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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Ke t V dso TOWNSHIP HCA US 0)\)
SECTION- ay _T Q7 N-R 19 W
ADDRESS BQQ~P02DS h.A ST. CROIX COUNTY, WISCONSIN
SUBDIVISION N A LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3 ~et~ROOr~
Noma
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v
0
1000
1~~~,U (3eo y8,
o
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: yRu'Atio
Alternate benchmark
SEPTIC TANK: Manufacturer: Wf--Z 6 Liquid Cap. UUr t, L
Rings used:j-Manhole cover elev:~~U•~J~ Final grade elev:_M•s
Tank inlet elev.: TG3 Tank outlet elev.:- 97, Y7
No. of feet from nearest road:Front Side RearFt.bV+~ aoU'
From nearest prop. line:Front , Side, Rear Ft.~
t
No. of feet from: Well , Building: CD l
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
I
i
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear_Ft.
Distance from: Well Building
- 1.5 5
5ho 3.05 N e+ ax" U55
10 -31
SOIL ABSORPTION SYSTEM _9 n V1 Z"V
Bed: N Trench: Seepage Pit:
Width: Ica Length Number of Lines : __~_Area Built o~ U
Exist. Grade Elev. 7 -Proposed Final Grade Elev. ly•a _
Fill depth to top of pipe: 3 O - '1 " ,
No. feet from nearest prop. line:Front , Side , Rear~( Ft.~
a'
No. feet from well: 1q5 No. feet from building Ia
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:
p INSPECTOR:
DATE : a 9 I PLUMBER ON JOB : ~dUrY
LICENSE NUMBER:
i
6/90:cj
LOQATION: HUDSON 24.29.19.256FR DS ROAD, LOT 3
Wi'sconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
'aaboranJHumanRelations
INSPECTION REPORT
Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 149272
Permit Holder's Name: ❑ City ❑ Villages] Town of: State Plan ID No.:
NELSON MICHAEL T HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/pai o 54JwLe; 6: a ~c W t~ UeQ _ V 020106680100
TANK INFORMATION ELEVAT ON DATA A9200118
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W2, f k S Benchmark /a
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet o~Ja~ 9 7_ 4 y
TANK SETBACK INFORMATION St/ Ht Outlet .6 q ~7, V,'
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic y NA Dt Bottom
Dosing NA Header/Man.
Aeration NA Dist. Pipe
Holding Bot. System )a,6~ 9b~ yy
PUMP/ SIPHON INFORMATION Final Grade IeV
Manufacturer Demand 5&j- t A X ~l
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System: ( ~{LJ /c), y-~ OR UNIT
DISTRIBUTION SYSTEM
Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. 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 -Teed/ Trench Edges Topsoil E] Yes E] No C] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
r K
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 5 lagFq-~_~ (01 ~d
SBD-6710 (R 05/91) Date inspector's signature Cert. No.
r +
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
e
I
3 s
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
NEES
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ZZus 8% x 11 inches in size. ec f r viapplication
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNE~.. PROPERTY LOCATION
E (or W
V' 1 ~ 1 5G.) '/a S W S T , N, R 19
PROPERTY OWNER'S MAILING AD~ESS LOT # BLOCK #
Yu, D -S- a
CITY. STATE ZIP CODE PHO nIENtJMBER SUBDIVISION NAME OR CSM NUMBER
k C: • 7M T
. TYPE OF BUILDING: Check one CITY NEARES ROAD
11 ( ) ❑ State Owned VILLAGE : D
❑ Public N 1 or 2 Fam. Dwelling-# of bedroom _.J_ AR L NUM
III. BUILDING USE: (If building type is public, check all that apply) _
r ~
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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. ONew 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 ❑ Mound 300 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
(~j REQUIRED (sq. ft.) PROPOSED (sq. ft.) (GPIs/day/sq. ft.) (Min./inch) ELEVATION
G "0. "-AFeet 9YT~ Feet
CAPACITY
VII. TANK Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank - 1006
Lift Pump Tank/Si hon Chamber E] 1 11
VIII. 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) MP/MPRSW No.: Business Phone Number:
kin v, Cf4_ I V11
Plumber's Address (,Street, City, State, Zip Code
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved 7S1tary Permit Fee (Includes Groundwater Date Issued ssuing A nt Signature (No Sta s)
Approved El Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
r j
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 few
criteria in the Wisconsin Administrative Code will be applicable.
