Loading...
HomeMy WebLinkAbout016-1058-30-000 r 0 cn0 ~-00 d `+1 o E f c o (o > > o 3 M 0 (D -0 c _ 3 _ m ~ # 1 x~ 3 U) Z z -4 (D a m co ° m Wo 01 d N n y v CD (p CD S- 0 7 (D o UT O O ^ N CL 7 (o d W \ O p _ C p W O C') 3 OCD w _ a W O 7 (n 7 p CD 0 OW m (Q vim, y a CD F~ I W o C: CD 3 a U U V v' (7) F-I W F- .0 (D o0 o 00 00 ID o r ti Q W o I- CL n n O a Z O O O n !r• o c Q " p y c 1-0 m C(D n v 3 a a ti rD N (D rt w - o a v o v (D r * C (D L u. ° PO lV F-J- 77 CD C~ CT U) O D (D CL y z W H I---' N Z o N O z D CD 0 d c (n V W O N N ) _G ON O G (D O N rZ W (D a dl d 3 s(D s C/) ~O v\ m p A Z n c' c N (D on ~ C) F! rt < W V { W CD < O o a 3 z o' o z N N z V O G7 I N > Q CD CL N Q _Q CC L N a O G a~ o f~ m C (n m 3 3 m o o b 3 n O (o m y O N O O A ~ R7 N (D Q O O O yA C) CD O L y ti Parcel 016-1058-30-000 12/05/2005 02:31 PM PAGE 1 OF 1 Alt. Parcel 27.30.15.403B 016 - TOWN OF GLENWOOD 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 - TEIGEN, RAYMOND J RAYMOND J TEIGEN 1395 300TH ST GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1395 300TH ST SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 27 T30N R15W 20 AC NW NW ALL THAT Block/Condo Bldg: PART OF N 1/2 NW 1/2 SEC 27 THAT LIES N OF SOO LINE ABANDONED R/W OF WISCONSIN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) CENTRAL RR CO. 27-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 914/300 07/23/1997 730/605 07/23/1997 689/522 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 34,900 46,900 NO UNDEVELOPED G5 4.000 3,000 0 3,000 NO PRODUCTIVE FORST LANDS G6 14.000 28,000 0 28,000 NO Totals for 2005: General Property 20.000 43,000 34,900 77,900 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 43,000 34,900 77,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING OFFICE c~ St. Croix County Courthouse 911 4th Street A ~ Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form ,ja essential &Q that ~um Rro erty can D_Q located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------------------- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION----------------- FEE: $25.00 (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME: C 4f PROP. ADDRESS: CITY -~~~e~tc•`c~^~'~ C ` ~N- Legal Description x_1/4 of the X1/4 of Section, T Town of folrr rrc~ Lot Number Subdivision: FIRE NUMBER LOCK BOX NUMBER ~&I -3C}-11:)v Color of house Realty si.gn by house? If so, list firm: y PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual 'requesting services: Telephone Number REPORT TO BE SENT TO: _ , j 9 •S _ S"4101 CLOSING DATE• signature_ E ~ J GLENWOOD CODE-8 TOWNSHIP 30 NORTH C RANGE 15 WES1" - • •.r+r• .,.r.' A+LI.v IN B LAWRENCE S RODNEY 111111 R. (U -rw.4.. ..•.r• LAURA SCHUG62 t' .J CARLA a • D 8 CLA 7 r AO JOE RA SIMONSON Q 134 LAwSTUEN PAULUS STACK I DEiTMAN TA ARAN DAER7 RICH IRO ZEJOLIK © N 8 JANIC M+CH/AE B 2 HERMAN 315 fl KENNETH SPEER ROSENBERRY PITT 8 JOHN 00 54RAH 6 LOUIS EMMA TACK Y 92 ASSILLUS ER NITCHEY 115 9fl D *IJLINE 254 104 3 S HENKE O • 4 90.72 206 114 120 © 149 111 975 • 7 584 99 ®ALLEN 8 AROYS W R ER ) q 3 a ~~E II KAY ¢ Oj L WARN FRANCIS SCNUG I ER a0 S LARENCE ERNEST J. STACK LOGGHE M 1055 PRINSON a 4 EMAR CHNERLA JaCKELE. SEVERSON ITCH FAN. ' 123 0 140 n BO 191 O 9825 2tS 3 49 0 QO( 227 276 t37 m • O4 • FRANK O JAMES •08ERT 8 B GERALD 8 A'D ROGER 8 A g -WARNER © SCHUG .MARY DOROTHY tlltf IoRE ° HT EA OERA MITCH ES 8 JA 40 JOHNSON N$B MES fl TAND- ' rNCL- 0 • ORRAINE De S A URT Tp 0 A 40 so