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a ST. CROIX COUNTY
WISCONSIN
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Not ZONING OFFICE
t'ua+nS.
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ST. CROIX COUNTY COURTHOUSE
Y7 911 FOURTH STREET • HUDSON, WI 54016
7~i - -
(715) 386-4680
E
June 8, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern: /
An onsite investigation of the Gordon Green property, located in
the SE 1/4 of the NE 1/4 of Sec. 1, T30N-R17W, Town of Erin
Prairie, St. Croix County has been conducted.
This onsite revealed suitable soils at a depth of 24". This site
does require 12" of sand fill beneath the mound for new
construction..
Should you have any questions, please feel free to contact this
office.
erely,
mes K . Thom s n
Assistant Zoning Administrator
cj
iartrr e~ntl0 1,EsWIE 01. 30 PRI~% * SEWAGE ?YSTEM County:
Labor,and Hlu'Tan Relations INSPECTION REPORT
' Safety and,Buildings Division ST. CROIX
• (ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
171461
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
GREEN GORDEN ERIN PRAIRIE V/ru
BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: cct7 ~ /ru
01 -100 -
TANK INFORMATION ELEVATION DATA A9200226 -
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /<S
UuD Benchmark , 0
Septic S
Cln
Dosing c.o
Bldg. Sewer
Holding St/010C Inlet Sji Say
TANK SETBACK INFORMATION St/ Outlet 6 1 5'
TANK TO P/ L WELL BLDG. Ve Intake ROAD Dt Inlet 7/
Air Septic >jCIO' NA Dt Bottom
Dosing NA Header / Man.
Ae Ion NA Dist. Pipe p r
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer `C. Demand 'r iZ"
6 ~
Model Number GPM
3
TDH Lift 3 / Friction System~~ TDH Ft Loss
Forcemain Length ` Dia. tC; Dist. To Well >7511
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT ide Dia. Liquid Depth
DIMENSIONS `f DIMENSIONS
LEACHING Manufa er:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION Typeo r CHAMBER Mo a Number:
System: el,~ OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) , x Hole! ize x HolSpacing Vent To Air Intake
Length 13142~_ I Length Dia. I? Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over / Depth Over , xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center / p2 „ Bed /Trench Edges Topsoil r~ [>es~Q No ~jYes~" ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) z ,r
1
Plan revision required? E] Ye P_N_0 ~7
Use other side for additional information. ,z ~3 f
SBD-6710(R 05/91) Date inspector's Signatu a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: t•
:4DlLHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
A SANIT Y PERMIT# _ff
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ `~4111on C/(/~ 1
8 % x 11 inches in size. c ecl(if 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
l(.~ r c Qt, 5i:-: '/4 Ma- '/4, S f T 20 N, R /7 . E (or) W
PXERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
J( 75.0 /~Cp r A-Je.
CITY, STAT ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR CSM NUbMER2 a) 1, 1
_31 ~Zl
II. TYPE OF BUILDING: (Check one) 11 State Owned CI VILLAGE ~CAl,4 ` NEAT RO~q
❑ Public 14 1 or.2 Fam. Dwelling-# of bedrooms 3 PAR L TAX NUMBER(b)
III. BUILDING USE: (If building type is public, check all that apply) f (O ~D
1 ❑ 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. 0 New 2. ❑ Replacement 3.E] Replacement of 4.0 Reconnection of 5.0 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 N Mound 30 ❑ Specify Type 41 ❑ 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
450 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
-~-7~-40 so,D Feet os'~`r
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank AM I DQ )Q F1 F1 I M
Lift Pump Tank/Si hon Chamber Irt F1 I F1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu er's Signature: (No S Lmps) M MPRSW No.: Business Phone Number:
1_0 4-,9
Plumber's Address (S t, City, state, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
p Disapproved San'tary Permit Fee (Includes Groundwater Date issued I u ng Agent Signatur Stamps)
) n~
Approved ❑ Owner Given Initial Surcharge Fee
1l
(0
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8, Buildings Division, Owner, Plumber
INSTRUCTIONS d
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.
Changes in ownership or plumber requires a San,tary Permit Transfer/Renewal Form (SED 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 ycu have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety 8 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 131/2 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.
