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236-1760-01-000
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Permit Holder's Name: X City Village Township Ness, William I City of Hudson 'ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake ROAD Dosing Friction S tem Head Aeration - Length Holding Dist, to 36.29.20. TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Friction S tem Head TDH Ft - Length Dosing Dist, to 36.29.20. Bldg. Sewer Aeration SYSTEM T P/L BLDG WELL LAKE /STREAM Holding Manufacturer: INFORMATION PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Numb Vent to Air Intake TDH Lift Friction S tem Head TDH Ft Forcemain Length Dia. Dist, to kT91I WA Y.Ti1:7 3 drel01W County: St. Croix Sanitary Per it No: 71 Vent to Air Intake PIT DIMENSIONS State Plan ID No: Inside Dia. Parcel Tax No: DIMENSIONS Length Dia 236- 1760 -01 -000 Sectionrrown /Range /Map No: 36.29.20. d■ =V V 910100 BY \I_1 BED /TRENCH Width Length No. Of Tr s Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Length Dia Length Dia Spacing Bldg. Sewer SETBACK SYSTEM T P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: MMI, SAM Bot. System Mob mg BED /TRENCH Width Length No. Of Tr s Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Length Dia Length Dia Spacing SETBACK SYSTEM T P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Bed /Trench Center Pipe(s) Topsoil Yes No Yes No Length Dia Length Dia Spacing SOIL COVER v Pracaiwo Svctamc nniv YY Mnrrnd Or At - Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspectio # r - Inspecti n #2: Location: 1201 Mayer Road Hudson, WI 54016 (Government 36 T29N R20W) NA Lot 1 o 66.29.20. 1.) Alt BM Description = q,stf� . 2.) Bldg sewer length = a Q - amount of cover = 3 (1D �-eQ ,� -r 6,- - - Plan revision Required? Yes f` No �( �-{, Use other side for additional information. (�►- `'� Date insepctors Signature Cert. No. SBD -6710 (R.3/97) ti County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road ' Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. Coup Sa�ni Permit # ❑ Check if re isi&n-iq�evious application W h y . ....,..... ,., 1. Application Information - Please Print all Information `. j.° ":° Location: Property Owner Name 1/4 _ 1/4, Sec 1p T N, z < R ZV E (or Property Owner's Mailing Address Lot Number Block Number (� v' ( City, � U�5 0 to nl wl Zip Code 3 6� Phone Numer / Subdivision Name or CSM Number C5M UdL. 2. o -7K it Type of Building: (check one) 1 or 2 Family Dwelli No. Bedrooms: laity ❑ Village I�ITown of 9L - of , ❑ Public/Commercial describe use): (i v ❑ State -owned earest Road n /p� ` �U�� �«4cc Ice It. Type of Permit: (Check only one box line Check box line on on if applicable) Parcel Tax Number(s) �t� • T' 4 -6 `'" 1.�tepair 2. El Reconnection 3.❑Non- p(umbing ❑Rejuvenation A) Sanitation Z B) Permit Number State Sanitary Permit was previously issued Type of POWT System: (Check all that apply) j9_ Non- pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal /Treatment Area Information: 2� -f I.-J6 A1. 1 G!' d 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min.Anch) Elevation Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Tanks Tanks / �= 11. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationCnstallation o �. A license is not required for terralift repair or the installation of non- plumbing sanitation syster Plumber' Name (print) Plumber's S' nature (no sta s o ��1 �� Plumber's Address (Street, City, State, Zip CoW �, mot; s✓ K6(t' < 111. County Use Only Disapproved Sanitary Permit Fee amps) APlxoved Owner Given Initial Adverse �� Determination � IX Cond of Approval /Reasons for Disapproval: 4 1 �J Q d �� -7 Z. a7;� 33 ti 14 P �o T- - N << _ qo , E L P` �E �o", uJ L, L # 0�' pca� y 1 V . µa m rye LL �f, tf+t b 1 606 66- LL DR mt ,j% O o il J N46 04 1 <<_ Vo l E� PG I IA mt LL o/or va r m 00 z� G)_ m n 00 zy W0 4 0o IZ Z z 2 r 0 Z v 0 0 1 0 0 0 7 C":> s N w V F— U) 0 IN Z N 0 0 z 0 c o� 0 m 0 eJ r � C z m m X r n N N O� �co �a 3 3 SQ m o�i d my ° m� a < ��� N a m m fD N Vl p C co 3 O Cl) N N p - — nc'o n o C m to O W CL ,z t° O CA o � N ° 7 c v 3 � mm �D cg w Q �. W w g'a � qq � i N 1 m y O. > 3 G ; p 0 O ° Ot ° c °' ° —_ �? y � a m m � o c -gy m o g 78 c N M c c 8 0 d r. —m g� �n y� 'b y �7 oil �o L �a y N r X Z z I m m A Z r =i3 z m m Z z z D z 0 X 0 0 0 R J 2541P 002 St. Croix County Occupancy Affidavit �([ II '' rr ri' FFe'2E k' t N Q. S S S Name — (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 124 Page - 5'a9 Document Number p b St. Croix County Register of Deeds Office: A parcel of land located in the %. of the _' /, of Section, T N - R � W, Town of . /kosrw , St. Croix County, Wisconsin, being duly described as follows (include lot no. and L, subdivision/CSM or detailed legal description): hvw e14jv. , heN'T 1 .4=' q 754S 5710 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/02/2004 01:30PH AFFIDAVIT EXEWT # REC FEE: 13.00 TRANS FEE: COPY FFE : 3.00 CC FEE': PAGES: 2 Name and Return Address /.�26iCL. M,oSf e0 n5+d= tc��cn LLC, QI �} C Y � mson Va lltY Rd a3(0- 1 - 7(00 -00-cm. Parcel As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a .3 bedroom home, or a design flow of V .JF0 gpd. The design flow is calculated by a suming ISO gpd for 2 individuals per bedroom. There are currently _2., occupants Irving in this residence; 6 occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system Will need to be modified to acoomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. �,/� t l ir ewr ties s day of f • e . doo L /( ENTICA N Signature(s) o•F �` l S authenitcated this day of MArrh TITLE: MEMBE9 STATE BAR OF.WISCON (if not, � Z Y Q stage Nd 4 F by § 706.06. Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Iwape. Wes S. ACKNOWLEDGMENT STATE OF WISCONSIN St. Croix County. fh2nQ�P a Pew 'a' lly came before me this �_ day of — P-oC4 th e above named to me known to Instrument and W•, mr r , �MAAICOPA COUNTY My Commiseion Expires September 22, 2007 If not state expiration date: THIS LEGAL DOCUMENT — DO NOT REMOVE" � This lntbmolkn mast be completed by subnWer. , name 6 return address and PfN (lf requtredl. Other Jnfortnatlon such as the g arding dauses. leeyal desc Ww. eta may be placed on this Brat peye of do do= *M or may be placed on edcffkw el papas of ft dwwrient. fift Use of Urfa compage adds one papa lo your docur W9 end SZ00 to UK reooniirro Nee. *gs=Wh Statures. 59.517. ST CROIX COUNTY SEPTIC TANK MAINTEI? ANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer W 1Ltr14an. AJ EA5 Mailing Address kZ01 nnAtiGfL '0.L gP o Property Address (Verification required from Planning Department for new construction) 1. S City /State — nN Parcel Identification Number 2 6— _7(o Q— a 1 — a JO LEGAL DESCRIPTION Property Location _ '' /4, '/4, Sec. 31,, T2jN -R W, Town of RupSoA) Subdivision �-7 Ja✓a�2N �dT �f , Lot # 4_ Certified Survey Map # TVA /62 3 , Volume , Page # c:P q . Warranty Deed # X9`1,5; �_ , Volume ? Page # Sz4 Spec house ❑ yes Kn 0 Lot lines identifiablexyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper inaintenanc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systei can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by master plumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewater disposal syste: is in proper operating, condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge I/we, the undersigned have read the above requirements and agree to maintain, the private sewage disposal system with the standan set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatic stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within ? days of ee year exp' ti date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) the propeYAe scribed abo> by virtue of a warranty deed recorded in Register of Deeds Office. IGNATURE OF APP DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE CITY OF HUDSON COMPUTER NUMBER 236 - 1760 -01 -000 Parcel Number OWNER NAME: First WILLIAM Last NESS PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 31 TOWN 29N RANGE 19W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 2.030 PLAT LOT BLK 01 1201 MAYER RD 15 02 LOT 1 CSM 7/2074 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Monday, March 29, 2004 2:40 PM Bruce Moat 715 3818531 ... . I I . _p,03 03/2912004 13:15 4803919371 MAIL N OFFICE PAGE 01/02 wwoftL Iii, WON 1;00 PM _ _ &ut:a most 715,901,ml r.09 I ti r CROIX COUNTY S 3I' + X TANK MAWS*ANCB AOItEBMENT AND 09wNENHI? CRRTMWION FORM Owneriftyar �_ lums tvraillaS Addrem __ J%Ql L1104 j& %,gib2 PrOpOdY • ddtats 11.6 1 °Tw (Vaificadoa repaired fpm Flsa j Vq;ar moat ror yaw con k - %tk%) �j ,�/► dk twit lstalo Y He�iceS IQeritificlt�on Nut>76tx L AL Property Location ,,14, , _ V" sm. T N•t.7cq—w, Town of _ UglOKAQ subdivision Lot N Cargtfeti survey Mop r VV6 cJ 3 ..