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Parcel 020-1019-10-100 01/03/2006 09:08 AM
PAGE 1 OF 1
Alt. Parcel 14.29.19.91 C-10 020 - TOWN OF 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 - ZABA, BRIAN
BRIAN ZABA
981 TANNEY LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 981 TANNEY LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.551 Plat: 4039-CSM 15/4039 020/01
SEC 14 T29N R19W PT NE NE FKA LOT 1 OF Block/Condo Bldg: LOT 1
CSM 4/1079 NKA CSM 15/4039 LOT 1 3.551AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-19W NE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
06/22/2005 798378 2828/157 PR
07/16/2003 730463 2316/238 SC AF
02/27/2002 672299 1845/138 SC AF
06/04/2001 647254 1652/191 WD
more...
2005 SUMMARY Bill Fair Market Value: Assessed with:
91494 284,700
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.551 78,300 212,100 290,400 NO 05
Totals for 2005: ~
General Property 3.551 78,300 212,100 290,400
Woodland 0.000 0 0
Totals for 2004:
General Property 3.551 49,300 177,900 227,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 146
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
ST. CROIX COUNTY
WISCONSIN
Personnel Department
1 1 N 1 M II N N N - Maur ST. CROIX COUNTY GOVERNMENT CENTEI
1101 Carmichael Road
Hudson, WI 54016-7710
Telephone (715) 381-4310 FAX (715) 381-4301
III
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HilNlAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 PLUMBING
MADISON, WI 53707
E9CONVENTIONAL ❑ALTERNATIVE BUREAU OF P State PI nl.D. Number.
n
❑ Holding Tank El In-Ground Pressure ❑ Mound (I/ assig ed)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DAXTryE1
Fl 6 -g
Kenneth Nelson RR~~ 2, Box 359, Hudson, WI -BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NE'-4 NE-4, Sec. 14, T29N-R19W, Lot 1, Town of Hudson
Name of Plumber. MP/MPRSW No.. TT Sanitary Permit NumberAnthony Zappa 1614 . Croix 38528
SEPTIC TANK/HOLDING TANK:
MANUFACTURER . ILIQUID CAPACIT TANK INLET ;L
TANK OUTLET ELE V.. WARNING LABEL LOCKING CO R
1 ^ ~ PROVI ED: F~-T"~ PROVI D.
U( YES L-TUnv NO
BEDDING : VENT DIA.. VENT MAT HIGH WATER NUMBER OF ROAD: PROPE TV WELL
I ~ J
❑YES O / ( . 1BUILDINI. VE T FRESH
M. LINE. IA. ET.
ALAR FEET FROM
NEAREST y
❑ NO
DOSING CH MBER:
MANUFACTURER 71 IQUID CAPACITY PUMP MODEL IPUMP,'SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
ES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
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:
BED/TRENCH WIDTH! LNOOF JDISTR PIPE SPACING COVER JINSIDE CIA -PITS LIQUID
TRENCHES. l MATERIAL: PIT DEPTH
DIMEN NS
GRAVEL DEPTH FILL DEPTH J I OISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV IjVL 8E i ELEC. END PIPES LINE: AIR INLET.
G/'/1(QD ~•[J / FEET FROM f NEAREST-
61" f
MOUND SYSTEM:
Mound site plowed perpendicular to slope NkKt ture of t materia l for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: s to ae certain that it ON REVERSE SIDE. SHOW ELEVA-
ia r medium sand. 1"'IONS MEASURED.
❑YES ❑NO SOIL COVER TEXTURE I A PERMANENT MARKERS JOBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH.'BED DEPTH OVER TRENCH BID DE TH O T PSO SODDED SEEDED MULCHED.
CENTER EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACIN GR h L DEPT BE OW P FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN( L MA ERI, NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.. CIA. ELEV.. PIPES. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY VER M ERIAL G VERTICAL LIFT CORRESPONDS TO APPROVED
/ j/ PLANS
❑YES ❑NO 1 V / ! ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOWELLS. NUMBER OF PROPERTY WELL. BUILDING.
FEET FROM LINE.
J/ I
❑YES ❑NO ❑YES
O NEARESTT-
0 2- 7
1Ia. I c, 14 1
8,01 °a
LA J W
Sketch System on Re ta in county file for audit.
Reverse Side.
SIGNATUR /'f TITLE.