SBD-6398 (R.11/88)
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ONSITE SEWAG SYSTEM
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AS BUILT SANITARY SYSTEM REPORT
OWNER Cm! Ahsa ne-" TOWNSHIP_ _ E e41 k P4tkC kT Q
SECTION T10 N-R 11 W
ADDRESS ~QSD / fi13TILAiE~ ST. CROIX COUNTY, WISCONSIN
/Ye,Lj it);,, C /-7
SUBDIVISION LOT LOT SIZE
PLAN VIEW
H EVERYTHING WITHIN 100 FEET OF SYSTEM
af'
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INDICATE NORTH ARROW
BENCHMARK:Elevation and description: d&Y, .M 6~S 306(014
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap. If= Q
Rings used:QManhole cover elev: gtWelev:
Tank inlet elev.: I IrQ
~nk outlet c~--v':f
No. of feet from nearest road:Front Side, Rear Ft
From nearest prop. line:Front , Side, Rear Ft. LAS
'
No. of feet from: Well /L , Building: /4
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
PUMP CHAMBER
Manufacturer: U Liquid Capacity: U
Pump Model:39Pump/Siphon Manufact. . 4,m~ ump Size cV~
Elevation of ' n'kl v~~
Pump on elev 1 um o elev.:
p Alls cycle. aal
Alarm: Man.: Switch Type: ocation
Distance from nearest prop. line: Front- SideRear_Ft.]~
Distance from: Well ...7 Lobf Building 2 1
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
r
Width: -Length -Number of Lines: Area Built S
Exist. Grade Elev. . Proposed Final Grade Elev. /D`S!' y
Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft.7Q
No. feet from well: /Ode No. feet from building (06,
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well building nearest road
Alarm Manufacturer:
INSPECTOR:
DATE: ~Z PLUMBER ON JOB:
LICENSE NUMBER: AAPf
6/90:cj 6 9
0 4
0005 ~
! Z~
PUMP CHAMBER
Manufacturer: LJAO,~ Liquid Capacity: o
Pump Model:05;P39.Pump/Siphon Manufact.. "AIPump Size 410
Elevation of j?jgnk(;l1,:.~ v
Pump on elev21 um P o elev.: ans c cle:
Y
Alarm: Man.: Sa F~~ Switch Type: tKA_0~_Clq~ocation
Distance from nearest prop. line: Front, SideX , Rear-Ft.]
Distance from: Well 7 -Building
SOIL ABSORPTION SYSTEM IV'►
Bed: Trench:- -Seepage Pit:
Width: Length_Number of Lines:_L_Area Built,? ` 1
1 Mfr'
Exist. Grade Elev,16LI Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side, Rear Ft. 2-
No. feet from well: 7 100r No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front Side Rear Ft.
No. feet from: Well building nearest road
Alarm Manufacturer:
INSPECTOR:L _
DATE: PLUMBER ON JOB:
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itSiRY• Lim e - /2
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c ~ TV,
p,.PA i n q
p1VlSiON, RICE Distribution Pipe
SVe ifi (r S n d E -
Topsoil H IG G_ ' 1 Z t~
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E
Slope
Bed Of 2 1. Force Main Plowed
Aggregate From Pump Layer
Cross Ssicfion Of A Mound System Using 90 Q 94 f+, ~ tr" For The Absorption Area L- ..L-T I-~'
Z f~, w Z-Z. ;
L
Observation Pipe
- - ( Force Main
W o f From Pump
Distribution Bed Of i - 2 2»
Pipe ' Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using AFor The Absorption Area
51GNED: LII.tN,t NUM0r-'K; ' UAtC. I
i-a
0P
TI.0AA _.,VOKI(SHEET M~'R~ Z
lj , serf, < - 3~' N, k 17 ~-c1' _S Cam) x C 4~~
1„ R4OUN.YiIchi /O1.0 Lt. CST . r-iH 9
II. IN-GROUND PRESSURE SYSTEM•Conttnued-
1. Wastewater Lord, Total Daily Flow= gal. 10. Force Main: Q~
Use s. ILHR 83. 15 (3) (c) Minimum Dosing Rate= Rpm-
Adm. Code and PROVIDE A DETAILED Diameter = in.
