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4 XonsinDo=,nentofIndustry, SOIL AND SITE EVALUATION REPORT Page
oar and Human Relations -1 of 3
'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach completq, site plan on paper not less /X~1 i size. Plan must include, but St. Croix
not limited to vertlbal and horizontal refer a (BM), dire % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location nd.. stancejo nea~st ro 6 l -GDl~
4
APPLICANT INFORMATION-PL A~PRINT*L Ij~tM REVIEWED BYZ DATE
PROPERTY OWNER: cc> " ! p c"~° PROPERTY LOCATION
Dan Davis LOT 1/4 1/4,S T
GOVT
SW SW 4 28 N ,R 15W W
PROPERTY OWNERS MAILING ADDRE S' fi LOT # BLOCK # SUBD. NAME OR CSM #
RR 1 , NA
CITY, STATE ZIP CO E N OCITY ❑VILLAGE MOWN NEAREST ROAD
Menomonie, WI 54751 5 1 l
(J New Construction Use kA Residential / Number of bedrooms 3 ( J Addition to existing building
xj Replacement [ J Public or commercial describe
Code derived daily flow 45n gpd Recommended design loading rate S bed, gpd/ft2_6_trench, gpd/ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) _determine after monitoring It (as referred to site plan benchmark)
Additional design / site considerations use as long & narrow a rock bed mound as practicable 5' x 75' will fit site
Parent material loess over till Flood plain elevation, if applicable NA It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S U ❑ S U ❑ S U El S U ❑ S U S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0-8 10YR 3/2 -
2 8-17 10YR 5/3 c 1 f 10YR 611-
44 2 m sbk mvfr cs if .5 .6
Ground somewhat gritty w/ s
elev.
87.8 ft 3 17-27 7.5YR 4/6 - sl 1 m sbk mvfr cs if .4 .5
Depth to 4 27-47 7.5YR 4/4 c3p R-Gy sl 0 m - - - .3 ::.4
limiting
factor sid all seepage @ 7" it lacks A+4'
8"
Remarks:
Boring #
g zr~ 1 0-8 10YR 3/2 - sil 2 m sbk mvfr cs 2f .5 ~.6
7 Y
2
parting to r
2 8-17 10YR 5/3 c2p R-Gy sil 2 c abk mvfr cs if .5 .6
Ground
elev. parting to 1
86.5 ft.
3 17-26 7.5YR 4/6 - lcs 0 sg ml - - .7 .8
Depth to
Uimlb si ewall seepage 33; standing wate @39; pi lacks A+4"
tor
8"
Remarks:
T Name:-Please Print Phone:
Henry F. Grote 715-AA5-9681
Address:
PO Box 57, Knapp, WI 54749-0057
Signature: Date: CST Number:
10/31/92 3065
PROPERTY OWNER Dan Davis SOIL DESCRIPTION REPORT Page 2 ofd
PARCEL I.D. ! '
Boring # HOrizan Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
t 1 0-7 10YR 311 - sil m cr mvfr cs 2f .5 6
2 7-17 10YR 5/3 c2p R-Gy sil m abk mvfr cs if .5 6
Ground parting to pl
elev.
RA-9 ft. 3 17-26 7.5YR 4/4 f3f R-G lcs s ml - .7 .8
Depth to
limiting
factor standing water ® 41"; pit lacks A+4"
711
Remarks:
Boring #
` While other sites might be examinaed on t is property; CST suspects the o tcome will be imilai
base on the owners descri t on which includes ales of tractors bec in9 mired on nominally h 9h
i v
Ground
elev. group and the like. CST wou d suggest addition 3l exploration if the owner and uyer co ld agree to
ft.
such (This might make plan approval of a holding tank a passible option). Group water onitor ng at
Depth to
limiting the s veyed area is another possibility which might all the instal fation of a mounds stem p obablp
factor
using lextra s nd. The moderate structures shoul suppor a mound if ufficient epth ca be de onstrated.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
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Wist on ;in Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 1_
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
91 St. Croix
Attach complete site plan on paper not less t 1 i • e. Plan must include, but
not limited to vertical and horizontal refere ' t (BM), direction of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location a i ance near road.
