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PUMP CHAMBER
Manufacturer: e e /lam_ Liquid Capacity: 4,e,
Pump Model: AI S Pump/Siphon Manufacturer: c� .Ile r Pump Size
Elevation of inlet: �f ,� Bottom of tank elevation: 2r
Pump off switch elevation: ��, / Gallons per cycle:
'l
Alarm Manufacturer: .104 U Alarm Switch Type: V
Number of feet from nearest property line: Front, Side, O Rear, Ft. D
1
Number of feet from well:
f
Number of feet from building:
(Include distances on plot plan) .
N t '/
SOIL ABSORPTION SYSTEM ea cc o, I%• 7 G�'Y ��• SS AoA", o�Ae-
Bed: ,2 ,at/,,3,Trench:
Width: Length: Number of Lines Area Built: ���
Fill depth to top of pipe:
Number of feet from nearest property line: Front, ®Side, O Rear,0 Ft .�1D
i
Number of feet from well: /A,2
Number of feet from building: 3
(Include distances on plot plan).
tO SEEPAGE PIT
Size: A 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, 0Ft.
Number of feet from well: Af
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: /
Dated: o�'l D Plumber on job:
License Number:
3/84:mj
MENEW
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
s�
OWNER �o11y1 r/�!O TOWNSHIP �- •��5e SEC. T N-R/ W
ADDRESS ST. CROIX COUNTY, WISCONSIN
X7
SUBDIVISION L f LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirem( Qi
SHOW EVERYTHING WITH' <�'
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w w
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l y
M �' 40 V
Cb
ti
ti
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gw r
ly C9 4j
>dSa
Ae,a
INDICATE NORTH ARROW
BENCHMARK escribe the vertical reference point used
Elevation of vertical reference point:
P .lOO Proposed slope at site:
SEPTIC TANK: Manufacturer: /� 2e � Liquid Capacity: ���p
Number of rings used: �_ Tank manhole cover elevation: � , G
Tank Inlet Elevation:-71/1 Tank Outlet Elevation: M-
Number of feet from nearest Road: Front,�Side,Q Rear, O jJ/ feet
From nearest property line Front,0 Side,0 Rear,O Lf6 feet
Number of feet from: well building:
(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
P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISOA,WI 43707 BUREAU OF PLUMBING
NE!4,Nl1 ,S21,T29&30—R19W 9'CONVENTIONAL El ALTERNATIVE State Plan l.D.Number
:
Town of E. St. Joseph ❑Holding Tank ❑ In Ground Pressure ❑Mound
(If assigned)
60th Street
-� NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
John Thode 1110 Hwy. 55 Hastings, MN 55033
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: �t-g—7 3°
4 REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No [ogty: $anrtary Permit Number:
Byron Bird Jr. 3318 t Croi x 95995
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. FEET FROM LINE: AIR INLET:
DYES ❑NO ❑YES ❑NO NEAREST.
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO OYES ❑NO
GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL: NU BER',OF PROPERTY WELL BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) ❑YES ONO 111E'REST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH T METER 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- NQ OF DISTR_PIPE SPACING: COVER INSIDE DIA.. #PITS: LIQUID
�# TRENCHES. MATERIAL•
PI'S' DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO DISTR ',. :PROPERTY WELL. BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END. PIPES: LINE: AIR INLET:
FEET M'ROM
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
❑YES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ❑NO ❑YES FIND
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED ISEEDED,, MULCHEDCENTER. EDGES: ❑YES ❑NO YES ONO OYES 0 N
PRESSURIZED DISTRIBUTION SYSTEM:
° I.WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
p .. TRENCHES:
q 77 MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. INO,DISTR. JDISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKINGELEV.: ELEVDIA.. ELEV.: PIPS: DIA.:
MM1 HOLE SIZE HOLE SPACING: DRILLED CORR ECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
❑YES ❑NO OYES ONO
CO MME N PERMANENT MARKERS: OBSERVATION WELLS: Mega •r PROPERTY WELL: BUILDING:
VF Ma !LINE:
❑YES 1:1 NO DYES E:1 NO lSIEAF3E3T
L
1. �S
a•�
'rsk4tch System on Retain in o ty file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710(R.01/82) Zoning Administrator
r _
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. A new permit maybe needed .
if there is a change in your building plans, system Io7:6tion, estimated wastewater flow (number of bed- '
rooms, etc.), depth of system, or type of system;
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be -
submitted to the county prior to installation;.
