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HomeMy WebLinkAbout042-1057-30-000 0 Ch O 3 v 0 C m ~1 ° cfl ` m M -0 m ~ z -0 . ^ v 1 ` 1 O p7 • 0 7 Z ° ? O ON CD p n 5~ to C N (D m Z n _ ° C N CD N CO N CD - Q 0 0 p C_ 0 w O CD -0 0 O CD 7 > > W O (7 v7 JJ ~7 C7 7 N 0 O O . z O P) O Crl y C 0 a) N o !r C' fll C (D ~d r; n (o m D a a o ,J N rt n m W rt rt m V r-i a c D r. < o w H w o i W ~ 4- a m 00 00 a n c ~o to w cn cn D 3 N v 4- H N r~ O P. Z ro w Z O O O• F-3 n a N x < z m N fn fJ7 m D r < v v v CD ;L a rn D ° d v rt 2 A _ N CD W C) N 3 _ a I °w N H H cn . a o o N W oo O IQ :~Il Z •w Z y CD o Q O ~o w a 01) t-h r-+ O =r ~ _b h Ul W C/7 Z3 (D N CD • `5y `:E' (D CD N w n x 3 rt (D (C] N Fl- 0 w m a. a 3 m n N z = O A Z a a z 3 C rQ No < CL z c r: cn 3 m CD 41 .D w iu Q _ CD Q o CCD a CD m 3 c Q v 0-0 o M CL N o n o aam v c 'p O j .N . O Cp CD 7 m :E 3 =3 o z C0~O ~,xoo A. mm°-r QC CD< CD O ' N p N i CD 3 ~ z 0 o j N S N 7 P.Z. j O d ~ • A p b V N O O ° a ° : Parcel 042-1057-30-000 10/05/2005 07:30 AM PAGE 1 OF 1 Alt. Parcel 20.29.18.3198 042 - TOWN OF WARREN 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 - VEVANG, BRENT A BRENT A VEVANG 1062 80TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1062 80TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.600 Plat: N/A-NOT AVAILABLE SEC 20 & 29 T29N R18W SW SE OF SEC 20 & Block/Condo Bldg: NW NE SEC 29 LOT 1 CSM 6/1680 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/01/2004 767451 2607/082 WD 06/18/2004 766284 2598/546 JD 07/23/1997 754/385 07/23/1997 436/571 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.600 40,500 127,800 168,300 NO Totals for 2005: General Property 2.600 40,500 127,800 168,300 Woodland 0.000 0 0 Totals for 2004: General Property 2.600 40,500 127,800 168,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 REN T29N:-R.18W 11 SEE PAGE 43 HRE' s~~x° lv r / (er¢/z Con r2 /k'2 17 77 Sr7c. 77 3 9 i Tczrnes m h /`b, X&%sp-r f P vti it efi N Z w w.r 0 v • 711 -J ^ nI! - 17 - s ,p. • >ich s ~ ~ J LOCL/s p ~ N pia -roc/- er- oi7 M 'Y e a~ei ryy - eono~ lives Ne/sow 0 eta i- ~ Aeo~ Z:~v Nr rcy~ h i - lac i~ a !C 9a y .3zo IJUn .UJ 0 - /in _ Vr Bo Ficden.c.~ z4-o ~ A Z LC S- f7 ^a A) t50 kN Jf-,-.7 ~3e r7 .9c S.h • • l ~ /63 3 • ~ ~ c /moo AVE. rrrcrg • ~ ~~rv /c~~ ~'edin<v7 t ~ y • = 1/i~yrrrru- /o T HE rrrF Lchczr-f,~rrrr~.,, fccdr ic'~• rPNK A w : l~ 1 Shy ~or7 r~Q/>; S/7C / r-. ryYr v<`fr /A/////ez 77 d'O ~v ~SS h'ennef// loa7rzc ~ ^7u/ 7e Wes ~F>avy b p~ f/ei'in~ ollnrr ~rcdE7re~k 470 r9-9.36 ~a6f./ horns/d Pr' /c /~c r / .N/ B.W • f lJO s Yea-r air if'tt i77leT l1 i ii7s, U v~ ti l act//r• ~ f i c dr E /E~ G er. Sire O FLA. s Mf //n • / Znc. P'Ll Bce~ Hen- is1Y,l /s/8v moo ry o /moo Sao YG° /C,o /60 i AVE. 5 0 [We 0 • - Nc: hvr//e Qur/>DQr'/ene c n ,e Bo 76. ¢ e- l/an fjCBk WIZ v~ h 41 5 vo 4 w~ /3 Famed , yr V1 2 Z' o F~ v~ //6.5 ^ r II A f I/io/a2 ~Cfrcr/far afuX 17- 7c/'E ~1. /r O~ //a,// is'? iue/ we u."J L• i7~., i9 zoo Find EDe/ores - 3 ` s 5chu/tom /arn)/y phi • T f io •W~, • r • • •s /VA-7 897H E • • `1 • n~as~ < /7t/ ~a p.Y ~ r~ ~ Y /fi<.n7, t-s d ~ ~,Q10 ~ W n ~ v Drt ry/ + ` Y' p;.