IN%
APPLICANT INFORMATION-PLE RINT AU-INIAT REVIEWED BY DATE
t tit. v"
PROPERTY OWNER: ~y y 0 C' ROPERTY LOCATION
Dan Davis G'c GOVT. LOT SW 1/4 SW 1/4,S4 T 28 N,R 15W W
PROPERTY OWNER':S MAILING ADDRESS ~LOT # BLOCK # SUBD. NAME OR CSM #
RR 1 " - - NA
CITY, STATE ZIP CODE ❑CITY ❑VILLAGE MOWN NEAREST ROAD
M
New Construction Use kx] Residential / Number of bedrooms 3 [ ] Addition to existing building
jx] Replacement [ ] Public or commercial describe
Code derived daily flow asn gpd Recommended design loading rate -9 bed, gpd/0-6 trench, gpd/ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) determine after monitoring ft (as referred to site plan benchmark)
Additional design / site considerations _ use as long & narrow a rock bed mound as practicable 5' x 75' will fit site
Parent material loess overta~~ Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S )W U ❑ S U ❑ S U ❑ S U ❑ S U i~ S❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 1 0- Y -
2 8-17 10YR 5/3 c1f10YR 611 - sil 2 m sbk mvfr cs if .5 .6
Ground somewhat gritty w/ s
elev.
87.8 ft. 3 17-27 7.5YR 4/6 - sl 1 m sbk mvfr cs if .4 .5
Depth to 4 27-47 7.5YR 4/4 c3p R-Gy sl 0 m - - - .3 ~.4
limiting
factor sid all seepage @ 71' it lacks A+411 I
Remarks:
Boring #
1 0-8 10YR 3/2 - sil 2 m sbk mvfr cs 2f .5 .6
2 parting to r
2 8-17 10YR 5/3 c2p R-Gy sil 2 c abk mvfr cs if .5 .6
Ground
elev. parting to 1
86.5 ft.
3 17-26 7.5YR 4/6 - lcs 0 sg ml - - .7 .8
Depth to
limiting si ewall seepage 33; standing wate @39; pi lacks A+4"
factor
811
Remarks:
CST Name:-Please Print Phone:
Henry F. Grote 715-665-2681
Address:
PO Box 57, Knapp, WI 54749-0057
Signature: Date: CST Number:
10/31/92 3065
PROPERTY OWNER Dan Davis SOIL DESCRIPTION REPORT Page 2 oli 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-7 10YR 311 - sil m cr mvfr cs 2f .5 6
2 7-17 10YR 5/3 c2p R-Gy sil m abk mvfr cs if .5 6
Ground parting to pl
elev.
RR_5 h 3 17-26 7.5YR 4/4 f3f R-G lcs s ml - - .7 ':.8
Depth to
limiting
factor standing water @ 41"; pit lacks A+4"
Remarks:
Boring #
X.
While other sites migh be examinaed on t is property; CST suspects the o tcome will be imilai
base on the owners description which includes ales of tractors bec ming mired on nomi ally h gh
Ground
elev. ground and the like. CST wou d suggest additional exploration if the owner and uyer co ld agree to
ft.
such (This might make plan approval of a holding tank a possible option). Groun water onitor ng at
Depth to
limiting the s veyed rea is another ossibility which might all the installation of a mounds stem p obab4
factor
using ktra s nd. The moderate structures shoul support a mound if sufficient epth ca be de onstrated.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
. . . . _ . . . .
C4 X. . . _ . . . . . . . _ . _ . . . . .