5. Private sewage systems must be properly maiptaineck 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 owners 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 buildirg 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 81/2 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,bther 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 in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground War
included the creation of surcharges (fees) for a number of regulated practices which Wisco WS
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T88S1C�3
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.
o
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)
— SANITARY PERMIT APPLICATION COUNTY /
7 DILHR In accord with ILHR 83.05,Wis.Adm. Code
STATE SANITARY PERMIT#
9
—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
I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO
PROPERTY.OWNER PROPERTY L CATION �Y
O •G. '/a S pit T , N, R E (o
PROPERTY O NER'S MAILING ADDRES5 LOT NUM ER BLOCK NUMBER SUBDIVIS ON NAME
CITY,STAT1500r ZIP CODE PHONE NUMBER CITY NEA AKE OR LANDMARK
^_ VILLAGE Q�e
TOWN OF:
r
II. TYPE OF BUILDING OR USE SERVED: 121 — /a W7 1700
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. El 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.xConventional 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. Mseepage Bed b. ❑Seepage Trench c. ❑ Seepacie 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): rJ -
Z ���' �vz �"PZ,!-Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY #of Prefab. Site Fiber-
in allons Total Manufacturer's Name Con- Steel Plastic Exper.
INFORMATION New xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank -e e ❑ El
Lift Pump Tank/Siphon Chamber .0 G/ 1:1 ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's S• re:(No Stamps) MP/MPRSW No.: Business Phone Number:
r
�`7 < CSC
PI s 6ddress(Street,City,State,Zip Code): Nam f Designer:
� e C�J 3 Silo/•
VIM SOIL EST INFORMATION
Certified Soil Tester(CST)Na CST##j_-Z_2^A_7 r aQ 3
CST's ADDRESS(Street,CiffyLA59e,Zip Code) Phone Number:
I"OUNTY/DEPARTMENPME ONLY
❑ Disapproved S tary Permit Fee Groundwater Date Issui Agent Signature(No Stamps)
19 Approved ❑ Owner Given Initial r�� Sur ar a Fee Q 9(JQ,,
Adverse Determination /� ""' —/ —U / 6
X. CO TENTS/R SONS FOR DISAPPRO AL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
` s
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 Key
Location of Property � _ r Section / , T 70 N-R W
Township
Mailing Address
n
Address of Site
Subdivision Name
. Lot Number
Previous Owner of Property /�7 A, �G
Total Size of Parcel (/ C e
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number l qJ 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) eeAti6y that ate atatement6 on thi6 ohm ane t1Lue to the best o6 my (oun)
knowledge; that i (we) am (ace) the ownen(,6 o6 the ptopeAty de/scAibed in thin
in6o4mati,on 6oirm, by v.chtue o6 a waAAanty deed neconded in the 066.tce o6 the
County Reg.caten o6 Deeds as Document No. S' and that I (We) pneseWy
own the pnopoa ed site bon the s ewag a di 6 pob d ys em (on 1 (we) have obtained an
easement, to nun with the above de cAibed pnopehty, bon the eon,6tAucti.on o6 said
ayatem, and the name has been du.t neconded to the 066.ice o6 the County Reg.is.ten o6
Veeda, as Doewnent No.
SIGN < OIL ER SIGNAT OF CO-OWNER (IF APPLICABLE)
C�
DATE IGNED DATE SIGNED
A.
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA
G�lTCLAIM DEED
J REGSTERS OMCE
42,.,90 y ,0P IIA I .5
ST. CROIX CO. WISE
Recd. for Reoad this 20th
day Of May A.D. 19 8 7
Of--4:45 P ,,,0 Ma
James O'Connell syr
quit-claims to —
T a ,y �j d•r �`. �� a�o
deputy
the following described real estate in s C 2 d % >< County,
State of Wisconsin:
RETURN TO
Tax Parcel No'
FEE
This homestead property.
