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Parcel 030-1012-90-000 10/24/2005 09:28 AM
PAGE 1 OF 2
Alt. Parcel 03.29.19.55T 030 - TOWN OF SAINT JOSEPH
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 - KADIDLO, DONALD G & JUDITH
DONALD G & JUDITH KADIDLO
I
~I
611 OLD MILL RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 611 OLD MILL RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R19W PT SW SE COM 521 FT N OF Block/Condo Bldg:
SE COR, TH W 518 FT, NWLY BY DEFL >
63DEG 127 FT, TH SWLY DEFL > 90DEG 233.5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT, NWLY DEFL > 90DEG 50 FT, NELY BY 03-29N-19W
9-R1.9 FT. NWLY 400 FT TO
Y BY
0 x
el , more...
00
rL d Parcel History:
(D 0 d Date Doc # Vol/Page Type
0 07/23/1997 989/501 QC
0
rt
N ~ ~ O
W 4 z
00
00 o Fair Market Value: Assessed with:
rn 0
Last Changed: 07/07/2004
a
Acres Land Improve Total State Reason
Ul , 3 1.000 50,000 196,000 246,000 NO
v ~ 1>
w ~
F--'
Co
v, 1.000 50,000 196,000 246,000
o N 0.000 0 0
0
~n 1.000 50,000 196,000 246,000 'Ji
v ro 0.000 0 0
rt
w rt
0 1 Certification Date: Batch 121
m
x
Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 030-1012-50-000 10/24/2005 09:29 AM
PAGE 1 OF 1
Alt. Parcel 03.29.19.55P 030 - TOWN OF SAINT JOSEPH
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 - KADIDLO, DONALD G & JUDITH
DONALD G & JUDITH KADIDLO
611 OLD MILL RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 611 OLD MILL RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.820 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R19W PRT SW SE COM SE COR W Block/Condo Bldg:
505.62 FT, NWLY BY > OF 59DEG 888.09 FT
NELY BY > OF 90DEG 150 FT TO POB, NWLY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
BY > OF 94DEG 354.47 FT, NELY BY > OF 79 03-29N-19W
DEG 181.5 FT, SELY BY > OF 105DEG 402.2
FT, SWLY BY > OF 90DEG 150 FT TO POB
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 917/215
07/23/1997 916/204
07/23/1997 914/628
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.820 52,500 0 52,500 NO
I
Totals for 2005:
General Property 1.820 52,500 0 52,500
Woodland 0.000 0 0
Totals for 2004:
General Property 1.820 52,500 0 52,500
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 030-1013-10-000 10/24/2005 09:29 AM
PAGE 1 OF 1
Alt. Parcel 03.29.19.55V 030 - TOWN OF SAINT JOSEPH
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 - KADIDLO, DONALD G & JUDITH
DONALD G & JUDITH KADIDLO
611 OLD MILL RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 611 OLD MILL RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 8.462 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R19W PT SW SE BEING LOT 2 CSM Block/Condo Bldg:
11/3072 8.462AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 505/398
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 8.462 103,500 2,900 106,400 NO
Totals for 2005:
General Property 8.462 103,500 2,900 106,400
Woodland 0.000 0 0
Totals for 2004:
General Property 8.462 103,500 2,900 106,400
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 SEC. T ~N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION j' LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
n
)~OdSr I. X1 ST-lr 6 Ci~L','f Gv1 t S ' b r4-L0
T, P_,of
v,irLL
/ZUY D i U
0
/ /toPV S eu ~
Vtly; S7Ac K
of
0vF2 /bo 7o
INDICATE NORTH ARROW
1F. LLTi
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: ~J Proposed slope at site: G~
SEPTIC TANK: Manufacturer: J2, 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, Rear, O feet
From nearest property line Front,0 Side,0 Rear, O ~
U feet
Number of feet from: well J , 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: Length: Number of Lines: c,Z Area Built:
Fill depth to top of pipe: Z o
Number of feet from nearest property line: Front, O Side,0 Rear,0 ht.