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~~/f9i nSifrY~ iartr> In~uSt~s$ • 15.59A, WXYE S?&%E SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
18 543
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
CADY
ST BM E ev.: Insp. BM Elev.: BM Description: / Parcel Tax No.:
O6 004-1009-2 ~
TANK INFORMATION ELEVATION DATA A9200430 a7 3
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
ptic Benchmark
Dosi ng
Aeration Bldg. Sewer
Holding 1 4/a jWHt Inlet
TANK SETBACK INFORMATION
Verit
TANK TO P/ L WELL BLDG. A
irito ntake ROAD D e
Septi NA Dt Bottom
Dosing NA Header / Man.
Aeration A Dist. Pipe
Holding y f,~o~ Bot. System
PUMP/ SIPHON INFORMATION Final Grade
M acturer Demand
Model Number GPM
TDH Lift Friction S stem T Ft
oss
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH ngth No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN I DIMENSIONS
SYSTEM TO P / L BL WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER
Mo er:
System:
AFik~=A Z
DIST TEM
Heade / Manifold istribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. ngth Dia. Spacing
SOIL COVER x Pressu ms Only xx Mound Or At-Grade Syste y
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil El Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) -
LOCATION: CADY 4.28.15.59A,SI1W1SW, 290TH
j
yyl
~vF7.6c . 3~ i)vc ~
~a~T revision required? ❑ Yes 0I<O
Use other side for additional information. ALP '11L_
2LI:t:~ra 1
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
> i
SANITARY PERMIT APPLICATION
7DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY A/i L-7
1A -
y STATES NITAR PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
834 x11 inches in size. c if v on top fousapplication
-See reverse side for instructions for completing this application. STATE PLAN I.~D./N MBEa Q
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. o~ - 7 / a~l~t O
PROP RTY OWNER PROPERTY Q L,O'AJC,ATION
~N ,3 U) % Y.,S TOV ,N,R / E(or
PROPE ~Vr MAILING ADDRESS LOT # BLOCK #
CITY, STATE I ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
N"o Mb 1l)
11435 71 _0 1. TYPE OF BUILDING: (Check one CITY NEARESoOA`i~~
❑ state owned VILLAGE JT,.
❑ Public V!*1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) oo _ )j g _ ~ 6
1 El Apt/Condo <
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. IZ!sLReplacement 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 Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 El Mound 30 El Specify Type 41 M Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
"7 (~lS Feet Feet
VII. TANK CAPACITY Site
in alIons Total # of Prefab. Fiber- Exper.
INFORMATION New Fixistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank DC)o 2S(
Lift Pump Tank/Si hon Chamber r El El I F-1 -LEL]i EJ
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Piu er's Name (Print): I ber's Sign ure: (No Stamps) P PRSW No.: Business Phone Number:
ca.e, ~tirte~ 7/S- -73S//
Plumber's Address (Street, City, State, Zip Cod
~~7s
IX. COUNTY/DEPARTMENT USE ONL
❑ Disapproved Sanitary Permit Fee (includes g round water Date IssuedF-A Issuing Agent Signature No Stamps
Approved ❑ Owner Given Initial W~-
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: C/ V-1
SBD-6398 (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 alicensed
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-the
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 number(s) 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.
III. 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- SliiIICHARGIE
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.
SBD-6398 (R.11/88)
Wisconsin Department etioIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
t. Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attch plelg, site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
hot limited'to vertlbal and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. i
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION '
Dan Davis GOVT. LOT SW 1/4 SW 1/4,S 4 T 28 N,R 15W W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
RR 1 NA
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
M (715) 235-7971 Cady I 290th St.
[ J New Construction Use 6cx1 Residential / Number of bedrooms 3 [ ] Addition to existing building
jx] Replacement [ ] Public or commercial describe
Code derived daily flow 45n gpd Recommended design loading rate s bed, gpd/ft2 _6 trench, gpd/111:2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) de rmin after moni on ng ft (as referred to site plan benchmark)
Additional design / site considerations use as long & narrow a rock bed mound as practicable 5' x 75' will fit site
Parent material loess over till Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE 7AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable for system ❑ S U 1:1 S U ❑ S U ❑ S U ❑ S U S❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
} -
1. 10YR 611 -
2 8-17 10YR 5/3 c1f sil 2 m sbk mvfr cs if .5 .6
Ground somewhat gritty w/ s
elev.
