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Parcel #: 038-1160-20-000 05/18/2006 11:50 AM
PAGE 1 OF 1
Alt. Parcel#: 34.31.18.753 038-TOWN OF STAR PRAIRIE
Current X
ST.CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
SCOTT M WARNER O-WARNER, SCOTT M
1835 110TH ST
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description " 1835 110TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.720 Plat: 1974-GERMAIN &HANNER ADD
SEC 34 T31 N R1 8W GERMAIN&HANNER ADD Block/Condo Bldg: LOT 12
LOT 12
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-31 N-1 8W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1127/525 WD
07123/1997 825/54
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.720 30,000 141,400 171,400 NO
Totals for 2006:
General Property 1.720 30,000 141,400 171,400
Woodland 0.000 0 0
Totals for 2005:
General Property 1.720 30,000 141,400 171,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 312
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP =�y )16�:.� SEC. T N-R / 25 W
ADDRESSf/G!�(�i-/w�����ST. CROIX COUNTY, WISCONSIN
SUBDIVISION , u� n �LOT LOT SIZE
PLAN V
Distances and dimensions to meet requirements of IL1IR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
frame �D -Pp' S6/
O
S'^(
i Y
308--------�►
i
O ?o
�F`,—
► � l
T-
INDICATE NOAtH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: t04 roposed slope at site:
SEPTIC TANK: Manufacturer: rAj ,��_Liquid Capacity• y :9d4'.:9
Number of rings used: � _ Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: X '?
Number of feet from nearest Road: Front,or/side,ORear, O ��� feet
From nearest, property line Front.0 Side 10 Rear,� feet
Number of feet from: well y�`-8-/-' building: /
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
Manufacturer: Liquid Capacity:
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
5 a
Bed: Trench:
Width: 5- Length: 7 Number of Lines:l Area Built:--,7.4n2
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, t .�_
Number of feet from well: Q �
Number of feet from building:
(Include distances on plot plan).
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).
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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspecto
Dated: P er on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUWAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
State Plan I.D.Number:
NA-,SA-,S34,T3IN-R18W CONVENTIONAL ❑ ALTERATIVE (If assigned)
Tows. o4 Sta& P)Lat'A,e ❑ Holding Tank In-Ground Pres re ❑ Mound
Lod A E L R ADDRESS OF PER HOLD INSPECTION A E:
Tnoy StAawv� Route 1, Lot 16 N.R. E,6tate�s, New Richmo id //-- / U" g� 2,00
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FRO PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
HentLy Nech.v,iUe 3258 St. Cnoix 119362
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
( PROVIDED: PROVIDED:
' 90 1 (-�� [ YES ❑NO ❑YES NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO RESH
^� ALARM: IFEET FROM LI AIR INLET:
El YES NO f C rl- ❑YES ❑NO NEAREST—+1 15 .3
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ED No ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROP RTY WE BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LIN AIR INLET:
PUMP ON AND OFF ❑YES ❑NO NEAREST—�
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAM T R: AT 1 AND MARKING:
or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: f TERIAL: PIT DEPTH:
DIMENSIONS a
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW 1IPES: ABOVE COVER: EV. f�: EL .EpIrD;` PIPE: LINE: %5 a AIR INLET:
�
'T I ll !V1 FEET FROM
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
DIMENSIONS TRENCHES:
MANIFOLD PUMP MANIFOLD DISTR.PIPE I MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE. HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO E_-]YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF P OPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ❑NO ❑YES ❑NO NEAREST—�
s•a�
Sketch System on Retain in county file for audit.
Reverse Side. TUBE: TITLE:
SBD-6710(R.06/88) i'�.(� C Zoni n Admiwizt tal ton
SANITARY PERMIT APPLICATION COUNTY ^�O/
� DILHR In accord with ILHR 83.05,Wis.Adm.Code C
STATES TARY PERMIT#
&_�')
–Attach complete 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 LL
PROPERTY OWNER PROPERTY LOCUTION
Q/ /a 1 1/4,S T 2/, N, R 8 E(o W
PROPERTY OWN MAI G ESS LOT NUMBER BLO/C�iK�N BER SU VISION NAME
CITY STATE w�+� ZIP CO E ONE NUMBER CITY ,�.yt �j NEAREST ROAD,LAKE OR LANDMARK
ri
LLAGE: SfOI�P14A;
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. 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. onventional 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. El Seepage See a e Bed b. Se a e Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Mi utes per inch): REQUIRED(Square Feet): PROPOSED(Square Fee o:
. �,• CSn '7� ' eet rivate ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New xisting Gallons Tanks Concrete structed glass App.