LIST OF SIZING ON PLANS. - 11. Total Dynamic Head:
2. Depth to Limiting Factor = ft. System Head = 2.5 ft.
3. Landslope = _ . % Vertical Lift = ft,
4.. Distance from Dose Chamber to Friction Loss= ft.
Distribution System = ft. TDH
ft.
5. Elevation Difference Between 12, Pump Selection:
Pump and Distribution System = f ft. Pump will discharge at least gpm
6. Absorption Area Sizing: at 4!~, 1_ft. total dynamic head
Area Required = ~7S sq. ft. Pump odpfI and manufa hirer: dgP 33
Bed or Trench Length (B) _ ft, md`A r... ee
Bed or Trench Width (A) • ft. 13. Dose Volume:
Trench Spacing (C) • ) ft, 10 Times Void Volume of
a. Mound Height: Distribution Lines= /541 gal.
Fill Depth (D) ft. Daily Wastewater Volume+
Fill Depth Downslope (E) • ft. 4 Doses In 24 hrs. • gal.
Bed or Trench Depth (F) • ft. Backflow = gal,
Cap and Topsoil Depth (G) • ft. Minimum Dose = gal,
Cap and Topsoil Depth (H) • ft. 14, Dose Chamber:
8. Mound Length: Volume gal,
End Slope (K) _ SIG::? ft,
Total Mound Length (L) • ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: , 1. Wastewater Load, Total Daily Flow • • gal.
Upslope Correction Factor• Use s. ILHR 83.15 (3) (c) , Wis.
Upslope Width (1) • ft. Adm. Code and PROVIDE DETAILED
Downslope Correction Factor • LIST OF SIZING ON PLANS.
Downslope Width (1) _ ft. 2. Required Septic Tank Capacity = gal.
Total Mound Width (W) • ft. 3. Percolation Rate =
min./in.
10. Basal Area: . 4. Absorption Area Sizing:
Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83
Natural Soil = and PROVIDE A DETAILED LIST OF
Basal Area Required • sq. ft. SIZING ON PLANS.
Basal Area Available • sq. ft. Required Area = sq. ft.
11. If Standard Tables from Chapter ILHR 83 Length = ft,
are used, Indicate Table # Width = ft.
12. For the Distribution Network, Use Numbers 5-14 in Section 11. Number of Trenches •
11. IN GROUND PRESSURE SYSTEM Trench Spacing = ft.
S. Distribution System:
1, Depth to Limiting Factor • ft. Lateral Length = ft.
2, Landslope = % Number of Laterals =
3. Percolation Rate • min./in. Lateral Spacing = in.
4. Proposed System Elevation • ft. Distance from Sidewal) to Pipe = in.
5. Wastewater Load, Total Daily Flow: gal, System Elevation = ft.
Use s. ILHR 83. 15 (3) (c) , Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL
LIST OF SIZING ON -PLANS. ` Fill in All Items from Section III
Required Septic Tank Capacity • r( gal,
6, Absorption Area Sizing: V. SEPTIC TANK
Percolation Rate n. 1. Capacity =
= . ft.
Area Required sq
sq. ft. 2. Manufacturer: UJ
System Length = ft. 3. Show Site Constructed Tank Details on Plan
System Width = ft.
7. Distribution Pipe Sizing: VI. DOSING TANK
Hole Sirc = i in. 1. Capacity = i,
Hole Spacing = ft. 2. Manufacturer:
Lateral Length • ft. 3. Pump M inulaclur•
Laicr.d Sim In. 4. Pump Mudcl:
L.iler.tl Spacing It. 5, Operating Head= ft.
Distance Irnnt Sitlewalido Pipe in. 6. Flow Rate= gpm.
H. Distribution Pipe Discharge Rate: 7. Show Site Constructed Tank Details on Plans
Nunther of I toles I'et Pipe
1 luw 1'ut' I'il+ _ Itttt, VIII. IIOI.UING 1 ANK
Witold Si/ 1. Capacity = gal.
)c enlct or unit) 2. Man1.11JO lrer:
I t It. 3. Show Site Constructed Tank Details on Plans
Olamctur = in.
