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Home My WebLink About022-1015-20-000 �Q— \STSt.CROIX Croix OCounty OCourt OFFICE Courthouse 911 4th Street 9"x Hudson, WI 54016 Telephone - ( 715 ) 386-46801 t The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions , Realty Firms, and private individuals . Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address . Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25. 00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175. 00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25 . 00 (Determines if system is properly functioning at time of inspection) Property owner's name -rAVAIIc.S Property owner's address )f �, /gdX 1a90 Legal Description 4w 1/4 of the x_1/4 of Section �_, T gig_N-R_$ Town of Lot Number Subdivision Name FIRE NUMBER Yb90 S LOCK BOX NUMBER LIT Color of house /te, Realty sign by house?j� If so, list firm: �C�tri.a.� �eCc�fcL PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off , or sill cocks are turned off , making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting uestin services : T Telephone Number S'- ;;,F" 0 REPORT TO BE SENT TO: --.� � 5 ca k l Closing date i / Signature COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST, CROIX ZONING REPORT NO.S 34901/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 10/12/89 COURTHOUSE DATE RECEIVED: 10/11/89 HUDSON, WI 54016 ATTNS THOMAS C. NELSON t OWNER. Thomas A. Johnson -73 � LOCATION: R . , 29, Hudson COLLECTORS St. Croix Zoning SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATIONS BacteriologicallY SAFE NITRATE-NS 1 ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE � 5 LAB TECHNICIANS Pam Gane ; ST CP4A, WI Approved Lab No. 19 \1, COUNTY CitE s .OF•\NDEP&%D P V Means "LESS THAI`" Detectable Level Approved bYS ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX{OUNTY COURTHOUSE- ''` ' 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 October 11, 1989 Thomas A. Johnson 700 2ed St. Hudson, WI 54016 Dear Mr. Johnson: An on site investigation of the septic system on the property of Thomas A. Johnson at Rt.1 , Box 129, Town of Kinnickinnic was conducted on October 10, 1989 . At the same time I also obtained a water sample and submitted it to the laboratory for testiang. The results of that testing will be sent of you as soon as we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel Tree to contact this office. Sincerely, Mary J k s Asst. 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Phone: 273-5066 Ellsworth, Wisconsin C��3ar r G E H L 273-5041 • East Ellsworth, Wisconsin 54010 s CSEPARTK ENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION DISO WI 53707 State an I. D. Number: A, , NWN4 NW-1-4, Sec . 6 , T28-Rlt CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Kinnickinniq 90th St. LJ Holding Tank ❑ In-Ground Pressure Mound !o NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 'om Johnson PEI/au 573 90th St. Hudson WI 54016 Ott, 70` BENCH MARK (Permanent reference point) SCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL CST REF. Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: Dale Hudson 1-6629 St. Croix 1355 SEPTIC TANK/H0I:BmNr8;FA 11 -NI - .T 6 s MANUFACTURER: IQUID CAPACITY: ANK LET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ~C l P~ROVI?;' PROVIDED: ~t> ~G LL~'YE5 NO ❑ YES 0411 BEDDING: Olsff DIA.: MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH Q,~; e_ 1-1 ALARM- Q FEET FROM LINE / AIRINL T:/ YES ❑ NO D EST-♦ yrj OSING CHAMBE . 