Tanks I Tanks �f
Se tic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Ptum er's Signature:(No Stamps) MRQ=SW-Nti Business Phone Number:
Plumber' ddres Street,City Step Cod Name o esigner:
BL z9o�e A— al _a�*L i
VIII. SOIL TEST INFORMATION
Certified it Tester(CST)Na e CST# ^�
C;
CST's ADDRES (S re t,Cit te,Zip Code) Phone Number:
14 IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Is g Agent Signature(No Stamps)
Approved ❑ Owner Given Initial (S��}{�ch rge Fee
L,
Adverse Determination
/4 ��
X. COMMENTS/REASONS FOR DISAPPROVAL:
IVe-
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
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. All revisions to this permit must be approved by the permit issuing authority. Anew permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (numbe;r of bed-
.rooms, etc.), depth of system, or type of system;
-4. Changes in ownership"br plumber,requires a Sanitary Permit Transfer/Renewar Form (SBd 6'3'99) to be
submitted to the county prior to ins�ll.atian;
5. Private sewage systems must be properly maintainet: The septic tank(s) should be•p l$nped 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;
II. 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'% 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; 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 legislation is more
commonly known as the groundwater protection law. This change,n statutes\,was the ;
result of ovor,2 ears of stead ne otiafion^arn# ubkc-debafe. Tfte roundw,1t6r bill - `
Y Y 9 P 9 Groundtier -`4
included the creation of surcharges (fees) for a number of regulated practices which Wisco 1W
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure
is used in your building is returned to the groundwater through your soil absorption e
system or the disposal site used by your holding tank pumper..
a
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
^ 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.
-----------------------------------------1----�--------------------------------------
Owner of property
Location of property 1/4 50_1/4, Section 3 , T 31 N-R—f—W
Township / �al /P/
Mailing address ( f GIJf /o/ xy
Address of site
Subdivision name_
Lot number
1
Previous owner of property � ����?�s'� ������G� f-7
Total size of parcel _ 7 /�;'Anf `D
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
andPaeNumber � l/
g 7 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, r�ecorded in the Office
of the County Register of Deeds, as Document N
l
Signature of Owner Signature f Co- er (If Applicable)
Date of Signature Date of Signature
a
x, tTlllE '�iMl0011!llf+�IM��-�
RK'd
MKIn 1" Banner, as
t_ n n OCY 1 S IM
d a
2:90 r.r
an v ! as vorsh rital
wr.
Century 21
r;
Somerset, Ni.
��wtr«w.In Overly,
i
Tart Parcel Noc
Lot 12# Germain and rrs Addition in the Torn of Star Prairie.
FM
f
t }
In not
Thla hoMMO d 0Topl�►.
. EMO9pdontaMranatA9t recorded easements and rights of way
Oa1911fAiB' ,_ 10 th t�d October ,T! 88
(SEAL)
• Edward E. Germain • John A. Hanner
(SEAL) ISEMj
<r
3= e � •
N
ANTHONTICAIM ACKNOWLEDGEMOff
v,
STATE OF WISCONSIN
1 '.
St Croix
PenaraMy carers before me Mwa 10 tii �y of
&Ahwtl obd 9ria day of ,19 Oct o b e r ''I 98-L on Won named
Edward E. Germain and John A.
anner
•
TIRE: MEMBER STATE BAR OF WISCONSIN
(�not b me known to he the person who execulsd On
,
n II- I -d by 1 706.08,Wit Stm&) bregoirrg and acknowledge urn
THS INSTRUMENT WAS DRAFTED BY 4�
Jchn D.Walsh John D. V a D. W '••,
Notary Public
Iftak nra my�;a a*wvlicaled or admowledgad. Both �==e c e�m ba e= —*-,q 8 1
'wu«an vM•«r Mprww ■+r ay.aq.iw�ra w qo.a«p.•w oMo.n...pn+..s. ,' s/:'
~ B
f L�C
WAMIANTY DEED r
Tq�
FORM No.2-1982 !i?701
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER /0 FIRE NO.
