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Parcel #: 020-1158-90-000 01/07/2005 04:22 PM
PAGE 1 OF 1
Alt.Parcel#: 20.29.19.896 020-TOWN OF HUDSON
Current OX ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): *=Current Owner
*FEDERATION,WALTER S
WALTER S FEDERATION
491 MAUD CIR
HUDSON WI 54016
Districts: SC= School SP=Special Property Address(es): *=Primary
Type Dist# Description *491 MAUD CIR
SC 2611 SCH D OF HUDSON
SP 1700 W ITC
Legal Description: Acres: 1.460 Plat: 2329-PINEGROVE HEIGHTS ADD
SEC 20 T29N R19W PINEGROVE HEIGHTS ADD Block/Condo Bldg: LOT 03
LOT 3 Tract(s): (Sec-Twn-Rng 40 114 160 1/4)
20-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
02/27/2003 711469 2157/02 WD
777/553
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
48979 207,700
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.460 24,600 136,100 160,700 NO
Totals for 2004:
General Property 1.460 24,600 136,100 160,7000
Woodland 0.000 0
Totals for 2003:
General Property 1.460 24,600 136,100 160,7000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 213
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges 00 Delinquent Charges 00
Total 27.00
b �
PUMP CHAMBER
anufacturer: Liquid Capacity:
Pump Mode Pump/Siphon Manufacturer: Pump S °-
Elevation of inlet: Bottom of tank elevatio
Pump off switch elevation: Gallo er cycle:
Alarm Manufacturer: Ala itch Type:
Number of feet from near property line: Front, e, O Rear,0 Ft.
umber of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: V'CS Trench:
Width: /1_ Length:_:2 Number of Lines: Area Built:_,�� I/
Fill depth to top of pipe: y��r
Number of feet from nearest property line: Front, O Side, (Q} Rear,0 Ft .
Number of feet from well: �✓✓
Number of feet from building: y�
(Include distances on plot plan).
EPAGE PIT
e: Number of pits: Diameter:
Liquid the Bottom of seepage pit elevation:
Area Built:
Has either a drop box r distribution box O been used on any o he above soil
absorbtion sytems? (Check one .
HOLDING TANK
Manufacturer: Capa y:
Number of rings used: Eleva on o ottom of tank:
Elevation of inlet:
Number of feet from nea st property line: Front, 'de, O Rear, O Ft.
umber of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: -'4 _—Z Plumber on job: ^ ZI 1
License Number: 5
3/84:mj
z
I �
Form - S T C 104
AS BUILT SANITARY SYSTEM REPORT
OWNER DAAL-- NSHIP f� /�r�>n/ SEC. T N-R W
ADDRESS �lr ST. CROIX COUNTY, WISCONSIN
SUBDIVISION P,AIIE QWjJ==LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of II,HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
N
Muse lffs
/U . ys.
4E� Sy`
z ��Xs2. BEp
S��PhG�
s 131-1 Sa �
u' ,L _
0G'/00,0 INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ,_5( 1 40T SLACE
c
Elevation of vertical reference point: A00i Proposed slope at site: Q
SEPTIC TANK: Manufacturer: Liquid Capacity: 1006
Number of rings used: &d A/C Tank manhole cover elevation: 9(Or' 7
Tank Inlet Elevation: /• 6 0 Tank Outlet Elevation: 9y,,3 G
Number of feet from nearest Road: Front,�Side 0 Rear, 0_��� feet
From nearest property line Front,0 Side, Rear,O feet
Number of feet from: well building: �y------
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.IFX 7969 BUREAU OF PLUMBING
MADISON,WA.3707
NE a"S E 4,S 2 0,T 2 9N-Rl 9W MCONVENTIONAL El ALTERNATIVE State Plan l.D.Number:
,
1 I assigned)
Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound
Lot 3, Pine Grove Heights
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Dan Schneckenberg Route 1 , Clear Lake, WI 54005 �0-
BENCH MARK(Permanent reference point)DE RISE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MPIMPRSW No.: County: Sanitary Permit Number:
Donavin Schmitt 3205 St. Croix 92547
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLLL,,,EEET ELEV.. ITANK OUTLET ELEV.: IWARNING LA EL LOCKING COVER
OVI D: PROVIDED:
7[ ES ONO ❑YES O
BEDDING: VENT DIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: jVt,Nj O RESH
nALARM' FEET FROM LINE: AIR 1 LET.