0.,7 c'E o.35 Lr MANUFACTURER: BE I 53o LIQUI CAP PUMP mot) PUMP/S+PHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES 54'NO I -2/ J . W Cd 3 K 64561 ~ YES NO YES ❑ NO GALLONS PER CYCLE: LIMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERT WEL . BUILDI G: VENT TO FRESH FEET FROM LINE. / AIR INLET: ~S? PUMP ON AND OFF BETWEEN ~~n± -70 [~ES ❑ NO NEAREST f~ LENGTH: DIAMETER: M ERIA A D ARI~y$ SOIL ABSORPTION SYSTEM. Check the soi moisture at the depth of plowing FORCE P.XfC• e' or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN /Y[- (o the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGT PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSION GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF P BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET. NEAREST MOUND SYSTEM: = Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM SlQjD6Q fid and furrows thrown unslopae' f,rrA aound systems to make certain that it ON REVERSE SIDE. SHOW 10_ r YES E] NO ~ meets the criteria for medium sand. ELEVATIONS MEASURED. I c SOIL COVER TEXTURE: PERMANENT~MA-°RKERS: OBSERVATION WELLS; [S ❑ NO C'rS ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: Ir ( ❑ YES ®'I~S L7Y S ❑ NO L 9 ~ 0!!~ PRESSURIZED DISTRIBUTION SYSTEM: r i aF o ra 9g• 5 ' WIDTH: LENGTH: NO. O TER r, GRAVEL DEPTH LOW PIPE: H ABOVE COVER: BED/TRENCH j TRENCHES: I/ DIMENSIONS 36 1 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PE. MATERIAL & MARKING: ELEVATION AND ELE ELEV.: DIA.: rr ELEV.- PIPES: DIA.: n VAA .,I/ DISTRIBUTION HOLE SIZE: HOLESPACING: DRILLED CORRECTLY: COVER MATERI VERTICAL LIFT CORRESPONDS TOp INFORMATION /r ry Q-•~. APPROVED PLANS y Lt~YrES ❑ NO ❑ YES PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILQMG: COMMENTS: ~r FEET FROM LINE: ( &?YES , NO S ❑ NO NEAREST---* 5,77 t"Adt r, o~ d et i in county file for audit. Sketch System on V Reverse Side. SIGNAT RE: TITLE: SBD-6710 (R. 06/88) ~ ~dd. U _ ua TOIL HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY MEMO STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than Alf 8'i4 X 11 Inch@s In SIZe. Z ❑ revislonPrevious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S9O '7~O/~ 7l PROPERTY OyIER PROPERTY LOCATION / ~~SOn S% Nup/a A/1/4, S T N, R / $ (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # __5-7 3 901:2r- Sf- 14/X CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM N'Uf R II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD --I- / State Owned ? VILLAGE , i /7/ C, 90 ss - ❑ Public Z 1 or 2 Fam. Dwelling4 of bedrooms PARCEL TAX NUMBER( III. BUILDING USE: (If building type is public, check all that apply) 0 6 r 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 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.,0 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 21,9 Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43E] 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 ooZZ REQUIRED (sq. ft.) PROPOSED sq. ft.) (Gals/day/sq. ft.) (Min./inch) n Q ELEVATION T~O 1-375 76 q 7' 7 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Con- INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App. Tanks Tanks Septic Tank or Holdin Tank lew Lift Pump Tank/Si hon Chamber 00 Vill. 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:? 