(is) Is not
Dated this
20 f�' day of &A
(SEAL) a (SEAL)
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
b (� _
,(Z •L. a-� County. SS. 4-4—
authenticated this day of '19 Personally came before me this ab day of
, 19 the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known t9,bl§• a per 1 who executed the
authorized by§706.06,Wis.Stats.) foregoing insiW,,N3ntt``and,((acP dge the same.
THIS INSTRUMENT WAS DRAFTED BY �`.' '•�`/>?�i
/ cc A -f- I-tn R-41-t) •Notary Public = County,Wis.
(Signatures may be authenticated or acknowledged. Both My Commistian ,) a manettt--(Jf not, state expiration
are not necessary.) date: ����� `�� 19�� •)
�. V \
_ �l
Names of persons signing in any capacity should be typed or printed below their signatures. NTF 2281
STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 1075.Green Bay,WI 54305-1075
QUIT CLAIM DEED FORM No.3-1982
4#26804 78iPAGE 528
REGISTERS OFFICE
ST. CROIX CO., WIS,
Recd. for Record this 10th
day of June A.D. 19 87
June 10, 1987 of 2:00 P. , M,
—gym__ e_ O'Connell
TO WHOM IT MAY CONCERN: Deputy
I, John Thode, state that the size of the septic system
located on my property within the NE, of NE, of Set. 21 ,
T30N,R19W along the North 500 feet of the subject premises
is designed for a three bedroom residence.
ohn Thode
1110 Highway 55
Hastings MN 55033
The above named individual appeared before me and acknowledged
that this information is true and correct, is th day
A N��' , -
1
of June, 1987. "'
v .•
lfCAnn B e r e
St. Croix County Clerk
Notary Public-Wisconsin
H
a
STC - 105 r
r
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
a
OWNER/BUYER � � rzl
ROUTE/BOX NUMBER �tJ U �-t_ Fire Number
CITY/STATE S ptit/Z-Ck s-e-t GV SC zip—,< 2 S
PROPERTY LOCATION : ' 7 14, k 14, Section , T _7,� N , R /7 W,
Town of Sr c,IGSep 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 put into
the system can affect the function of tide 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
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth , herein , as set by the Wisconsin Depart- b
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SIGNED
DATE
St . Croix County Zoning Office
P. O. Box 98
Hammond , WI 54015
715-796-223S► or 715-425-8363
Sign , date and return to above address .
. .
INSTRUCTIONS FOR COMPLETING FORM 115 - SB[j 6395
TobevcornIkteand accunTe soil test,Yom rep��>�tmusliodjdy:
1, Cumn|,ve |oow! dosmicxivn�
Z, The usmsectkm muudoady indioatewhE.1therchisise mmidaocecv rummerca| Project;
3. K8AX| ,,1UK8numboruf bedrooms orcommaroio| use p|annmd;
4, |,thb a nawo, mp|ooemvrupvuam;
5, ComcJ�� thevubabUitysuingboxos.A0TE \3SU|TA8LEFORAHOLD|WGTAWKQNLY /F ALL
OTHER SYSTEMS ARE RULED OUT BASED DW SOIL CONDITIONS;
& PLEASE usp�heabbpminzionsohmmn horo fnrwritiny pn�fi!udwa:riF�ion�and oomp!atinn�ho�o«p|an;
7, MAKE A LEGIBLE diagram accurately locating your test locations, Cvmvino to scale is preferred. A
-iwpm,xtosMort,nay be used ifdesired;
8 Make sure your benchmark and pn,tiou! de"adon reference point are doudy shown,and are permanent;
8. Complete all anprnmrime boxes as to dates,names,addresses,flood plain data,Percolation test exemp-
tiun. ifapp,upriauo,
\O, if the information (suoM as f!ood plain,elevation)does not anp|v' rduxe N.A�in the appropriate box;
11, Sign the hxm and place your current.address and your certification number;
12. Make |eoib|a copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
'
'
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
m — Stone (over 10^> BR — Bedrock
cot) — Cobble <3 10 ') 3S — Sandstone Gravel gr — Gw:} (Under 3") LS — Limestone
Send HGyV —
High G,uundmmter
cu — Coarse Sand Pere — Percolation Rate
mod , — Medium Send VV — Well
f« — Fine Sand Bldg — Building
|» —
Loamy Sand > — Greater Than
Gandy Loam ( — LouThon
Loam Bn — Brown
Si|r Loam B| — Black
Si Silt Gv — Qray
°o\ — C\nvLowm Y — Yellow
�o| — Sandy Clay Loam R — Red
,id — &Uty Clay Loam mot — Mottles
' sn — Sandy Clay ,i' — with ,
sic — Silty Clay fff — few, fine,faint
°o — Clay *c — common, coarse
PI. _ Peal: mm — IN10anv' modium
d distinct
m — K8onk � — ^!
