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Wis{ ``tin Department of Industry, SOIL AND SITE EVALUATION
E~bor and Human Relations ~ Page of
Division of Safety and Buildings in accordance with s. ILH Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. st` . r r
include, but not limited to: vertical and horizontal reference point (BM), di io and 4 s" r- 0 I
percent slope, scale or dimensions, north arrow, and location and distan earest itv, Parce I
--3d log
g A7 . V!
APPLICANT INFORMATION - Please print all informat vie Date(
Personal information y provide may be used for se ndary purposes (Privacy la 04 (1) (rr " 3 -7
Property O r QE
1/4,S T N,R e/~ E ( W
Pro erty wner's Mailing Address I:o 131 c # ubd. Name or CSM# Z
D
City State Zip Code Phone Number ❑ City ❑ Village own Ne est o 69 -S-361
❑ New Construction Use: Residential/ Number of bedrooms Addition to existing building dr
❑ Public or commercial - Describe:
Code derived daily flow 44 gpd Recommended design loading rate gibed, gpd/ft2 / A trench, gpd/ft2
Absorption area required A4 bed, ft2 trench, ft2 Maximum design loading rate 44/4 gibed, gpd/ftz__,,! L trench, gpd/ft2
Recommended infiltration surface elevation(s) /1 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material Flood plain elevation, if applicable ft
❑ In Ground Pressure AT-Grade System in Fill ' Holding Tank
S = Suitable for system Conventional Mound
U = Unsuitable for system ❑ S U S U ❑ S [ K U ❑ S W U ❑S o u El S W U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
D~j I %j13~~ ~'Y r G
17 7 'C
-2 Yoi~ ZeYlz jog 3-1
Ground
elev.
Depth to
limiting
factor
Lin.
Remarks:
Boring # G
-alk
Ground
elev.
9~ft.
/ Depth to
limiting
factor
in. Remarks:
CST Name P ase Print) ignature Telephone No.
Address Date CST Number
i
- s
PROPERTY OWNER S'u lr r-e 17 SOIL DESCRIPTION REPORT Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure Dtft2
in. Munsell Qu. Sz. Cont. Color Texture Gr. I Sh. Consistence Boundary Roots
Bed , Trench
j
,
Ground
elev. G a 1 r
ft .
Depth to
limiting
f ctor
Remarks:
Boring #
rte'
Ground
el~
Depth to
limiting
fact r
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting ;
factor
'n. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
` limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
PROPERTY OWNER W-- 1','17 SOIL DESCRIPTION REPORT Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.~
Depth to
limiting
f ctor
in.
Remarks:
Boring #
0 9~ .
Ground ~
elev.
.
ft
Depth to
limiting
7in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
Soil Test Plot Plan
Project Name Barbara Bergren Byron Bird Jr.
Address 2173 Co. Rd. H
Deer Park Wi 54007 -4i~ 4-= 49=~,
TM #3479
Lot Subdivision Date 7/10/96
NE 1/4 NE 1/4S8 T 31 N/1316 W Township Cylon
❑ Boring O Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of White Stake Red Ribbon
System Elevation 101.1 * H R P Same as enchmark
-
. Well
I
5'
Existing 4
Bedroom 5'
use
vvh ~ 0
25'
c Failing System
T 25'
00' Overflow
o.
x
B.M. B-2
20'
36' 4%
Slope
B-3
Mound
Area
36'
B-4 45'
-1
4'
Wisce►-sin epartment of Industry, SOIL AND SITE EVALUATION j
Labor and+iuman Relations Page --/of
Division of Safety and Buildings in accordance wit Wis.
~almty
Attach complete site plan on paper not less than 8 1/2 x 11 inches in si 'CAmust
include, but not limited to: vertical and horizontal reference point (BM , tion art) r r'~r
percent slope, scale or dimensions, north arrow, and location and di n'oe'to nearest road. Parcel I.D. #
APPLICANT INFORMATION -Please print all inform tion. Re 1g: P~~ Date
Personal information you provide may be used for secondary purposes (Privacy aw, 15.04 (j (i ` a 4
-7
Property Owner ro n
Gtr~GC►Y ~"f'/'~ 401/4,S T N,R E ('C=am
Property Owner's Mailing Address Subd. Name or CSM# &/aU
Zze 42~~ - - W VaoleXae,`F State Zip Code Phone Number e- 0 - Oh Nearest Road
F-1 City El Villag J2"Town
❑ New Construction Use: Residential / Number of bedrooms- Addition to existing building
X Replacement Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate/ '-)ed, gpd/ft2~.,Z trench, gpd/ft2
Absorption area required _!j bed, ft2 _ trench, ft 2 Maximum design loading rate/f red, gpd/ft2y- ranch, gpd/ft2
Recommended infiltrVon surface elevation(s) • ft (as referred to site plan benchmarK)
Additional design/site considerations C_ , rt-Z /w -
Parent material C~reG / ~7 Flood plain elevation, i applicable ~Il~~~_ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
❑ S U
U = Unsuitable for system ❑ S ® U PS S ❑ U ❑ S O U ❑ S f R U ❑ S au
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
IvA, 'e-
17,11 Iewt j5* 1" 1 zvf A- law_
Ground 1 `
elev. 10"
< i. a ft• G v2 C//
Depth to
limiting
fact r ;
it in.