779 -:I :)al, zr-a ,/,/i,y6t1:r-a4? O, Z ~g Z 71-,5, Plumber's Address (Street, City, State, Zip Code): o 19'la /'n ~7- -Ea~G~u/i >i IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuin Agent Signature (No Sta s) Approved F-1 Owner Given Initial Surcharge Fee) Adverse Determination /2? q5-- ZL~~,,o Z--L_= 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, Plug INSTRUCTIONS Y 4 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 wil!' 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 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: t. 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 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. Owner of property Location of property Sl, z119 1QV 1/4, Section W , T ZF N-R-1/Z W Township f~ 11 1112 r C Ti, r i?r7/~~ Mailing address if l 1-3,e>X / ' 9 Address of site _am e.- Subdivision name Ax Lot number A Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes ~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 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. ; 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. ignature of ner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature - 1. ~ ~ ««..+....M»..s ..wM..M.««..... /~w._».•.... ' « 1 } ii,. asev+w - P,t «..r... ~r+ M..,.......,...«.. ~ ` C Vim Ilr.r1►.w.t » 1 D tent of the hest 512 feet of the Sit} Of the NM} 6 Tow whip 28 North, Range 18 Vest, St. Croix OWN tR l0 acres of the Nft of the NWk of Section b, Tows►ahip 28 ftoV .8 West, St. Croix County. ltisconmin. Ram; a x z i g'.~ r ~~r~ •,q +«i.,»y~~....... ~R.ld //qty. i 4b 04) 4. easments, restrictions and rights-of-way ~,s-fe vi.ea..Ms: Oki of record, it any. day of A11iguAt,----- - 1s...~. $th (SLAL) N. Triebold Arlene J. Triebold ,..ti.r-«._......_.... • (Birk") - - .......IStAL►; ~~Tilf>K!><O~TION AO=NOWLRDOURST Edwin B. Triebold, Fs J STATS OF WISCONSIN J. Triebol........ . - ~nti• No 2b _ft d._..AlIfialat 19.86 Peesolaft ease before as this A W tt tbt alwe 1A111~M1~. Y e~.~Cs,-,4t!t~- 11........ T .~ilnucul_.k1a _._......._..__M _ Bu►>R OF WISOONSIN k to me ka"a to be the Perna . CF ia+eeefar W "peat and mk wwieft* the sale. ' F s e~ WVAFM r d Lundeen 4' , Mary pubw IN AMISMIUMA"L or aphuea Wom Beth Is pen"agant., eaR. etaea 3` _111Y commiahm"Is evo s eft" IA 'MW `V e6ft aMr* M RY9Q 1rtYMd Y•1i11► 1mdr .1e.aft"&'' r r ! H H a ST C'- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT C St. Croix County z d OWNER/BUYER ROUTE/BOX NUMBER 'f,~X Fire Number CITY/STATE {;'yE ✓ f~~~~ ; 7.IP ~r'yOLZ. PROPERTY LOCATION: 5/y ti)' Section-6 , T 4~2 ~ N, R _W, z2 r/St. Croix County, 1K, - Town of2~;''71711- Subdivision , Lot number 0 . Improper use and maintenance of your septic system could result in I 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 um er. What you put into the system can affect the function of the septic tank as a treat- 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. o I/WE, the undersigned, have read the above requirements and agree U) to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- 10 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. SIGNED DATE A/ `,72 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. URT,NI CNT.OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS 115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) ME: LOCATI •N SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVIW % Nv'/ rA4 G /T Z1 N/R/gI (or 5 (V .1 1 /1/•s COUNTY: OWNER'S BUYER'S NAME: MAILING 4- COUNTY: sf . C,~o,X -morn C~To t-7 sus 30 09 lls s n Z USE DATES OBSERVATIONS MADE NO.BEDRMS: COMMER AL E CRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 N ❑New Replace I ~fZ7. ~O 3-2940 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND:PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:lopti Hall I'VI U S ❑U DS U ❑S U OS,®U If Percolation Tests are NOT required DESIGN RATE: I If an any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A x PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i ~ l l nom' ! ° /O n SC B- f ,Z•5 d>7 5' of7//s."/. ~ • ~38lsal° '~'3 s.~° •~31,175-c B-Z 2'5 `1-27 /)an , Z. B-3 z~~~ 9~,5 •~7~~s,1• -91.~~s,'/- .928SC B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 PERIOD PER INCH P- j • O' Alton 30 *3 P-,?, z•o' Alp ii e- 30 7N, 79/1' - 35,E P- -o' Ato in e- 30 01 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 991 _ ! i _ . a I t r i - I, 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 print : , TESTS WERE COMPLETED ON: -T)a/e e/ -2 90 ADDRESS: L CERTIFICATION NUMBER: PHONE NUMBER (optional): 14 IL ZZ -5 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 0 ILHR-S3 D-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section 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 ratingboxes. 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 to scale is preferreid. 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 appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, 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 your 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 - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow sci - 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 pt - Peat min - Many, medium m - Muck d - distinct p - prominent HWL - High water level, * Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in seMrirry a sanitary. perrnit. 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 subrnitted 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. 1 ~ I t . Qw 93 d rr o o Tor; Nom e • 0 1 14 do M ~~j ~ SD I'1 3 0 90 st ~10 I3,M • - /00 1 o~ C3 z L ~i - 97191 30 30X Lid" BZ - 94.37 B3 96,:5'7, 22.5 Pole SW 5' o 1,7 B M, I PI ~ nCA fnar~ iS de a-f a~ N, a), c.or^n(f r po/c -57eo B't ❑ - Deno d r $ore Poles P# d - Z~enotcs ~erc ~,Io~PS 150' t1 B,M, -.Denotes atAc l lvor.K /►'j OGIno~ is zY X 83.5 Garaye ® = 2 ~ooo~ol , Fx;s4 n9 50~ S'e~f1 r: sec. • o !,loos e- S • f'o sur7'aCL' . i ~ £xist,'n~ J7,-YWCI~ o~ i n T s i Nib'/y Nun -7-z? N R/SW 3 -29 - 90 LYQWr1 !3y 1✓~~' ~6Z9 ~ esT 3513 / _ ~o~ 90 s { I of y cJ Rage Straw, Marsh Hay, Or Synthetic I.9verinp Distribution Pipe` Medium Sand Tod II G N Siopei T ~gd Of 2 Force Moip., Plowed Anrepate From Pump Laydr Lit. q 7 A /st) `Cross Section Of A Mound' System Using S A Pod Far The Absgrptlon A,reo' F - .5--' .p Signed: Ft. N 63 Fts, ~ icense Ngmbelr; MP G,,~ ~ p, Ft Rate: -07 1~1D Ft. K lo-25R.