87.8 ff. 3 17-27 7.5YR 4/6 - sl 1 m sbk mvfr cs if .4 45
Depth to 4 27-47 7.5YR 4/4 c3p R-Gy sl 0 m - - - .3 .4
limiting
factor sid all see a e @ 7" it lacks A+4'
8"
Remarks:
Boring #
1 0-8 10YR 3/2 - sil 2 m sbk mvfr cs 2f 1.5 .6
2 parting to r
2 8-17 10YR 5/3 c2p R-Gy sil 2 c abk mvfr cs if .5 .6
Ground
elev. parting to 1
86.5 ft,
Depth to 3 17-26 7.5YR 4/6 - lcs 0 sg ml - - .7 .8
him Ong si ewall seepage 33; standing wate @39; pi lacks A+4"
8"
Remarks:
T Name:-Please Print Phone:
Henry F. Grote 715-665-2681
Address:
PO Box 57, Knapp, WI 54749-0057
Signature: Date: CST Number:
+ 10/31/92 3065
PROPERTY OWNER _ Dan Davis SOIL DESCRIPTION REPORT Page 2
PARCEL I.D. #
Boring # Htlrizon Depth Dominant Color Mottles Texture Structure Consistence Bourlctary Roots pf)/jt .vk~. Bed Trench
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
r:
h 1 0-7 10YR 311 - sil m cr mvfr cs 2f .5 6
2 7-17 10YR 5/3 c2p R-Gy sil m abk mvfr cs if .5 6
Ground parting to pl
elev.
8A_5 ft 3 17-26 7.5YR 4/4 f3f R-G lcs s ml - .7 .8
Depth to
limiting
factor stand ng water ® 41"; pit lacks A+4"
Remarks:
Boring #
While other sites migh be examinaed on t is property; CST suspects the o tcome will be imilat
base on the owners descript on which includes ales of ractors bec ing mired on nomi ally h gh
Ground
elev. group and the like. CST wou d suggest additional exploration if the owner and uyer co ld agree to
ft
such (This might make plan approval of a holding tank a possible option). Group water onitor ng at
Depth to
limiting the s veyed area is another possibility which ght all the instal ation of a mound s stem p obabl:
tor
using extra s End. The moderate structures shoul suppor a mound if ufficient depth ca bed onstrated.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
:x
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
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oe
DEP'*RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INbUSTRY, DIVISION
LABOR AND supplement to PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS previous report \ / MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145) 715-235-7971
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
W 1/4 SW V4 4 /T28 N/R 15 W Cady - - NA
COUNTY: MAILING ADDRESS:
St. Croix Dan Davis RR 1, Menomonie, WI 54751
USE DATES OBSERVATIONS MADE
In NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: .
Residence 3 NA ❑New QReplace 11/18/92 NA
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: rM I N-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional)
11 S QU ❑ S ❑ U 0 S EJU Holding Tank
S DU au
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: NA Floodplain, indicate Floodplain elevation: NA
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-4 w 40 -101 19 8 ? similar to B-1 (previous 115) w/ sidewall seepage @ 19
B_5 -%55 h101 9 8 ? similar to B-1 (previous 115) w/ sidewall seepage @ 9" &
B_ standing water (frozen) @ 53"
B5 w54 -101 11 8 ? similar to B-1 (previous 115) w/ sidewall seepage @ 11 &
-
B- standing water (frozen) @ 52
[B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P-
P-
P-
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.