p — Pnonin*nt
— � HWL — High wa0rlevel,
° Six gonon^! voi| vmtumm surface water �
fnr|iquid'*ostodisposal -413K4 — Bench Mark
VRP — Vertical Reference Point
/ -
'
-
TO THE OWNER:
�
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. Aoomplme set of plans for the private
sewage system and u permit application must bo submitted to the appropriate local authority in order to ,
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. j
~
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON,WI 53707
(ILHR 83.09(1) & Chapter 145)
1LOCATION: SECTION: OWNS MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
1COUNTY: IOWNER'S/BUYER'S NAME: MAILING ADDRESS:
Sf G ro i J n Tl / S"6 �as n ,7 �5�S"®3
USE DATES OBSEI&ATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑Replace `1 2 �J
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND:�� IN-G®ND-P�URE: SYSTEM-IN-FILL HOLDING TA K:RECOM ENDED SYSTEM:(optio�)[ZU
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area i�s/in the
under s. ILHR 83.09(5)(b),indicate: I Floodplain,indicate Floodplain elevation: /D
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- �' 75.2 a-E: �On 6y 6- 32 �i-2 /,sf 3,2--syA5 r
B-
a_G n �� c-�.�
B- � � . r � �jY' f! "off 7
�- r� f� (/
B_ q B- - 9' of s1
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOR 3 PER INCH
P- rt C L
13 No P- ®�,-c G
P-
P_ I
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.
SYS ELEVATION > , � � SPry► �
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I,the undersi rk ptify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: ill NUMBER: P ONE NUMBER(optional):
` CJ_�Z/Ot9 Q Q 41 7 !7
CST SI NATUR :
r
nISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
R-SBD6395(R. 10/83) —OVER —
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PLOT PLAN
PR JEST oc%� DRESS 1jk,5
1.4 1/4/13A/ /Tao N/R/� W TOWN . 5/` C NTY
MPRS Byron Bird Jr. 339 8 DATE b
BEDROOM CLASS PERC l CONVENTIONAL IN-GR D PRESSURE
CONVENTIONAL LIFT MOUND HOLDI G TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA _J�?�l� pERC RATE BED SIZE /�X.
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark _ 4,9-4, e
* H.R.P. �'i.a .v
a Borehole Q Well Scale = Feet
0 Perc Hole System Elevation 2
TYPAR COVERING--
1 2'
12" 3- 0 6' 0 3'
I 60 Sewer Rock
i 12' -
�3�-0 �-
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PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS �a
VENT CAP
y' C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
?_!5' FROM DOOR,
JUNCTION BOX MANHOLE COVER
� 12"MIU.
WINDOW OR FRESH
r INTAKE
GRADE
I y"MIN.
CONDUIT — ____
18"MIN. \��\\\ ----------
INLET PROVIDE I ----
_T
AIRTIGHT SEAL
I III
APPROVED JOINT A ( III APPROVED JOINTS
W/C.I. PIPE ( III W/C.I. PIPE
EXTENDING 3' I II ALARM EXTENDING 3'
OKITO SOLID SOIL B I i I ONTO SOLID SOIL
I
ON
c _ I I
I
ELEV. FT. Pump---- --�
y OFF
D
CONCRETE BLOCK
RISER EXIT PERM17fED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFICATIOI%]S
DOSE
TANKS MAMU FACT UREER: fie' `-5 NUMBER OF DOSES: PER DAy
TANK SIZE: GALLONS DOSE VOLUME.