DYES NO ✓� DYES NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO DYES ❑NO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. V
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL 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 INSIUE DIA. #PITS LIQUID
BED/TRENCH / I TRENCHES MR IAI PIT DEPTH
DIMENSIONS lI/ r �
GRAVEL DEPTH FILL DEPTH 1.111R.,PIPI DISTR.PIPE DISTR.PIPE MATERIAL: NO.DIS NUMBER OF PROPERTY WEL BUILDING. V NRESH
BELOW IPES A E OVER. ELEV. N E ELEV.END: p PIPES. FEET FROM LINE t' /�/ AI INUC
/( 1. /
NEAREST------p-
MOUND 1 Q � .\/
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.
1:1 YES El NO
SOIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS
1:1 YES ONO ❑YES NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED 16E'UEUE1YES. MULCHED
CENTER: EDGES.
OYES ONO ONO OYES �EINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFO D DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.: ELEV.: DIA.. ELEV.. PIPES DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
YES El NO ❑YES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
—]YES NO YES NO NEAREST
Sketch System on ` Retain in county file for audit.
Reverse Side.
SIGNATURE-. TITL&.
Zoning Administrator
DILHR SBD 6710(R.01/82)
INFORMATION & NSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is vz id 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 perm t must be approved by the permit issuing authority. A new permit may be needed
if there is a change in yoi r building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of sys em, or type of system;
4. Changes in ownership or dumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county p for to_installaiion;
5. Private sewage systems r lust be properly maintained'The septic tank(s) should be pumped by a licensed
pumper;whenevef;neces; 3Ky,,-usually, every 2`to 3`years;
6. If you have questions con :erning your private sewage system, contact your local code administrator or the
State of Wisconsin, Burea i of Plumbing, 608-266-3815.
To be complete and accurate its sanitary permit application must include:
I. Prcperty owner's name ai d mailing address. Provide the legal description where the system is to be
installed;
Il. Type of building or use se ved:1f public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in nu nber of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Cf ack only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all .ppropriate boxes depending on system type. Check experimental only if project
is in conjunction with Univ �rsity of Wisconsin;
V. Absorption system informi tion: Provide all information requested in ##1-6;
VI. Tank information: Fill in th , capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manL �acturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon ch amber and holding tanks for this system. Check experimental approval only if
tanks received experiment it product approval from DILHR;
VII. Responsibility statement: I istalling plumber is to fill in name, license number with appropriate prefix (e.g,
MP, etc.), address and phc ie number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certii ed soil tester's name, certification number, address, and phone number.
IX. County/Department Use Oi ly;
X. Comment area for use by ( ounty or resaon given when application is disapproved.
Complete plans and specifi rations not smaller than 812 x 11 inches must be submitted to the county. The
plans must include the folic wing: 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 ,r pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the loca ion of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications or pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump r iodel and,pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) : oil test data on a 115 form.
---------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsir Act 410 was signed into law. This legislation is more
commonly known as the ground vater protection law. This change in statutes was the
result of over 2 years of steady egotiation and public debate. The groundwater bill Ground Moir
included the creation of surchar ies (fees) for a number of regulated practices which Wisco ill'$
can effect groundwater. The sun harge took effect on July 1, 1984. All of the water that buried reasure:
is used in your building is returr ad to the groundwater through your soil absorption buried
system or the disposal site used by your holding tank pumper.
The monies collected through th use surcharges are credited to the groundwater fund adminis-
tered by the Department of Natu al Resources. These funds are used for monitoring ground-
water, groundwater contaminati( n investigations and establishment of standards. Groundwater, t
it's worth protecting.
SBD-6398(R.03/86)
SANITARY PERMIT APPLICATION COU�Y
7 In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT#
9 7
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8'/z 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
DAM ,6'/4 , "r '/4, S R 41 T c/, N, R i E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME A -
��
CITY n NEAREST ROAD,LAKE OR LANDMARK
CITY,STATE �ZIPCODEPHONE NUMBER VILLAGE: ^(,.
1114 TOWN QF-
II. TYPE OF BUILDING OR USE SERVED: f44-0--/M - d so-
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. �4 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. El 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. X 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. 19seepage Bed b. ❑seepage 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):
",,.! ��..� �f� Feet �Private ❑Joint ❑ Public
6-
VI. TANK CAPACITY Site Fiber- Exper.
in al Ions Total #of "Name Con- Steel glass Plastic App INFORMATION ManufNew xistin Gallons Tanks structed
Tanks Tanks Se tic Tank or Holdin Tank GC?� ❑ ❑ ❑
Lift Pump Tank/Siphon 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): Plu er's Signature:(No Stamps) w
/MPRSW No.: Business Phone Number:
_77
r '.� , ,.