SYSTEM ELEVATION
i I I t 1 E ; ( r ~ i t
Site edition p bor detailed analysis 0 soil pro i es;( pits are about 4 dayslold and soils are
very solidi . f~.ozen -except,-where sidewa]~11 ag isLob er"ve1d
The exten of -free o o `o r drainsge in these ti ~ Solis oer ~ Ver __y
er o ht den e
.t' was--nestle tv d t arl thelupfro ion of Y p Pe ter-was-ms eR 9, a alele aii d pTo r~e-
an- ~o-ll ,
JS Similar Ito hose reported earlier.
CST is-4nfoirmep-by-tae plumber, Joe Menter, that a mQUnd;l tee}-north pf 194 or7 t1 same topagraphic
knoll as B-4 to B-6 had a "blow-out" )Kith effluent coming out the side of the mound. 'his; high ground ~ fN
E
m9u rob' b1-y'' t
p he best t at can be found on the"s site and CST judgement is that Oond~tions fOr Successful hd..cdnstu ionand__operation -are tnarg~ina _at -best..
~1-hc~ilding_.#~~__is..tlie_-fie-st bat Caere _
i
4-
attached plot plan, revisdd ftom earl er1repc(r - - -
See. r
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A
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with they rorse~alure d methods s i in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowle a `ef.
NAME (print): TESTS WERE COMPL
Henry F. Grote
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
PQ Box 57, Knapp, WT _ 3065 715-665-2681
CST SIGN T RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use suction must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Peecolation Rate
med s - Medium Sand W - Well
is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
'sl - Loamy Sand < - Less Than
'I - Loam Bn - Brown
'sit - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay III - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
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Dan Davis - Holding Tank
Location: SW 1/4, SW 1/4, Sec. 4, T 28 N, R 15 W
Town: Cady
County: St. Croix
Date: December 2, 1992
Owner: Dan Davis
Address : RR 1•'
Menomonie, WI 54751
Plumber. J eph Menter
Signatures
License # P 658
.c'
Attachments: 6748-Plan+AVpr6'x*al Application
115
SBD-6123 Holding tank agreement (copy)
page 1: cover
2: plot, plan
3: tank detail
page 1 of 3
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HOLDING TANK CROSS-SECTION AND SPECIFICATIONS
Approved Approved Locking
Vent Cap Weather Proof Manhole Cover
Junction Box w•.rM;..~ \,.L4A
4" C.I. 12"
Vent Pipe i
Final Grade 41'
77-77/
7,7r 7
Approved Joint
dater Tight
Seal
High Water
i
Alarm Switch' - _
1.
SPECIFICATIONS Approved
Joint w/
TANK Manufacturer: C.I. Pipe
Tank Size: 2-~ Gallons Extending
3' Onto
ALARM Manufacturer: SS ~~Q~~~n S s~d...g Solid Soil
Model Number: 1eo~ Hw
Switch Type ~.oYC••~ b
11 NUMBER OF BEDROOMS:
L ~QVwF~oh
OWNER'S NAME: ADDRESS: RQ1 +-tm..o •~w~ , ~t s4A-rI
LEGAL DISCRIPTION: SW k$ Sw 1=, Sec. T Ztb NCR \Y W
TOWNSHIP/M
COUNTY:
pGE S~S~~N►
~rially
p WID
OF ~N~ N OF sif
0 g1Vw14 D SCE
P
Go~R
SEE.
3 0 ~ 3
HOLDING TANK SERVICING CONTRACT
Contract Date
This contract is made between the
Holding Tank Owner(s) Name(s) and I Pumper's Name
t2
Dan Davis I /1
LJ
I /T C~
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
- part of SW 1/4, SW 1/4,-Sec.-4, T 28 N, R 15 W
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of St. Croix
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to
enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access
road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay
the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper.
3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis.
Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees
to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in eff ect until the owner or pumper terminates this contract. In the event of a change in this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality
and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) (Print) I Owner's Signature(s) - ~"'00"
~tLV L ~F
41,
ctrl-
ry
Dan Davis I Subscribed and to efor ~ this date:
I N0'AR
Pumper's Name (Print) I Pumper's Signature a~d+~ Notary Public
c~ My commission exp%I iZ~
i M M; Mb
Pumper's Registration Number
SBD-7574 (N. 11185) This instrument was drafted by the State of Wisconsin Department
of Industry, Labor and Human Relations, Bureau of Plumbing.
