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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I N o n°r r■ ■IINo ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
May 19, 1994
02,0- /6
Ms. Margaret Strehlo IqT-� e&nj ±�W3
722 Glenna Drive
Hudson, Wisconsin 54016
RE: Water Inspection for Strehlo Residence
Address: 722 Glenna Drive, Hudson, Wisconsin
Dear Ms. Strehlo:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
Sincerely,
Q���;
Mary J. Jenkins
Assistant Zoning Administrator
mz
Enclosure
� ►.� ST. CROIX COUNTY
WISCONSIN
---- --- � ZONING OFFICE
M N N p■ NomeG ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
X'!D
Hudson, WI 54016-7710
(715) 386-4680
May 16, 1994
Ms. Margaret Strehlo
722 Glenna Drive
Hudson, Wisconsin 54016
RE: Water (VOC) Inspection for Margaret Strehlo
Address: 722 Glenna Drive, Hudson, Wisconsin
Dear Ms. Strehlo:
Enclosed is the original test results from SERCO Laboratories
for water (VOC) inspection of the above property. If you have any
questions with regard to said report, please let me know.
Sincerely,
Mary J. Jen ins
Assistant Zoning Administrator
mz
Enclosure
cc: Pat Collins
D
SERCO Laboratories
1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178
LABORATORY ANALYSIS REPORT NO: 44626 PAGE 1 of 3
05/13/94
St. Croix County Zoning DATE COLLECTED: 05/04/94
1101 Carmichael DATE RECEIVED: 05/06/94
Hudson, WI 54016 COLLECTED BY : CLIENT
DELIVERED BY : CLIENT
SAMPLE TYPE DRINKING WATER
Attn: Mary J. Jenkins
CLIENT'S ID: Strehlo
SERCO SAMPLE NO: 65444
SAMPLE DESCRIPTION: Strehlo
Sample
of
ANALYSIS: 05/04/94
---------------------------------------- --------
Benzene, ug/L <1.0
Bromobenzene, ug/L <0.2
Bromochloromethane, ug/L <0.4
Bromodichloromethane, ug/L <0.2
Bromoform, ug/L <0.5
Bromomethane, ug/L (Methyl bromide) <1.0
n-Butylbenzene, ug/L <0.3
sec-Butylbenzene, ug/L <0.4
tert-Butylbenzene, ug/L <0.5
Carbon tetrachloride, ug/L <0.2
Chlorobenzene, ug/L <1.0
Chloroethane, ug/L (Ethyl chloride) <0.4
Chloroform, ug/L <0.5
Chloromethane, ug/L (Methyl chloride) <0.6
2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2
4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2
Dibromochloromethane, ug/L <0.4
1,2-Dibromo-3-chloropropane, ug/L <1.2
1,2-Dibromoethane, ug/L <0.2
(Ethylene dibromide)
Dibromomethane, ug/L <0.2
1,2-Dichlorobenzene, ug/L <1.0
(o-Dichlorobenzene)
1,3-Dichlorobenzene, ug/L <1.0
(m-Dichlorobenzene)
< means "not detected at this level" . 1 mg = 1000 ug.