JOYCE CE AWE ICMAEL a Z BAND 50 ~yD TNE BRT 39 Ross SHARON A O,•mN a wI WARNER Y RT ETA - OER Z 119 1 ISIN 160 ¢ I 2• B 132 40 B _ 160 I; ~_7ti6 DONALD 8 JAMES a MARY BONTE • 1NT H1A ~GLADYS W IO © JOHN fl ANa L. A 211 4Q RRY 0" ER- BONTE W • CECELIA MAOOM1W KNOPS X ANDERSON OavlO 2~ AMES B R 50 ' i 200 MAES T I54 • WESLEY EIAL 21 R ANDERSON •GLAOYS • 40 3 • OYCE B WILLIAM LEO a 7 SONTE S • NIElA HOFFMAN LYONS PHYLLIg 2 69 157 7 fl0 50 3 35 ® 160 2 160 n n 183 A 793 O3 NICHOIS ELMAR • 5 • 1 O9S5 160 150 t • A I's ~ • WES HERBERT a. • 1 t [Ra UN B M4alEHE - 4 • GREG a • 5 WESLEY B • 7 .-JD- 30 CA55EN5 RICHARD 8 ° ROSE sMnN AT R L eliCE I ,ps AIE'HLER IIMM 50 40 35 GRACE HATTIE ATNRYN• cRV e[R-T TUTTLE OBERMUELLER IOSERMUELLER BRTLE I 70 STRICT Eu[n 304 SON EMERALD FARMERS 11 . r2_ ~ 27_ EXCHANGE. INC. 0 AeMU 7 ROBERT I N WILL PALEwICZ nLLY (A(l 160 BO 110 j 139 01 IS ii KUEMN" j \'S9 I Y, CD I RICHARD I'd _T EVERETT DOROTHY 8 AUDREYO MES LVIN 8 .NOENWETTER ELWOOD MOE _ KLINEFELTEq 8 ERBA PETERSON FT+ED B 50 160 ISSON - 'ANLA BARBAR4 ` EWIS 'RENO CIm7E 00[13- 5O '10 QRINN MAN . ✓n E 8 993 GARY B OU ON AAOOE E LC NCY R DEA wal _R 31 P yQJF BE • ©6flIS ~6 119.52 :15 ~ (4 L,}.7 50 3 .20 •117 7 60 fl0 y~ 200 S 40 4 60 y ieNCIS LEROT 1. MOE 7 ALLEN A E 8 • • L 0 g ELLISON 8 ! ! SCMUG ELLA 8 JAMES L. JOANN O SUSAN E. PABEWITZ 1 1 20 ILUAN JOSEPH R ~i 67 TB OHMAN FRANK $TANOAERT BERENOS ANDERSON q B -BE + DRAXLER O ARNER ETU% 7 BO + 9 LAVER. B 'MAN • JOHN R MOE ETUX O sCRT CLIFFORD 8 JEAN EA- JL.LE NEE OONEY G I 77 BO .DO-M ANDERSON 0• RA'IST 220 RUEGER S L345 t 9 SALLY 120 Q 1345 30TH 2 117 EvELTN B PANTIN " WAYNE 8 2 INGVALO 8 / © pav10 B /yj ORTON Tux TUTTLE "O GEN ' WARD HIA / JS EIGA R SHIIRL EY REST S SCHRCEOEF~ R N 7 eo wo GI_ENWOOD CITY R n e m2 - 1.::.y - 6 I H NAN CY ROeCRTA I S K° L I- IVAN 7 31 40 2 Q 200 83 :NI 19 m • NoE w¢ 80 3ST 12 , 716 / NORA AO .S 1u t i / A 3 - 6 I L 212 L FRANCIS 41 1 s• e~ 08E,MUELLER J 0 Q 6 ? / WEVKE • ESWI4 I O NZ I t~^: ~ CHARLES I ¢ i~ MELTON P C. A. BO 8 JOAN m0 LLN MONSON L OAS` CLAR _ OESM+iH 11E RREN /.,MAN a!a so 155 ¢ m '(OERAL ER t, 2 4 •80 7 79 77 140 279 RO ~ • LANK NNCC1K5 SCHRIEBEA A~0 (FRANCIS OARRYL JAMES R'p1CL .SU[i1M LEON 8 EBMUELLER 8 MARY CHRISTENSEN ' SC L ' D151. I C •tRRr 80 MUNDT ET UX ISS THATER ETUX ELE. a r HELEN S CI L 2 BOOTH I Nq LMOE EBLY 120 0 SO WILLIAM NCanp TS 5O 50 40 39 I4-0 HOFFMAN 1024I7 _ 1 4p 50 60 3 z 40 j4ENW000 BlR7lEtGH A. DONALD B V RRUCE 8 (~~y6...~~~, I 1~ a~~• CITY LA VON NE ELORES •D ,KAREN v a I~JLEROY DONALD 8 GARY MOE I I LL + SI LARSON THOMPSON KONDER BRUCE MOE JULIE 4EERT ONDER RIEBURC 715 80 7 32 60 20 O 52-- w r4T SIT- CURTISS JA. 8 HELEN ANNE BRUCE ALBERT 8 LEONA AN 07, W B E • EIR BOOTH THOMPSON ONDER IRENE 2 MARVIN 8 OAHL LADONNA DORIS 72 KRIZAN AM' E M I 80 3 • UTCHI TEIGEN s 2 120 40 43 T4 I 120 29 138 0 17 GARY 8 HELEN LAURENCE 8 AB81E 60 MARIE N- MMr HOE' R ERT B DON n v36 HaUGEN 1_ LLIAM BOOTH AGEN. CURTIS J 4 Q7 ROMA U~LOM BOOTH SCOTTY 3 CROSBY 353 'Aw[s 6 71 0 r3 168 06p TEIGEN D 225 2 240 • 120 60 MnRTTN50N 4 U1LlOM \ 66 `••80@7 JEDWIN Ao•It[R a NI _ AMES © 50 • 120 p1.1Erns S EI W 13373 1585 50 40 rRE Tv Ev,vsr/ IP ~9 Nail T•7l S PRInNG F=1 t I /234c.. I cr~rlnAJ T20N.R'15W • 175 3 2 I 175TH n~ 1 = AVE. x _ L170TH ~ n ~ AVE. ~n 1 E 1707H . h 128 - 17 co 8 q I 9 N 10 1g5 II AVE. x Q n v~i 12 tH m L! AVE. N oo I ?A LD 160TH PO. A E. :'E. in ~60a ~ VE. k 158TH AVE. IO 16 = N D I~ 17 ° m 16 `ybSH pVE ti o