� C M ,�,� Warranty Deed # "1t>n S'� L. a Volume .1.��� Pw 0 . 914 .. Sm house 0 Yam )(no Lot 401 ideadifiabwxym D rio US'ip4.�'>F b"dt use and maffiteru4ae 017'a►►rNPdc ryareagid teaatt V fr P failtuc pa handle wu4es. Pr�pert►eyad4nea< Poe itlkct tae oa ®l the l4pk wary *rea Yearn Or looser, it oeedW by a l wwd s m". 4%s yeu put ft tb$ aver IaP& took w a ttttatmeet V1401 in dte wane 4*09 ey*m, TU ttrapattY owaar arraa to submit m SL Q*K ZoaiAS Dapartotatu a eartftiooft loran, dreed by the sinew tad by ttasawpf�setso. r, �eesttaYMtn®tmnMr,�rtetrlta;d mr• 1tteasedptrntwr (l) the w4gew.terd rim ie is proper operuleg atoaA►tion and/or lE) apor tslpeotiass a yw t y m� { , du itptl0 salt t< 1S em 113 N, of dWV Ywa, the aadanl`eed have recd the abwre rapkirmtteab tad .pe w Uuiettte tlw private iewapa dtepotet eyatart With tha ataadan swtttrlb,tuns Oe�ft rtroimtofW&%ntIW$Gw ee.ftteotwtscoaa4L Cettilteatk awl ffiet ytw�x eaprye ryetera Au bean tpatataiad rash in 4"Viated and t %mW ro am St Crelrt Cowry Zanint type wulft 3 6ayn o�t� ` yarn expire ` dete. X DATE iP- IZMFICA33ON 1 Ste) ly that all staterrlattl on this rorm tip tnto to tho but of n(our) krowte*, t (we) am (arc) tlx owna(s) 4 e PrOA dbed a v vlrtwr of a w�straety died recoMed In ROSWOof Duds Offlm 6 t?P AYPLJCAW7' li/tTtt :a•a• Nty intbratadoo LW it mir .. nprcstsled may rttealt in ttte Nniiary p"! bdap rwekad by the Zau4 o speriv ar. 90004 A.it►ei with tht apolt.otlon: a MOP" warpnq dw pant Ux RepietEr of �eedc o!!lSee a `QPY al tbo cerririad MUM ju ttteteteaoa i wrde is the waframy died �J 25911 00.3 J 2124P 529 Paul L. Anderson a divorced unremarried man Grantor conveys and warrants to William G. Ness. Grantee. the following described real estate in St Croix County; State of Wisconsin: A parcel of land located in Government Lot 4, of the Southeast One - Quarter (SE '/4) of Section thirty-six (36), Township twenty-nine (29) North, Range twenty (20) West, in the City of Hudson, St. Croix County, Wisconsin, described as follows: Beginning at the Southwest corner of Lot 1 of a Certified Survey Map recorded March 15, 1989 in Volume 7 of Certified Survey Maps at Page 2074 as Document No. 446133; thence S89 °07'49 "W, 21.19 feet to the centerline of the old railroad right -of -way; thence N21 °2749 "W, 181.84 feet; thence N74 11 16'19 "E, 19.91 feet to the Northwest corner of the aforementioned Lot 1; thence S2I *27'49 *E along the Westerly lot line of the aforementioned Lot 1, 187.37 feet to the Place of Beginning. 707536 REG REGISTER OF DEEDS ST. CROIX Co., MI RECEIVED FOR RECORD 01/30/2003 68:00AM EXDPT # REC FEE: 11.00 TRANS FEE: 24.00 COPY FEE: CERT COPY FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS: ` GWIN LAW FIRM, S.C. 430 Second Street Hudson, WI, 54016 -1510 236 - 1760 -00 -000 PARCEL I.D. NUMBER OR G.I.S. This is not homestead property. (is) (is not) Exception to warranties: TOGETHER WITH AND SUBJECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. Dated this /9 day of March , A.D., 002. v' , (Seal) � (Seal) Signature(s) AUTHENTICATION authenticated this day of , 20 TITLE MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY: Attu. Huah H. Gwin, GWIN LAW FIRM, S.C. 430 Second Street, Hudson. WI. 