MEMBER l
Ara
7 SERCO Laboratories
1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178
LABORATORY ANALYSIS REPORT NO: 44626 PAGE 2 of 3
05/13/94
SERCO SAMPLE NO: 65444
SAMPLE DESCRIPTION: Strehlo
Sample
of
ANALYSIS: 05/04/94
---------------------------------------- --------
1,4-Dichlorobenzene, ug/L <1.0
(p-Dichlorobenzene)
Dichlorodifluoromethane, ug/L (Freon 12) <0.5
1, 1-Dichloroethane, ug/L <0. 1
1,2-Dichloroethane, ug/L <0.2
(Ethylene dichloride)
1, 1-Dichloroethene, ug/L <0.2
cis-1,2-Dichloroethene, ug/L <0. 1
trans-1,2-Dichloroethene, ug/L <0.1
1,2-Dichloropropane, ug/L <0.1
1,3-Dichloropropane, ug/L <0.2
2,2-Dichloropropane, ug/L <0.2
1, 1-Dichloropropene, ug/L <0.2
cis-1,3-Dichloropropene, ug/L <1.5
trans-1,3-Dichloropropene, ug/L <0.9
Ethylbenzene, ucj/L <1.0
Hexachlorobutadiene, ug/L <0.3
Isopropylbenzene, ug/L, (Cumene) <1.0
4-Isopropyltoluene, ug/L <0.5
(p-Isopropyltoluene)
Methylene chloride, ug/L <5. 0
(Dichloromethane)
Naphthalene, ug/L <1.0
n-Propylbenzene, ug/L <0.4
Styrene, ug/L <1.0
1, 1,2,2-Tetrachloroethane, ug/L <0.2
1, 1,1,2-Tetrachloroethane, ug/L <0. 1
Tetrachloroethene, ug/L <0.2
Toluene, ug/L <1.0
1,2,3-Trichlorobenzene, ug/L <0.2
1,2,4-Trichlorobenzene, ug/L <0.2
1, 1, 1-Trichloroethane, ug/L <5.0
< means "not detected at this level". 1 mg = 1000 ug.
MEMBER
i
SERCO Laboratories
1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178
LABORATORY ANALYSIS REPORT NO: 44626 PAGE 3 of 3
05/13/94
SERCO SAMPLE NO: 65444
SAMPLE DESCRIPTION: Strehlo
Sample
of
ANALYSIS: 05/04/94
---------------------------------------- --------
1, 1,2-Trichloroethane, ug/L <0. 1
Trichloroethene, ug/L <0.4
Trichlorofluoromethane, ug/L (Freon 11) <0.7
1,2,3-Trichloropropane, ug/L <0.2
1,2,4-Trimethylbenzene, ug/L <1.0
1,3,5-Trimethylbenzene, ug/L <1.0
(Mesitylene)
Vinyl chloride, ug/L <1.0
Total Xylene, ug/L <1.0
This sample's analytical results are AY--nab below the U.S. EPA's
SDWA Maximum.Contaminant Level of /30/91 for those requested
compounds which are also on the SDWA MCL list. Sample received with
no cooling method.
The analytical results in this report pertain only to the items tested.
All analyses were performed using EPA or state approved methodologies.
Samples that may be of an environmentally hazardous nature may be
returned to you. Other samples will be stored for 30 days from the
date of this report, then disposed of by SERCO Laboratories. Please
contact me if other arrangements are needed. This report may not be
g P Y
reproduced, except in its entirety, without prior written approval
from SERCO Laboratories.
Report submitted b
P Y.
Diane J. ` Berson
Project Manager
< means "not detected at this level". 1 mg = 1000 ug.
a IIl Y
MEMBER
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
I
ST. CROIX COUNTY ZONING OFFICE REPORT NO.S 62195/01 PAGE 1 j
ST.CROIX CTY GOV.CTR REPORT DATES 5/17/94
1101 CARMICHAEL ROAD DATE RECEIVED*# 5/12/94
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
II OWNER*. Margaret StrFrh to
LOCATIONS 722 Glenna Dr., Hudson
COLLECTOR: M. Jenkins
DATE COLLECTEW 5-10-94 j
TIME COLLECTED. 10'30pm
SOURCE OF SAMPLES Michen faucet
DATE ANALYZED45-1294'
TIME ANALYZEDS2;00pm cc �;
/+ 70NINGOFF1Ci �
COLIFOh`'M,MFCCS 0 /100 mi `/ '��; f
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 4 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAD TECHNICIANS Pam Gane
�.NDFVFNpENr
�p WI Approved Lab No. 19
V
4
C Means "LESS THAN" Detectable Level. Approved by:
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
a
� ►.� ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r r r r A N r. r, CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
• �-
. = Hudson, WI 54016-7710
' (715) 386-4680
SEPTIC INS blTION *AT£R,., TES REQUEST FORM
J
\ Please specify desired t�st(s) & remit appropriate fee with
application. Outside water lines are often turned off during
inter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained.
