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Parcel 040-1016-50-000 10/22/2004 08:04 AM
PAGE 1 OF 1
Alt. Parcel 04.28.19.601-2 040 - TOWN OF TROY
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): * = Current Owner
* HARVEY, DONALD R & BILLIE D
DONALD R & BILLIE D HARVEY
536 VALLEY VIEW DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description *536 VALLEY VIEW DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.300 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W PART E 1/2 SW 1/4 LOT 2 Block/Condo Bldg:
CSM3/720 EXC PT TO HWY PROJECT
7200-04-21 HWY 35 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1146/294 WD
07/23/1997 843/522
07/23/1997 713/289
07/23/1997 701/287
2004 SUMMARY Bill Fair Market Value: Assessed with:
171,300
Valuations: Last Changed: 07115/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.300 53,500 135,500 189,000 NO
Totals for 2004:
General Property 2.300 53,500 135,500 189,000
Woodland 0.000 0 0
All 2.300 53,500 135,500 189,000
Totals for 2003:
General Property 2.300 39,600 125,300 164,900
Woodland 0.000 0 0
Total 2.300 39,600 125,300 164,900
Lottery Credit: Claim Count: 1 Certification Date: Batch 220
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
a+
OWNER TOWNSHIP SEC. T N-R 9 W
ADDRESS 1~~LLE~ f/~r ST. CROIX COUNTY, WISCONSIN
a T
SUBDIVISION LOT 0-1
LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
. U To /~oz r l ~62o P F27 Y
21,
vEtV7 3171111cK 6%.
A LT- -
sz7r.
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CL- ~l4t.ri-GL
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0KIVE I,AY
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used GoT
Elevation of vertical reference point: v0. 0 0 Proposed slope at site: ,o^.11=
SEPTIC TANK: Manufacturer:Z Liquid Capacity: ~G J r>
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front K71% Side o Rear, O feet
From nearest property line Front,0 Side, Rear, O U feet
Number of feet from: well _s_ building: ' f
(Include this information of the a ove plot plan)( 2_ w 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: y,~ f Trench:
-r
Width: Length: Number of Lines: Area Built: 2' 29
Fill depth to top of pipe: U
Number of feet from nearest property line: Front, O Side, O Rear,~I?t .
Number of feet from well: ~v
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: If ? 0 X111
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & HUMAN RELATIONS SAFETY & BUILDINGS
P.O. BOX 7969 t PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
XXCONVENTIONAL ❑ALTERNATIVE State PlanLD.Number
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PE~VI.T HOLDER
INSPECTION DATE.
Jeffrey Badman Valley ew Drive, Hudson
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN.
REF. PT. ELEV.: CST REF PT. ELEV
E2 of SW-,, Sec. 4, T28N-R19W, Town of Troy, Lot#2
Name of Plumber
MP/MPRSW N... County Sanitary Permit Number:
Gary Zappa 3300 St. Croix 58953
SEPTIC TANK/HOLDING TANK:
MANUFACTURER.
LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COV@R
PROVIDED: PROVI5,56D P
BEDDING: VENT DIA VENT MATL.. HIGH WATER RYES ❑ NO E- es/
j NUMBER OF ROAD: PROPERTY WELL'. BUILDING. FEET FROM
❑ LINE JVENTTOFRESH
AIR IN Er.
YES NO ❑ Y S''/ NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER
WARNING LABEL y CKING COVER
PROVIDED** P OVIDIED
:
❑YES ❑NO ❑Y, ❑N(J YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY E L B G VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LIME I AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN(,TH DIAMETER ATER AND MAR ING
or excavation. (If soil can be rolled into a wire, construction shall cease until =FORCE
the soil is dry enough to continue.) CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. COVER
TRENCHES INSIUE DIA. st PITS LIQUID
DIMENSIONS MATERIAL PIT DEPTH
GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF
BF LOW PIPES ABOVE COVER ELEV. INLET ELEV. END PROPE RTV WELL. BUILDING. VENT TO FRESr,1
PIPES FEN FROM LINE'. AIR.INLEr:
NEAREST--s
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-
❑YES NO meets the criteria for medr m sand. 1"IONS MEASURED.