N 15 14 0 50TH AVE AVE. 0 13 I50TH AVE. 150TH AVE c x N -15 0 o 20 M 21 145TH = 221 AVE. - - - - S 23 I 24 D x G 1 I cci I GLENWOOD 1140TH AVE. f 1 CITY 140 135TH AVE. I I z 29 1 1 .28 1 I 2~7 i x 1 26 F 1 170 135 H AVE. 130TH 1 1 25 C 1 1 AVE. ( - - J L 0 L _ N 13Qrr 14 127TH AVE. AVE. 1300 x F- n x w 32 I ° a 33 ~ 34 RUSTIC 3'S I it s 36 s g a o I O _ 128 p w SPRINGFIELD TWN. _ - 1200 Croix Road C6-E6 oad 271St Street 1C F3 oad R3 F4 280th Street 1A-B, E-F 127th Avenue F4 oad R4 290th Street 26-F 130th Avenue E1-31 5-6 F5 load 295th Street 3A, B 135th Avenue E2, 6 C6 ,eek Road C6 297th Street 3C 140th Avenue D6 300th Street 3B-D, E, F 145th Avenue D5 1 5th n,:- , k ST. CROIX COUNTY v tYs WISCONSIN 1. ?5 ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET HUDSON, WI 54016 (715) 386-4680 Apr. 29, 1992 Raymond Teigen 1395 - 300 Street Glenwood City, WI 54013 Dear Mr. Teigen: An inspection of the septic system on the property of Raymond Teigen located at 1395 - 300 Street, Glenwood City, WI was conducted on Apr. 28, 1992. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. r,~erely ; ) Tt- MarJJ:Jenkins Assistant Zoning Administrator js • v 1 AS BUILT SANITARY SYSTEM REPORT OWNER E 'NF: L d / e TOWNSHIP6/-fWk1 d SECJt7y-`czN-R-W ADDRESS &L-e,Ili4leoel ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE dZ ~L~ PLAN VIEW Distances and dimensions to meet requirements of H63 RHOW EVERYTHING WITHIN 100 FEET OF SYSTEM TTI I I -T I di a e oath Arrow l SC BENCHMARK: (Permanent reference Point) Describe: Pc. ILA ll e,e CIS'' Elevation of vertical reference oint : 5e, I b, p q41, r Slope at site: SEPTIC TANK: Manufacturer: f/I~LS Liquid Capacity: (0cl Number of rings on cover : Tan manhole cover elevation: Tank Inlet Elevation: 10 t/ Tank Outlet Elevation: p 1J PUMP CHAMBER Manufacturer: Number of gallons _ Number of gal. pump set or a cycle gallons; total capacity o 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 o pits feet diameter feet liquid depth sccpa6t-: Pig. L1i1Cpe-elevaLiu,, bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile depth SEEPAGE TRENCH: width 6'r length le 0 PERCOLATION RATE / AREA REQUIRED trig j- AREA AS BUILT INSPECTOR r DATED PLUMBER ON JOB LICENSE NUMBER ~ It r 1 1 ~ J I i r I I 1 r 4 O/ _ ^Q ' O w Z l l'. I F Z TMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS aBO & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.U. BOX 6969 MADISON,WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan LD Number: (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure D Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. BENCH MAR Pe-anent referent= Point) DES / IBEeIF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. Name f Plumber: MP/M7:7 Cou my. Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL IL OCKING COV R PROVIDED: PROV ID 't XS c C c I O G' C~ YIYES ❑NO ❑ INO BEDDING. VENT DIA.. VENT MAIL. HIGH WATER NOAD: ROPERTY JVVELL. BUILDING: VENT TO FRESH ALARM NR ~i f P L1AIR INLETFEE YES ❑NO ❑Y S O /C. /GC f /1c7~ 7 DOSING CHAMBER: _ MANUFACTURER jElEbDiNB~ IfiOUID CAPACITY PUMP MODEL PUMP/SIPHON MAN OF ACTIIH ER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ❑NO/' DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF I'HOPERTV JWELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM I NF AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. eck thesoil m istureat the depth of plovving FN T II TER MATERIAL ANo MAHKING or excavation. (If soil can be oiled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR PIPE SPACINCI COVER INSIDE D #PITS LIQUID BED/TRENCH TRENCHES MAT tyAL - PIT )tA DEPTH DIMENSIONS /CC c.