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Parcel 026-1044-50-000 10/12/2006 08:29 AM
PAGE 1 OF 1
Alt. Parcel 15.30.18.218A 026 - TOWN OF RICHMOND
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 - OSBORNE, DORIS
DORIS OSBORNE
1562 HWY 65
NEW RICHMOND WI 54017
Districts: SC = School SP =Special Property Address(es): Primary
Type Dist # Description " 1562 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 35.890 Plat: N/A-NOT AVAILABLE
SEC 15 T30N R18W 35.89A PART SE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
15-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 993/130 TI
07/23/1997 814/397
2006 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/22/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 4,500 64,200 68,700 NO
AGRICULTURAL G4 32.210 5,500 0 5,500 NO 00
UNDEVELOPED G5 0.680 100 0 100 NO
OTHER G7 2.000 7,500 49,000 56,500 NO
Totals for 2006:
General Property 35.890 17,600 113,200 130,800
Woodland 0.000 0 0
Totals for 2005:
General Property 35.890 17,500 113,200 130,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 026-1044-60-000 10/12/2006 08:32 AM
PAGE 1 OF 1
Alt. Parcel 15.30.18.218B 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - CARLSTED, DIANNE A
DIANNE A CARLSTED
1731 96TH AVE
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1564 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 4.110 Plat: N/A-NOT AVAILABLE
SEC 15 T30N R1 8W 4.11A PT OF LAND IN SE Block/Condo Bldg:
1/4 OF NE BEG NE COR TH W 242'S 739' TH
E ALG DRIVEWAY 242' TO E LN N 739' TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
POB 15-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1085/543 WD
07/23/1997 1044/260 WD
07/23/1997 725/536
07/23/1997 706/56
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.110 43,200 90,900 134,100 NO
Totals for 2006:
General Property 4.110 43,200 90,900 134,100
Woodland 0.000 0 0
Totals for 2005:
General Property 4.110 43,200 90,900 134,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 144
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
s
Jf 43
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~ (715) 246-2017
Sweriby's, Realtor
MON /~NARRCH "See Us Before You Buy, Sell or Burn"
_ 11
RINTING, INC. REAL ESTATE • INSURANCE
y New Richmond, Wisconsin 54017 214 South Knowles Avenue
QUALITY JOB PRINTING New Richmond, Wisconsin 54017
10% Off On Wedding Invitations (715)246-222Z ❑ (715)Z46-2223
~ COMPLETE TYPESETTING SERVICE "WE SELL THE EARTH"
i
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP I C~ /1'~O~jy SEC. Tgo N-R IB W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IIH-R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
7
d,3
ld~
3/~Jj~~ f t `fin\`
t
6 l
q /
30
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer:4,eLiquid Capacity:
Number of rings used: ® Tank manhole cover elevation:
Tank Inlet Elevation: 9;7 0-4 Tank Outlet Elevation:
Number of feet from nearest Road: Front, 04 ide10 Rear, 0 feet
From nearest property line Front,0 Side ,p Rear, O feet
Number of feet from: well n building: 3-7/
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liqu" Capacity:
Pump Model: Pump/Siphon' Manufacturer: Pump Size
Elevation of inlet: i Bottom of tank elevation:
Pump off switch elevati Gallons per cycle:
Alarm Manufacturer* Alarm Switch Type:
Number of fe from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well.:
Number of feet from building:
r
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Z Length: Number of Lines: L__ Area Built
Fill depth to top of pipe: c
i
Number of feet from nearest property line: Front,/ Side, O Rear,O Ft.s
Number of feet from well:
Number of feet from building:
-r-
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built~"
i~
Has either ,'a drop box O or distribution box O been used on any of the above soil.
absorb on sytems? (Check one).
DING 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:
Plumber on job:
Dated.
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
:
aCONVENTIONAL ❑ALTERNATIVE State Plan ID.Number
(I1 assagnedl
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Albert Osborne RR#4, New Richmond, WI
BENCH MARK (Permanent reference paint) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV
SE, NE-,, Section 15, T30N-R18W, Town of Richmond
Name of Plumber. IMP/MPRSW Nn. County Sanitary Permit Number.