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Paul L. Anderson (Seal) * ACKNOWLEDGMENT STATE OF WISCONSIN St. Croix COUNTY (Seal) A Personally came before me this A? day of March, 2002, the above -named Paul L. Anderson to me known to be the person who executed the foregoing instrument and acknowledge the same. Form —STC- 104 AS BUILT SANITARY SYSTEM REPORT CI't OWNE D y f SAUllY ow/Fy u Sea t) SEC. T JN -R .20 W ADDRESS 93/ CJ.L ?,,za, & ST. CROIX COUNTY, WISCONSIN /tCl� Su.0 G�1isc S SIC� /� SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II.HR 83 A G' `'F.t kf1 [IN 100 FEET OF SYSTEM 1 � SA fl A_ r 9''RoDL QTY L.iNL I I AoPo s£o �Fcs iDZAf Prv"'.,sro lvt � T EA wr ACRD I •I CI `L -- -- �_ I 0" 1 ©uTrl -- �Rc�PG/tT Y 1"�irs FGlEO �R�vf w�Fy NORTH ARROW IND BENCHMARK: Describe the vertical reference point used X,, g "05ox fA4V0"fr Elevation ouvertical reference point: /OO' Proposed slope at site: j( r SEPTIC TANK: Manufacturer: Liquid Capacity: /Oct ej Number of rings used: �5_ Tank manhole cover elevation: Tank Inlet Elevation: . /.S' Tank Outlet Elevation: 9J`• 9/ Y ' Number of feet from nearest Road.: Front Side .1O �O Rear , O �� feet • From nearest-property line ."'Front 1 0 Side 1 0 Rear, a feet Number of feet�om: well /0 / , building: /4' (Include this informat�ott -the above plot plan)( 2 reference dimensions to septic tank) 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, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: A4 s 61 . 93 30 Trench: Width: J�' Length: ' Number of Lines : _ Area Built: 95 1 VZA-P 1 T Fill depth to top of pipe: 3. S Number of feet from nearest property line: Front,, O Side,(3 Number of feet from well: 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 i 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: Dated: Inspector: Plumber on job: � C License Number: Z c-p0aQ IsroS . 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABQR & HUMAN RELATIONS DIVISION r P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: SW4, SW 4, S 3 6 , T 2 9N -R2_(T ) F X1 CONVENTIONAL ❑ ALTERATIVE (If assigned) of Hudson ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound P D ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gerry & Sandy Lowry 931 Willow Ridge Road, Hudson, WI 54016 �/-6- 91 111 f 6_ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: HER PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: TRENCHES: MP /MPRSW No.: County: Sanitary Permit Number: Zappa Bros. Inc. MATERIAL: 3300 St. Croix 119424 SEPTIC TANK /HOLDING TANK: MANUFACTURER: - LIQUID CAPACITY: Z K INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 1 ' Ljaj� q� . YES El NO El YES NO BEDDING: VENT DI .: VENT M TL.: HIGH WATER NUMBER OF ROAD: PROPERTj( I WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES NO L El YE NQ- NEAREST 11110' �� 3 �� t �' DOSING CHAMBER: MANUFACTURER: I BEDDING LIQUID CAPACITY: FUMPMODEL: PUMP /SIPHON MANUFACTURER: t NIN (3 ACtL Lvt;Kirv" �uvtn 10E PR OVIDED: ❑ YES El NO YE NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PRO TY WE ILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF 1-1 YES ❑ NO NEAREST --► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I KMTERIAL:AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) rnNVFNTIf1N01 CVCTFIIA- BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER FILL DEPTH ABOVE COVER: INSIDE DIA.: # PITS: LIQUID DEPTH: TRENCHES: 3(p TRENCHES: I tp MATERIAL: PIT DIMENSIONS ( MANIFOLD _ 4 DISTR. PIPE MANIFOLD MATERIAL: NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: GRAVEL DEPT LL DEPT DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES' ABOVE COVER: L V. INLET: LEV. END: a " PIP S: FEET FROM LINE: 1 AIR INLET: DISTRIBUTION NEAREST HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV. ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENT PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY LINE: WELL: BUILDING: � �' ❑ YES ❑ NO ❑ YES ❑ CYO • FEET FROM I NEAREST ---' 0' Sketch System on Reverse Side. SBD -6710 (R. 06/88) 'DD SIGNATURE: TITLE: Zoning Administrator Retain in county file for audit. SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY 0)? STATE SANITARY PERMIT — Attach complete plans (to the county copy only) for the system, on paper not less than // 9 f/ ,? 