❑
SOIL COVER TEXTURE
PER ANENTMA KERS OBSERVATION WELLS
DEPTH OVER TRENCH BEE) DEPTH OVER TRENCH /BED ❑'YES ❑NO YES ❑NO
CENTER DEPTH OF TOPSOIL SODD D SEEDED MULCHED
t„
EDGES
YES ❑N YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LATERAL SPA N GRAVEL EPT W PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD A RIAL. NO. DI R DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV_ ELEV DIA_ ELEV. PIPES DIA:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIA
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
COMMENTS: PERMANENTMARKERS:YES ❑NO ❑YES ❑NO
ICESERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE , ,
TITLE
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT
~ ®ILHR Ohl COUNTY
OEPRRT
TEnT OF (PLB 67) UNIFORM SANITARY PERMIT #
In OUSTRY, LRBOR 5 HUMFln RELRTIOnS
-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 OWNER MAILING ADDRESS
1= = is 1V ip - r
PROPERTY LO ATION E1~lc:
,L 1/4 SVl/4, S T.?J, N, R E (or) TOWN OF: /LU
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST OA , LAKE OR LANDMARK STATE PLAN I.D. NUMBER
C .r t/N L Z 1-/ - l/ 6
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms:- ❑ 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 U CO
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):
/
/ s- V ® 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: /MPRSW No.: Phone Number:
( ~ _7 DU (21,s) ,e -.~ts,0
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
/ J y ❑ Owner Given Initial
C7.• ~tf ° ~J~~ It 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 o
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
5 `1' 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 J err je V-J=~5~~ Q~y'►7Q
location of Property
E - SlJ Section T N - R j W
't'ownship /_-.Ll Y
Mailing Address Un`ley Ujee-j
Subdivision Name
Lot Number
Previous Owner of Property 00l1 Ylca a/ Lit l/GY ~y ~C i P/yl~s> SCi7yi~ a r-
Total Size of Parcel
Date Parcel was Created Q~7'
Are all corners and lot lines identifiable?_- Yes No
is this property being developed for resale (spec house) ? Yes` No
Volume and Page Number ~w 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 del-~v.
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPFRTy OWNER CERTIFICATION
I (We) CeAt%b y that aU 5 tatemen-tS on -th4 s 6wtm aAe tAue to the b" t o6 my (oun )
knowledge; that I (we) am (a)ce) the owneA(a) ob the pAope&ty deg cAibed in ,thin
cnboAmation. boAm, by viv tue ob a wwuc.an-ty deed neeoAded in the Obbiee ob the
County Reg-i~steA ob Deeds as Document No. ~5.? ; and that I (we)
t-m-mentty own the proposed site bon the Sewage posaX 6yatem (oA I (we) have
obtained an eahement, to Aun with the above d" ele.i.bed pA.opeA.,ty, boA the
con,StAue-ti.on ab said system, and the same has been duty A.eeorcded in the Obb,tce
ob the County Reg-i~s-teA ob Deeds, as Document No. 35~'>Q l )
/S e1TUWV1OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
/_7 d'~ ~alam( ~i 12
DATE SIGNED DATE SIGNED
H
rl
STC - 105 r
r
H
SEP'T'IC TANK MAINTENANCE AGREEMENT
St. Croix County
d
y
OWNER/ BUYER ~re_~Ty,- le 4 v Gt 133 dw d h
ROUTE/BOX NUMBER Fire Number
C I T Y/ S T A T E _IL~ S 's C S _L 11' _ `S yrJ1_IC-
PROPERTY LOCATION:, Section TN, R W,
Town of ~ Qy St. Croiy, County,
Subdivision Lot number-
I
Improper use dnd 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 receivc 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
I/WE, the undersigned, have read the above requirements and agree Cn
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart- a
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. q
DATE _~?grc,jt _ /3 1
St. Croix County Zoning Office
P.O. Box 98
Hammond, W1; 54015
715-796-22%9 or 715-'«25-8363
Sign, date and return to above address.
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IN' DUSTY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
HUMOAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.0!90) & Chapter 145.045)
I_OCAT"ION: SECTION: TOWNSHIPe~?171t11tff~tlTY: LOT NO.: BLK. NO.: SUBDIVISI N NA F
4- /TZ~N/Ri ~iN -rte 0\ M.