H
STC-105 r
y
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
t7
a
OWNER/BUYER ry-!U Jr_~a
ROUTE/BOX NUMBER Fire Number
CITY/STATE Kcdt) M0 'I.IP
I, U
PROPERTY LOCATION:-U) 14, 14, Section, T ~ N, R _W,
Town of , St. Croix County,
Subdivision Lot number
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into i
the system can affect the function of the septic tank as a treat- j
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
I/WE, the undersigned,, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with N
the standards set forth, herein, as set by the Wisconsin Depart-' b
ment of. Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
S I G N E D
D ATE
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
APPLICATION FOR SANITARY PERMIT
STC-100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property ,gam} 2),q (f Location of Property 3 Section , T.-A,8' N ~R W
Township
Nailing Address Plmd M0A) 176
Address of Site lei) l5 a
Subdivision Name
:Lot Number
Previous Owner of Property A A-tJ k~ &(j 1` S Q
Total Size of Parcel _01004-1
Date Parcel Was Created
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for resale (spec house) ? Yes X No
Volume and Page Number as 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
1 (We) centi6y that att statements on thi.6 6onm ane true to the best o6 my (oun)
hnow.tedge; that I (we) am (ahe) the owneA (s) o6 the pnopen ty des cA ibed in this
in6o4mation 6o4m, by vdhtue o6 a wa4Aanty deed neconded in the 066.ice o6 the
County Regiaten o6 Veed6 as Document No. ; and that I (we) pneaentfy
own the pnoposed site 6oh the sewage d Apod sys `em (on I (we) have obtained an
easement,. to nun with the above de,a cA bed pnopeh ty, bon the constnuc ti.on o6 said
system, and the same has been duty neconded in the 066.ice o6 the County Reg.ia.ten o6
Heeds, as Vocwnent No.
SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
7 T-777
4 77186 E•ro 0
. carodaw. *bow me or ass O.
Vaador "Us gad agrees to convey to Purdlaoar►`Well the fowat aid ton per` ;
ionAanee of " contract by Pureh&M. the fotl d%g Nopae~ ~ tlw ?it prolits. ti:wres and otber appust~ ~ (4 Owhi. 3 o °p~
J -I
recta... y 4141" of i sisresr, re
ilk • ~L~
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Tax Parcel No... r r,
. QNester (SO),
m,
Southwest Quarter south m,
Y Station ~uV. (4)• c
• South of Interstate" 1lg1M'~ x
; lt4n `tf tea (.1~1"~. ~
Township Twenty-eight (20 North.
1lisconsi>~~.
West, Township of Clay. 8t• Croix County.
This is..A;ft- . hoawstea4 property..
(ka) l'u not) Route •1,. MenOw4nie
- -s
Purchaser &F-V-0 to urchow the Property ind'U pay to Vendor at 'p, +lt;` ;r
in the following manner: (a) $ . '
ar:, qQ® 09...... ,~obecltar.ritt►;iptcre>aC'ft'onir
at the execution of this Contract; and (b)athe balance of $ 3.0+• • per. te at per acne
'st?
brsof an the balance outstanding from two to time at the rate of. 9....... pe
SWA PO A in faL Y fauowa'
In monthly installments of not 1698 than 542.00.
month icooftencing'upon g
on the 10th of each and every
x closing which is on. or before pece>ber 20,A99 1:
ZOt~t
he entire outstanding% balance shall be pat . in full on or before the x~
provided, howrover, . t , :day of
;
012... ( the maturity date).