8% X 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION w %4S`y,i % 4, S T,`� , N, R E (or W PROPER OWNER'S MAILING ADDRESS I LOT # IBLOCK# CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) U State Owned ❑ Public ®1 or 2 Fam. Dwelling -# of bedrooms III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 4 ❑ Church /School 8 ❑ Mobile Home Park 5 ❑ Hotel /Motel 9 ❑ Office /Factory ROAD 10 ❑ Outdoor Recreational Facility 11 ❑ Restaurant/Bar /Dining 12 ❑ Service Station /Car Wash 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution 11 ® Seepage Bed 12 ❑ Seepage Trench 13 ❑ Seepage Pit 14 ❑ System -In -Fill Pressurized Distribution 21 ❑ Mound 22 ❑ In- Ground Pressure Experimental 30 ❑ Specify Type Other 41 ❑ Holding Tank 42 ❑ Pit Privy 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION C3 3L 9,9 4PO Feet VII. TANK CAPACITY Site in ga Ions Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass App Tanks Tanks structed Septic Tank or Hoidin Tank 3 A t, O Lift Pump Tank/Siphon Chamber o FE1 -1 1 El I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): TPlumber's Signature: (No Stamps) - MP /MPRSW No.: I Business Phone Number: IX. COUNTY /DEPARTMENT USE ONLY LJ Disapproved sanitary vermn ree (mcwaes urounc Approved ❑ Owner Given Initial '(1j�, f 44 Adverse Determination 1 Surcharge Fee) K. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or State of Wisconsin, Safety & Buildings Division, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards.- - SBD4M8 (R.11/88) SB APPLICATION FOR SANITARY PERMIT This application form is to be the property being developed. the permit issuance. Should owner /contractor,(spec house), completed when the property appropriate deed recording. ------------------------- - - - - -- STC -100 completed in full and signed by the owners) of Any inadequacies will only result in delays of this development be intended for resale by then a second form should be retained and is sold and submitted to this office with the ------------------------------------------ - - - - -- Owner of property (3 - frwp ' w Location of property S X 1/9 X 1/9, Section 3.�_ T �' N -R_W Township — f� D�JS'O�J Ma i1gng addrVss l Previous owner of property �} tVOL-W-5 0/U Total size of parcel �• © .�f�'R� Date parcel was created Are all corners and lot lines identifiable? t., Yes No Is this property being developed for resale (spec house)? Yes 1/ No Volume and Page Number 20as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. ---------------------------- PROPERTY OWNER CERTIFICATION I(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. h/' �f� �� ; 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 C n y Register Deeds, as Document No. ). Signat re bf Owner Signature of -Own (If Applicable) Date of Signature Date of Signature Subdivision name Lot number e — DOCUMENT NO, , �I WARRANTY DEED I THIS SrA!:E RESERVED FOR RECORDING DATA 44656 S')'ATI BAR OF M WISCONSIN FORM 2-1982 j 1 VOL REGISTER'S QFF(r - - _ ST. CR01X CO., w Pau. --- L.. -.- Adder - son, . a .divo.rced...unremar.ri.ed i man Recd for Record - - - -- --------------------- ........... ... _.. _ --- _-- - -.. ....._.. -- - - - -- -.. �� 6 ��� f: "Atl 1 � 189 conveys and warrants to .. - Gerald -.R... LOwry-.,and ... - -.. .... _. -.. jj �t 10:15 A. M Sandra L__- I,owzy., - as. marital_ s.urvivor_sh1p.. .. property ....... - - - -- - - - - _. _ Register of Deeds - -- --------- - - - -- -- - - - - 1... - - -- - -- - -- .. II ---------- -------- - - - - -- ............. ......... I ... - - -- (I RETURN TO Atty. _ David Estreen - - -- - - - - - -- ------------- P.O. Box 359 .... .. .... _ .._ --------- - - - - -- - - - -- - _. ._.... . ...... -.. j Hudson, WI 54016 the following described real estate in --- ._ ......St_._--Cro.ix .... ........ ...County, State of Wisconsin: T:ax Parcel No: ... 236_- 1760-00 See attached legal description TRANSFER FM a�$G�Td This ....... ],S ... nQ- t ------ homestead property. (is) (is not) Exception to warranties: bated this .__ ........ I 5th -------------- - - - -- ---- day of --- ..._March --- ----- __ _. ___. 1!89 » Paul L. Anderson ............. •.... -- - -- - (SEAL) -- - - -- - .(SEAL) AUTHENTICATION Signatures) .... Paul__ L_. Anderson ................. authen4 15 t. ay o p i March________. 1989-. t ... . . ............... - --- -- Gwin -- ---------------- * ------------------------------------------------ TITLE: MEMBER STE BAR OF WISCONSIN (If not. • .......... .........