ALARM MANUFACTURER;
INCLUDING BACKFLOW: °?�O�• 3 GALLONS
MODEL HUMBER: �L /V CAPACITIES: A=0;7-0 INCNES OR GALLONS
SWITCH TYPE: B= IMCNES OR d GALLONS
PUMP MANUFACTURER: �Ol/ C= CINCHES OR p200 GALLONS
MODEL NUMBER: / D=- IKICHES OR ,oZ GALLONS
SWITCH TYPE: 5xw/ MOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEKI PUMP OFF AND DISTRIBUTION PIPE.. 20 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . , . . . . . . , �_�, FEET
+ FEET OF FORCE MAIN 'L,0`S_FYc FT.FRICTION FACTOR.._[r_L— FEET
TOTAL DYNAMIC HEAD = // 3�FEET
INTERNAL DIMENSIONS OF TANK: LENGTH �L_;WIDTH ;LIQUID DEPTH
2
SIGNED: LICENSE NUMBER: / DATE'6-3_'tr�
m
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
WEATHER PROOF
y'C.I. VENT PIPE APPROVED LOCKING
25' FROM DOOR, JUNCTION BOX MANHOLE COVER
WINDOW OR FRESH 12"MIU.
A-i:71 INTAKE
GRADE
I Y"MIN.
IB"Mlu.
CONDUIT -- ----
18"MIN. ���\\\ ----------
IK INLET PROVIDE I -----
_T
AIRTIGHT SEAL
I I �
APPROVED JOINT A I I I APPROVED JOINTS
W/C.I. PIPE III W/C.I. PIPE
EXTENDING 3' 1111 ALARM EXTENDING 3'
ONTO SOLID SOIL &B I i I ONTO SOLID SOIL
I
ON
c I I
I
ELEV. FT. PUMP �
OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED DULY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC f SPECIFICATIONS
DOSE -
TANKS MANUFACTURER: 4w e e/(3 KIUMBER OF DOSES: � PER DAy
TAWK' SIZE: 07a GALLONS DOSE VOLUME.
ALARM MANUFACTURER:
INCLUDING BACKFLOW: °��°�• 3 GALLONS
MODEL NUMBER: �`/y CAPACITIES: A= INCHES OF, GALLONS
SWITCH TYPE: g=��_INCHES OR GALLONS
PUMP MANUFACTURER: ;ee-e ," G=—,G=INCHES OR 00'2 GALLONS
d �
MODEL NUMBER: D= INCHES OR s�--AfP— GALLONS
SWITCH TUPE: lWor 7�Cfl/ NOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE 3GPM, INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..� FEET
+ MINIMUM NETWORK SUPPLY JPRESSURE . . . . . . . . . . . FEET
+ 2:!5-- FEET OF FORCE MAINS S-F%FT.FRICTION FACTOR..� FEET
TOTAL DYNAMIC HEAD
INTERNAL DIMENSIONS OF TANK: LENGTH _;WIDTH 7 ;LIQUID DEPTH -.74_
SIGNED: LICENSE 'NUMBER: ���� DATE:6_3? 7
TDH HEAD/ CURVE
CAPACITY C E
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• I TOTAL OYNARMC NEAWCAPACITY PEN 1111N/TE
��-rt �—.—�.�_ EPP►YENt AND OEMATENINO
EFFLUENT AND DEWATERING aEN1ES s�-s7.se s7 Ir•/» lu lss
,• _--�
F 1 GAL oAL (iAL GAL
-- ,, I - S .] 85 101 _61 et
24 \ SEWAGE AND DEWATERING _10 57 79 et e1
26 a 57 Se
.0 N 56
33 _St t
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16 sEMES s.7 ae se se >»
GAL GAL GAL GAL aAL
105 toy too too
—10 sa let
14 // ,\ 11 i I tS zo N St /u
20 33 123
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57 M DE MO EL
59 i �7 207
LITERS 80 160 240 320 400 480 SIC; _.
FLOW PER MINUTE 1`,OV
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P.O. Box m"?