` Alternate Position' of 1. g3-S . FtR -----r Force Main W z ~ Ft, l_ Obseryotion PIpe'r y B 7'K r Force Main . ° - From Pump 7Distrlbwtion ed O f Pipe Aggregq!i Obserwatipn Pipe Permanent ~IQrkers . Wq 4" i } t Plan View Of Mound Using A BeO For The' Absorption .Area F4~` Rage 2 Of# i~ A A' Perforated Pipe Detail En View 'Perforated (ins Cof:, r^I~:.: PVC Pipe Holeeipp►•d Qn:t3ortom, Are 940olly Spaced' PVC Force Main i. PVC .r... .Yz Manifold: pipe Qistripu,tion AIti1114t1< 'Position Of ` PIpOOF~~ idal.lt Lo►t, HRlff :Should Be ' t NeO Fa Fpd Cap layout r. En Qi?p 04?.ribu1ion. Pipe f P 3i; X.:3G'nhPs X Inch Otil piathgter Signed w, J/ -Inch(es). Liwse. dumber: _ Af 6eZ9 Manif4 d: t► 2 Inches Date E SYSTEM Fcr a Mit . Inches 1 oP i pe A ~ ~r o~ eS~P . N RELAI101'4 ( 1y ~.gt Wa b.t WFi.. PAGE OF ' PUMP CHAMBER CROSS SECTIOU AND SPECIFICATIONS' VENT CAP 4%.T. VENT PIPC WEATHER PROOF APPROVED LOCKING , JULICTIOW BOX MANHOLE COVER 25' FROM ODOR, WINDOW OR FRESH 12 MIU. AIR INTAKE I GRADE ' `I' MIN. COWDUIT 18"MIN. ~ 11~ IAILCT PROVIDE I I AIRTIGHT SEAL ( III ' ' I I I APPROVED JOINT A 'APPROVED JOINT W/C.T.. PIPE I I I( W/C.I..PIPE CXTCNDILJO, 3' {~L~TIp~ I II ALARM EXTCRIOIIJG 3' ONTO 6OL10 SOIL B \ I I I ONTO SOLID sou y Dip A i ON 4 LLEV. FT. PUMPS OFF D COLICKETE BLOCK I RISER EXIT PCKMITfED OWLtJ IF TAMK MAWUFACTURCK HAS SUCH APPROVAL gE D SEPTIC E SPECIFICATIONS 005E TAAIK MA►JUFACTURCR: T~ IJUMBER OF DOSES: PER DAy TANK SIZE: ?00 GALLOWS' DOSE VOLUME ALARM MANUFACTURCR: -S,T ,4lec fr^n INCLUDING BACKFLOW: GALLONS MODEL WUMBCK: - 4- 9 CAPACITIES: Aa•?Z'8~ IjJCHES Olt GALLONS SWITCH TYPE: 1,9&_ ✓'C aey PUMP MANUFACTURER: you .38g$ •''f g n Z IIJCHES OR3y'0y G►LLOAS C. a ~O'1I INCHES OR /73•y GALLOWS MOpEL NUMBER: Gt~~~3 ~ 0- 17- IAICHES ORMyz.Y GALLOWS 27 SWITCH TYPE: - <°'"CUMOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE- GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AWD.,DISTRIBUTIOW PIPE.. _LL_ FEET + M..II'W~IMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . ?.5 , FEET + FEET OF FORCE MAIN X _L8_LFYoFT.FRICTIOU FACTOR.. /-7Z FEET TOTAL DJUAMIC. HLAD = H17Z FEET IMTERWAL DIMEWSIOIU i OF TAWK: LEWGTH ? _ ;WIDTH Z' ;LIQUID DEPTH 7 SIGWE04,00,& e, AUW4 ~ LICEUSE 1.JUMBER: /LlP~~ZS~ -Z7'9) t DATE: SUbmersibkc),, Eff I ent . Performance Curves Pumps y~ Al METERS FEET 90 MODEL 3885 25 6o SIZE 3/4' Solids • WE15H • 70 = 20, WE10H 60 102 WE07H is WEOSH 40 10 30 WE03M i w WE-0 ~X ^ 20 5 10 1 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i , 0 10 20 30 m°/h CAPACITY ~GOULDS PUMPS, INC. SeeAFri,► vvY=awa METERS FEET 120 MODEL 3885 35- N -FT. 110 WE15HH SIZE: 3/4" Solids 30 100 90 25 80 70 X 20 60 50 WEOSHH 15 40 10 20 } 10 1 0 p 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 • 30 m'/h 6110 Goulds pumps, Inc. CAPACITY Efted" July. 1585 6 Rage -t~ Trl- ' SrAra, Marsh Hay, Or St►nthetic Cb'verinq t/ 0s.tribu•tipn Pipe` Medium Sand ~F.. TOE, 11 _ G Y t °Ye Slope:' : I 10~~ Qf N 2; Force - oln Plowe d t~~~ ci qq regata Frotn R~► ►P..! Laxe , CrQS Section Of A Mound System llafPg' -F 7 S ..A Qed ':or The AbsQrphon #rea'•- 5 G '.Sig Ft ned . 1`~•LaG~'~~ ,a _ Ft~ , pate• Ft ' t Alt,qrnate ~Pgf t on. F of' Force N i Ft t,. L : : 77 J - 2 Qbsera,f,ion p~ 777 1 r~ , T•~h }~r_-•*•_ +T !TTT • t Force Main 777 From, Pump t l Oistr(butiojn e d 0 f T: . PiPB . i : A : , r • : g ,q - r\y/y 4 serv t .a ~Q,n Pi..e M P r m nen e ~ rS 01 1.8 . to, . r .P an : V(ew Of M un sl Q: lJ r7 A 8_e For _ T h A p Ian AreQ ~~I t= 77-41 it,rla•~y ;i ~k~~, 't' ' ` raja 1• p. j,C W t ~ Of-7 Page i1 t, S Perforgfed Pipe Detoll 7y. yrEn View •i )Perforated Fns Qoe,, t,~•:.:. PVC Pipe n } . Q},4Ae~?. / HotR~ ~4GCfed Qn:~ortorn, Are'Sa11y Spaced PVC Force Main Distripution 'Ali7}rR4t>f •'PCgIfIon Qf f P+ar FQf~a