••- ---- ---•-........._ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED nY Gwin,... Gwin - -- - & --- Gwin 4 30 2nd___St,._,,_ Hudson,_ Wl __54 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ss. --------- --- - - - --- -- _-- ---- - -- -_ -- -County. Personally came before me this _ - -- - - - -_- ...day of .................................... _---- _ 19 -------- the above named - - - - - - - - - - - - - - -- - - - - -- NIA.- - - - - - ---- ------------ ---- ------ ---- -- --- --- - - - - -- - -- - -- --- -- - - - --- --- - -- - -- to me known to be the person _.. ........ . who cxccuted the foregoing instrument and acknowledge the same. .----------------- - - - - -- - ----__ Notary Public - --- --- --- - - -- -- -- .County, '"'is. My Commission is permanent. (If not, state expiration date: ....... - -----•-- - - ----- ------ _. _ ...... , 19 __. .) *Names of persons signing in any capacity should be typed or printed blow their signntures. WARRANTY DEED STATE BAR OF WISCONSIN FORM No 2— 1uv2 wisronsin Lexul PInIlk 1 It,, .... � VOL 8T) WVA01 A parcel of land located in Government Lot 4, SE4 of Section R19W, in the T29N, R20W, and the SW; of the SW; of Section 31, T articularly described City of Hudson, St. Croix County, Wisconsin, more p as fo3lows: Lot 1 of a Certified Survey Map dated December 6, 3 -988, Maps in recorded on March Volume Croix {Coduntyrasydocuument # the office of the Register 446133 on page 20 Together with easement to use for sw�mmIng, f fishing, picnicing and other -c,zreational uses in common with the grantorc- and other owners of land in Govern- - , Lots 3 and 4, Section 36, Township 29 ?�]ortYz, Range 20 west:, to whom the ,raptors or their grantees, heirs ar assigns may grant similar nrivi.l egPs, t}Ze ,omeowner.s beach located in said Governmentot 4, Section 36, Township 29 North, ti ,nge 20 West, more fully described as follow BE AREA: Continence at the intersection of the center line of old R.R. Yt� W aii t�ic� North line of said Government Lot 4, said point being 881-81. feet West and 1316.73 feet north of the southeast corner of said Section 36, and ti POINT OF BEGINNING for parcel to be described; thence proceed South 37 0 57' East along the center line of said old R.R. R/1 a distance . of 43.45 feet to an iron pipe; thence proceed South 40 °09' East along said center line of old R.R. R./11 a distance of 170 feet to an iron pipe; thence proceed South 36 0 29' East along said center line of old R.R. R/W a dis- tance of 179.50 feet to an iron pipe; thence proceed South 29 0 53' East 1 & o R.R/ along said center line of old R. R/ a d stance. o f 17 - t ed' iron pipe; thence proceed South /P nW I� a s t ak e rc�re meander line due West rt distance of 25 feet to an fro pip of Lake St. Croix, being 45 feet more or less from the water's edge; eander line a distance o thence proceed Cr North 37°35' west along said meander 579.51 feet to an iron pipe set 85 feet more or less from water's edge thence proceed North 88 °30' Fast a distance of 275.09 feet to the POINT OF BEGINNING. The grantee's use of the ts`each includes the right to beach a small boat he cr bo ats the but doe long include rantee o s construct assigns retain r r other n tile right to permanent structure. So g a orti.o ro nate share of the exercise this easement he or they agree to pay a proportionate }axes and maintenance expenses thereof, it being understood that the share attributable to the land described in this deed shall not exceed }? ath Also, a non-exclusive easement to use as an access road or o e,,_,ch area a parcel of land 20 feet in width adjacent to and North of the South E� ;e of. Section 31, Township 29 North, Range 1.9 West: and Section 36, Township 2. North, I;ange 20 West zapping from t he west end of the existing `oNlinnFapolci� { a,;2 centeriine of the former right of way of the Chic, �go, St. Pau'., Omaha Railway Company and l and i n wayrunning in .terly of the centerline o r�! � �1 rection from the South line: of said Section 36 to the :oath line of the abov &e scribed beach area. t raptors, at their election, from convey - This deed shall not prevent } .. 