-SHOW ALL INFORMATION ON PLANS-
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
' INDUSTRY,, DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSH MUNI ALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
F 1/ N V/ 1 /T36 N/R 11 E (O 1 0.04 Hr oa r" Q_ - - -3 5.5 cures
COUNTY: MAILING ADDRESS:
G: CM-6 Gallo". Gr a 9 0 /~c~t" Je kc~.'",a~
USE DATES OBSERVATIONS MADE
BEDRMS.: COMMERCIAL DESCRIPTION: [PROFILE IONS: 1PERCOLATION TESTS:
W Residence
It`JResidence V /14 XNew ❑Replace 57/ ZQ 1 O Z Z_
RATING: S= Site suitable for system U= Site unsuitable for system ~p of 7
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
rk .1 sou as[K u [IS NU ❑s~u md,~,A
osou
Prcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the .r
der s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /V /4-
L-II- PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- r 60 I6ZrO'y 29 6u 91, te" S,( S I 9`'1--ZV'9 t 5.1 rt Ca6,?_V!
Z 9d S i -s ca 89,L 5<! B
".5 T. / Af< 66vRd 9. s 1 4 C44 w /d
B- Z 60 -/y /pN hdivvc 2'51 w" ZY 3211"
2 'It B- GAOr iu ti t~ v 7`, 3~t~ ..(op << t 1 w ACL
B-3 66 /03`D' n.~ le, Z~ /7 ff- Z K s~ (v B~ ~~c gs
- PK61--
B 3 (c~``r' boo`` fC B~ U, A CM 114
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD PER INCH
P- I
P- to
P- \ 'Z
P- I
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 qoi s 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 ' ~Ow
CA_ e_
a ~ a t
3
1
I
1 j I ~7{
1 ~~-,ill
N
E
F
N-i
T
I, the undersigned, hereby certify that the soil tests reported on 't for' im ea y me i44
th t o dures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the test tc the owl ge d belief.
~rt
NAME (print : ~ STS WEFUIE COMPLETED ON:
it
sT y 9 Z
&4ka 4-A
ADD SS: /ro ry CERTIFI N NUMBER: PHONE NUMBER (optional):
u
S
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
)ILHR-SBD-6395 (R. 10/83) -OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 -
To be a.completel and accurate soil test, your report must include:
1. Complete legal description;
2. The use soctign 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;
8. 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
aplyropiiiete;
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
Boll Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under T') LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
Is - Fine Sand Bldg - Building
Is Loamy Sand > - Greater Than
'sl - Loamy Sand < - Less Than
`1 - Loam Bn - Brown
'sil - 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 fff - few, fine, faint
'c - Clay cc - common, coarse
mm - Many, Medium
pt - Peat
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
I
j
TO THE OWNER:,
This soil test report is the firit step in securing a sanitary permit. The county or the Department may request
verification of thissoil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application roust 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.
DEPARTMENT OF REPORT ON Sok
INDUSTRY, CCpp//~+~wt
LARC?R A~VD PER1x1~J PON W 1
HUMAN RELATIONS
83,?f M &L~. r 3
1/4: f*- 1/4 IM N/tt
cOVN A ;c
5~* C4-6 1, Ab
l1SE ~ rF •'`!i
~l.~@$IdeRCa ~l] / ~ LAJ ~~W ~...r{~Pf7~0A1
RATING. S°- Site suitable tot system U= Site unsuitable forstislerr+
ms, 24- Ej I
r . S • F'd
Percolation Tesu are NOT r"olred ff Arty! ~Ct1
-111 der s. ILHR.83.09(5)(b), Indicate= Elac>t#ttajn'„
MCIFILE DESO-Al
I$08ING AL P H OC1N A MN HE CHIk :C
NLUSER fyiFl IN. ELEVATIIGN p u T O !b
i
,3 66
,,'PERCOLATION
Tiws
DEPTH WA I1~H IN HOLE T ST TIME ~f~ WAI
IbLNJFiER INCHES AFTER SMELLING INTERVAL-MIN- Ft C t
P-` A:
Mb* PLAN-, Show locations Of percolation testa, soil botinga and tr}e dimensidins 'of &u1!1
.pMat and vertical. elevatipr4 rotprence Rolfrt aild'Fhrlw them rC tin on,the plot plan.
d#farx9 slime, I
SYSTEM ELEVATI IV
~-JT all,
1
1, the undersigned, hereby Certify that the soil texts reported op,.th~for~ wore. mode by ,w in
Administrbtive Code, and that the data recnrdecl arld the IACa itisr Lof'the t;i4g4 JTe A tq she be
ADt3'R~'E151; -
QISTRIBLITION: Original and one cony to Local AwTho, ay. riorierty Qwnw amf ;loll 't'ester.