3. MI revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
:submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every.2 to 3 years.
6. if you have questions concerning your onsite sewage system, contact your local code administrator or 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.
11. '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.
Vf. 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 fo• 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'h 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 main:/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; close 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)
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.
----------------------e-----------------------------------
Owner of property
Location of property ',)6t/1/4 S x/114, Section T N-R_16
W
Township e----
Mailing address
Address of site .l b-0
Subdivision name 8,114
Lot number ~j
Previous owner of property Q ~e L~-
Total size of parcel 3 „ U
Date parcel was created
Are all corners and lot lines identifiable? --4v Yes No
Is this property being developed for resale (spec: house)? -Yes i ~_P!o
Volume /ice, and Page Number 4-~ b as recorded with the Register of needs.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:-
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. K ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
Signature of Owner Signature of Co-Owner (If Applicable)
Date of Signature Dare of Signature
DOCUMENT ' 77
NQ. n : r
• 87'AT]r" BAR OF WIC'4Adlf I
low,: Two
wAMAIM Ugft ~ '7 17"WMM"=MQ ex rm
r
S
Thie Deed, made between - Det~ta.ia.8 ~7 r
L da A. GilleAwa-te•r, h4&bap L'111 er awd..... V
aad•~+rif~.
akja
. Gilhenwaters
and kichael
T. Nelson
Grantor,
~itnesseth. That the said Grantor, for a valuable ova ' Grantee, k
ldtrtsttAO Y ad
conveys to Grantee the following described real estate in St CroiM " } ~
Count', State of Wisconsin:► ro
Para of the Southwest Quarter of the Sauthwegt
Quarter
Of Section 24, Township 29 North, Range 19 West, Town
o'f Hudson described as Lot 3 of the Certified Survey Map Ta=ParesiMe
filed
in Vol. 8 of C. S.M.'s, p• 2;..3, in the Register of
?yy
Deed's Office for St. Croix County, Wisconsin.
This is not
(it) ( is not) homestead property.
Together with all and singular the he
And grantors, Dennis R. nditametita and a urtenances thereunto belon in
warrants that the title is ~ Gtlienwatet and Linda A. Gil a e;
good, indefeasible in fee simple and free ISnwater
easettents, covenants and restrictions of record'elear of encumbrances except
at"I
if 'Any,
and will warrant and defend the same.
Dated this
day h` 16" 91
(SEAL) ~%IZN
b`ls R. CiIenwater'` `.'(SEAL)
Linda A. •(,illenwat• rr~, 43BAL)
AUTHENTICATION
Sinaturt•(.;.i ACBNOWLBD(iMBNT.;;
STATE OF WISCONSIN
a .i=.u,t: ate' j tuts r 5t . CroiX
day n,_
l t+ County.
P rrsonaliy came before mt this
Ik.nnifi R. Gillen 1991.... the
water andi,
_ ~
TITLE: 51F: dF3Fkti t..i i lenwater
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Hut 7,rd i,y enwatr"~
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k now•n to il>,e the "
rk~ ✓c o, "t.n, ('r• .L; s' {I .Orfl;Di nn inatrl~ persons..; who EXpcilw the t
FD F.Y acknagrl
nd
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by y -->~rE~fd1jE//•
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1 n7tratttil or f4p1 otn a'nbtio St. •CrCIiX~ r..
ar 1 MnouFc l~ecl. itnth~ N(y l,mm~tiss3 Y rllif '
ants Perm anc ~ tr E ar
ta+1 af W
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A
JUL 25 1991
ST. (7;N;::;- CRxsI A FILED
COMPf~EHE~IV&~ POtRK$ Nlf\11~iI1!\dC s
ANC' r0W)C C,00,v4tJMT F-r
This instrument drafted by Fran Bleskacek Proj. No. 91-10 JUL 2 51991
4`71834 No 36 J Rp o Deed"
St Croix co., wi
West line of the SWj of Section 24
N0002410711W 2612.42'
= 1306.21' 1306.21' V)
N
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> _ > >
rD o
N '7 Cn Z N 7
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G,. A I N VOL, 7 , eG, 1913 r '
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\ LQT 2 I LQT 1
0
(SO0005152"E) I I< s x ti
\O N00025'40"W 959.1 ' 10 G O
il-
600.00 359. 11' 1' Uai 0
\ Proposed Drive _ Iv ;n a 0 r
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F o a cavil r ni to rt `.y
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S00012' 49"W 575.80'
(North 577.05') IC A
• v -r \C , S , M. IN VOL. 2, PG. 450 I f- I D y
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E 3 Bearings are referenced to the
West line of the SW} of Section 24,
'o 'o assumed to bear N0002410711W.