v lliilowbss any default in payment, interest shall accrue at the rate of 12.. % per annum-sn the etii1ie Ole,
alimRttit a .+►c~rlaratian or tpatpsiLy,
po
41
is[aal(: (w>siell ahIJ1 include, without limitation, del"ip4uent interest and, upon'
lalatlea
r pia atprrgQd by Vertdor► s&ress to pay monthly to Vendor amounts sufficient to pay, realty
} fire and required. insurance premiums when due. To the extend rrceivsfd bJ'
1Nsd 0=00 tatMf►apx'ioapsesaawetas
pap ge-tbMi d'ilgations w.>ieen due. Such amounts received by. the Vendor
to
0 Il wraaes will be 4"wited into an escrow fund or trustee ac'"arit, but sbal! aoi bear ip#ife 41;
A ~ttahic rid: by law.
$10111101* dolt _ be brat to interest on the unpaid balance at the rate specified and thIn to pencijal.
date hereo 19..,
` ~>Pl at any Lime after.
t ~faltn or fat upon principal N ry
.
tt D11lf~irsion of Vendor.*,
L, tbht contract shall not be ' ,..:tcd a+ in default with respect to pa)meAt.so
{h a. j
. s the r►oat of inf pr+p
r.. to thsw9aJA bs>;apasat princtpal, and interest (and in such cage accruinw interest from month to pavntb x411 b*" t"
eM~ e
it Nar then the amount that said indel,tednoas would have been had the mdOthly •FaYmeol*
a~:` Y.u» s~ 4• that a+onthly pants rhrll he continued.in. the event of credit,oA 04 i pow0ded i 040 811 first tpla fiad'ab0Me7
of insat'aftis at eondraanatlon. • tho : condiamed pry.ices being thereafter exciuded•herefrotn.
Ptlrebuw statesthat Pureh#Awr is satiailed with the titl us shown by the title evidence submittait to PurelsasaR
t* ~
.~pr aatieetletespt: f1f~1e . ~ "e~~.~'' ;
the cot of tatura titii- eviiitnce • ; It title evipeNeM, Is in t** f" 61 so absleAet.
t
Alrehaser stress re is
be retaloO by Vendor untl?i a fall Furxlaae . p VAid.
j~ e(~I~l<.,.~ .
Purchaser ~4*11 lsl' entitle to take lossaaticn of tbM1 Prnp~v on 4 y
i, 0090,r Out o ma•
~ '~a a ,
1
,
a i4
boo" keii or lopeft all, 11M voodoo
dr1~11Mg ° r- t ~
M
E sit ~aMN~I,±~'!° #li► Yaader
° V ~~a of
that(
t= s
- ~ mew is wr ~s~ r w bN ti°r .
t Vasdor deems
carte to be eowmitted on the Pteperty, to Mee!
from from 1i~ superior to *A lift of IS Ce dikM.
06
r : s/a tM Property.
°~tw tdt Ifterest sod etber moms shall be_ =8H PON a
lie sad eoemeti . ' E`
imWift ~ , a~ spot and VMdor claw Of &H Property, free a
be frA .10 Property,
6: ARE
r Mtso~ at purchaser, and except :
• s
s>!li► tiw K ~rlM.b - .
W..
detain. In .Cite *ay nt ol.esny .
povehow 1.y of lie am=" sed~(a) is the event of a t Of is ddMt MI
fetlowing the specilied due date or lb) is the even , MAW&
61111101011100 for a paW a< days 30 days lonowin` writ m
con Mrh~utb times for a period e outstanding balance under !'~s en"
'
mail), then the entire
t1y Vwder is at Vendor's option and without notice (which P r a r ~3 z ,
rights anu remedies (subject to any limitations provided ~
Vendor may, at r his tio hgh ct eforthis C*ntr&et a"
eclosu with an
fs iMM a" rapy~ the property back: t rou str alancewith interat tberelK
iWlaM wo doll payment of the entire outstanding b,
60 be dateandother amounts due hereunder (in which event all amounts
fulfill this Contract and v
AM 4109111 ( pages for fail uro to
ific per'orma °e of this Contract to
asdotr may sue for apec
~sg ,m(snee, with inter thereon at th cote in effect on L11R
est
As ww~_ enderi is w1deb event the Property shalt be tuctiom 1 purchase judicial Price oak s or ad shy
ti
~r im
Mier K ~~O VMder Amy sue at law for the entire unpaw cf
( _ rientraet at an end and remove this Contract as a cloud on title is a
- tlMlesRM tll+ th) Yeoiir of PYSeh"W is insignificant; and (v) Vendor may harE Purchaser ejected from
it tt.e htsiati t `
,t : MltiO~ tmta a tq collect any rents, issues or o[ita during the Pendency Of " .