DILHR-SBD•6395 (R. 10/8.3) OVER -
S T C - 105 H
SEPTIC TANK MAINTENANCE AGREEMENT rt
St. Croix County
r
OWNER/ BUYER a ~~1 0
ROUTE/ BOX NUMBERS J '`~61-16- 2d Fire tdumber~
AA~~ d
CITY/ STATE 1~ P.t c)' t.~ i . ZIP S`~ O -7 M
PROPERTY LOCATION:'.5E_k,~&k, Section T ~V N. R E 7W,
Town of ,Nl lrC7`a Pi St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed '~sep~tic tank pumper. What you put into
the system can affect thi function o the-septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents may be eligible to recieve 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 'sys'tems agree to keep their system properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater 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.
H
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 Depart- W
meat of Natural Resources. Certification form must be completed .d
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the 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 tesah by
ovner/contcactor,(spec house)p then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
- - - - - - -
- - - r - - - r- r- --r - - r r ---r------------
Owner of property G0-f-A6cn Gr0, g
-aE,_.1/1 ,l/4, Section T 5~ P-RJ_-V
Location of property
Township .,Ev'~ 4 ! T~ I V,
Mailing *adze$$ 96,0 H070t A-ti~..
c'~ (IV, a 64 Q t
~~Sl Lot
• Address of site
Subdivision name l) A4
Let number
Previous owner of property „ D~J;~, ~tia✓~i 4.5a J'OA
Total size of parcel -z::,~ • Q CV-101,
I
Date parcel was created
Ace all cornets and lot lines identifiable? as 0
Is this property being developed for resale Cspsc house)? as k/lo
Volume 74k and Page Number ;as recorded with the Register of Deeds.
- - - - - r - - r - r - r - - r r r r - - r- - • - -r - - - - -
INCLUDE
WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DENO which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NU11at;R, and
the BRAL OF THE REGISTER OF DEEDS. In addition, a testified survey, it
available, would be helpful so as to avoid delays of the reviewing process. It
the deed description references to a Ces;tifled Survey Map, the Cettified survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(Vs) cettlfy that all statements on this form are true to the best of my (out)
knowledge; that I (we) am (ate) the ownerts) of the property described in
this lntotmation totm, by virtue of a warranty da d r cotded In the office of
the County Registet of Deeds as Document No. and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to tun with the above described property, for the
conettuctlon of said system, and the same has been duly recorded In the office
of the County Register of Deeds, as Document No.
Signature of owner signature of co-owner III Applicable)
41- -19. - -L
Date of Signature Date of Signature
% DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-IM
482230
REGISTER'S OFFICE
Howard Whiteford and Charity Whiteford, husband and wife ST. CROIX CO., WI
as j - o in.i.n-t t enant - s - Recd for Record
- AP P 2 01992
- -
conveys and warrants to --Gordon-_B.-Green ----------------of 1:50 P M it
nn
- - - - Register of Deeds
RETURN TO -
the following described real estate in St_.-_ _Croix County,
State of Wisconsin:
Tax Parcel No:
j
j The Southeast Quarter of the Northeast Quarter (SEJ of NEJ) of Section One (1),
Township Thirty (30) North, of Range Seventeen West, EXCEPT all that part
thereof which lies East of State Trunk Highway "63". j
i,
ii
I,
it
iI
i
~I I
I~
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ii
This is-not----
homestead property.
it (is) (is not)
Exception to warranties:
-
Dated this - day of April 19.92....
i~ - 19.92
A
- - - -------------(SEAL) _ (SEAL)
I
~ *Howard Whiteford
_ ~ - ~ - - (SEAL) "4 - - -------(SEAL)
1-1.
j Ich- -ity 'teford
I.
I;
,I
I
AUTHENTICATION ACKNOWLEDGMENT i
ii Signature (s) -Howard Whiteford- and Charity STATE OF WISCONSIN
Whiteford ss.