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No. 36
VolA 8 Page 2383
_ I, Allen C. NYhagen, registered Wisconsin Land Surveyor, hereby certify
surveyed, mapped
and that de escr the ibed directhetilon and ofparcel1whichGislrepresented by this Certified
of the land parcel surveyed and
Survey Map; that the exterior boundary
mapped is decribed as follows:
located in part of the SW4 of the S~qk offSection 24,
T2A9N, parcel R19W, of land Town o of f and Hudson, St. Croix County, Wiscon
.described as follows:
at,, the SW corner of said the
Commencing
Section 24; thence N00024107"W, along of said section, 406.01 feet; the SW's of said section, 13W6.21 feet; thence N89051' 18' E,
west line o this 1 feet;
along the north line of the of the oint of beginning of the west
thence S00°25'40"E, 12.38 feet et to the p
• thence S88049'00"E, 907.54 feet; thence S000121411450along t St.
lion, Map recorded in Volume 2, Page at the line of Certified Survey
C 575.80 feet to the northerl.ysa~aht-
roix County Register of Deeds office, thence S67°54'20"W, along
of-way of the town road (Badlands Road); the east line of
right-of-way, 969.21 feet; thence N00025140"W, along
Map recorded in Volume 7, Page 1913 at said office,
9Ce59.rti1f1 i fedeet Su to Survey the point of beginning.
Above described parcel is subject to all easements of record.
I, also certify that this Certified Survey Map is a correct representa-
6.34 that I
of
tion to scale of the exterior boundary surrovisionsveyed of and described;
provisions
have fully complied with the current
the Wisconsin Statutes and the Land Subdivision ordinance of the County
of St. Croix in surveying and mapping same.
g
Allen C. Nyhag n Date
Vol^ 8 Page 2383
No. 36
Q
~4
IC TANK 2b~IrdTi iv~;~~ ; : t1cREErI`A:N1 G;
St. Croix County
O1ME R/BUYER
0
ROUTE/BOX NUMBER Fire Number ti
CITY/STATE_~iC~ zip
/ D
PROPERTY LOCATION:'_k, Section, T.sN, R /c/ W, 1
Town of St. Croix County, 1
i
Subdivision 'Z.ot num, ber .
i
ATiproper use and maintenance of vc!ur septic could result r.
s premature failure to ?candle wastes. Propai. ma- Ai •t'enanci! con-
sists of pumping out the septic tank every three years or soonwa.
if needed, by a licensed 'se tic tank stun er.r~Ihat you put into
the system can affect the- funct on -o t c ae-tic utir.k as a treat-
ment stage in the waste disposal system.
St. Croix County residents -na be eligible to recieve P. grant for
a maximum of 607. of the cot,'-.of replacement of a failing system,
wh c 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 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 day;; ptk;
three year -expiration.
H
I/WE, the undersigned have read the above r_e4iAr =erts and agree o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed .b
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED T
DATE F az 9
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
d -
DEPARTM~NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
L,~BQR AND BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 7969
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWN HIP/
I Y: OT O.BL SUBDIVI NAME:
114.'U14 2Y lbl N/R14(or
COtJ TY: , OWN R' BUYE JIS S~Mai MA 0~ADDRESS.