Number of feet from well: > j
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:
Inspector:
Dated: Plumber on job:
License Number: f r U
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 796~s BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL DALTERNATIVE State Plan l.D.Number
(If assigned)
❑ Holding Tank D In-Ground Pressure ❑ Mound
INSPECTION DATE.
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: R
Don Kadidlo 825 St. Croix St., Hudson, WI /--f-T- , 3o
REF. PT. ELEV.: CST REF. PT. ELEV
BENCH MARK (Permanen[ reference point) DESCRIBE IF DIFFERENT FROM PLAN.
SGI SE, Section 3, T29N-R19W, Town of St. Joseph
Name of Plumber. MP/MPHSW No.. County Sanitary Perm,[ Number:
3300 St. Croix 64881
Gary Zappa
ELABEL LOCKING VER
SEPTIC TANK/HOLDING TANK: _
MANUFACTURER'. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARONIIDNGD
~n PR PROI_IDE
a ( C~~n L~ 'S~ ,2 YES NO ' Et NO
ROAD: PROPERTY WELL. BUILDING VENT TO FRESH
BEDDING: VENT DIA.. VENT MATL.. HIGH WATER- NUMBER QF LINE - { ) LAIR INLET.
( ALARM ' FEET FROM v (!//i ~p / L! /y
OYES NO / OYES ONO NEAREST
DOSING CHAMBER:
PUMP/SIPHON MANUFA H WARNING LABEL LOCKING COVER
MANUFACTURER BE DUING. LIQUID CAPACITY PUMP MODEL d•~ ! PROVIDED: PROVIDED'
OYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE PUMP AND CONTROLS OPERATIONAL MB OF PRO ERTV WELL BUILDING JVER ANLOETRESH
: EET OM LI
(DIFFERENCE BETWEEN
PUMP ON AND OFF) OYES ONO NEA ST
LENC; DI ETEH MATERIAL AND MARKING
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: uoulD
WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER _ INSIUE DIA. ttP1T5 DEPTH.
BED/TRENCH 2 TRENCHES "At"E~IAL PIT
DIMENSIONS
E)/ AIR
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL. POED R NUMBER OF PROPERTY BUILDING VENTTOFRESH
. LINE ~ W///~J INLET: I e)
BELOW PIP ABOVE COVER Eg It E. E yq~~~ Z FEET FROM /
3 Y - NEAREST
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-
OYES O NO meets the criteria for medium sand. TIONS MEASURED.
PER MANENT MARKERS. OBSERVATION WE LLS
SOIL COVER TExtuRE
OYES NO OYES NO
SODDED SEEDED MULCHED
DEPTH OVER TRENCH.'BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL
CENTER EDGES. OYES ONO
OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER
WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE.
S
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL PNOEDISTR. DD ISATR. PIPE DISTRIBUTION PIPE MATERIAL N MARKING
FELEVATION H TRENCHES
ELEV.. ELEV. DIA.. ELEV.
AND
N COVER MATERIAL VERTICAL LIFT C ORRESPONDS TO APPROVED
INFORMATION HOLE slzE HOLE SPACING DRILLED CORRECTLY PLANS
DYES ONO DYES ONO
NUMBER OF ROPERTY WELL BUILDING.
RVATION WELLS: LINE
COMMENTS: PERMANENT MARKERS IOBSE P
FEET FROM
DYES ONO DYES ONO NEAREST
JAL'
0
Sketch System on R in in county file for audit.
Reverse Side. ITLE
DILHR SBD 6710 (R. 01/82)
WISCOnsln APPLICATION FOR SANITARY PERMIT
ILHR ~ -BOUNTY
D (PLB 67) UNIFORM SANITARY PERMIT #
- DEPRRTR1EnT OF
- InOUSTRV,LRBOR 6HUTRn 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. NPLEASE PRINT
PROPERTY OWNER AG ADDRESS
/
-r r.