COUNTY: OWNEP'e BUYS-RD'S NAME. MAILIN ADDRESS:
~T ..t?)' I_r!!t. r _iPJ !nrf 1"- _ `'n?~' a Z LLB t
_ DATES OBSERVATIONS MADE
! 7NB U RMS.: COMMEAL DESCRIPTION: p91OSTS
,~Hrsidanca XNew ❑Replace UI a /
cr..- ~_.'.t 4 for T Il CAE P ► LL_o?
RATING: S= Site suitable for system U= Site unsuitable for system +
CONVENTIONAL: MOUND _ _
: N-GROUNDPRSiURE: SYSTElU1-1N-FILI HOLDING TANK RECOMMENDED SYSTEM: (optional)
-
r❑ U NS EAT.- S ❑ u 0 ~1 ❑ U ❑ S 20 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: L_
Floodplain, indicate Floodplain elevation: N , 1~`t
t; c. t J"AA L- PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH' ELEVATION OBSERVED _ EST. I HE: T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _
` r F~.7S' 5L SrL; /.SB'3NSi~-jO,ro7 •'4- 4 C7 g £33•
B ] J y8.8 I~ 'aF~ • rJ W' Moro S • 0,Wd E~N M16D S tµICwY Pac KF- T5.2, 47 B~1 ►gn S r r~
t 1 .1 l.ry' 3 t- e,,Ll1.S-80b-i c.L;4.1?'~•a1- R•~~.1?`QN iE. ~,i?'
S~ o•as S•tS S' 8~ •a•4L' t~.J 5i ~•os~' N ~ ~K., w
B y o0 98.9 NorJ 3, 4z' /.a~' 3LS:L l,SV't3 S;l. C>2•o.~jZ' NS"Lw
_ ^•9~' e.1 L u/ Cm d G R MoT•Z,G7'4in/hfJ!D' /•99 8tq
B 5,67 S. nj r- 7 /o4 ~.oo•aLs:l D•83'8~15it6Gr~.:os3'SNS~ C,r~'Q4z gN~a_1<sr
_ _ ,7' a.~ ~5 • o.r~' N L s• o.CS' £ L Cx r•s8' f,N M to 5 cSrl: ;6570' B..1C.S Gie Z 9z' SN lkM S
00 a9z lS-C-L)i,oo' N 4 le.~1•Zjr BoaL5y~6it ru,63' amt Ls
POcIGE S QF Jr 'O.zs' 8N Md P- rncaT .Sal 5r,.rS%10.17'BN 4.00 $n! PAS ~ ~brIP -
B 50 TZ A' 7R.a® 7-,* L rS. jt•~t~HNS•'LjO.t7' •r►ti11r7} ; 0.3 .rLSjs•+cr
_53' w •a Mn E'L 6rc,; 1,17' awl aS G R•; PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INeli••GS AFTERSWELLING INTERVAL-MIN. PEFFRIQD 1 PERT D PERIOD PER INCH
98, #z
P ~B'
P
P- PERG -v
PLOT PLAN: Show locations of percolation tests, soil borinqs 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 I,en e rat
of land slope.
SYSTEM ELEVATION rcxo
0
it
1r'=TCH yo ''r• a9- 1
,
TI.
erg. D~; IT
35
• ,r
IL
!R
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods s~°'cilied it, It-j'! b^ , •;;,i
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
;NAME Griot): - -
f TESTS WERE COMPt_ETED ON,
(ADDRESS' CE RTI (CATION NUMBER: PHONE NUMBER (opt k ,d)
CST SIGNATURE:
DISTRIBUTION: Original and orr! copy to Local Authority, Property Owner and T,i,•,
DII Irr' `dRI) 6395 iIl, 0?/h?) O~
L
NOTE - "T
DEPARTMENT OF REPORT ON SOIL_ L7VI11 /`1 BORINGS AND SAFETY & BUILDINGS
INDUSTRY,` I- .7 DIVISION
HUB AN RELATIONS PERCOLATION TESTS (115)1 r`tl'MADISON, WI 5377077
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: JOWNSIIIP/IUt7N1C`fi'itL-fT1 : LOT NO.:BLK. NO.. SUBDIVISInN NAME r, s:.