rR ' ~oitit: Hgle' shauio e~ ' Neil f4 40 Cop tf I Er, Qtip pisf.ribu)ion. Plpe Layout P. 31 . ur,r ,!I 3•~~ X 3G zhe a Y` 3a'` pes Signed No1.e 9fi mter Inch 'Inch(es) t,icnse um per. ~ P ~z 9 - /'f 6 i fQl d if Man Z Inches tvi 7,7 e FQ. .14 Inches 3 hod p c 7~3 t , F r~ 1 . PAGE OF I ' PUMP CHAMBER CROSS SECTIOM AMO SPECIFICATIOUS VENT CAP 40C.Y. VCNT PIPC WEATHER PROOF APPROVED LOCKIMG , JUNCTIOIJ BOX MAUHOLE COVER 25' FROM ODOR, WINDOW OR FRESH 12"MIL. I AIR INTAKE I GRADE IB~MIU. COWDUIT ` 18"KIN. \ - it r r E~ !5N Ct ~y•,,:' PROVIDE I I#JLCT f•; AIRTIGHT SEAL I I I r J . ~ I V I :APPROVED J01N1 APPROVED JOIW 7 A I I III /C.I. w/c.I. PIPe W S PIPE r .I. [XTCNDINb 3 ~luv I II Al_ ARM EXTENo1uG 31 OUTO 60L.ID SOIL 8 " I I ( ONTO SOLID i01► r+ ~,r c ' I 1 LLEV..__ Lw ..'.i` PUMP-~ OFF r D , COWCRETE BLOCK ,•APPRO RISER EXIT PERMITTED OWLy IF TAWK MAWUFACTURC:R HAS SUCH APPROVAL 3 FDOING I 1a SEPTIC € $PECIFICATIOMS DOSE TAWK MALI UFACT URI`R:- WUMBER OF DOSES: PER OAU TANK tac _ foo .,t.GALLOWS " DOSE VOLUME ~ ALARM MAWUFACTURLR: S1-71ec/ .l IIJCLUOIIJG BACKFLOW:__/L3,5__GALLONS MODEL WUMBCR: - /-q_ CAPACITIES: A=.?Z._-f~ INCHES OR3Sg~ GALLONS SWITCH TYPE: IY21°- ✓•c "!::I 8= Z IIJCHES ORyo'y G6LLOU5 PUMP MAIJUFACTURCR; o .38 5 ✓ ~ u lol C IUGHES OR 3'y CALLOUS MODEL WUMBER: ----WEO 3 D--/?- INCHES OR2461'ZY GALLOWS SWITCH TYPE: We•~-C" -V IJOTE: PUMP AMD ALARM ARE TO BE MIIJIMUM DISCHARGE RATE-- GPM INSTALLED Old SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWECN PUMP OFF A1IO..OISTRIBUTIOW PIPC.. FEET + MIIWIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . ?•5 FEET ♦ V,FEET OF FORCE MAIW X -LL&LF~ loo fTFRICT1oW FACTOR..-/.'?Z_ FEET TOTAL OyIWAMIC. HEAD = `f Z FEET INTERIJAL DIMEWSIOW~ OF TAWK: LEWGTH 7 --.-_;WIDTH 7 iLIQuIc) OEPTH 7 SIGHED: % 1G~.~-X6-•1. LICEIJSE "UMBER. DATE: _Z 7 '9D ion, cT~insdn • Performance ' • . SUbmersibl*E6 Effluent Curves Pumps METERS FEET 90 zs so MODEL 3885 SIZI_ /4' Solids WE15H 70 X 2P, WE10H 60 H WE07H 15 50 WE05H 40 10 WE03M WEW 20 5 ' 10 0 0 0 10 20 30 40 50 60 70 80 90 100 1110 120 GPM 0 10 20 30 nP/h CAPACITY [qGCULDS PUMPS, INC. se-LA W44 MW N= 008 METERS FEET 120 MODEL 3885 110 WE15HH SIZE 3/4" Solids 30 100 90 25 70 20 - - - - - - - - - - - - - - - - - - - - 60 . F WEOSHH 15 40 10 30 20 S } 10 0 0 O V 20 30 60 70' 80 90 100 110 120 GPM 0 10 20 30 m'/h 01985 Goulds Pumps, Inc. CAPACITY Effective July. IMi5 ST. CROIX COUNTY WISCONSIN ~r *T r ]\)r f Y ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 385-4680 May 1, 1990 Division of.. Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Tom Johnson property, :Located at the NW-k- of the NW4 of Section 6, T28N-R18W, Town of Kinnic- kinnic, St. Croix County, revealed suitable soils at a depth of 30" below which seasonable high ground water was noted. An additional 12" of sand should make this site suitable for a mound. Should you have any question, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj x x v4X FLASff Irs-9 !RGBNCT COMMUNICATIONS amm FOURTH STRW ISCONSIN 54016-1698 rna aauzwnvamE s (715) 386-9329 WAX) G3/G2/North American 6-Minute FM Mode DATE: j - 90" NUMBER OF PAGES INCLUDING THIS PAGE: TO: NAME: DEPT: _ I COMMENTS: _ FROM: NAME: DEPT: _ NON-EMERGENCY BUSINESS TELEPHONE DIRECTORY (NON-FAX NUMBERS) St. Croix County Emergency Communications Center (715) 386-4701 St. Croix County Sheriff's Department (715) 