CITY/STATE Off/,, /`/ (i�1J�G�/7G� :�,� ZIPDr 7
PROPERTY LOCATION: LL114 S tJ 1/9 Section , T--:.3 R W,
Town of �� // i �-� , St. Croix County,
Subdivisio i� C�ii� �lf/9/7���� Lot No. Ao_
Improper use and maintenance of ������
your septic system coulcT result in its premature
failure to handle wastes. Proper maintenance consists of pumping out the septic
tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 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 verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department 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 - -
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY,. - C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS BOX 76
(H63.090)&Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ Y: OT NO.: LK.NO.: SUBDIVISION NAME:
NW 1/4 S'0/ 34 Al N/R 18�ktor►w Star Prarie 12 /a rmain & Banner
COUNTY: UYER'S NAME: MAILING A ESS:
St. Croix Troy Strawn IR.R.#1 lot 416, . Estates New Richmond Wi. 5401
USE DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DES IP ION7 /a O A ON TESTS:
Residence 3 n/a 0New eplace 10-29-88 n
RATING:S=Site suitable for system U=Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUNDPRESSURE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
r9S ❑U CAS ❑U XH S ❑U ❑S �U ❑S �U conventional
F rcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
r s.H63.09(5)(b),indicate: Class 2 Floodplain, indicate Floodplain elevation:n/a
decimal' PROFILE DESCRIPTIONS page 19 COD2
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTHS OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 6.83 101.26 none >6.83 .75bl.1. 1.83bn.sil. 4.25bn.s.l.
B_ 2 7.00 101.20 none >7.00 .83bl.1. 1.50bn.sil. 4.67bn.s.1.
B_ 3 7.76 101.75 none >7.76 .92bl.1. 1.67bn.sil. 2.67bn.l.s. 2.50bn.s.l.
B_ 4 7.33 102.38 none >7.33 .58bl.1. 1.17bn.sil. 5.58bn.s.1.
B_ 5 7.58 101.00 none >7.58 .67bl.1. 1.08bn.s.sil. 3.08bn.s.1. 2.75bn.l.s.
B_ 6 7.00 101.38 none >7.00 .75bl.1. .50bn.sil. 3.42bn.s.l. 2.33r.bn.s.1:9r til
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 P R PER INCH
P-
P-
P-
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 97.75
l
F_ !A
i
E 1
I --'
4
i
r
I
_._
_.
t
I
- .w �v< _� _ — —
N € 3
Flo
- - - -�— -
T � � ( l
_._
Avf
� � [ 1• /
� ; �o o i i € "�►
3
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:
Gary L. Steel 10-29-88
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
988 N. Shore dr. New Richmond Wi. 5401 715-246-6200_
CST SIG UP!E:
CR.
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 - SBD - 6536
To be a complete and accurate sail test,your report mast include:
1. Completes legal description;
2. The use section must clearly indicate wltetber this is a residence or commercial project;
3. MAXIMUM number of bedrooms or coolrnCrcial 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 vo-iting profile descriptions and cornpleting the plot pan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet naay he used if desired;
8, Make sure your bO;N hmark and vertical elevation reference point:are clearly shown,and are permanent;
93 comolele all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exernp-
tion, if appropriate;
10. If the informalron (such as 'flood plain,elevation)does not apply, place N,A.in the appropriate box;
11. S<r n the fo, n'l-Ind place. yeaur c:urre:nt address arld your ce.rtificaliorl number;
13, Make lullible copia's and iSlFitlut:e as recfuired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY%fal T HIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
snail Separates and Textures Other Symbols