0 Water (VOC's) $185. 00 ❑ Septic $50. 00
Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria
retest $15. 00
Owner. Requested by:
Address:
Iff ? Address:
�-1 ZIP ZIP
Telephone N°: — Telephone N°: ( )
Property address (Fire If & S; et) :
Location: , ec
, ; , S . , T 7-IN -R=W, Town of
Realty firm: Lock Box Combo: Closing Date:
s/
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Water sample tap location:
Is the dwelling currently occupied? _-4i-Yes ❑ No
If vacant, date last occupied:
Age of septic system:
Septic tank last pumped by: Date:
Previous Owner's Name(s) :
Have any of the following been observed?
❑Y ON Slow drainage from house.
❑Y ON Sewage Back-up into dwelling.
❑Y ON Sewage discharge to ground surface or road ditch.
❑Y ON Foul odors.
Other comments relative to system operation:
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: DATE.
1/94
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
1N
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? ❑Yes ❑No
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound
Approx. size ' X OGravity ❑Dose ❑Pressurized
Ft. z OBed OTrench ODr Y Well
Molding Tank 00utfall pipe
OBSERVED DEFICIENCIES 00ther OUnknown
Septic tank
Setbacks: OHouse ❑Well OProp. line 00ther
Dose tank
Setbacks: OHouse ❑Well OProp. line 00ther
❑Locking cover OWarning label ❑Pump/Floats
OAlarm ❑Elec. wiring
Soil Absorption System
Setbacks: OHouse ❑well OProp. line 00ther
❑Ponding: ❑Discharge:
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
,�►�. ST. CROIX COUNTY
WISCONSIN
— ---- `ti ZONING OFFICE
1 N N Y p p N p — live� ST. CROIX COUNTY GO CENTER
1101 C e 2
= Hudso 16-7710
IF0
SEPTIC INSPECTION / WATER TEST REQUE OW4
V- 21994
ST
Please specify desired test(s) & remit appr is c0tlee wi
application. Outside water lines are often t FFdit)a
winter months, making access to the home necessar .` 11 as t�!
arrangements with this office to insure that entry c e1j4j_ d.
Water (VOC's) $185. 00 ❑ Septic $50. 00
❑ Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria
retest $15. 00
Owner: Requested by
Address• Address:
• ��JZ��y-,� ZIP ZIP
Telephone N4: Telephone N°:
Property address (Fire W & Street)
Location: ', , ,, Sec. , T N, R W, Town of
Realty firm: Lock Box Combo: Closing Date:
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Water sample tap location:
Is the dwelling currentl occupied? -&,Yest ❑ No
If vacant, date last occupied:
Age of septic system:
Septic tank last pumped by: Date:
Previous Owner's Name(s) :
Have any of the following been observed?
❑Y ON Slow drainage from house.
❑Y ON Sewage Back-up into dwelling.
❑Y ON Sewage discharge to ground surface or road ditch.
❑Y ON Foul odors.
Other comments relative to system operation:
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE. DATE
1/94
a s
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
1N
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? ❑Yes ❑No
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: OBelow grd OAt-Grd ❑Mound
Approx. size ' X ❑Gravity ❑Dose OPressurized
Ft. Z ❑Bed OTrench ❑Dry Well
Molding Tank ❑Outfall pipe
OBSERVED DEFICIENCIES ❑Other OUnknown
Septic tank
Setbacks: ❑House ❑Well ❑Prop. line OOther
Dose tank
Setbacks: ❑House OWell ❑Prop. line ❑Other
❑Locking cover ❑Warning label ❑Pump/Floats
❑Alarm ❑Elec. wiring
Soil Absorption System
Setbacks: ❑House ❑Well ❑Prop. line ❑Other
OPonding: ❑Discharge:
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
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PUMP CHAMBER
Manufacturer: Liquid Capacity:
� S
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: 91� Trench:
Width: / 2 Length: $-S' Number of Lines: 2 Area Built:
60
Fill depth to top of pipe:
t
Number of feet from nearest property line: Front, O Side, 0 Rear,0 Vt . _
Number of feet from well: !mo l
Number of feet from building: ,?9
(Include distances on plot plan).