t' S
r eeff/s
USE DATES OBSERVATIONS MADE
NO. BED MS.: COMMER I ESCRIPTION: PROFIL D RIPTIONS: ATI N TESTS:
esidence ~ew ❑ Replace ~ `f, ►v
RATING: S= Site suitable for system U= Site unsuitable for system
IN-GROUND-PRESSURE: SEM-IN-FILLHO~LDING TANK: RECOMMENDED SY M:(optional
OS RU
l
CNXETEff] L: IMQPND: ~U
S 2A
if Percolation Tests are NOT required DESIGN RATE: ~r If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHX, ELEVATION OBSERVED ES . HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
V7 0-* Ixyl 'AZV
B- 2- , s 9s o 7 sr
B- 7
0
x.43 °
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER Wfe"VE AFTERS WELLING INTERVAL-MIN. PER( D 1 PERIOD2 PER10113 PER INC
P_ / SO' Il/ 2 ~c 3 3 /s x'
P- r ' Y
P- 3 r
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 ~-Z
,
40
33 ;
l
_3 I 33
<Ijil
I
,
E
O
e
z ,
c f ~ t ~ 1 I
s ~ , ~ I I
( '17-1-
3
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (grin TESTS E COMPLETED ON:
0A
ADDRES : CERTI (CATION NUMBER: P ON NUMBER optional):
40~y~e
CST SIGN TU
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. /
DILHR-SBD-6395 (R. 02/82) -OVER -
f r ~
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a cornple~e and a to soil test, your report most include:
1. Complete legal description;
2. The use section roust clearly indicate v pis is a residence or commercial project;
3, MAXIMUM number of bedrooms or -ial use planned;
4. Is this a new os. -ent system;
5. Complete - rating boxes. A SITE IS SUITABLE FOR A HOLDINGTANK ONLY IF ALL.
OTHER SYST7V . F RULED OUT BASED ON SOIL CONDITIONS;
0. PL-ASE use t` nations shown here for writing profile descriptions and completing the plot plan;
7. A LEGIBLL -am accurately Iocatiflg your test '-)cations. D,awing to scale is preferred. A
-heel may v. n if desired;
8. your bend rk and vertical elevatic,r Terence,- are shown, and are permanent;
9. Cc ler all appropriate boxes as to dates, r~ adc'ress 'food plai lata, percolation Lest exemp-
tici,if :,;>propriate,
10. ° `orrratior, +rn .in, eleva ) does not apply, pl;-(-, ~._k in the appropriate box;
11. y ,1 all(` /c>us t addres your certification
12. M• ~i1>1 e cop ALL SOIL. TESTS 1 'JST BE FILED WITH THE
LOCAL AUTHORIT DAYS )MPLETION-.
-VIATIONS FOR C FIED SOIL T "ERS
~h
Textures p " rrnbols
BR - Bedrock
cob r 3 - 10") SS - Sandstone
gr - der 3"} LS - Limestor,
V
us 4IGW - P" f ; -'.water
cs . d Perc P F ;te
med s W
I's Bldg Building
(s - f > Gir )ter Than
sl - vas a'y n \ _ -r la11
'I - Lrrr;,r Bn
*sil - Silt Loarn BI - Bk,:k
s€ it Gy Gray
*CI - Loam Y Yell
scl ~ ~cai Clay Loam P - Pot'
sicl - ty Clay Loarn mot - Mc
rdy Clays with
Clay. _ w, f,rint
Man ur,
p
r di BM -
4
VRP - Terence Paint
TO THE OWNER,
n ;,'i securi"', Jtary p" Th,, c, tr,~ r it Yfi r'ay request
A < he private
der to
J
Pe-B- L. 6 7 _P L OT A W I-' 0 S S 5ECTK)1\1
`q M NAM F 71ov, s -e
L U C 10 n1_.. 1~ -L I C E N S E 0 0,
. n
P C-0 --I
/000
c► N IT Jn^
Qtr) .
~~O --CEO, Pv
.
q= - 6.3'
/V : Welk s fAn-f4. ~k~1j 100
,mil
II
~U y Wooo" rev)cr Po'l Zl lbb,o
P~{LfkS -
FRESH Al INLETS AND OBSERVA'T'ION PIKE
Cl;O~S _SECTION
Approved Vent Cap
ire Minimum 12" Above
Final Gra~~ _ e JA)
j 4" Cast Iron
Above Pi
' Vent Pipe
To Final Grade
Marsh Hay Or Synthetic Coveri.ng
Min. 2" Aggrcyl-ii
Over Pipe
Distributio7~ vet I E- Tee
Pipe 1
_
Aggregate n Per-fora ted Pipe Below
Beneath Pipe Coupling Terminating P
` Bottom of System
RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
)STRY, DIV131~"N
69
aBOR AND PERCOLATION TESTS (115) MADISON OX 11907
JMAN RELATIONS , W1 (H63.09(1) & Chapter 145.045)
BUD. SUBDIVI I NAME-
)CATION: SECTION: TOW HIP/ "T-4' OT rJO
> W 1/45d/ 2Y /T29 N/p 11 j~j `f (or 1l
:)U TY: OWN R' BUYE AME: 17a.2-
;E LI A D SS: DATES OBSERVATIONS MArjE
NO. BEDRMS.: COMMER I E CRIPTION: A
:
Residence ew ❑Replace
STING: S= Site suitable for system U= Site unsuitable for system ROUND-PRESSURE )WVENTIONAU . ►yl(y1 ❑U W-GN S DU IS -IRU N-FILL Q SG TANK: RECOMMENDED SYSTEM:(ogtiona
2~S EJ I M DW
Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
-der s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
.)RING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNES.:, COLOR, TEXTURE, AND DEPTH
JMBER DEPTH X ELEVATION OBSERVED E IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
' U e 37.Z' ~l/
S 9S, ! 7 4f`, r j 'e9'~rash . Z.s- o*/_r fps` 6G+ ess[f,..
