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Safety and Buildings Division INSPECTION REPORT CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.:
14 63
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
CAND RUSSELL E & DEBORAH FOREST
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
014-1062-10-000
TANK INFORMATION ELEVATION DATA A9200341
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic uJI- Benchmark f
`Z.33
Dosi
rig, e&,4fil
Aeration Bldg. Sewer
Holding St/ Inlet
TANK SETBACK INFORMATION St/ Outlet 01
d C,2
TANK TO P/ L WELL BLDG. Ventto ROAD
Air Intake Inlet
1
Septic r D r NA
Dosi NA Headed. r r qQ_- 637
Aeration F NA Dist. Pipe .
Holding Bot. System S Z~ 91, 3F~'
PUMP/ SIPHON INFORMATION Final Grade
Man r Demand o~5. T~ 6 r
Model Number GPM ° r'~ 7
TDH Lift Friction tem TDH Ft /0(v, r
Forcemain Length Dia. Dist. o
SOIL ABSORPTION SYSTEM
Lengt l No. Of Trenches PIT f Pits Inside Dia. Liquid Depth
I I
BED /TRENCH Width
DIMENSIONS DI I N
7
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACH'146 Manufacturer: ___W INFORMATION Type O r r CHAMBER um er:
SETBACK
ystem: w 7/Sd OR UNIT
DISTRIBUTION SYSTEM
Header t~ Distribution Pipe(s), r x Hole Size x Hole Spacing Vent To Air Intake
Length t
_ Dia. Length Dia. y ~ 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 __TT~
Bed / ~eweh Center/9- ~ Bed / Freneh-Edges /Q Topsoi ❑ Yes ❑ No ❑ Yes
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes E .P14"` kdsl/ Use other side for additional information. gnie 9
SBD-6710 (R 05/91) f ,yam D` e Inspector's Signatu a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
{
I
SANITARY PERMIT APPLICATION
E:D1LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~-Al
,Q tr.
8% x 11 inches in size. 1:1 Ch r is on 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
A, 1F% %,S_70 T-71 ,N,R (ollm
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
fr).2 VV
II. TYPE OF BUILDING: (Check one) ❑ State Owned O VI LAGE : NEAREST ROAD _ a 7a ❑ Public L t' 1 or 2 Fam. Dwelling-# of bedrooms .7- PARCEL AX N ER( )
111. BUILDING USE: (If building type is public, check all that apply)
1 El Apt/Condo _/0
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. El New 2.,®-Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
-rO all" O 1-7 Feet 6 Feet
VII. TANK CAPACITY Site
in gallons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank OBO Qfuy
Lift Pump Tank/Si hon Chamber El T M 1:1
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY /DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a t Id
e ssue Issuing A nt Slgnatur o Stam
Approved Surcharge Fee)
E-1 Owner Given Initial 9~--
Adverse Determin lion
X. ,.PONE TI NS OF APPROVAL/REASO FOR DfSAPPRO A • m l:E~-n
cyA~&~ ZAP
~C
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS
1. Asanitary 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
si bmitted to the county prior to installation. x
5. Onsite sewage systerbs 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 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.
Vill. 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 mains1water 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 'k15 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)
STC-100
This application form is to be completed in full and the owner(s) of the property being developed, Any Inadequacies
will only result in delays of the e tdevelopment be intended for resale by~owner/contr ctor (d this
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 ~ U.55e 11 C, A r (-arS d
Location of property N r 1/4 1/4, Section Jo
T1N-R l5 W
Township
~Ore.S t-
Mailing address h+1
~l cc 1~ ~i c ons, 5-
Address of site
/qpo ~?afh ,5tree_t'
Subdivision name
Lot no.
Other homes on property? yes ✓ No
Previous owner of property ~ car 1 L~cn ~ in
Total size of parcel
y a °_res
Date parcel was created nQL 'n +o owner
Are all corners and lot lines identifiable?