SEEPAGE PIT
d
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation, of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, a Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
r7N /
Inspector: ! ex—
Dated: Plumber on job:
License Number:
3/84:mj
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,� �_ TOWNSHIP SEC. T N-R11W
ADDRESS leg A SK ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ` LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
7k�xi5�ir+y
1
D � I
X3-5- j9"%B
i
S I i
c�
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used �y�• 3� tJ��
..
Elevation of vertical reference point: Proposed slope at site: ,-/q a
.r
SEPTIC TANK: Manufacturer: �«��Liquid Capacity:
Number of rings used: 10 Tank manhole cover elevation:
Tank Inlet Elevation: /p Q�� Tank Outlet Elevation:
Number of feet from nearest Road: Front,MSide,(aRear, O /j" 7 feet
From nearest property line Front,O Side,O Rear,O x .5_0 r feet
Number of feet from: well }"�Q building:
(Include this information of the above plot plan) ( 2 reference dimensions to se
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
P 0°&0X'7969
MADISON,WI 537Q7 �T�t
SE,SW,2y9,2,9,19W MCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(lf assigned)
Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound
Lot 9 Presidential Estates
NAME OF PERMIT HOLDER: 717 SS OF PERMIT HOLDER: INSPECTION DATE:
Margrette Strehlo North Street, Hudson, WI 54016 �'�y"S7 ��•Uv
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
David B. Fogerty 3289 St. Croix 88483
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: _ LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER
W� PROVIDED: PROVIDED: RI
NO
�a Z*ES ❑NO ❑YESL�INO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY 17; BUILDING: AER NLET RESH
ALARM: FEET FROM LINE:
DYES REST 1 �5� +
DOSING CHAMBER:
MANUFACTURER'. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. 7MATERIAL ED LOCKING
ROV IDED OVER WARN NG
❑YES
JO ❑NO ❑YES ❑NO
PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROP ER BUILDING: AIR NOT RESH
GALLONS PER CYCLE: LNE(DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH: DIAMETER AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA. SPITS LIQUID
BED/TRENCH TRENCHES: 'I MATERIAL: PIT DEPTH
DIMENSIONS �— +'
GRAVEL DEPTH FILL DEPTH JOISTR N F DISTR,PIPE DISTR.PIPE MATERIAL: NO.D R. NUMBER OF PROPERTY WELL: BUILDING: V NI LE FRESH
BELOW PIPES. ABOVE COVER: ELEV.IN ELEV.END. n r. PIPES FEET FROM LINE r�Q AIR IJNLE7.
Coll chi'Ia�k vL NEAREST t+
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
OYES ❑NO PERMANENT MARKERS OBSERVATION WELLS
OIL COVER 7ExruRE
DYES ONO OYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER: EDGES:
DYES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DIS7H. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.: ELEV.: DIA.: ELEV.: PIPES
ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS'
OYES. ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY :
IFEET FROM LINE:
�j
OYES 1:1 NO OYES El NO NEAREST
q)
Sketch System on / , Retain in county file for audit.
Reverse Side. G E
rlrLe,
ATUR
Zoning Administrator
DILHR SBD 6710(R.01/82)
Thomas C. Nelson
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. A14 revisions to this permit must be approved by the permit issuing authority. A new permit may by needed
if there is a�'change in your buhing plans, system—location, estimated wastewater flow (number 6.f bed-
rooms, etc.), depth of system, or type of system;
4: Chantgesih ownership-or plumber requires a Sanitgj"y Permit`fransfer/Renewal FO'rmr (S$D.6399pto be'
submitted to the county prior to installation;
5. Pri'vat'e sewage systems musf be Properly maintained. The septic tank(s) should be"pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I Property owner's name and mailing address. Provide the legal description where the system is to be
installed:
I'. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only,;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/z 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 otheYtreatmentWnk§; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; 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.