386-4640 or (612) 436-5440 St. Croix County Courthouse & All Other County Offices (713) 386-4600 or (612) 436-6888 ST. CROIX COUNTY :..Yr WISCONSIN mss: ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 1, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Tom Johnson property, located at the NW-',- of the NW4 of Section 6, T28N-R18W, Town of Kinnic- kinnic, St. Croix County, revealed suitable soils at a depth of 30" below which seasonable high ground water was noted. An additional 12" of sand should make this site suitable for a mound. Should you have any question, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj DUST MENT.OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION:A/ SECTION: WNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: S% N 1'0 !/4 D/4 G /TZgN/R S (or TO IA~ COUNTY: OWNR~'.S BUYER'S NAME: MA LING ADDRESS: ~oirl s~ 30 V c Wills lJ.: S D Z USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IgLpE CRIPTION: PROFILE NS: 1PERCOLATION TESTS: Residence 3 /A(// ❑New Replace I -27-90 3 1 RATING: S- Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(opti nal) ❑S U S ❑U ❑SRU ❑S U ❑SBU If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: AIA Floodplain, indicate Floodplain elevation: 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- 1 a>7 .1071315~~/0 >7~'1 SCE i B 3 ~3 ~.~7 ion ~ B s,l ~3 s 4,4 t- rl B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD t P RIOD 2 PERIOD PER INCH P- • o /VO YL 30 P- Z A ii e 30 P- 'O 30 ss., Sy Sy'~ P-. P_ 24- 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 _ 99~ L f i I i i I7 a f I i y'.__ { I I I, 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 (print : TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) - OVER - r. a INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section 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 to scale is preferred. 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 appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, 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 your 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 - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loarny Sand > - Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI Black si - Silt Gy - Gray *cl - Clay Loam Y Yellow scl - Sandy Clay Loam R - Red sici - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ with sic - Silty Clay fff - few, fine, faint xc Clay cc - common, coarse pt - Peat rnm - Many, medium m - Muck d - distinct p - prominent HWL High water level, * Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sari itary. permit. The county or the Department may request verification of this soil test in the field prior to pt;rrnit 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 perinit. The sanitary permit must be obtai!wd and posted prior to the start of any construction. 4wne,~ ; 3 3ed r-ao►r Nome 83 ~M ~O~inson. o 90 St, ,L/Slope I3M -/00 "D 13Z. Z \ 8o' bi - 97-91 30""x 40~ Bz - 9q,.37 30 22,5' Pole SW B3- 9G~S2~ of R~ 3encA fnar ;s jrade a N, W , C 6,-Y?C_ Y ~o A -57C 0/ 8" ❑ - Deno 6.5- B,,,-(f Poles P# C - Deno Tes ~e r C ~,/o ~PS 150 I'I A'B~M, -.Denotes ~e✓tC/1 /►~ar~ • /►'f OLIno~ is ,ZY X 83.5 ~arQye ®,=~1 5 F x.s n T,Z n e t; e 9 S 50 ~ • o ilous e, sec. .(Fr s1'e o~er~~ow ~-o sur~aCe . .i A6on~oneal F~//eon in o. N s i Ni~J'/y /Vcv -Tz~ N ~ Igo 3-29- 90 ~YQW 17 !3y ~ ~p ~z9 CsT3~l3 90