~ r/ t j~ ' ~ - /-ur /n,)[) /C o ~ ~ ~ l ~ ~z c 9 z ~ • 4 • H , ~ p.. ~ l ~ ~ f To es 8 C p E h v 66 -3 J,9,9 t 2 - 1 v 1 c 70/ia )~7f W //-c 'U V N F- fl Al L L ctS .AVE. ROBE RTS~ eu•rN ~ , u a • ~ • ~ ~ nIAS. Li ti • • ~ • .:~r, • TT • • R. zo, lp lb", y / - Cow/a. err F G- i~~~etu v ~ p f, z r~/Pt 1-~, /rl r' ~r, rrr t Kc fh Us:7~ ~3a 2 qo 50 wrr;U, EcY e • Win` o x io O Co~rne// Coo, /g/7&&r- on 67 V ti - la r • nei/ N .jam f~nC7~/'son - w • • r / `9 h • W/ KES 65 O/a v e C / O 'Co Erna// v 4, 2 0 - t! : r ( Jc'or ~ C //QU,FE ne 4 . r o 0 y~. 77rc Leonaic/~ ~ j ~ ~ • ~ Leong uck ✓~rQ/~P " • Y~ ~~i cc ~;/oi/0 Mann ~ /srcbc%-t , i " zo 5 ? _ _ ~Irc~cr:~on De/a e • 77 i • R 4r a3 • • • .Pus r c ° d Lar / = l ~a r'r Wes/e ~i o + 9 9 Eli>rr E TJcrrst/61e ./Cy Dor S z/ Cow/es •ebord r-.~ r n ~ ~ ~ ltc, ~'o es r riQrbc b+r J>~ r ai ~ w h F r' ~6 Be~ix2 C s -5/v , DR , 'c< ~~N rn~ rs>BB fcn~~ 33 TN - • /cso All 1, ~ iz< ■ fig . / ! • ST 1) • ~o~f / o KIN r> Ec _ ~ Z ~ • ~ ~ ~ ~ ~ o-177217~f>'e/en A/C, ,.Tz' i 0 • cTEwP// ~r,r• ;7_1~ ~ ~ - ~ C' ~ t ~ ~ ~LOIBIT~~Se/7 c60T ` l/• 7 •.aY c, ~o d zoo AVE ~5/ C'~~ h Corn/y l✓ SEE PAGE 17 Form- ST C- AS BUILT SANITARY SYSTEM REPORT 4 7 OWNER TOWNSHIP Lt~~ lr-LL;F e1V SEC. T~_y N-R l ' ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIONLOT LOT SIZE PLAN VIEW 6 2v Distances and dimensions to meet requirements of I11IR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~cs2~ s L - ' INDICATE NORTH ARROW BENCHMARK: Describ the vertical ~reference point used E eof ver ical reference point: 19 Proposed slope at site: 02i~ SEPTIC TANK: Manufacture. Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side, Rear, O From nearest pro ert line Front, Side, Rear, feet py 0 0 0 Number of *et 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1 Lenith: Number of Lines: !7j Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, aside, O Rear,0 Ft . 3 Number of feet from well: "715- ' Number of feet from building: / 3 (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: i 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 XbCONVENTIONAL ❑ALTERNATIVE slate Plan LD Numhar IIf assigneAl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER- INSPECTIO DATE John Denucci RR#2, Badlands Rd., Roberts, WI 54023 P iZ 0 S BENCH MARK (Permanent refers -point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. JCSTHEI. IT ELEV SW SE, Section 20, T29N-R18W, Town of Warren Name (If Plumt,er. MP/MPHSW N<~ Cr„~ty t~,F, P--1 Number Henr Nechville 3258 St. Croix 4971 SEPTIC TANK/HOLDING TANK: i r MANUFACTUHER LIQUID CAPACITY TANK INLET ELEV TANK OUTL E WARNING LABEL LOCKING COVER PROVIDED PROVIDED IJYES NO DYES NO BEDDING. VENT CIA VENT 1,1AI1 fw;H WA R NUMBER OF ROAD. PROPERTY WELL BUILDING VENT TO FRESH ALM LINE LAIR INLET FEET FROM ` I YES LINO "YES LI N ❑O _LEAREST --L- DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP M(Ii)Et rl-I P ilW '(10, I.'ANOF A(. T I II' E i I WAR NING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES LINO ❑YES LINO OYES LINO GALLONS PER CYCLE: PUMP AND CON TROL S OPERATIONAL NUMBER OF PFIOPEHIY WELL. BuILDINC VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM L-INF AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST-- 0 SOIL ABSORPTION SYSTEM. Check thesoil moistureat thedepth of plowing ❑Ina,FTEIi 1111111 F1IALANDMAHKLN,, 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. Or JDISTR PIPE SPnc¢Nt, ) iII:f _PIIS LIQUID BED/TRENCH HENCIIts Ertl , ! PIT DEPTH DIMENSIONS _ GRAVEL DEPTH Flll. DEPTH DISTH PIPE UISTH PIPE DISTR. PIPE MATERIALO Dlsll?NUMBER OF WELL WELL BUILDING