Gary L. Steel 3254 St. Croix 64853
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY . TANK INLET ELE V.. TANK OUTLET ELEV.. IWARNING LABEL LOC ING CCER
P DPRO E
YES ❑ NO S[:] NO
BEDDING: VENT DIA VENT MAT L.. HIGH WA f'E R NUMBER OF ROAD: PROPERTY WELL. BUILDING IVENTTO_fARESH
/ ALARM FEET FROM LI 2 AIR ~OLE
OYES N I OYES ONO NEAREST / 3() 37
DOSING CHA BER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
EYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUI LDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) OYES ONO NEAREST 30
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER 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 LENGTH NO. OF DISTR. PIPE SPACING COVER - JINSIDE DIA. -PITS JLIOUID
BED/TRENCH J TRE~s{ ES f MATVIAIF 2 PIT DEPTH
DIMENSIONS ~ / 4
GRAVEL DEPTH F ILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DI R NUMBER OF PROPERTY WELL'. BUILDING. VENT TO FRESH
BELOW PIPES Aecy~ COVER ELEV INLET ELEV ENO PIPES FEET FROM L E AI
r NEAREST-► S 1° Y'
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.
OYES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
OYES ONO OYES ONO
DEPTH OVER TRENCH.' BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES
OYES ONO OYES ONO EYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV.. DIA. ELEV.. PIPES. DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED
OYES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING:
FEET FROM LINE.
OYES ONO YES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710 (R. 01/82)
7Z-,5 conSin APPLICATION FOR SANITARY PERMIT /J
~YD>JC COUNTY
D I T LHR (PLB 67) UNIFORM SANITARY PERMIT #
mEl OG USTRV, LRBOR 6 HUMRn RELRTIOnS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNE MAILING ADDRESS
T ,
PROPERTY L CATION CtTYi:
V':
S 1/4 ~ 1/4, S &D, N, R (or) W TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION N ME NEAREST R AD, LAKE OR LANDMARK STATE PL/jN I.D. NUMBER
Jq 74-
_I
TYPE OF BUILDING OR USE SERVED
A 1 or 2 Family Number of Bedrooms. Z ❑ 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.
❑ 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 t)Q
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):
~Q l jZ_Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation the private sewage system shown on the attached plans.
Name f Plumber (Print): / Signature: /MPRSW No.: Phone Number:
~6-lvl_/0
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
i;1 f ; , V{ ❑ Owner Given Initial
C / Qj ~ OcJ Approved Adverse Determination
wa-Aw,t&
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,("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
Location of Property ' ;4, Section TZ 0 N - R l8 W
Township
Mailing Address I~
Subdivision Name
Lot Number `
Previous Owner of Property _.~"~th'11t r) S bn'-n e--
Total Size of Parcel c~CJ ~~'t~►~Lc'p
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes 'f No
Volume :U and Page Number / 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) eeA i6y that att a.tatementd on .this ~oiun aAe .true to the best of my (ouA)
knoweedge; that 1 (we) am ( cute) the owner (b ) o6 the pnopen ty de6 c&i.bed in .thi.6
injo4mati,on 6o4m, by viAtue of a wa4&a.nty deed %ecoAded in the 04jice o6 the
County RegisteA of Deeds " Document No. 38 S ; and that I (we)
pnebentey own the pnopobed d.ite jot the .sewage p e eya.tem (on I (we) have
obtained an ea6ement, to Aun with the above de6cA bed pnopexty, 6oA the
condt.u.c ti.on o6 4 aid A yd.tem, and th.e Game has been duty heeo tded in the 0 j jive
o6 the County Reg.i d.ten. o6 Deed6, ab Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
,0 71, _0_11
,~`J
~ ~ 4"d A'4 ` r tW : x'~ ~ ~x?.e a '.~4 ' `"ta,` k ~ kgY
1~7 PONY
A ST.. ,C,ROIX COUNTY ABSTRACT COM
fie 1.V. HUDSON WISCONSIN
CONTINUATION OF p!<STRACT NO. 3278a
0 o'clock in the -A--M•
? fYa"the, day of January 24th 19 67 at Ig j_
of the land described as:
S of NE4 and S of NW4 of Section 15
EXCEPT E 242 feet of N 739 feet
108
National Bank of New Satisfaction of Mtg..(No.102
irst Dated Feb. 3~
ichmond, a corporation, by Ack. Feb. 13, 1967.
res.,,,, Cashier and Corp. Seal, Rec. March 3, 1967-
28 86.