Plumber's Address(Street,City,State,Zip Co Ae): Name of Designer:
T', ZAI JA° f
Vlll. SOIL TEST INFORMATION cST#
Certified Soil Tester(CST)Name
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
Hf° g ;, rC At , y'�f
IX. COUNTY/DEPARTMENT USE ONLY Issuing Agent Signature(No Stamps)
❑ S�tary Permit Fee Groundwater ate rcharge Fee Approved ner Given Initial j ±.ca e� .`�� �n I
Adverse Determination 9u
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 LA61 < °ilJVt�Li�11s:L1'.�t
Location of Property --, l14 _,I L- � Section 2,0 , T K N-R 9 W
Township / &,Q S 42
Mailing Address PCB
Address of Site /'� T� '� n 0 a ( �
Subdivision Name
Lot-Number
Previous Owner of Property C H d 41)
Total Size of Parcel lk
Date Parcel was Created MY-3
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume 2 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) ceAtijy that att statements on this 6oAm cute true to the best o6 my (ouA)
knowledge; that I (we) am (ate) the owneA(s) o6 the pno penty dens ch i.bed in this
injo,tmafiion boAm, by v,ihtue of a waAAanty deed, t eco&ded in the 064ice of the
County Regi6teA o6 Deeds as Document No. � � and that I (We) pne�sentty
own the pnopo.aed .6 to 4ot the sewage dLSpos system (oA I (we) have obtained an
easement, to nun with the above descA bed pnopenty, bon the construction ob bai.d
.system, and the .same has been duty Aecorded in the 04jice o6 the County Reg.usteA ob
D e as Document N _5 % 1
SI ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
i
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
777pr�
ST. C 6X Co., W IS,
Reed. kv P,,-cod JbIs 7th
1 i.cha.rd U. Stout & Janet P Stout , husband _ daY Off May A.D. 1987
and wire , and Ilaud H `-'tout , a single person ---y-- --
conveys and warrants to Danny L Schnechenberg 4�P �+
....a.,.. Illimmer 0
RETURN TO
the following described real estate in "`�t . Croix County,
State of Wisconsin:
Tax Parcel No: 7 n 2 1 R G�
Lot 3 , Pinegrove Heights Addition to the Town of Iiudson
"`ANSI
�.;. �0
Fug
This is not homestead property.
(is) (is not)
Exception to Warranties:
7th May 19 87
Dated this day of '
(SEAL) (SEAL)
is r u
(SEAL) l �l Cox �jq�LJ, 44)
1 P�•
( a a E . STOU1,
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) "' ' STATE OF WISCONSIN
(`rni x County.
authenticated this day of 19 Personally came before me this 7th day of
aM0 0 dD :�� ib`l a zr ,19 the above named
h2rrl C )trnat , Tanet P_
�,s ••PUBL1 5� rtotat and Maild FT- Stout
TITLE:MEMBER STATE BAR OF W I`61N W'S
(If not, to me known to be the person c who executed the
authorized by§706.06,Wis.Stats.) fore tinstir ment an acknowledge tie sarr}e �
THIS INSTRUMENT WAS DRAFTED BY
_'0
tli�har� 01 Stott s C°. A
Notary Public County,Wis.
(Signatures may be authenticated or acknowledged. Both My Commission Is permanent. (If not, state expiration
are are not necessary.) date: /1-11 ,19 �J)
Names of persons signing in any capacity should be typed or printed below their signatures. NTF 2280
WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 10208,Green Bay,WI 54307-0208
Form No.2—1982
En
H
y y
- r
STC - 105 9
H
` SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County
. v
9
H
OWNER/BUYER D,4,&/ —
n_-
ROUTE/BOX NUMBER /� d� ,�. Fire Number
CITY/STATE 7� ��l; " i ��, '. _—� ZIP _6 wile,
PROPERTY LOCATION : ME �„ 4, Section_ _, T N , R t_W ,
Town of ySt . Croix County ,
Subdivision � fai���=^_ -T Lot number
��N
Improper use and maintenance of your septic syste►n 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 �uuiLer • 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 ula 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
H
three year expiration . °
E
I/WE, the undersigned , have read LLB, ni—Nie requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein , as set by the Wisconsin Depart
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County rig Office wit4iin 0 days
of the three year expiration date .
�Z
SIGN D °
DATE
St . Croix County Zoning Office
P .O. lox 98
Hammo id , W1 54015
715-7 )6-2239 or 715-425-8363
Sign , date and return to above address .