VENT TO FRESH BELOW PIPE" ABO E VEH FI EV INLE T ELEV END PIPES FEET FROM LINE AIR INLET J~ ~C l / NEAREST 10 ~ 1• zf 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 LI NO meets the criteria for medium sand. TIONS MEASURED. ❑ _ SOILCOVER TExTuHE - FIM1IANF NT MAHKI lfS OBSEHVATI(,N WE L LS DYES LINO ❑YES LINO DEPTH OVER THENCH BED DEPTH OVFH TRENCH BFD ~FPTH OF TOPSOIL. ti(IDDf 11 SFFOF D MULCHED CENTER EDGES ❑YES ❑INO ❑YES LINO ❑YES CJ NO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LIE N(,Tfi NO. OF LATERAL SPACIN(; (,HAVEL DEPTH BE LORI PIP! FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATEHIAI Nn UISTH UISTH PIPF DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV DIA ELEV. PIPES DIA. ELEVATION AND DISTRIBUTION INFORMATION 11111 ESIZE HOLE SPACING DRILL E D COHHFT L Y C)VEH MA I EHIAL VERTICAL LIF T CORRESPONDS TO APPROVED PI AN.S ❑YES LINO ❑YES LINO RNEOPERTY WELL. BUILDING. COMMENTS: PERMANENT MARKERS. O BSERVATION WELLS. NUMBEROF P LINE s 1 - FEET FROM - I ❑YES LINO ❑YES LINO 1NEAREST t A9 1. C, Sketch System on Retain in county file for audit. Reverse Side. -BtT" ATURE - TITLE DILHR SBD 6710 (R. 01/82) ~I I Wisconsin APPLICATION FOR SANITARY PERMIT DILHR COUNTY OEPAFr mEnTOF (PLB 67) UNIFORM SANITARY PERMIT # - InOUSTRV, LRBOR S HUMFIn 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 PROPERTY LOCATION CITY: VILLAGE: 1/4 1/4,S , T - , N, R E (orXW TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 2 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. D"-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 - Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEF*A 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/MPRSW No.: Phone Number: Plumber's Address: PN.m Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ` y ❑ Disapproved Y ~j o `~1 7l ❑ 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/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. Owner of Property Location of Property ' LLF 14 5 14, Section _-;t C' , T ;2,2 N - R IS W Township /-V/I r /r F/1/, Mailing Address 4L2 41 Subdivision Name ~/Z) ~~f) Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? y~ Yes No Is this property being developed for resale (spec house) ? Yes/No Volume y__ L, and Page Number S- -7/ 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 (We) cut.i6y that att dtatementb on thA 6oAm are tAue to the but o6 my (our) know-edge; that I (we) am ( ahe ) the owneA (b) o6 the pnopen.ty deb cA bed in th i b in6o4mati,on 6o4m, by viAtue o6 a wa4Aanty deed Aeco4ded in the 066ice 06 the County Reg-iAteA o6 Deedb as Document No. a fs ; and that I (we) pAeeent.ey own the proposed 4 to 6oA the sewage diApo.6at dydtem (oA 1 (we) have obtained an easement, to Aun with the above desexi.bed pnopenty, bon the conet&ueti.on o6 eaid b ydtem, and the name has been duf-y )LeeoAded in the 066ice o6 the County R " teA o6 Deeds, ad Document No. SIGNATURE OF WNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H a ST C- 105 rr- • a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a _ H OWNER/BUYER lv L _i /V 6 OUT~BOX NUMBER ~ T2 12,eL Fire Number CITY/STATE 7.IP S'YQ PROPERTY LOCATION: _Ster 4, SE 4, Section Tom'` N, R /c3 _W, Town of 4,L1Ck- 7~LC7 Al' St. Croix County, J~. Subdivision 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 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. Ho