DILHR SBD 6710 (R. 01/82)
Wisconsin APPLICATION FOR SANITARY PERMIT
DILHR =•i (''T CnU=X COUNTY
DEPRgTR1EnT OF (PLB 67) UNIFORM SANITARY PERMIT #
In DUSTPV, LABOR 6 HUMRn RELRTIOnS ~y
-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
PR=,~ WNER MAILING ADDRESS
-LSO rva 42 o
PROPERTY LOCATION CITY:
1/4 1/4, S ~ , T , N, R ! E (or) W TOWN of
LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
v L q
TYPE OF BUILDING OR USE SERVED Q~ -1O/~--
N 1 or 2 Family Number of Bedrooms. Public (Specify):
THIS PERMIT IS FOR A:
X 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 /00c)
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: /V C "'T
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):
X Private L:1 Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Si9nature: P/MPRSW No.: hone Number:
I (~l 3eG-,UT6
Plumber's Addre Name of Des`ig=-- -
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: {/Date: F-1 Disapproved
O)
1 74-3 1 j( ❑ Owner Given Initial
Approved Adverse Determination
yy&uz~
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.
AS 3UILT S_1NITAItY SYS'ILhI RL:PORT
OWNER TOWNSHIP ~W
N SEC. C;~ N-R
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION - LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
a
D
~w
'
w
tT I I Wl." irr, 1 1:
e PSn L; E
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe: %o/0'rAUo..,e 6x i+ciroaS Fitom
I~i+vprrry won v e2 (/Vh/) o„i o7-H2'2 fSLJE or 7A,1VOY LAN--
Elevation of vertical reference point: ~Ub.pp Slope at site: b d
SEPTIC TANK: Manufacturer:z~ycSJ~n,~ Liquid Capacity
Number of rings on cover Tank manhole cover elevation
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number ;
Type. of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length 3-y tile dept]
SEEPAGE TRENCH: width- length
PERCOLATION RATE AREA REQUIRED AREA AS BUILT 2O °A"
c INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP /v SEC . To qN-R 9W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
b
~T 3
A
1
w
P PSG a E
j
l di at N r h Hw
BENCHMARK: (Permanent reference Point) Describe: %o/°or /i~Pl.e /7C/?04S f%tOm
~/3[)pC2TY r,^,eL (Nk/) oti 07-*~2 .rZD-- Of 7/VNNPY LANG
Elevation of vertical reference point: /yU,pU Slope at site: d a
SEPTIC TANK: Manufacturer:,~57~~„/ Liquid Capacity:0
Number of rings on cover Tank manhole cover elevation
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute- horsepower ----;brand name of pump
and model number
Type. of warning device-
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE;__ Number of pits feet diameter
feet liquid depth _ seepage pit inlet pipe-elevation
bottom of seepage pit elevation- _ feet.
SEEPAGE BED SIZE: number of lines width-/ ? length__~aY the depth
SEEPAGE TRENCH: width length- _
PERCOLATION RA`1'E__ AREA REQUIRED AREA AS BUILT- 2
INSPECTOR
DA'Z'ED PLUMBER ON JOB
LICENSE NUMBER _ -jz
Fu rm - S T C 100
Owner of Property
Location of Property J--- 4 /V_~ 4i Section 1' o` 2 N R_12 W
Township A
Mailing; Address 2j
Y49,1 bl
Subdivision Name r .'r..
Lot Number
Previous Owner of Property /U/a
Total Size of Parcel 5-9,1 'x 90' 2y 'r Date Parcel Was Created _-T--`-
nib ~
Are all corners identifiable? yes_ No
Include with this application one of the following:
.Certified Survey Map
.Deed
Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. -11/4 yY-T ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
C-~
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
OATS SIG11 DATE SIGNED
tYX:.
NE CORNER
I SEC..14, 29NP R/9W
NORTH LINE OF THENE%4P SEC. 14 COUNTYMONUMENT
~ 6I6~
S89041,08"w 594.95' / 589041 '08"W 728.00
i moo J 550.89' 2I
I I ~ Q o
I ~ A: 09 \
I 4.06
t
LOT 3
wESrLINE ~ 5.005 ACRES TO FoRrY LINES Q>
OF THE NE-NEB 4.634 ACRES To R.o.w. ~
V 218018 SO. FT.
I I U)
i i h
N89°4/'08"E 593.37' C~ z'
550.52' <
r Ljj. IZ.BS' J.
I ~
~ I
LOT 2 0.
ICI d 6.221 ACRES TO FORTYLINE ^ W '
al h 5.778ACRES TO ROW
I~ 270987 S0. FT.
I I a'
J
13 i CL
z
t I 589°4/'O8"W 591.40'
a
550.05 °j
I
I t
~:I I
SCALE 200
Q of , LOT -p
I~ OTT
i PI h 6.650. ACRES TO FORTY LINES m 0 200 400,
IX)
~r 5.761 ACRES TO R.O.W. a
289674 S0. FT. /VOTE.- LOT I DRIVEWAY
A CCESS TO SE FROM
13 331 ANNEY LANE.