Yes No
Is this property being developed for (spec house)? Yes
✓ No
Volume-k 9 and Page Number _
of Deeds. as recorded. with the Register
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT
NUMBER & THE SEAL OF THE REGISTER OF DEEDS VOLUME AND PAGE
certified surve In addition, a
y, 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
the property described in this information form, bthe owner( y virtue sof of
warranty deed recorded in the office o
Deeds as Document No. f the County Register of
own the proposed site for the ~ sewage~ disposal and t sI (we
e)
ystem) oprresently
I (we)
obtained an easement, to run the above described rt, for
the construction of said system, and the same haso been duly
recorded in the office of County Register of deeds as Document
No.
Signature of applicant
Co-appl nt
Date of Signature
Date of S gnature
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ R u.55o 1 I E Arc can d-
ADDRESS: 7O +h S+reut- FIRE NO: 19 a 0
LOCATION: N 1/4, NE 1/4, SEC. X30 T 31 N-R 1.S W, NE A)E
TOWN OF: Forest ST. CROIX COUNTY I Q.5
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 to
help with the cost of the 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 system properly
maintained.
The property owner agrees to submit to the 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 from 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 DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED: .
DATE:
-
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
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at`quarter of the Northeast quarter (NEB-NEk) of S*'
Ilp, Range 15W, St. Croix County, Wisconsin.
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dpa Industry,
and Human Relations SOIL AND SITE EVALUATION
Labor REPORT Page of
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
LINTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ID. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPER OWNER: PROPERTY LOCATION
GOVT. LOT 1/4 . 1/4,S3 T_.`~ N,R / E (odW
PROP OW R':S MAILING ADDRESS LOT BL # SUED. NA OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑ ITY ILLAGE jff0 N NEAREST ROAD
~
S-1 -2 Lr- 1 -
O New Construction Use pC] Residential / Number of bedrooms _ O Addition to existing building
~Q Replacement Public or commercial describe
Code derived daily flow ~Q gpd Recommended design loading rate bed, gpd/ft2 , _f' trench, gpd1 t2
Absorption area required Z(~Q<;- bed, ft2 94D - trench, ft2 Maximum design loading rate bed, gpd/ft2 . / trench, gpolft2
Recommended infiltration surface elevation(s) 91 ft (as referred to site plan benchmark)
Additional design / site consi erations
Parent material it . , 5, /Zy Flood plain elevation, if applicable it
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U - Unsuitable fors stem WS ❑U OS ❑U 0S ❑U 79S ❑U ❑S I9U ❑S OU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxbry Roots GPD/ft
In. Munsell Qu. S Cont. Color Gr. Sz. Sh. Bed Trerich
Ground 3 _
e, Z LJ
l
Depth to _ s..
limiting -
factor
I
Remarks:
Boring #
A/ 1A
7 q1 4111 -12, ~rl
Ground
elev. N s~
~L 444-/7 mad,' z9a i zo _Y/
Depth to - -
limiting
factor
Remarks:
CST Name:-Please Print Phone:
Address:
Signature: Date: CST Number:,,/
PROPERTY OWNER - SOIL DESCRIPTION REPORT Page&_of
PARCEL I.D. 8
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourcW Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
;:,2 -9--22 zin 1AJ
Ground
elev, „
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Depth to -
limiting
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Remarks:
Boring #
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elev.
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Depth to _
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Boring #
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Depth to
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Remarks:
Boring #
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Remarks:
SBD-8330(R.05/92)
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REPT131 FORESTER ST. CROIX COUNTY ZONING PAGE 1
¢4/25/92 09:00 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/28/92 AREA: JT
Activity: A9200341 9/28/92 Type: CONVSEPT Status: PENDING Constr:
Address: FOREST 30.31.15.465,NE,NE, 270TH
Parcel: 014-1062-10-000 Occ: Use:
Description: 180263
Applicant: ARCAND, RUSSELL E & DEBORAH Phone:
Owner: ARCAND, RUSSELL E & DEBORAH Phone:
Contractor: WILSON MICHAEL E. Phone: 268-2537
Inspection Request Information.....