0% j to a corporate Home Association to be j the beach area and the road thereto, Qr -( �eci At grr � nt.ors itle p and e other own } ers s of f laknd� rariLec 4 i r successors in t Qv-ea and roes:, and the grantees agree that if such an association is cYgani_zed f1hcy or their successors in title may become members. Together with and subject to aan ot�e thismshall re or restrictions of record, if y, any such other recorded encumbrances beyond the term established by law therefor. 446133 CERTIE ED SURVEY MA Located in Government Lot 4, SE 1 /4 of Section 36, T29N, R20W , and the SW 1/4 of the SW 1/4 of Section 31, T29N, R 19W, all in the City of Hudson, St. Croix County, Wisconsin. Surveyed for: Paul Anderson 288 River Ridge Road Hudson, W i1 Z � 1 � u vt -(, f R SLUFFLINE N Z\ � o N 9 _. 0 �b�e0 W to = M F- V W W O N W U_ ? O J V' to Q W W N LOT 1 88,464 SO. FT. (2.05 AC. ) F «ED MARI 51%9. .1 Owes �a�tt 10' WIDE WALKWAY , X97.96' u EASEMENT .�,�► 000' S 86' 12' 58'W �+ 1 , N _ ` 04 9 60 - 't^ �� \ \ -____N89 "E OV W f , W `\� N= \ L S 1/4 COR. 0 ' ." 0 0 SEC. 3 I PIPE IS 0.16' NORTH OF LINE W O SE COR. W�me MW _ \ r H O a w W 1a N \ 10' WIDE WALKWAY , X97.96' u EASEMENT .�,�► 000' S 86' 12' 58'W �+ 1 , _ ` 04 9 2 7.75 1 - 't^ S 89 "GI �— -____N89 "E SW COR. S 1/4 COR. SEC. 31 SEC. 3 I PIPE IS 0.16' NORTH OF LINE ALSO SE COR. SEC. 36 + ACCESS EASEMENT RECORDED IN VOL . 408 PAGE 591 . LEGEND SECTION CORNER MONUMENT. O I ° X 24" IRON PIPE WEIGHING 1.68 LBS./ LIN. FT. SET. • 3/4 ° IRON PIPE FOUND. • I" IRON PIPE FOUND. • 1 1/2 ° IRON PIPE FOUND. X I RE - BAR FOUND. SCALE IN FEET I"= 100 0' 25 50' 100 200' VOLUME 7 PAGE 2074 488 -1514 DRAFTED BY JWG Rvi6tN I/zo/69 r LOE ZOva L WHOA Io �lt:D ' 2utuaa ' d pjExao alrQ •uospnH }o A410 agl }o ltounoo AI10 agl AC ' panoaddu dgaaau sT. dru:z silty �r,�ranS OHS, aim NCS nW 653 /vZ/ ! 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LU — y L In ova N d LA 0 Pp N i OF t r OF � t 6 73) c� r• z w 1 To TV M ---� LGd p ---�, P • i STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER ROUTE /BOX NUMBER FIRE NO. CITY /STATE PROPERTY L 7/ ZIP T R � W, Town of O/V , St. Croix County, M Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), 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. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Cr0 ounty Zoning Office within 30 days of the three year expiration date. / SIGNED DATE ` / A 1 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS • INDUSTF�Y, C DIVISION BOX 796 LABQR A RE LATIONS PERCOLATION TESTS (115) MADISON W 53 07 HU N RELATIONS (1-163.090) & Chapter 145.045) LOCATION: 1 /4 1 /4 E TI p 36 / Tz9 N /Rztf(or /MUNIC LITY: ITY QP N0j,5oN OT NO. i LK NO.: SUBDIVISION NAME: esr�' VOL A P31 COUNTY: .S Cled OWNER'S 666er4 , 4^A41/ CoW,'�Y MA : 1 93 )o-a ,,, ie►oeti ko)c4 1461 k/1 S4 USE DATES 005tNVAI IWN F MAUL NO. DR ICOMMER A DESCRIPTION: I Q fit,, • Residence u New Replace ) M )4�I 2l / / %yik ZZ /9� F So ►�s hook 6 DAK O ATl urrs. Ca ci...,.:..IJ. #.,. ...,....., r rs c:.........r;,.t..t. s.....,...... NV NTI NAL: S ❑U MOUND: 9 S ❑U IN- fOL TYSTEM-IN-FILLIHOLDING �!1 S E3 f�.J S ❑U T j N � K: EIS MV RECOMMENDED SYSTEM:(optio 1) Co�IVciNTio AL If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)lb►, indicate: CLASS f Floodplain, indicate Floodplain elevation: NA r\ r, Zr PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEP•TH1fq ELEVATION P H T R UND ATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O BSERV D ES 1. HIGHES B' J 99Z /DO. �orJ > 9 9 � z7` BLSt.T� //' 5 1 ., Mj B- iazS 1po,SZ- NdNt 7/0.2< 32" LSL �j�$e1.IC Z" a SC /wS B- $.?, 9Q ,IS o rl� > 8 3 z 7 " Ls 27" Z S "/ *,,) f4>Q B. 4 P > 8.zs' zt "$tZTS laola .- Iekw A7S -��,,e B > � Z o>J� > 75 ZI ". ANL 2� >$�� SL 4 4�$ RN B- -- IC tj AT f G hEeFr PERCOLATION TESTS TEST NUMBER DEPTH ICES WATER IN HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. RATE MINUTE PER INCH PERIOD 1 p 1 PERIOD 3 P . ! 