PROPERTY LOCATION
11/4, 1/4, S , T,Q , N, R E (or W TOWN 0F: ST
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LA DMARK STATE PLAN I.D. NUMBER
Xr C /
TYPE OF BUILDING OR USE SERVED a3O-I~I~- 7~~~~d
1 or 2 Family Number of Bedrooms: ❑ ublic (Specify):
THIS PERMIT IS FOR A: ❑ Repair
J K New System ❑ Tank Replacement
El Privy
El Replacement Soil Absorption System El Revision ❑ Petition for Modification
❑ Reconnection
❑ Alternate System
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Holding Tank
❑ Seepage Trench ❑ Seepage Pit
J ed
Seepage B ❑ Privy ❑ Pit Privy
System-In-Fill ❑ In Ground Pressure Vault
issued
❑ Existing, For Which A Previous Permit Is On File, Permit #
❑ 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 L)
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: J PV1 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
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
~.J/~.- 6 Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Number:
Name of Plumber (Print): r nature/: ( )I) j pG
/t f Name of Designer: O J V
Plumber's Address:
COUNTY/ DEPARTMENT USE ONLY Disapproved
Signature of Issuing Agent: Fee: Date: L~ Owner Given Initial
XApproved 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
F A ~
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 inadequavies will. only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractgr,("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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
a
Owner of Property
Location of Property 14, Section , T N - R W
Township
rte;
Mailing Address
Z
Subdivision Name
Lot Number
Previous Owner of Property,
Total Size of Parcel
Date Parcel was Created C/
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume Q 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.
PROPERTV OWNER CERTIFICATION
I WeY eehti.6y that W atatement4 on th,i,a 6otm ane fitue to the but o6 my ;(oust)
hnow.ee.dge; that 1 twe) am (ane l the owner la 1 o 6 the pnopeh ty du c4 ibed in tw
.in6o4mati,on 6oAm, by viAtue o6 a wah anty deed tecakded in the 066.iee of the
County Reg-i..a.teA o6 Deeda as Document No , 3 3 , 3 and that I 11we )
pneaentty own the ptopoaed & to bon the ae.wage poa ayatem (-Oa I (we) have
ob,tai.ned-an easement, to Aun with the above duehi.bed pnopenty, bon the
con6#1tucti.on o6 said ayatem, and the name has been dully necon.ded in the 066.iee
o~the County Reg,ieten o6 Deeds, as Document No. )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
H
a
ST C- 105 r"
r
. a
ti
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
a
OWNER/BUYER /"vls~~~'
ROUTE/ BOX NUMBER Fire Number -
CITY/STATE ZIP
PROPERTY LOCATION: 4, SS 4, Section T N, R W,
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
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
the standards set forth, herein, as set by the Wisconsin Depart- u
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.
- r'
S I G N E II-
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
INDUSTRY; DIVISION
LABOR ADD PERCOLATION TESTS (115) MADISON, WI 53707 P.O. BOX 76
HUMAN RELATIONS
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME:
~ f~'/a '/a 3 /T 1fN/R IYE S,~• 014141
's Pti-- P~i~ df PLUS A~ S
COU TY: OWNEWSfBti~`E S NAME: MAILING ADDRESS:
5 ~oi~ MR 3 'RS. )6oj kADi%D/o ~~-S S~• CidiX S/• vD.S6A1 U-)IS. S S~air,
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: rA OFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ~ A), ~ ❑New :X~IReplace P R~ L -es
WA/ U ~D
RATING: S= Site suitable for system U= Site unsuitable for system SAS 6VAy e T s 4 13 $ L (I +7P P P a p •
CONVENT OUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
ls-KS ❑u EiS ❑u EIS ou aS Hu roN0~J;oA3Al ~
If Percolation Tests are NOT required DESIGIy RATE: LF'loodplain, an
n Q~~ S, y portion of the tested area is in the /i_
under s.H63.09(5)(b), indicate: 0 indicate Floodplain elevation:
PROFILE DESCRIPTIONS
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 OBSERVE (SEE ABBRV. ON BACK.) . r
3 ,v
B Sr /D D . S S, D a . se 3 " A,,% , S7 -7 4
GR 2. Zy, ' D.P. U es GR 3.0p"741i
B-
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PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES _t F e
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIO . PEcE~: CH
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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 percent
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 correct to the best of my knowledge and belief.
NAME (print TESTS WERE COMPLETED ON:
ADDRESS: ) CERTI ICATION NUMBER: PHONE UMBER(optional):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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