Requestor: MIKE WILSON Phone:
Req Time: 09:09 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Parcel 014-1062-10-000 04/05/2007 12:36 PM
PAGE 1 OF 1
Alt. Parcel 30.31.15.465 014 - TOWN OF FOREST
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 - BEESTMAN, JUDI L
JUDI L BEESTMAN
1980 270TH ST
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1980 270TH ST
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 30 T31N R1 5W NE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-31 N-1 5W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/16/2001 651179 1680/433 WD
07/23/1997 973/307
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/18/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 15,000 51,300 66,300 NO
AGRICULTURAL G4 10.000 1,500 0 1,500 NO
UNDEVELOPED G5 28.000 28,000 0 28,000 NO
Totals for 2007:
General Property 40.000 44,500 51,300 95,800
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 44,500 51,300 95,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 311
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Industry, Sol A L U AT I O N REPORT Page Of
Labor 2nd Human Relations 1 ,
Division of Safety & Buildings accor with 05, WIS. Adm. Code
~ COUNTY 1
J
Attach complete site plan on paper no than 1 in Ian must include, but
not limited to vertical and horizontal r ce point q 1 dir n an o f slope, scale or PARCEL I.D. #
dimensioned, north arrow, and locatio d~'sta~~lo n*%!pst road.
REVIEWED BY DATE
APPLICANT INFORMATION-PLE P I6A#RM
PROPER OWNER: C PROPERTY LOCATION
' GOVT. LOT 1!4 1/4,S~OT~ N,R E (o(W
41 27
PROP OW R':S MAI I G ADDRESS - LOT BLO # SUBD. NA OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑ ITY VILLAGE DOWN NEAREST ROAD
-
(7/-1
[ ] New Construction Use Residential /Number of bedrooms [ ] Addition to existing building
pQ Replacement [ ] Public or commercial describe
Code derived daily flow , ='&Z gpd Recommended design loading rate bed, gpd/ft2__,,:§- trench, gpd/ft2
Absorption area required 11,2-< bed, ft2 961 trench, ft2 Maximum design loading rate , bed, gpd/ft2_,~trench, gpd/ft2
Recommended infiltration surface elevation(s) 91,X ft (as referred to site plan benchmark)
Additional design / site cons erations
Ao
Parent material r r 13-^ _~n, Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem 0S ❑U OS ❑U 0S ❑U CAS ❑U ❑S 19U ❑S OU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouncbiry Roots GPD/ft
Boring # Horizon in. Munsell Qu. S Cont. Color Gr. Sz. Sh. Bed Trench
kit Al~
Ground
elev.,
2V~ft-
Depth to s- - -
limiting
factor
Remarks:
Boring #
7,
l, r_2
OLJ
Ground sw
elev. „
ft.
Z~-7_21 W412 A1,10
Depth to
limiting
factor
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Remarks:
CST Name: Please Print Phone: 12 2Z
Address: 1
Date: CST Number:, .
Signature:
~Lz S~~21 9,2 ,,-2
PROPERTY OWNER Ld SOIL DESCRIPTION REPORT Page,.-~ of
PARCEL I.D. # .