County.
I
ii authe icated h- .~__[___taf ofApril 1 19__92 Personally came before me this ________________day of
_ rr
Q4., f 19_..--••- the above named
t * Hendrik W. Van Dyk
•
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- jl
authorized by § 706.06, Wis. Stats.) j
to me known. to be the person who executed the j
foregoing instrument and acknowledge the same.
ij
THIS INSTRUMENT WAS DRAFTED BY ii
j Reinstra, Van Dyk & Needham, S.C. it
j 201 _ South Knowles Avenue,---Box-•1-2-7-------------
New--R-ic- m-ond-r---W1.... 4-0-1-7---------------------------------- Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19----
11 *Names of persons signing in any capacity should be typed or printed below their signatures.
-ARR°~VTY TWIn STATr RAR nT? WTSC.nNRTN Wisconsin Legal Blank Co., Inc.
IL
I
DOCUMENT NO. WARRANT 1~ DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM -2 -1982 j
482230 -7. 1
REGISTER'S OFFICE
Howard Whiteford and Charity Whiteford, husband and wife, ST. CROIX CO., WI
as j oint - t enant - s - Recd for Record
r
APP 201992
conveys and warrants to . Gordon B. Green at 1:50 P M
..---------------~~C.~
Rof Deeds
RETURN TO
. -
the following described real estate in St•.•_ Croix County,
State of Wisconsin: _
Tax Parcel No: 0(Z----
I
The Southeast Quarter of the Northeast Quarter (SEJ of NEJ) of Section One (1),
II Township Thirty (30) North, of Range Seventeen West, EXCEPT all that part
thereof which lies East of State Trunk Highway "63".
i
ITE
i
i~
I
II
i
~i This is not homestead property.
(is) (is not) j
Exception to warranties:
I,
!i
Dated this - 1 day of --April------ - - 19 92
1
r
- - ------------------(SEAL) 6~.---- (SEAL)
- -
*Howard Whiteford
1.7
(SEAL) i ✓:r a?J ` t uf----- (SEAL)
*Charity teford
- -
II
it
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) .Howard Whiteford and Charity STATE OF WISCONSIN
i
l
Whiteford ss.
da oAp r il
authe icated h'
f 19_ - 9 2 _ Personally came before me this day of i
4L~ -------19-------- the above named
r ^ `
K!_
Hendrik_ W. Van DY.k
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- -
I~ - - - - - _
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
~i foregoing instrument and acknowledge the same. j'
THIS INSTRUMENT WAS DRAFTED BY
Reinstra, Van Dyk & Needham, S.C.
201 South Knowles Avenue, Box 1.27------------- *
New--Riehmo-nd- ---1-••- 40-1-7--------------------------------- Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date- 19--•-•---•)
"Names of persons signing in any capacity should be typed or printed below their signatures.
'i
*'rt.TtR *1TY DFRtI STATE BAR OF wTSCONSTN Wisconsin Legal Blank Co., Inc.
ST. CROIX COUNTY
45F' y~ WISCONSIN
ZONING OFFICE
III -
ST. CROIX COUNTY COURTHOUSE
71-1
r 911 FOURTH STREET • HUDSON, WI 54016
-1 (715) 386-4680
IW
June 8, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite investigation of the Gordon Green property, located in
the SE 1/4 of the NE 1/4 of Sec. 1, T30N-R17W, Town of Erin
Prairie, St. Croix County has been conducted.
This onsite revealed suitable soils at a depth of 24". This site
does require 12" of sand fill beneath the mound for new
construction.
Should you have any questions, please feel free to contact this
office.
Qe rely,
.mimes K. Thom9son r
Assistant Zoning Administrator
cj
• ST. CROIX COUNTY
WISCONSIN
{f.M
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
June 8, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite investigation of the Gordon Green property, located in
the SE 1/4 of the NE 1/4 of Sec. 1, T30N-R17W, Town of Erin
Prairie, St. Croix County has been conducted.
This onsite revealed suitable soils at a depth of 24". This site
does require 12" of sand fill beneath the mound for new
construction.
Should you have any questions, please feel free to contact this
office.
erely,
mes K. Thom son
Assistant Zoning Administrator
cj