NE// 4- /Tz5N/R~~7 C,S,P
COUNTY: OWNERS BUYERS NAME: MAILING ADDRESS:
Sr, r,' ; 1•.fr J~t.~ r~ r/~- .LI~E-T
USE _ DATES OBSERVATIONS MADE
NO. BEDRNIS,: COMMERCIAL DESCRIPTION: rr'-t PROF LE DESCRIPTIONS: PER OLATION TESTS:
Residence L^JNew ❑Re lace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRE: SURE SYSTEM-IN-FILLHOL DING TANK: RE COMMENDEDSY T~M:lopii.mall
S ❑U QS ❑U ❑UlS C7S > U_
If Percolation Tests are NOT required ESIGN RA iE:
If any portion of the tested area is in the ~
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
EC-IM1,L- PROFILE DESCRIPTIONS
F-a F -r _ _
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH-1.N; ELEVATION OBSERVED EST. HIGHEST 1-0 BEDROCK IF OBSERVED (SEE ABFRV.ON BACK.)
b L S1 Lj 7O' ZN S I L~ 0, 67 8N :S, 'L- G2~ Z. gJ' Bq
B oc~ ~8~ 0✓v~r 19.0 0
/C.Lr 1 i ocA: F_ jSJ 2, 4,7 5n!111ED y
MEOs
1 1. /7' 3 L $ i L 1. s-8' •T S ! L, p. /„nv L L 3, S; LL o. l 7 '
B-~ nJS~o,z_SBnJ5;L1o.z,S'g,.1~~oe,~4Z'i~nrS~'-,(,00' ~N';•GK_ rl/
B 3 9, Do 98 , 9 - -N o rl - - 3_4 ~ /,CU' e L S : L • SD' e3.J S : L ` r~ i a ~Z n1 5,L w C LA',' F cur ~ ; ,
- - - ) e..,SiL -/Ctrsd 6r ,,P MoT•2.67'Jnll11L'DJ'l•99314~ ~
B 5~? S28, n) > i0 4 _ l.oo'BLS Z,o•8S' , t t;-C,•o.83'Sr1SL o,4Z'B.v -w <Srs
o. 17' 8.4 • p. 17' E14 ! S• D.Z$' L cv~-C:w .C';' /..Sg• jS r~ M ED 5 ~j • `-0• ~'~nt CS C-r le.• Z.` 71' BN MSO S
S 9;C0 X7,8 ot~E 4,00 o' 9?_ aoen, ands
POG IG.E IS OF r C.Z. nl i ' 1 T M d k~ w. C - Ste[ JiJ ~I 1111 U .`Jt, Cam?
B- o°,SO X7,7 1 A0 'rf3,`_70 z. 6L~ ro )o.33' J L5, 5-lc;
P4 !A) S ~ (5r; 17' Bn1 C'S ~G PERCOLATION TESTS Z"_'Z I',
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL INCHES RATE MINUTES
NUMBER INefi6S AFTER SWELLING INTERVAL-MIN. PERIOD 1_ _ PERIOD 2 _ PERIOD 0- PER INCH
P- r _ ot•lE X13.17 3 '~Y /d ;/j C^
P- 3 4,33
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.
SYSTEM ELEVATION
/
_ a
S k'F__ TCN
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rinna
7-' 0
Jf.4 f i°' TP 31
I - fN
/✓G/30~ /
79. 3J
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er
(T ~5
91' -A L : 35 4J~7 39 6 ^ t
TRCG~ACTB ~ O COL /.,YI D nJ '^"'G ST
So/6~ 9.. ~ bra s Ma v. - - i 1 1 L o ~ f rJ R N E"fZ " ~I11
:iy .f✓.z ~ ~ ~ -...t ILL
ctws en -Zan r.d f ` e4f
T-O P o Jr LOT
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.
iNA~ME (print): 1 ESTS WERE COMPLETED ON:
ADDRESS j CERTIFICATION NUMBER: PHONE NUM EH (optional):
622
4-0 7
- - r -CST SIGNATURE:
f °f.{ Qn! C (T, E t< r rvJ r F{ t o i t t-° r r._ c. O,r
WFIIC.}} rlft L'ONr~ 1 r: t~ T'! i ,.r
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tr.ster.
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