Remarks:
Boring # /
An-o 42 cd~-L < T r
oe=
O +
1 . >
Ground 42
ele
y~~t. ,
Depth to
limiting
factor
a24-in. Remarks:
CST Name (Please 'nt) Si re r Telephone No.
Address /01 _ Date CST Number
PROPERTY OWNER ✓ rj~ rfSOIL DESCRIPTION REPORT
Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Szz. Sh. Bed Trench
3 O/
o r
~ < r G
Ground !
/I vle elev.
G
Depth to
limiting
factor
7 in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 03/95)
r T ~j^ N~SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
V'2 Y4 x Ac
Ground' _
elev..
k-4112, 7-
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Moftles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
'n' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBDW-8330 (R. 03/95)
' Soil Test Plot Plan
Project Name Barbara Bergren Byron Bird Jr.
Address 2173 Co. Rd. H
Deer Park Wi 54007 STM #3479
Lot Subdivision Date 7/10/96
NE 1 /4 NE 1/4S8 T 31 N/R16 W Township Cylon
❑ Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of Barn Siding
System Elevation 96.5 * H R P Same as Benchmark
Barn With 2
Bedroom Barn
Living
Quarters
Illegal Holding Tank
100' UB.M. Barn
25' 75'
15'
24'
Well
75'
20' 25' B-1
Shed
0'
60'
B-2
6%
lope
Mound
Area
B-3
Owner: Bergren, Derrick D. & Barbara Computer 006-1016-30-000
Address: Parcel 08.31.16.106
Unknown Municipality: Cylon, Town of
Address: 2173 Cty. Rd. H
Deer Park, W 154007
0312812007 Bergren, Derrick D. & Barbara Pam Quinn
need to send owners a letter to find out if failing system was ever replaced and we just don't have
a permit in database.
0511812007 Bergren, Derrick D. & Barbara Carrie Stoltz
Sent letter requesting an onsite
0512112007 Bergren, Derrick D. & Barbara Carrie Stoltz
9:56Am Barbara called back re: letter. (715) 269-5361 or (715) 377-3202. 1 called her back & set
up an onsite for 5/22
0512212007 Bergren, Derrick D. & Barbara Carrie Stoltz
met with both owners onsite. Found the holding tank by the barn. Looked in the apartment.
Owner has all water disconnected & shut off, it is just used for storage. There is no sink, toilets,
ect. There is a cleanout pipe in barn without a cap, I recommended putting a cover on it, so
nothing gets into the tank. The tank is concrete, we have no permits on it. It is approx 20' from
barn & meets the setback to the well (100+) and to service drive (w/in 25'). It has a concrete lid
with no lock, but has no handles to lift it with. Would be very hard to get off. The owners no
longer have horses and the barn is unused at this time. I told them if they ever change use, to
notify this Dept for proper paperwork & inspections. The drywell for the house is off into a
wooded area. I saw no evidence of surface discharge. The owner, Barbara said she pumps
every 1/5 years. I said I would make sure she gets on the maintenance cycle. She also showed
me where the borings were in relationship to the drywell. The borings are atleast 150' from the
drywell. I spoke to Kevin on this and we will ask the owners if we can periodically check the
system. Put this into a tickler file to check 2 times per year. File abated for now.
Parcel 006-1016-30-000 03/27/2008 01:42 PM
PAGE 1 OF 1
Alt. Parcel M 08.31.16.106 006 - TOWN OF CYLON
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 - BERGREN, DERRICK D & BARBARA A
DERRICK D & BARBARA A BERGREN
2173 CTY RD H
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2173 CTY RD H
SC 0119 AMERY
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N R16W 40A NW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/25/2005 801323 2850/317 QC
07/23/1997 1097/047 WD
07/23/1997 844/43
07/23/1997 427/606
2008 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 09/07/2007
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 5,000 0 5,000 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 3.000 12,000 258,000 270,000 NO
Totals for 2008:
General Property 40.000 17,100 258,000 275,100
Woodland 0.000 0 0
Totals for 2007:
General Property 40.000 17,100 258,000 275,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00