Ofl�fi4' O. Louls� Konfuary 402m
(50?) 779-2731 Qu�urr �iA,os S�cF �93Q
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Parcel #: 030-2067-70-000 12/11/2006 12:04 '
PAGE 1 OF F 1 1
Alt. Parcel#: 35.30.20.609M 030-TOWN OF SAINT JOSEPH
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
O-WEINGARTNER, GERARD J
GERARD J WEINGARTNER
198 RIVERVIEW ACRES RD
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description * 198 RIVERVIEW ACRS RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.560 Plat: N/A-NOT AVAILABLE
SEC 35 T30N R20W PT GL 4 PARCEL AS DESC Block/Condo Bldg:
IN 593/13 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
35-30N-20W
Notes: Parcel History:
' Q 3 -"5D3— Date Doc# Vol/Page Type
/ 06/28/2004 767155 2604/385 WD
11/21/2000 634111 1561/408 WD
07/23/1997 769/41
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
170041 321,000
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.560 93,400 185,100 278,500 NO
Totals for 2006:
General Property 1.560 93,400 185,100 278,500
Woodland 0.000 0 0
Totals for 2005:
General Property 1.560 93,400 185,100 278,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 130
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 030-1045-10-100 01/30/2007 02:18 PM
PAGE 1 OF 1
Alt.Parcel#: 21.30.19.163B 030-TOWN OF SAINT JOSEPH
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
ROBERT A&MICHELLE K MCGLADE O-MCGLADE, ROBERT A&MICHELLE K
1500 60TH ST
SOMERSET WI 54025
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description * 1500 150TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: 3336-CSM 12/3336
SEC 21 T30N R19W PT NE NE BEING LOT 1 Block/Condo Bldg: LOT 1
CSM 12/3336 EZ-IE-1279/58
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-30N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
04/13/1998 576903 1313/534 WD
07/23/1997 802/264
07/23/1997 779/145
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
168855 266,500
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 79,400 151,800 231,200 NO
Totals for 2006:
General Property 5.000 79,400 151,800 231,200
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 79,400 151,800 231,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1 01997
rp'�'Aeb qU �
ST.CROIX COUNTY q� ,V8 199J
SURVEYOR'S RECORD f"S;-1 w-
L CroG wows
564501 CERTIFIED SURVEY MAP
Located in part of the Northeast Quarter of the Northeast Quarter of Section 21, Township 30 North,
Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin,
I Prepared for and at the request of:
OWNER:
Wil ( John and Anne Thode
C' �' 1500 60th Street
I Somerset, WI 54025
i
Q Q
>- 00 1 Drafted by: Kristi A. Eyiandt
W1 �1 LJ1 Ora+esxufl�gd
04 LEGEND
~I 01 of zi °i V� 8 97 ,� � ~ County Section Corner Monument
of Record
o1 ( L,I c3 i wj RONALD F. t % • Set 1" x 24" Iron Pipe weighing
�i 1=-I O1 �I JOHNSON Z a minimum of 1.13 pounds per
r XI of JI linear foot.
WI 01 E-1186
>I AMERY.
WIS
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(0 11) ov 3 \g3 ♦��I S U R`i owa'
W 0'f�yM11100p EAST 114 CORNER
SEC. 21-30-19
o \ `
60 T H S - R E
- -- - (ALUM CO. MON)
z �• _ - - - - - - - - - - - - - - - -
\ "-------S 01'16'37" E 263 "
'32 25-341 4.49! 60th St. ---- ---''�
01 E -.�
48.55 O�-----204.96'--- - i ��\ - ---- 2380.98'
Q - =-117. 2M-
Z �_ — - - - - - - - - - -
�. r 1 S01'16 7 E � \
r 1 � O \ \ EAST L/NE OF THE NE �
3 r 1 O \ \ 1/4 OF THE NE 114
R.0.W. ., co
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BUILDING SETBACKS
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Prepared by. GRAPHIC SCALE 1�►
A & E SCALE IN FEET: 1 inch = 100 feet
LAND SURVEYING & CIVIL ENGINEERING Z
Phone No. (715) 245-4319 BEARINGS ARE REFERENCED TO THE EAST LINE OF THE
109 East Third Street, P.O. Box 325 NE 1/4 OF SECTION 21 TOWNSHIP 30 N., RANGE 19 W.
New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S 01'16'37" E. 0
Sleet 1 of 2 ,
IVOT. 17 PAGE 3336