~ GHA 'F I_ DEPT i FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERT WELL. BUILDING'. VENT TO FRESH Bf L,ONl PIPCS ABOVE COVER ELEV INLIF ELEV. END PIPES. LINE AIR INLET: FEET FROM 2 -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- DYES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH RED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED DYES SEEDED MULCHED CFNTFH EDGES I DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: NJII)TH LE N(,TH INOOF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS M1'.nNIF I)L I) PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV FIEV CIA. ELEV. PIPES DIA.: DISTRIBUTION _ INFORMATION FIOL I `Tz _ HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO DYES ❑NO COMMENTS: PERMANENT MARKERS-. OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. D YES ❑ NO ❑ YES ❑ NO NEAREST j r Sketch System on "Re in county file for audit. Reverse Side. - SIGNATWiE'. - l TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: L 16 Property Location: City , Village di:jaw nshCounty: '/a Nt0'/aS / T, ® NCR 1,5 E (or W .e, A/ LLI 0 0 6 Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of 06public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY p Q Q HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: H LS D k 4~- EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit C~ ~S ❑ Alternative (specify) Seepage Trench O Water Supply: wner's Name as Listed on Soil Test Report (If other than present owner): X Private ❑ Joint ❑ Public /V I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Si ure: MP MPRSW No.: Phone Number: G ~4 I ~ ,4 ~ / d2 3s) 179 (o Plumber's Address: me of Designer: ` .Jf!!r Aj t 01 A COUNTY/DEPARTMENT USE ONLY Signa re of Issujng ge t: Fee: Date: a APPROVED Sanitary Permit Number: / ~y ` L d zlg!~T L, ' APL/ DISAPPROVED y eason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND S~ETY~I►BUILD. S INDUSTRY,, VI~¢a LABOR AND PERCOLATION TESTS (115) RF ISQN)9 x 37 HUMAN RELATIONS \ / ~ I'N~~s~37 r~ LOCATI,O,''N~~: SECTION: TOW S /MUNICIPALITY: LOT NO.: BLK. NQ: SUBDI N NA ONI NG '/a /T31) N/R/5E (or ~^'FdtE OU Y: OWN R'S BUYER'S NAME: MAILING A D ESS: USE DATES OBSERVATIONS MADE LPI~?r'Resiclence NO. BERMSCOMMERCIA SCRiPTION: PROFIV D TONS: ER A 10 TESTSAr ~I ew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system Zly CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDING TA K:RECOMMENDEDSYSTEM:(optional), If Percolation Tests are NOT required DESI ~NjATE: SYS EL I If any portion of the lot is in the / under s.H63.09(5)(b), indicate: /1rlr `I Floodplain, 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. IGHEST TO BEDROCK IF OBSERV (SEE ABBRV. ON BACK.) c75'& > 7 e t B-, - -7a ql/ ~ / 7 S B4 ')Y q6 'J/ ~2 7 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE IOD t P IoD2 -PER 4D PER INCH .3 P- 1Z.0 Pe ee P- 3 1 1Y2 _171 P- 7 ' P_ ~1y P - l; PLAN VIEW: 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 slop. SYSTEM ELEVATION RLA D ~rn uLl E o S ~o tN 6 E I _ m i, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NA pri t): TESTS WE E CO PLETED ON: ADDRESS CERTIFICATION NUMBER: PHONE NUMBER optio al): rr- CST SI URE: .a DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. Pr r r I t c) r r r ~ r w J ' \R M~ r® r~ I Q -ILL Q (:N ® \ p