01
i- 3 D~` 3, `~Z ~ ~ S.as ' • ~2',c~,! /.os%B.~ C at',c~.
73
3- 72, > 3
~G.Qs
-S 83 q2. e 7' f
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVELVELINCHHES RATE M;W,i'-'ES'-
UMBER Wi2Mt^$ AFTERS ELLING INTERVAL-MIN. RI '3" PER SNC
PERIOD 1 P
-33' t
~ _
'r ~-92r
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are thz hori-
-jal 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
land slope.
YSTEM ELEVATION _7-e-
11 all
_
10
~3 . ~ . _
te~rr,~, / J i /
-9117
41. N
I
2 [3s-'
-T ~m..r_
,
c I l ! _ ~ f l
' r
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
AME (prin - TESTS E COMPLETED ON
4lG - 9/
.DDRESS: CERTIFICATION NUMBER: P N NUMBER (optional):
r
~
eve?
CST SIGN U
•
ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil 'fester.
ILHR-SBD-6395 (R. 02/82) - OVER -
l
APPROVED
JUL 25 1991 ~
ST. Cr(0XCOUNTY
CCPwiEw NC FILED
s
.ANt) X-NIt C ~M
JUL 2 51991
T his instrument drafted by Fran Bleskacek Proj. No. 91-10 JAMES O'CONNELL
471834 Regis w d Deeds
St Cr* Co.. wi
West line of the SWj of Section 24
N0002410711W 2612.42'
r ~l .21' 1306.21' r
1306
rt
M =C
r• o
! rt n a °
0 o m
O N Z N '7
o C> au r
N '7 r O ° O -•H
Q7 Un
° N
°
Q_S , Mi I YQL: ~7. PG: 1913 P.
I m m
LQT 2 I LQT 1 Z
\ (S0000515211E)
Q 0
N00°25' 40"W 959.1 ' '
~i Co 1 r 359.11' I IC7 3 O rf
600.00 _ IV 1 0 `f. M
\ Proposed Drive - Pi
D I- `r
~2 e. W r I-D 13 m t/1 N.
F~ s n~ o w r~i~ ro
n cn o r INO 0 H
\\°o y ti~~' ° c ILO , O rt
W m IIV s ~
4, CD x 0
y
o y n
\ av G
\ ° _ Co 00 0
~ r C
6'0 220.001 H
~ / N
S00°25! 40"E ®O 4 :3 M
C) ~C £ m
\Y--" 00\ LrI rn
LO 0
C 10 0D CD
` G 10N 0, cn t-h -n
❑ to o rt M
O a IT Ir t~
~ y .0 0
~ O to En m
a ICn I-I N C/7
\-1110 J\ -n
5- En
`99 ~ IG7 3
``app \ 6T`%i Ir r' M
0
S0001214911W 575.80' N
(North 577.05') IC
Iz
\a' \`f' C,S,M:. '..IN VOL, 2. PG. 450 I I
r N
-
'mss.: • _ G 1-3
N '.hM4N `O r" W
Co CP
O d OD 7
0 0
v 0 0 O
m m m m m r r ` OT G
x x co x M O
O O f•. n r• rn t r
c- m o y aD x n. F„ rr a
c rt c* -3 1-1*
0
1C U2 Co ~a O N ~ ra~•y•,~ o <n r~ -h
~•1 C'f y 'n C) N "rl
O O O O O C/) Co -n O 7
1. O
m O T C a S
r t9i 9 O C 9 O C CD O N 7 O
O O 7 O C Cr -aj O _ -7 7 O 7 G It,
O C N d
H ,•r Ln rt N C1. W. ~ r O 7 G
i.. t•. f,. CD
W CtC o
Z I a r W a O Cn o
r - C > > v
o s -s cn
in
O ~ o N ' N Cr ' Co
F„ N N. CD 'ti rt O
H Welt . CD a Cr C a O ~ 7
° zo ' = y -3 o Bearings are referenced to the
Co West line of the SWJ of Section 24,
N H l0
assumed to bear N00024'07"W.