GROUNDWATER SURCHARGE
On May 4, 1984; 1983;Wisconsin Act 410 was signed into law. This Iegislajion is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2.year-, of steady negotiation and public debate. ,The groundwater biil Ground a efr--
included the creation, of surcharges (tees) for a number w regulated practices which Wisco iCI"S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasulIrIe
is used in your building is returned to, the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
0
The monies collected through these surcharges are credited to the groundwater fund adminis- °
terer by the Department of Natural Resources. These funds are used for n-ionitoring ground- t
\hate;, groundwater contamination investigations and establishment of standards. Groundwater,
?''s worth protecting.
c=..3D-6398(8.03!86)
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm.Code L"' W X
nammummommms STATE SANITARY PERMIT#
g V 8'_3
-Attach compldte plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO
PROPERTY OWNER PROPERTY LOCATION
s441tX '/4 !W %4, S T,� , N, R E(or
PROPERTY WNER'S MAILING A DRESS LOT NUMBER BLOCK NUMBER S DIVISION NAME
CIT ,STATE • ZIP COD PHONE NUMBER NEAREST ROAD,
Sa y8 ..l
II. TYPE OF BUILDING OR USE SERVED: ? - a . 0010—//S/60—610
Number of Bedrooms if 1 or 2 Family R OR ❑ Public(Specify):
ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. U New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2)
1. a. Conventional b. ❑Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ✓❑See a e Bed b. ❑See a e Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
I 60,11 140-21-.1 Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank ZPAO
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
ber's Name(Print): Plumber's Signature:(No Stamps) "P/MPRSW No.: Business Phone Number:
Zg s6
PI^ber's Addre s(Street,City,Sta ,Zip Cod.). Name of D signer:
O Lo
Vill 9011 TES INFOR AT N
'ied Soil Tester(CST)Nam CST'# jr 2
CS 's ADDRESS(Street,City,State,Zip Code Phone Number:
IX. COUNTYIDEPARIlrMENT USIE ONLY
❑ Disapproved Sa itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
PQApproved ❑ Owner Given Initial /D� �� Sur harge Fee ,(����,y,
Adverse Determination ! S Qv r�d� �� ��d�� /v" ""'' 1ne-
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
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 1 o�
Location of Property Section o< / , T N-R. W
Township LZLcr7ll�
Nailing Address
Address of Site
Subdivision Name
. Lot Number �.
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
R NTY. DEED
�3.9,..a�.- �Vc►
4;j PAU EEGISTERS OFF1C:h
ST. CROIX CO., WIS,
This Deed, made between
Dr. Charles Hopkins Toac'd. for Ra=rd this 11 t h
lay of J_ une A.D. 19 86
--------
Grantor, "`��
- - -------l------ret E� StreYilo� a single person Jam `'Connell
and. .......................................
...................... ----------------------------------------------------------•--------•---------------------- !Fof bow#
------- ---------------------------------------------- ----------------------------------------------- --
------- ----------------------------------------------------------------------------------------- Grantee, Deputy
Witne et ......
That the said Grantor, for a valuable consideration
'ran r - ------ -_--_-- -
-----------------------------•---------------------------------------- --------------
conveys to Grantee the following described real estate in ...... X RETURN TO
. C TOl............................
County, State of Wisconsin:
i
Tax Parcel No- -----------------------------------
Lot 9, Presidential Estates in the Town of Hudson.
YET"
This is---------------- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Grantor
---- -------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and rights-of-way of record.
. z
N
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STC - 105 rr-
a
H
SEPTIC TANK MAINTENANCE AGREEMENT c
St . Croix County z
ty
a
OWNER/BUYER to
ROUTE/BOX NUMBER ��� ,� Fire Number
.CITY/STATE7� G~Y� i ZIP
� T
PROPERTY LOCATION: /,C �It, Section, T cx N , R-2-LW,
Town of St . Croix County,
Subdivision Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper. What you pdt 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. H
0
E
I/WE, the undersigned , have read the above requirements and agree x„
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Offkge within 30 days
of the three year expiration date.
SIGNED p
DATE Q
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.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDWSTRY,, DIVISION
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.09(1)& Chapter 145.045)
LOCATION: SECTION: TOWNSHIP LOT NO.:BLK.NO.: SUBDI VISION NAME:
�/ 1/ ,t /T N/Rg E (o q 1 — /.
