OF SOIL 1NITH THICKNESS, COLOR, TEXTURE, AND DEPTH j
%!,,,BER DEPT= iN ELEVATION OBSERVED EST. HIGHEST TO BEDRC;CK IF OBSERVED (SEE ABBRV. ON BACK.) r
0.50' 8L LtS j Z, 00' ! COED S C7 t
C I
50 /~G-3l ONE r"nEu
. 5
0.~7 PL L v
~~G• x'/08.08 E /.,IONS ~!lO•3. 7/ Grt' O. JO V-0 5,,j GL 4.0o' StJ
6L L v f'S • 4.30, a,-,
3 17, T "'13
f 3.56 E E_ v S J. LO 8,o v S w O•S= o,7s $ L Y S Pat XC
Y (l.$p'dL saAFtCPAIJ y
_-v~.-..---_-_-_-~-- V
B r F$ I .00• V~s (J' f7 N E D ~J t~S W~y
I` t L"
r `E¢, o aQ I ~'v`GrJ= 7 J 3c),9'1 FS '^/Z < %4 µotttLO /s j2c$NtS ~ O,cS-O,oBr
1P- F- E6 U L-*P- hFOGtZo.iS R p B / S• L! Z,OO' g ! r$ v j ~a T k_
PERCOLATION TESTS
_ - -
DROP IN WATER LEVEL INCHES RATE MINUTES
a C_Lr lr."~. 1 ilV :%A~-tv11 fY. PERT D T-77---F E R!C'~ R. PER INCH
-17 PLAN,'. S^ow locations of percolation tests, soil borings and the dimensions of suitable soil meas. Indicate scale distances. Describe wttat ate n.e
a, and :--t •-a elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and perc,nt
o s o • . ESE ti 'tit. t' ! Ola. / = 'A BCIvE (NoerN Q°
STEM E
sc L- 1E ;
"Yo ir~OLZ
_cDc AT
t r , esr
-CT-"- t~l ktti't : ~ED~ MJST 'Pt#2GOLAT"/o►J
LFt. rN VnJD,STU~Bt=D J r P U T~`~T' ~I I
ED
SOIL. R MtnIIMVM Or` a
t r^ J
~ t I
F 1
x r ) F 8.• O r CO ver- GA~nJ S
' AcHt>✓ cb BY oat iI
I d` O I I: ; i , t
P-4 0
T I SQ FT. r_ C P t--A G E !J\ Em F 1 t
r 't
61
Ct~ F ) t3 ET
~r _Q ( G 1 50 . F%
t G- ~
FT
fro
i~ D¢.oP 50% I - - - r u, ~7
_ ,4'
a ' r t~N MA P- V-
T 'ti %-;C SOT ~~l-rJ t✓~-"IQ iy/ ~1
o ers ::ned. hereby certify that the soil tests reported or, this form were macJe by me i l arcoid w th thr ;)tocedu-s anti methods specified in the W,scoll"
„n,st ratwe Code, and that the oats recorded and tie location of the tests are correct to the host of my knowledge and Ixt oef
M` {iFSTSwFP i ?h^PLFTED ON
1 - - - CER?1FlCAT1,7fv N N BER PHONE NUMNER,uu:,on-'
R' S'
40
CS~NAT0RF j
:1 Vi~ F roar :r Local Authowy, Pt lnet!y Ovv,w, ;111
r
I)f PA131MFNT OF SAFETY & BUILDINGS
IND(ISTRY; REPORT ON SOIL BORINGS LAND DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 53709
HUMAN RGLATIONS
(H63.090) & Chapter 145.045)
LOf n f I~iN SECTION. TOWNSH4,P/MUNICIPALITY LOT NO.:BLK- NO.: SUBDIVISION NAME:
E '/a_N4 13 /r ;~/R zcP J,T ~1 Lo F--r, V, ; nd I-
COiiNI G UWNFfT'S~BUYER'S NNAME: MAILING ADDRESS: OL, 4 PA46 a . Z
~~oDEft.r.J 44,D P LA Z04 , 4 JI~S Jn.f
USE_ DATES OBSERVATIONS MADE
- - -
NO.BF.DRMS.: F71O M 1-CIAL DESCRIPTIN: PROIFI ED IPTIONS: AT/ON TESTS:
esidence ONew ❑Replace - l l
RATING: S= Site suitable for system U= Site unsuitable for system
COrNNV~ENTIONAL.: MbuWb: IN-GROUNDIPRE:A.SURE: SYSTEM-IN FILI- ~OLDING I~TAINK: RECOMMENDED SYSTEM: (optional)
SUS [:]U [fl S ❑U ' ~S ❑u ElS u 1:_u1
If PetculaUUn Tests are NOT required ESIGN RATE:
If any portion of the tested area is in the
under 0H63.09(SHW, indicate: I Floodplain, indicate Floodplain elevation:
I L- ~1(r Pt~rt C PROFILE DESCRIPTIONS `~~c~ j L ; tT ' gs A-MI~ ~j
&,A I
BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH'taL ELEVATION OBSERVED EST.-HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B _ 3, S8' !S L 0.7 Dr- B j L. .'S,3 g._, Meo t
0,&7' Irv F✓D $rj F S O.,art,5•
~•5C) aL~ SLR 0.83 J~ f5..r L_S~ ~,oa v S
B-
B-
B
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. pEgIOD t -F!E D PER INCH
P- /06 4$' Or1E
r3, t" 3 VI
P- 4-,: 04,Z 3/ V Z X8
P
P _
P_ O LE
PLOT 0LAN: Show locations of percolation tests, soil borings and the dimonsrons 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. z
SYSTEM ELEVATION jd:~lo• oo j. FOP-
+k- O , f I , \ I Z i t i
i
I 4•
I
r a /p..t ~ ~ ! 1 i .n
6 p3 a 1
O
5 AM 16'
O CJ M
Z a'3
2_ -Z
3
~TL'i -'I G L, I tic)
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)!
t
CST GNATURE: O
D[STs"{IBUTION: tai igmal and nne copy to Local Authority, Properly Owner anal Soil rester. 4^
171 i!i •'I~~l Ws 010 iP 0? 0") ()Vi 1-11
ROHL & TIMM EXCAVATING JOB
310 Arch Street SHEET NO. OF
HUDSON, WIS. 54016 CALCULATED BY DATE
(715) 386-8664
CHECKED BY DATE_
SCALE
o C
` ~-1
QRZ)
d C~ -
F _
lqj,
`
PRODUCT 2041 s Inc., Groton Mass. 01471.
PAGE 4- OF
C.ro5S 1 z0- A eI'S, 5~ rl--)
Fresh AI Inlele And Obeervallon Pipe
C.~ Approved Vent Cap
Minimum 12" Above
Final Grade
20 - 42" Above Pipe _ 4" Cost Iron
To Final Grade Vent Pipe
` Marsh No of Srnihstk Covering
"In 2" Aggregate
Over Plpe
Olelrlbullon
Pipe o o --Tee
6" AggregoIs
Beneath Pipe o Pertoraled Pipe Below
o CovWing Taminaling At
Bollom 01 System
Propose,D firl,l gri t
Ve.Je.~ 1 on
SOIL FILL
DISTR18UT101•.I PIPE
APPROVED S4?J NETIC CGV
2"OFAGGREWE ~_MATER1A1- OR 9" OF STPA
MARSH HAy
\~~OR
L 0 F%Z-21/2 AGGREGATE
E V, OFFEET,
DI5TRIf3UTIOIJ PIPE TO BE AT LEAST WCHES BELOW ORIGIUAL GRADE
AIJU AT LEAST20 IAICHES BUT MO MORE THAI) 42 INCHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXcAVATid)#J FKoM ORIGINgi, 69AIDF- WILL BE -2 IUCHES
MKIMUM Wr1t OF EXCAvATIOM MOM. 1161NAL GRAVE WILL 6E 3, INJCHES
SIGAIED
LICEWSE AJUMBER;
DATE
- I la