I/WE, the undersigned, have read the above requirements and agree vzi to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 1o 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. SIGNS 'i,? DATE /C/ % - ✓ St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. v i m x ~ O N N Q =r v v,w~= ~O~~~0 v tD O O n n (D O o 0 " a3 vt° ==w,c Q o c O w w toR ° 73 a CD CD N (gym 7R c O Cl) cD O n . I U g F~~ Do 0 ~ 0 ID lul w Co i~ 0 p» O (n a N nRr C~ ~ 8 = " O n O O O 11,0 0 ~ a o 'ID CO 11,0 S 02 1:03 0 ~ C- c aC: 3 c v E 00 m w O °.~o am v _ - O o) -0 D O N Q A~ aC n+ O (D O O DC -'o A., C) C) Nr O (7 = W n .n+ O C O a 2 w0~' ona~w n O 0 `CD v s C n (A CD m ~NCCD w wmp1 A. Z D ~c0 C Z ??a n m aN O O A (D M Nc; o?g`°o m S was - wa coW0 S -L Q cn 0 (D Ui 0 a cO F vima acof (D C 171 CA V 0 3 fD ° o CD S S m m 0 v o aO (D ~N n Q. co 0 ID Q w S `v o ~o o=,c~C °C1 o c c ip N N w wmw CDD=vCDC m D 0. CL cr~ 0 ~cQ w Er' CD c~ ID 0 r- cD a Si 0 O O cO C 0 CL C ID =r ID -0 3 p a=' aO = O , :3 CD O O y 0 I N DCPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/LOT NO.:BLK. NO.: SUBDIVISION NAME: sw 1/' 1/ 7;10 /T17 N/R16 E (o) W lahle)eew 3 A cl-c Lo 7 COUNTY: OWNER'SflBl 'f'R`S NAME: MAILING ADDRESS: . ST Cioix To ti N ~C NvcC APT' 2.._ ~DLn&) D5 Pee. Pa 13lE:R T'5 WI -S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 N ❑ New Replace ~S~~T 1 ~3 S~~T 1 LJ!- ~S' 5G S ~ ~ v,E~~~ t-- S/ G S SvQ ST/?i►T~S . RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®s [:]U J ©s ❑u ❑s ou ❑ ®s ❑u s ou 12'4e If Percolation Tests are NOT required DESIGN RATE:- If any portion of the tested area is in the under s.1163.09(5)(b), indicate: eki S S .t Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDR CK IF OBSERVED (SEE ABBRV. ON BACK.) r . p3' 9e, /3.0- V) s,P ' IdAi S/ OJO a. f-S A3. 90 /V B- 5 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / O < Z- .U v ~S S •Q~f% / ed P_ Z .7S w c, sS P_ - G..: P- 3 o PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or ibb ces. Degib~ at a dS~ hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all r gs andt hhV4'1 jio rcent of land slope. a~ IC0 SYSTEM ELEVATION 9/ • y~ - 7.111 r e f / 5 t3 60 esq. y$-~ 1 a ~ ) vcRr•~P~F ~r• _1 sue,- c ~.-1-. TN Po v/ O 0 p N 4 ?E r _ ! AeViX - 41r ~rr~ .4 i __V /D ICY A4 20 ' S&_T'Q4-CK 1%'1t7A-l 13AX . 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): HOMESITE SEP I K; PLUMBING Co. TESTS WERE COMPLETED ON: RT. 3 O'NEIL RD., HUDSON: WIS. 54016 2S ' y ~S ADDRESS: ER LIC. NO. 3307 M.P.R.S CERTIFIN NUMBER: PHONE NUMB (optional): WIS. MASTER PLUMB MINN. INKAUR & DESIGNER LIC. N0.00663 S S d Z 7 37 CST SIGNATU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - E an ,t mpirate d w_.£, o , no , t~ "Vm n ryas ,WA, L -F' E;< F 3iL t. VA iO W?. IS , , ,E! 4?s7Ei .~9., s" pro Vx7 s'`_ . n , 3 . v SIR VATAWLE R A i.,.,,._ G 1 FAN ONLY .e__ L._ . ru._ uvi 9w am, a nh. .ho . ._E. 'sti 3Edr C.Fr M€_-t IS d, _h c sat g lh'',°g5,+,7 plan; nj m'°° e , . a d VA L Wna s nIf ti .,=KR d W1 P.tM W. W.?.a KO"W£ MKI WP Mateq ShU _ t, .ffit'id W PlU a.1na; a, - e, h. .i j. ,s ;r,es!x i£7r`t tk't3c { rnp.. 10. 0 t ,,(.N kw t ,F, F£q F5..3 o . s War-, Onus Ce .+FK 500 NA, e,. top anvoindav box: 11. "'a vom cn. Mums " mawkwak F W 3 .ctla .S t ,!1E - :'Sr_€„_ '3_ A 4 g 4.6 a"ta „ .es'" a x-. ~s fl 1E s ff301 L ..a... 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