COUNTY: BUYER'S NAME: MAILING ADDRESS:
,r/ vo
USE DA ES OBSERVATIONS MADE
NO.BEDRMS.:1COMMERCIAL DESCRIPTION: PROFILE D PT ONS: A TESTS:
`Residence 3 QNew ❑Replace � � , _ o�
RATING:S=Site suitable for system U=Site unsuitable for system[DU CONVE�`NTIONAL: MOUND: IN-G(R'O�U,NIPRESSURE: SYSTEM-INN---F]�,IILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)EIS
DU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- s NaN� s r' 2r "o <
B- 2 7 'P-1 71 1 y3 C< I.Zf, e 0,C.
B- .2 67 s s
B f /03 3. 1 o L' n s 9 cf d.i' M
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH
P- /vIp s S s
P-
P- 3 NC ?
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 � A/
� '�
,
,
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i
,
t ;
i r
I
N
i S�'� �4TT•hc,�Ev Sf,/��T
f
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s
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.
NP IE(print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
1b c WM o 3 213 r;4
CST SIGNATURE
DISTRIBUTION:Original a .-1 one copy to Local Authority,Property Owner and Soil Tester.
�DILHR-SBD-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;
1 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;
S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
0. 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;
1 1. Sian the form and place your current address and your certification number;
12. Make legible copies and distribute as rerluired, 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
reed s — Medium Sand W — Well
fs — Fine Sand Bldg Building
Is — Loamy Sand > -- Greater Than
"sl - Sandy Loam < — Less Than
*I .— Loarn Bn -- Brown
*sit - Silt Loam BI Black
si — Silt Gy Gray
*cl -- Clay Loam Y Yellow
set _ Sandy Clay Loam R — Red
sicl -- Silty Clay Loam mot — Mottles
sc - Sandy Clay w/ — with
sic — Silty Clay fff few,fine,faint
Ic — Clay CC common, coarse
of Peat rnrn — Many, medium
m — Muck d — distinct
P -- prorninent
HWL — High water level,
Six general soil textures surface water
for liquid waste disposal BM — Beach Mark
VRP — Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in secrrrir,g a sanitary permit. The county or the Department may reposer
vrcification of this soil test in the field pi for to permit " suMrtce,- A complete set of plans for the private
s"-vvace system and a permit application must he se=hrlritl(ad CC the appropriate local authotity in order to
obtain a permit. The sanitary perrnil must hi; Obt<ih!Cd and posted prier to trio,start ()f aoy construction.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969
)
HUMAN RELATIONS \ J MADISON,WI 53707
(H63.090)& Chapter 145.045)
LOCATION: SECTION: OWNSHIP/°,;;; F;-',: LOT NO.:BLK.NO.: SUBDI VISION NAME:
�f ''5w'/a /T y N/Rid E (.4r
COUNTY: OWNER'S BifY�r1dIE: MAILING ADDRESS:
S I Amt l� (6 O t�ch Gtr s O/C
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: N ILE pE�SC I TIONS:1PERCOLATION TESTS:
Residence New ❑Replace /6/d'
RATING:S=Site suitable for system JU Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
❑S ❑ ❑$ ❑� ❑ ❑ 2S ❑u ❑S ❑u / T2 v,
If Pe:s.H6�3.09(5)(b),�Tests re NOT requ ired DESIGN RATE: If any portion of the tested area is in the
unde indicate: Floodplain,indicate Floodplain elevation: y�i?
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-
B-
B- 90
B-B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD 3 PER INCH
P- Z
P-
P- 3
P-_
P- 5' V 7
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 99. L
•_ d_. . ._ _...._._
r-
__
I
.z... ._.._n. J........... ......._v. - _
Y z
E
` E
E
TN
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3 ,
I
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E
r
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E
r
E
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.