In "431 page 83, # 75
Satisfies mortgage recorded
rank Osborne and in 11427"., page 569•
oris Osborne.
109
' Warranty Deed.
ank Osborne a/k/a Fritz con. $1.00 OVC.
. sborne and Doris Osborne, Dated Feb. 14, 1967•
Is wif<es Ack. Feb. 14, 1967.
Rec. Feb. 24, 1967•
-to- In 1143011., page 815, #287519-
r Ar lbert Osborne.
An undivided 1/2 interest in the S2 of NE4 and the theoSE-k of all
n Section 15-30-18, except a parcel of land located
f said Section 1 described olsN line iofisaidtSEheofENE~raedi -
f said SE4 of NE,,; thence W along the
with line SE f
ante of 242.0 feet; thence S ParallelE alongttheEcenteroofsaidriveway
a distance of 739.0 feet, thence
arallel with the N line of said SE4 of NE4 a distance of 242.0'feet
o,the E line of the SE4 of NE4; thence N a distance of 739.0 thetE 6
long the E line of the SE4 of NE4 to the point of beginnir 11
eet ,of the above parcel being used for State Trunk Highway 65
47~ evenue stamp cancelled).
t 110
Mortgage.
ti ~~box't?e, single, Con. $6,500-
Dated Feb. 14, 1967•
to Ack. Feb. 14, 1967•
Rec. March 11 1967 @ 4:00 P .
ak of New Richmond, a In "431"., page 54, #287567.
orporation.
Same land as shown at No. 109.
Recites: It is further agreed and understood bnoteonlyhforathee
hereto that this mortgage shall stand as security, renewalss partial rene - d all bove mentioned ntthereofaloverdrafts and other indebtedness now or
is and extensions either or any
ereaf ter owing said mort agee bintadditionatorthe rnote referred to
f them to the extent of 1500.
erein. (Satisfied, see No. 123).
Y ~
1 JF
ST. CROIX COUNTY ABSTRACT COMPANY
OF ABSTRACT
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
0
St. Croix County z
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14
0 W N E R MHtY-ER
ROUTE/BOX NUMBER Fire Number
CITY /STATE Z LP
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PROPERTY LOCATION:~~-',, Section
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Town of St. Croix County,
Subdivision 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 the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant Ior
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 stems 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
I/WE, the undersigned, have read the above requirements and agree Cn
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart-
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
'l'E
D A -_~_Z 7
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
INDUSTRY,,. C DIVISION
H
LABOR HUMAN RANEDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76
HUMA
N, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MbW+E+PA_l7 ~Y: V-4- TNO.: BLK. NO.: SUBDIVISION NAME:
5C /a9~/a 5 /T o N/R/91 (or) W COUNTY- OWN h WtttPl- ~ NAME: MAILING ADDRESS:
S~017
USE DATES OBSERVATI NS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence 7 5
New ❑Replace I 1 j
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRES SURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
ESS ❑V N$ Zo
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C OR, TEXTURE, AND DEPTH
NUMBER D&wrPTIN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 83
7 PC nj
9
A)Q A) 7 rP~°-ors ,n"JA .a ~si!<, S,,C.
z
le 'V 1 B- _Zlell
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INGI ES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
3
P- A) O d 7 3 D
P z 7-= V0 ,3c~ y y z
P- 420 .3
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
2-
SYSTEM ELEVATION
~ r e I o a -
gin -Jrwo
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N
S 5 6d~ 1-30' W Ali
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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 correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGN U
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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