~ I ~moo
u3kA q, 0 - 1': 24 "IRON PIPE WEIGHINO
- - - J t09 N89°58,01%,E - 549.55- - - - - - - - 1.3 85.AJNEAL FOOTSET
_ - N89°4939 E 589.27
MCCU TCHEON ROAD
SOUTH L INE
OF THE NE-NE
APPROVED
JUN 19 1981
ST. CROIX CCuNT-Y
CO PefN,'T1 OA'--S nANNNG '
4-ND ZOK:"iG CG:? WrTu
Volume 14 Pane 1.07q
(Continued Next Page)
APPROVED MEMBER
AMERICAN LAND TITLE ASSOCIATION
3
WISCONSIN LAND TITLE ASSOCIATION, INC.
I
I
DEPARTMENT OF, REPORT ON SOIL RORIN SAFETY & BUILDINGS
INDUSTRY', / DIVISION
LABOR AIMS P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS MADISON, WI 53707
(H63.09(1) & Chapter 145.045) 2 ~F!
LOCATION: SECTION: TOWNSHIP/MFJNIGaR4L+T'r` T NO: N BDI ION NAME:
1/ /TZDN/R ~E(or)W
COUNTY: OWNER'S/BUYERS NAME J MAILING ADDRESS:
LC1
USE DA SSE IONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑Replace 9 7J -1 c2s
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1 N-F I LLIHOLDI NG TANK: RECOMMENDED SYSTEM (optional)
OS ❑U CASEiUTQSL]U ❑SCCU ❑SEJU
If Percolation Tests are NOT required DESIGN RATE: I 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 04OH€S AFTERSWELLING INTERVAL-MIN. 1 PERIOD 2 PERIOD 3 PER INCH
P_i Zo - 4`1~ 4/ 1
P- 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.
a'
SYSTEM ELEVATION
,
f
_;7 1, 4X
9 E vJ
Q F ~ t O ` \~~c..
i 3
,
,
` Ill i , v~~
-
,
€
,
) I
r
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):
r 671 ,
ZE-
CST SIGNATURE:
i
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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nk , on _ 1. ..'te. E£ .
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€ Manion
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WSPA., 1F yw a r, _e Kowa in oxcs ,a_ .9-.._ n_i, -th un ti hi n _'.-k . y~ Q.U.M test' a) t _ F W ova A:P;
[ ~'je'l <,i f F? ko t as t.. p0 n i _ '.l,-wQ <ws nn <_q v, CIA Pi Wo rni f~ iotc i
i:.3iJ<.a :nd i° W., as ry 1 A€.. s,
F,. SV RE [L _D '~bJ l(IF i H
4 a ; ci;,£q ? _ 0/ICY f,a F z.'q91- 1- Y_ F1 p W,.. SS 4.0"sn'
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F r, Sy ;t? £i AW 3 a
OR Loan Tok
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nap, ZYM
> > ?"F t>E.1 ° u t , Or e. 3 in Tin on a >ano r r dn u , ! .a „ the a, C=l o F uy m quest
(suest
Rev 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES f-:%T I
P.O. BOX 309, MADISON, WISCONSIN 53701
Section 14 TN,R--!2E W, Township &r-M.u.n.i. Ali±y k~"- C• i'^ -
~ Block No. > County ~ lZ•~%~ ~
_ Subdivision Name
,r's/BnM Name: 71_-A~4 ~ ~Z VC
ling Address: tom, r"it Z_ xnsuX. 'L3 Z It I LUC ~ ~LL
Y'PE OF OCCUPANCY: Residence x No. of Bedrooms .31 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEWS-REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS Z- PERCOLATION TESTS s
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SOIL MAP SHEET S NAME OF SOIL MAP UNIT il- ~Z1,CN6171i° r-
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
Ir NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- )Lc'
P- 1. t :,t-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- ~(N/~ -7 t3
1. 1 i 4F 9
B- 3 `7 Z P ay ly e 7 _72- I I 1 "7'.
B- '17- 1,-.LA16,.V~~ ~ '7'Z LI lia ` le It I S 1'f
B- '7 io
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 44 'tqr),-Crit`5lndicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with he. proc6uc'' n j method
,necified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are cor Lct to the st IF my j 1
knowledge and belief. jtrlto
Name (print) Certification No.
Address
;`=me of installer if known
CST Signature~~~ 1
Copy A -Local Authority
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