N
c o ~ o
~ ~ in rt
r
0
°
Vol* 8 Page 2383
REP11131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
05/27/92 15:42 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/28/92 AREA: MJ
Activity: A9200118 5/28/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 24.29.19.256F,BADLANDS ROAD, LOT 3
Parcel: 020-1066-80-100 Occ: Use:
Description: 149272
Applicant: NELSON, MICHAEL T Phone:
Owner: NELSON, MICHAEL T Phone:
Contractor: BOUMEESTER, JIM Phone: 386-9020
Inspection Request Information.....
Requestor: JIM BOUMEESTER Phone:
Req Time: 11:05 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
REP47131" HUDSON ST. CROIX COUNTY ZONING PAGE 1
05/27/'9L 15:42 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/28/92 AREA: MJ
SELECTION CRITERIA
INSPECTION DATE - 5/28/92
INSPECTOR AREA - MJ
REQUESTS SELECTED - 1
I
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT jqj, / Page .1__ of
Lalbr and a;Dlman Relations
Dili ion otS&fety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
~ C_ "0' C1 i x
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S; PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or UZ4-/Ob 4
dimensioned, north arrow, and location and distance to nearest road:
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY 0 ER: PROPERTY LOCATION °
c~itf CSC N K_x /h -4 oj GOVT. LOT-)c 1/4 J 1/4,S-Z4 T Z r N,R / E (or) W
PROPERTY,qWNER':S MAILING AV~IESS Lq~ # BLOCK # SUBD. NAME OR CSM # P 1 C-1-3m CITY, STATE ZIP CODE PHON UMBER ❑CITY DYILLAGE EFOWN NFAREST
ROAD J~
kf New Construction Use 11f Residential / Number of bedrooms t.,( k) -e [ [ Addition to existing building
j J Replacement [ I Public or commercial describe
Code derived daily flow gpd Recommended design loading rate n _ bed, gpd/ft2 trench, gpd1ft2
Absorption area required bed, ft2 trench, ft2 Maximu9_1ft esign oading rate ? _bed, gpd/ft2 u trench, gpd/ft2
Recommended infiltration surface elevation(s) PAALGC 3 nF (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL M UND IN ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ~I S ❑ U 2 S ❑ U 9S ❑ U as [I U In S ❑ U ❑ S ~U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
X64 32 _ S q~i
Ground O y 3 " •
elev. S '
est. $`-i 2, D' ~0
Depth to
limiting
factor
Remarks:
Boring # Z 1 L r n1 f r~ U~ Z !'.4 n
-~3 C i a o
i r-
Ground
elev. 83 3.~ 6•
~Afi '1
Depth to
limiting
factor
Remarks:
CST Name: Please Print Phone:
Q n~N~>v
t ICU
Address: ' UC1~SsnN )
Signature Date: CST Number:
C i /Lt (33 q Ci
0/
PROPERTYOWNER ~[)►K`l*~~~~'~-~r'~h' SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #+~~WS 2 Q - 2 ~ • / ^7'
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Mx-day Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer
Ground 3d- r D r2 V4 elev
4 .-7
c~ ft. 'II
g3 1,25 jR,
Depth to
limiting
fc r
Remarks:
Boring # l S C. r /f') ( , 2 "r 4 -4 . `•.O .S
0.7
314
Ground
elev.
~,3ft
Depth to
limiting
factor
Remarks:
Boring #
6-7
,z 4 s C), ^ 1 D.7 a
Ground
elev.
iC ..`l ft
Depth to
limiting
factor.
rn33
Remarks:
Boring #
Ground
elev.
It.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
P46& 3~F3
-c
g 70
mss` ~
a
off,
6 3
c.~cxab F~n~c~ PoS-r' w r14
5P.k~ NV IT. ~j
E ~bJ>D~r ~o~ _ /Ofd .Od Vp i
J
Sc_dc.~ ~ QE.r~mrn~~ac.u ~vsTf r► EL iL~/A1'►Q~,15
~ -Aa
i
~ f