M
IN STF UCTIONS FOR COMPLETING FORM 115 - SB - 6395
To he a complete a d accurate soil test,your report must include:
1. Complete legal des( -iption;
. The use section mu t clearly indicate whether this is a residence or commercial project;
3. MAXIMUM numbe of bedrooms or commercial use planned;
4. Is this a new or rep icernent system;
5. Complete the suita ility rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
E. PLEASE use the aF )re.viations shown here for writing profile descriptions and completing the plot plan;
I. MAKE A LEt 1SL - diagram accurately locating your test locations. Drawing to scale is preferred. A
separate, sheen may )e used if desired;
S_ Make sure YOW bei ,hmark and veitical elevation reference point are clearly shown,and are permanent;
S. Complete all appr(;)riate boxes as to dates,names,addresses, flood plain data, percolation test exemp-
tion, if appropriate
10, if ts,e; inforrn,=tion ,unh as flood plain,elevation i does not apply, place N,A. in the appropriate box;
l 1. Sir n the form and I lane your ±;urgent address and yor:ar certification number;
12. kw:aa , le(iihle to)ic, and distribute as required. ALL SOIL. TESTS MUST RE FILED WITH THE
LOCAL AI-111-11ORI fY WIT'HIN 30 DAYS OF COMPLETION,
A BRE-VIATIONS FOR CERTIFIED SOIL TESTERS
Sail Sep,,ates and Textures Other Symbols
S lor3r ;,-„v,'r 10”) FAR — Bedrock
coh C,ohlr 1,3- 10"j SS — Sandstone=
gr C ava:1 (under 3"), LS — Limestone
*s ._ S nd, i-GVV — High {agog€n dvdater
Cs f S_ id Rerc - PE kcodMi•an Rate
E1}€d s -- 1 diurn Sadr'd 'VV -- "?,
I S<arr< E39dca lsa, .z',°nr,
k — L mroy Sand ._. Ct wetj Than
sl S IId3,/ L_s:7;'arn t -- Less Than
BI _. Black,
"'v L_o£fY?l y _.._ y falls
L t g y Clay Loam
c Its,.{ Clay Loam n1ot ;41l=. ,Ps
se- ndv Clay qj .trh
r„ q'¢
-_ r3r r:eJ -- cOt1i'="#Gri
at mnl — 1'"a9ny, medlUrn
r1 — jck d — distinct
p — promincrit
ElbaL — High +a;ater l`;s;=e.i,
Six q iii ai so,l teXtures surface vvate t
=r=r hgta < vvasta tlisposa€ BM Bench Mark
V13P Vr,rti€:al Reference Foint
TO THE OWNER:
i h!s soil test repor?_ is r e= first step in sracurMg a sanitary permit, The county or the Department may request
,t Ia€carp r> of rl s So Ost ire the field pai oi to permit A complete set of Clans for the private
e Vslon, .=,,r1 a p rani aaaplication :,,rant he SUhnlitted to the appropriate local authority in order to
t, .dtr3 a p -.r,rait. The sa +fai'v permit r°tricE, be obtained and hosted of to tart•,start of any construction,
EPAATAAENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, CC DIVISION
LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707
(1-163.090) &Chapter 145.045)
LOC TI'ON: SECTION: TOWNS HIP/I I Q y: LOT NO.:BLK.NO.: SUBDIVISION NAME:
NE �4 S 20 /T29 N/R 19f (or)w Hudson 3 n a I Pine
COUNTY: OWNER'S ME: MAILING ADDRESS:
St. Croix Dan Schneckenber R.R.#1 Clear Lake Wi. 54005
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: RI New DESCRIPTIONS: PERCOLATION TESTS:
Residence 3 n/a R]New ❑Replace Il 5-6-87 n/a
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
El s ❑u E S ❑U S ❑U I ❑S EU I ❑S 0U I conventional
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: class 1 Floodplain,indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS nage 58 EM
BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL T THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH X4, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 7.26 94.99 none >7.26 75bl.1. .92bn.sil. .67bn.l.s. 4.92bn.c.s.&gr.
B_ 2 7.09 96.07 none >7.09 .50bl.1. .92bn.c.s. .42bn.l.s. 5.25bn.c.s.&gr.
B_ 3 6.83 95.51 none >6.83 .83bn.s.l. .6.00bn.c.s.&gr.
B- 4 6.75 95.17 none >6.75 1.08bn.l.s. 5.67bn.c.s.&gr.
B- 5 7.33 95.96 none >7.33 .83bn.1. 6.50bn.c.s.&gr.
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 PER1003 PERINCH
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 92,18
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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 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 5-6-87
ADDRESS: CERTIFICATION NUMBER: [PHONE NUMBER(optional):
988 N. Shore Dr. New Richmond Wi. 54017 22298, / 15-246-6200
CST SIG RE: -
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
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