a.fiN i) t its say oral or wraten statements or art ions of Vendor, an election
an all eOXt& Old rred
or Alpme
to e less upon Vendor if a
Le any nd when pushed underK$wlhether abated or set) W* of tin LIe EVia Ace shall be added} to principal on paid by Purchaser,
Is 3WWWat
of any action of foreclosure of this Contract, Purchaser
Y- tba ott duri ~ y pdin homestead intere t. to collect the rents, tunes, w
a a wh-n so collected shill
to tbo at a "Boost of 01 tb epsb action, and such rents, issues. and profits
dw V1199" 6011 ` I e0a1lt i' fit' any legal or egcitable interest in the Property (by assig "!Wt , rf
as coavey s®aA tist traosler. an r term lease or in any other a•ay 1 without the prior
W% two avAsr *111 CoNraat or by option, long'
thre the outstanding balance payable under this Contract ss fast paid in full or the Is
iel< li 9 silo" of seny interest under this Contract sole} as security for an b14ebtw 8110*
the entire
asy M& transfer, sale or conveyance without Vendor's written consent,
. i tshial become imrriedistly due and payable in full, at Vendor's option witbelbtO
s y when d b ultdcr any
haser)ntort un er outstanding avoinst the Property on ote secured thereby. PrrovidN «Vi rated by may mu,.e any such aytnesils~ditn~!
su Contract except foe any ~settgtia t'>~ ntract. Purchaser es
ta~raN It of the amount then due under this Co made by Purchaser shall be consider payments 11 1
the MortAtea f VeirBor fait to do so and all pa~•ments so Y
tlds 40bnteact. of Purchaser.
Vander stay waive any default without waivinK any other subsequent or prior default o
the
Vendor a inure
benefits of All terwts of tide Contract 04 Purrchaserf n (ltpr of andowner ofothe Pr operrt7a~s he hers. legal r
to loin in the ~qft dt 0be
and Vaidor sad the spouse of
i in! to release homestead rights to the subject Property
taade aM y~ys lnereof.l Decenter , 19 91. _s.
jyy
taw this - day of <
falfith"Al
(SEAL.) E l4K~i1
• Daniel C, Davis
>~s
• - - - . r. (t tc . J ~~..l. Yoh--JL ~ . -
(SEA L1
Wendy S-. Skinner G O
ACKNOWLEDGUNNT;
AQTHNNTICATION
~
STATE OF WISCONSIN
W.
Signature(a)
St., Croix County. 1
.
.
Personally came before me this
December 1991 the above
der of 29
authenticated this
Daniel C.,. Davis
.
TITLE: MEMBER dTATF. BAR OF WiSCO?JRi.
authorized by 106•• Wis• htata.) to me l nown to he the person . 5...-_... who+
ton :'cHnt+ inserar"t. and acknowledge the sarew
-111, ~NSIRUMI NT Wt 4 DRAFTED I?.Y
~ g
Reuben Dearni`nk
+ Carl L..- Pete rsion.
. ,
Iy Public St Croix
. ; - ~f~ l'ommtss:ron is permanent. (it not. ate~t ~ ,
(Sit:nattnrea may be nnthentleated or slckni,a•lcdired. Ltot)• ~
date: AUQUSt .27 r .
- ttr+• not pero!iita'r}' ,
° ' - - trhw uwtr sisnao