st -- Stones (ove'r 10"} BR Be=drock
e oi, ..- Cep.b:c (3- 10") SS - Szmdstone
Gravel (under 3") LS -- Limestone
Sw d 1 G W - Hiah Gioundwatcr
as C rrse and Perc; - Pewolation Raw
1net s °-- ry dlmro Sand kN
k - F n Sant: Bldg Building
Loanw Sand r Greater Than x ',
sl ._ aa:-)dy Lown Tian
Loam Bn Brovm
S?4t L_c>a BI Black
si - Silt Oy Gray
`cl - {play Loam y yellow
scl ._ S<t!3cfy Clay Loam R Reid
sic! - Silty Clay Loam ntot - Mottles
sc Sanely Clay aAri ._ wlih
sic Silty Clay fit f€rw, fin;,taint
Glay irC __ Wlllr))Onr coarse
p - Pear rrlrst - Many, medielnr
> -- Muck d - distinct
p - prorninem
HWL High water level,
Slx general soil textures surface water
,or liquid vvaste disposal BM - Bench Mark
VRP - Vertical Red'erence Pain
TO THE OWNER:
This soil test report is thk; first step in securing!<a sanitary permit. The county or the Department rnay request
vet ifer.ation of this soii test in file field ps tern io pernnit issuance, A c;ornpleres seat of plans for the p6vate
,,en,v,jgo. system, and to permit apfalicalion rrlust be : lbmatcd io the= appropriate local authority in order to
LlntalCl a perelitt. The ,-,arwary flei "lit must be orl'tc'i@m d zfnd posted prior to the staPt of wly constructiml,
DEPQ,RTMENT OF
INDUSTRY REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
, DIVISION
LABOR`AND PERCOLATION TESTS (115) P.O, BOX 7969
HU'NIAN r*LATIONS MADISON,WI 53707
rte ' (1-163.090)& Chapter 145.045)
, TOWNSHIP/ OT NO.:BLK.NO- SUBDIVISION NAME:
NWT�SW�� N/R18)6or►W Star Prarie 12 /a retain & Harmer
COUNTY, a,,I MAI IN ADO
St: Croix : Tro Strawn
IR-R-G, lot #16 N.R. Estates New Richmond W. 540i/
USE
Na BEDA DATES OBSERVATIONS MADE
"t r .i RIPT O FILE DESCRIPTIONS—
�Resiiience :I ERCOLATION
�` .3 n/a RgNew ❑Replace 10-29-88 n/a TESTS-
RATINC3:S+Sito suitable for system U.Site unsuitable for system
L9 S U fA(��.Elul 9 S au gO -I��L H�SG'L�� .RECOMMENDED SYSTEM:(optional)
'�`,��}� conventional
If Percolation Tests are NOT required DESIGNflATE:
n [Floodplain,f any portion of the tested area is the
under s.H63,09(5)(b),indicate: C1aSS G indicate Floodplain elevation:n/a
'decimlt` PROFILE DESCRIPTIONS page 19 COD2
BORING TOTAL ELEVATION DEPT H GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH= OBSERVED ES IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 6083 101.26 none >6.83 .75bl.1. 1.83bn.sil.. 4.25bn.s.l.
B. 2;, 7.00 ', 101.20 none >7.00 .83bl.1. 1.50bn.sil. 4.67bn.s.l.
B. .7u 101.75 none >7.76 .92bl.1. 1.67bn.sil. 2.67bn.l.s. 2.50bn.s.l.
B. 4 7.33 102.38 none >7.33 .58bl.1. 1.17bn.sil. 5.58bn.s.1.
B. 51, 7.58 101.00 none >7.58 .67bl.1. 1.08bn.s.sil. 3.08bn.s.1. 2.75bn.l.s.
B. 6 ': 7.00 101.38 none >7.00 .75bl.1. .50bn.sil. 3.42bn.s.l. 2.33r.bn.s.l. har
PERCOLATION TESTS
TEST DEPTH-. WATER IN HOLE TEST TIME DRUP IN WATER L VEL-INCHES RATE MIND I ES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P p PERIOD 2 PERIOD3 PER INCH
P-
P- .
P-
F-
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 hork
tontal'end'vertieal elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of lend,elope '«
SYSTEM ELEVATION 97.75
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I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and rnethods 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,
z
NAME print
TESTS WERE COMPLETED ON:
Steel° _ 10-2 -`88
CERTIFICATION NUM13ER: PFIONE Nump-r-( npernianl►:
I�jchmond, Wi. s01-7 7 715-246 62CL0
tn r---- �.
CST SIGN 'URE: t"
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. `
DILHR-SBD-6395 (R.02/82) n,;f F' y
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