E (print►: TESTS WERE COMPLETED ON:
AD CERTIFIC I NUMBER: PHONE NUMBER(optional):
e } rj;
IGNATU
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6595 •
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
Sail 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 GrOurrdwater
cs - Coarse Sand Perc — Percolation Rate
med s — Medium Sand W — Well
I's -- Fine Sand Bldg Building
Is Loamy Sand > --- Greater Than
sl — Sandy Loarn. < -- Less Than
l — Loarn Sri — Brown
sil — Silt Loarn BI Black
si — Silt Gy -- Gray
*cl — Clay Loarn Y ._. Yellow
sci — Sandy Clay Loam R — Fled
sicl — Silty Clay Loam mot — Mottles
se — Sandy Clay "t -- with
sic —. Silty Clay fff -. .few, fine,faint
- Clay cc — common,coarse
pt Peat mm Many, rnedium
rn — Merck d — distinct
p — prominent
HWI- -- 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 sttrp in securing a sanitary permit. The county or the Department may request
ve'l of this soil test ill the field prior io Pet mil issuance. A complete set of plans for the private
sr va€e system and a permit: application rmist be suhmitted to the local ar,rtl:ority in order to
atnam a permit. The sanitary pelin,it must be ofitamed and posted prior to thrr start of arty construction.
L
F—PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(H63.090) &Chapter 145.045)
LOCATIQN: SECTION: TOWNSHIP LOT NO.:BLK.NO.: SUBDIVISION NAME:
II J'/a gf /T N/R/9 E
C FU=N TY: BUYER'S NAME: MAILING ADDRESS:
O
USE DA ES OBSERVATIONS MADE
NO.BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DES ER LATION TESTS:
Pesidence .3 QNew ❑Replace 6
RATING:S=Site suitable for system U=Site unsuitable for system - /e
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RE OMMENDED SYSTEM:(optional)
IDS I � �U � �U OS � � DU ,I' $-2' ✓k✓� t .�O
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: — Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL D PTH 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- ?r o . s APN4 T : f' sa <
B- 7 o i. ' J y3 L,
B- ? 67 v 67 8' f 3' s w
B- y P5— oY. 7 ,r3 s z ' f .-9 ' e- w �.
B- t /D 3 / 3, l 0 6' n t 9 ' ct
B-
PERCOLATION TESTS
TEST DEPTH" WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH ES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R D
P- /UIN S S r
P-
P- 3 NC 1 1
P-_
P_ 3� / f
Cs�
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, ce elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION �b 2 �y e�
y w - ` -
, E
E
-
tN
E
.a __ _ _ e _ � ... __.� _ �. _ _
}
r �
s i
3 --y
r
- -° - - l ..
i
T"
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.
N E(print): TESTS WERE COMPLETED ON:
c- Fd
ADDRESS: CER IFICATION NUMBER: PHONE NUMBER(optional):
' S�
�
CST SIGNATURE
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) -OVER -
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
INDUSTRY, DIVISION
LABOR ANb" PERCOLATION TESTS (115) P.O.MADISON WI 53707
HUM4I�RFLATIONS •
(H63.090)& Chapter 145.045)
LOCATION: SECTION: TOWNSHIP LOT NO.:BLK.NO.: SUBDIVISION NAME:
1/�1/ ,t /T N/R/9 E (o l 9 —
COUNTY: BUYER'S NAME- MAILING ADDRESS:
Cf Sy0
USE DA ES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: A N TESTS:
tesidence 3 QNew ❑Replace I
RATING:S=Site suitable for system U=Site unsuitable for system C
ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RE OMMENDED SYSTEM:(optional)
D S DU CAS DU CAS DU [_]S EA CAS �U �' s-z' tea,, �. r s .IoM
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: _ 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 ES IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- , s NoNe- '
s f s 4 c 4.
B- 2, 7 p Z. ' 1 5" w L.
B- 3 67 0 G7 P' s ' s
B- `l Fr 10,17 > Fr t7 s 2 "Za 1 14 '11A c !.7'Z;*
B- t 103 103. 1 o . L' ., s JP ' cf d.x' M
B
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- Alo s s s
P-
P- 3 D N 7
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 /e 2,/y
,
l __i_ ( r
tN
29 } l T
f
t
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t
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E
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r
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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.
NAA4E(print): TESTS WERE COMPLETED ON:
b 4r j' ' F6
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
233 SL
CST SIGNATURE
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
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