6 .70 Nomc 1 1()4) '3 p- z 7.20 NoNu /p4). o ' 3 > > 2 > 2 < P 2 G 19 8 2 0 ? Z > � Z •C P_ -- IC tj AT f G 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. SYSTEM ELEVATION 9� 0 ` " 60X'F.1_ 6 6. R 7 ©FF �srRtacJN F�„JIgTION ' IOO,OU �� _ S Zta ---�— _ - — -- _ _ _ $ -4 t Q� i-3o A o F � r — — — _ J g -1 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. DISTRIBUTION: Original and one COPY to Local Authority, Property Owner and Soil Tester. DILHP SRO -6395 IR. 02/82) — OVER - -- , OOt 1 001 ,O S'i o ga ,0 9 001 --..1 133 NI 3 d0S 9£ e '03S 2100 3S OSIV 3N1 30,HJLHON 1 91'0 SI 3did I £ '03S 7 I £ '03S 2100 MS / '800 VIS L8'L6Sa___3 „00,01068 N__ - - ° 8b,L0e69 S I VA 1 L'L'LIZ _ vy 5 —•Of' OL— ._ o � ♦ " a ' � N M °8si •Zj 99 S g g4p 0Ot 1N3w3SV3 o� r • 9B' LBj AVM>f7VM 301M ,01 'ld "OS b9b'88 1 10"1 , d ' • �L' 8 �j. N ''63163 dµti S0N tl'1 Z 1 � r N c 3NI1 .4eme OA I A O � i oprZ `Z It 1 \ scm N � d am► N v Ewa � � ® \ O,�H N •aw Igo” \ o•_ \ On ° wx \ 09 in N m m N a r O 'n z m N rn O n to s Ch m 'ld "OS b9b'88 1 10"1 , d ' • �L' 8 �j. N ''63163 dµti S0N tl'1 Z 1 � r N c 3NI1 .4eme OA I A O � i oprZ `Z It 1 - ,OOZ ,001 ,08 ,gz ,O .001 2"1 733 NI 31d0S 9£ '03S 8 00 3s -' Os1d 3N11 Ap 1 91 1 0 SI 3dld J I £ '03S -' 803 t,/Is 800 MS i / _ 19'Z6SiZ--- 3 0 68 N (� .J. ,4Z'ZIZ _ g4 5 —.Ot► Ot— 1'i o s° �.a .�-- • —•-""_ '- - ---"'"'�_ 9 . b� a •!f o o'a oi ti e / j.138 $ gO,p ° 'R' a 1N3W3Stl3 a AtlMl11tlM 3O1M ,01 96 stn rN ` co„� _ rN• ~N �� ° N \ t '�d �o•t 1 z : sC® \ O� v N l� '0S b91s'88 a : 1 10 c "' 3p \ Wm W 1 o v�► s2m \ �a 'o s 0 4� 3NI1J .In19 7 , 'oM o°„o \ r � iltl idNt` � 09 \ N rn d' \ rn N p f 0 z rn Cl' 0 rn rn w s � rn INDUSTRY, O,F REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSFbY, DIVISION LABOR AND PERCOLATION TESTS ( MADISON W 53707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LOCATION; 1� 1 / 36 /Tz-t N /RZ6lor /MUNICIP LITY: OT NO.:BLK. JTY aF 1WJY50N / NO.: SUBDIVISION NAME: Osm- VoL 7 A X074 COUNTY: ST lfled LA OWN ER' GGc,�er -;E S,4,4AY 46L-PY MAI : 43 I Lka rN 1P► &(,c 40AA ulw- k1 540 1Mr Residence NO. : COMMERCIAL ESCR PTIO _ -- New ❑ :R��ONV ❑, uAJK pBSERV D PER <41,_ tok N& 6S j0)LS RATIhIR• Sa Sits auitahl• fnr ev.tsm I I= Sits unsuifafais fnr aystem N DATES OBSERVATIOS MADE S: Replace ( Mi4es14 2 / 1 / 9 1 0 n7a"0C.W ZL� /4 ,R W ��� M �S ou ING�� D � �� Q�� :R��ONV ❑, CHA ACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) pBSERV D PER B / 991 7GTANK �(onl If Percolation Tests are NOT required DESIGN RATE: If an - q y portion of the tested area is in the under s.H63.09(5)(b), indicate: CL1e-,IS ' Floodplain, indicate Floodplain elevation: NA 1\,* V—, PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTWft. ELEVATION 12LPIH TQ R U NC D ATER- IHES CHA ACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) pBSERV D PER B / 991 /6 0, 13 �(onl > . Z 2'7` 6LSL_rS / 1 "SO SL $ ' eN M-S 'Z > Z > < P_ Z , e* a SL - .7 0 " j t o i" S B- $.33 ��3,r� o►,is > 8.33 z7 "" �srr'TS 27" L s� "IBtcN�ts B- .4 P. `1 Non►L- > S.ZS z� "�tcn 3Q" a •, $ �, �'is' �Ie B- 9.75 �?6,6o o>J� > .75 ZI "$LLlS " grJL /2"' *.q SL 441RN Al B- ELEVIltri0tu AT PLk 6 r, PERCOLATION TESTS NUMBER DEPTH I WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PER INCH PER100 I PER PER175D3 P_ / &. 70 N lfoaoo 3 'Z > Z > < P_ Z 7.20 NONI 00, O Z > Z > L P. `1 owt 82a > 3 >Z G ELEVIltri0tu AT PLk 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. 7'0 SYSTEM ELEVATION gENG1iM142� �f�l IN SAUTl1 FACI�S I ' 7d d tN I� g -z - - NCO 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. a�� zz 00 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 3%6- Aozo •• DISTRIBUTION: Oi igmal and one copy to Local Authority, Property Ownel and Soil Tester. DILHR SRD -6395 IR. 02/87) — OVER -- rl Lvr- 19 JOOO 6AL J'r7=-rAtv)(---> w &J06 ItN, , -wT a phopow py l Ap-szDgfvCE " ovot. JrD 7 -Pr- cna Ax&* ST PAOrSaY LT,E /v&.7-c EXrS 7-&i I 4,,, & L,,ELL ON n-rA Po-rvy 19 AgyXDr,.,E xs OVE/L 96' Z/ - f (/ // Aa9of4PT.Z0^/ A'XELID Io 73 �11=xs -J'Pj7e9< 0Y 1 OT 41VI-) CI Zor-f -TA/ som7N 'FACE OF p VGNT &EV, = 16o.00' 4 SEC7-To" JUTE Qar s� �� ---� � no�'�'cr 6"e fAVoy zowlqy 4/EvL" S kS 7 /?7 C17 OF 1) S. Clzo-Tx CowvrY 1 7 z .106 So u774 AkoperLTY LxvE /vo sc A LE h �- FRESH AIR INLET AND OBSERVATION PIPE F FF 0 1" E± VENT CA F ktkl 12" 77 ABOVE FINAL GRADE 4" CA. PION MiT FIFE Mk-'KW-J.lM OF 42" ABOW'- r'IPE TO FINAL GRADE MA613SH HAY OR SYWHETIC WYERING I I 1 2" AGGREGIATE OVER PIPE ISTRIBUMN FIFE El-Di ATICIN BED 6" AGGREGAM M -,TT= 4A PEFf IL 3E NEAT P TE' IS __91_3 I-T. SICiNED: LICENSE: DATE: TEE r I SOIL TESTINGBY: PEP&ORA11 PIPE IJELO COUPLINO TERMINATING AT BOTTOh.-I OF SYSTBA