i
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
.,.,...:<..<.>.:; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
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Remarks:
Boring #
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Boring #
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Wisconsin Department Relations Industry,
La Human Relati SOIL AND SITE EVALUATION REPORT Page _L Of
lx~rxl
~1,tion Msafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP OWN PROPERTY LOCATION
_ GOVT. LOT 1/4 1/4,S 30 T AR 40r)~g
PROP RTY OW ER':S MA LING ADDRESS LOT BLO # SUBD. N E OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE BLOWN NEAREST ROA9
~~Zge,4 4a_~ -7 ,
eg~;?'_ Z,!) '
[ ] New Construction Use N Residential / Number of bedrooms 3 [ J Addition to existing building
Replacement [ J Public or commercial describe
Code derived daily flow ~Sf gpd Recommended design loading rate bed, gpd/ft2,Z_,_2_trench, gpd/ft2
Absorption area required 37s bed, ft2 _ ~?7S trench, ft2 Maximum design loading rate _Z,.~? bed, gpd/ft2_Z_,~2 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site.considera'ons
Parent material se, /b_ Q~ '`?gO _ Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND 1 7 IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U ®S ❑ U ❑ S (ZU ❑ S ®U ❑ S 10 U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.rndar)r Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed
Trt~tch
0- g
q/:J ~ 7g
Ground s z, ~Em e2 _ _1 42 V"a ALL
elev.
Depth to
limiting
factor
Remarks:
Boring #
a
7, Ye
Ground
elev.
9' ft.
r
Depth to n~ . ` 4 9
limiting
I
factor
Remarks: s'
CST Name:-Please Print Phone:
/S -
Address:
Signature: Date: CST N m er:
PROPERTYOWNERi~~ l Oslo SOIL DESCRIPTION REPORT Page-of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. Bed Trerd
4>...3
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Ground
elev.
Depth to
limiting
factor
„
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
F-T
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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onsirrl)epartmentof Industry, SOIL AND SITE EVALUATION REPORT Page _of
r and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 1/4 rJ 11/4,S T / N,R % S W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE NEAREST ROAD
[ j New Construction Use [ esidential ! Number of bedrooms Addition to existing building
eplacement ( j Public or commercial describe
Code derived dairy flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ❑S ❑U ❑S ❑U EIS 13U ❑S ❑U ❑S ❑U ❑S ❑U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
T:vv. viiiY;~.;K
OX,
_ 64-6y - s, i < rnder
Ground - 2 /1511 z
elev. 2~ e 5l ~r
ft.
Depth to
limiting
factor
Remarks:
Boring #
kk~•:Y:v2R..•,~,f.:2
Ground 1
elev. r-
ft:
Depth to ;
limiting
factor jyj Zt
Remarks: r ~K ' - ~n C!1n
CST Name: Please Print Phone:
Address:
Signature: Date: CST Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed T Fer~
I
Ground j
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring # _
Ground
elev.
ft.
Depth to
limiting
factor
k
Rema
Boring #
ti
Ground
elev. I w
ft. I!
Depth to L(N
limiting '2-
r
factor
Remarks: a
Boring #
Ground
elev.
ft. .
Depth to
limiting
factor
T--1 T77-1
Remarks:
Sri') 8330(11.05/92)
ST. CROIX COUNTY
WISCONSIN
r er t ' '
rh, Y{ ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
WWI U (715) 386-4680
Aug. 12, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite soil investigation of the Russell Arcand property,
located in the NE1/4 of the NE1/4, Sec.30, T31N, R15W, Town of
Forest, St. Croix County, WI., has been conducted with the
assistance of Kim O'Connell, CST# 2344.
This onsite revealed suitable soil for onsite sewage disposal to a
depth of 37" while meeting the requirments of the A + 4" rule. This
site should be suitable for a replacement mound septic system
having 12" of sand fill.
Should you have any questions, please feel free to contact this
office.
erely,
ames K. Thompson
Assistant Zoning Administrator
cc: file
ST. CROIX COUNTY
. .
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Aug. 12, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite soil investigation of the Russell Arcand property,
located in the NE1/4 of the NE1/4, Sec.30, T31N, R15W, Town of
Forest, St. Croix County, WI., has been conducted with the
assistance of Kim O'Connell, CST# 2344.
This onsite revealed suitable soil for onsite sewage disposal to a
depth of 37" while meeting the requirments of the A + 4" rule. This
site should be suitable for a replacement mound septic system
having 12" of sand fill.
Should you have any questions, please feel free to contact this
office.
erely,
ames K. Thompson
Assistant Zoning Administrator
cc: file