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Parcel #: 042-1038-10-000 07/15/2009 08:53 AM
PAGE 1 OF 1
Alt. Parcel#: 15.29.18.225A 042-TOWN OF WARREN
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
00 0
Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner
0-HSBC MORTGAGE SERVICES INC
HSBC MORTGAGE SERVICES INC
636 GRAND REGENCY BLVD
BRANDON FL 33510
Districts: SC =School SP=Special Property Address(es): '=Primary
Type Dist# Description 966 HWY 65
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 11.380 Plat: N/A-NOT AVAILABLE
SEC 15 T29N R18W PT NE NE BEING THE SLY Block/Condo Bldg:
568.10'OF LOT 3 CSM 5/1357& INC LOT 2
CSM 5/1357 EZ-U-1417/272 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
15-29N-18W
Notes: Parcel History:
Date Doc# Vol/Page Type
02/23/2009 889279 SD
03/19/2007 846679 WD
07/26/2001 652167 1687/561 WD
05/19/1998 579402 1324/474 AF
more...
2009 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 11.380 67,600 158,500 226,100 NO
Totals for 2009:
General Property 11.380 67,600 158,500 226,100
Woodland 0.000 0 0
Totals for 2008:
General Property 11.380 67,600 158,500 226,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 302
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
_ FILED
3835 : 3 001`131983 _..
JAAE3 O'CONNEII 2V
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\ of Deeds
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CERTIFIED SURVEY MAP i9T
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PART OF THE SE 1/4 N E 1/4 a NE 1/4 NE 1/4, SECTION 15, 7 29 N - R 18 W
WARREN TOWNSHIP ST. CROIX COUNTY w WISC.
OWNER : MARVIN RISBERG ROBERTS, WISC. W J
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TOWN ROAD RIG OF WAY `
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MONUMENT, FOUND ga R.R. SPIKE IN
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IN CONC. 10/12/'83
S 890 32' 48" W _-_- X742.50'
UN PLATTED LANDS EAST 1/4 COR.
OWNED BY U.S,A. Vol. 5 Page 1357 SEC. 15 P.K, NAIL IN HWY. 65
(REMOVED 10/12/'83)
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969
BUREAU OF PLUMBING
MADISON,WI 53707
SEk, NE1,4,S15,129N—R18W jjd CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(If assigned)
Town of Warren ❑Holding Tank ❑In-Ground Pressure ❑Mound
HWY 65
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION CAT
Tim Thornsberr 1205 CITY o X04.2 7 2'3 Q
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: 11;1,1 REF.PT.ELEV.
Name of Plumber: MP/MPRSW No County: Sanitary Permit Number:
11,W1P ji. M)zpr.-, i 691_q 102777
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET;Ty-.ING PROVIDED OV ER
❑YES ❑NO
BEDDING: VENT DIA.. VENT MATL.: HIG H WATER NUMBER OF ROAD. LDINGALARM AIR INLET
FEET FROM
❑YES ONO [—]YES ONO N CHAMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER gDIAMETEH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ED] ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF Y WELL BUILDING VENT TOTRESH
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) OYES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH MATERIAL AND MARKwG
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA -PITS LIQUID
BED/TRENCH TRENCHES MATERIAL PIT DEPT+
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END. PIPES FEET FROM LINE AIR INLET
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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WE Lt
❑YES NO ❑YES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =OPSOIL SODDED SEEDED MULCHED
CENTER EDGES ,
1:1 YES El NO 1:1 YES ONO ❑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 DISTR [STR.PIPE DISTHIBUTION PIPE MATEHIAt.&MAHKIN6
ELEV.' ELEV.. DIA.. ELEV.' PIPES A.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLAN$CAL LIFT CORRESPONDS TO APPROVED
DYES ONO 1:1 YES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING.
FEET FROM LINE
❑YES 1:1 NO El YES El NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710(R.01/82) Zoning Administrator
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ,
APPLICATION
j
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 may be needed
if there is a change in your building plans, system location, 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 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;
Il. 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 a//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 0.1 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 in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground ate
included the creation of surcharges (fees) for a number of regulated practices which Wisco in's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur.e:
is used in your building is returned to the groundwater through your soil absorption o
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)
710—IL,
ILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm. Code T_
,, ,.v,..,..�,,o. STATE SANITARY PERMIT#/
/ ay7 �
—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 NO
PROPERTY OWNER PROPERTY LOCATION
7�
,&-r'/A �'/4, S T , N, R $" E (or)o
PROPERTY OWNER' MAILING ADDR S LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME
d %Z i
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDM K
S y o L Z� ❑..VILLAGE: S g'
TC
II 1W, d�a- 163
. TYPE OF BUILDING OR USE SERVED:
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. L/N 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. NConventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP II
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ seepage Bed b.0 56 See a e Trench c. ❑ See age 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):
Private ❑Joint ❑ Public
Feet
VI. TANK CAPACITY Site
in aa ons Tota ##of Prefab. Fiber- Exper.
INFORMATION New isting Gallons Tanks Manufacturer's Name Concrete st ucted Steel glass Plastic App
Tanks 1 Tanks
Septic Tank or Holding Tank 11000
Lift Pump Tank/Siphon Chamber -C ❑ ❑ ❑
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 Signature:(No Stamps) P PRSW No.: Business Phone Number:
Pum er's Address(Street,City,State,Zip Code: Name of Designer:
�-
VIII. SOIL TEST INFORMATION
Certifi Soil Tester(CST)Name CST#
y
CST's ADDRESS(Street,City,State,-Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sianitary Permit Fee I Groundwater ate Issuin Agent Signature(No Stamps)
91 Approved ❑ Owner Given Initial rcharge Fee
a � as.a v-1q 81 w
Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL:
r kb,, by �,e4 Ta►,skt:�
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 Aom L - NS f ekNJ K e^ ' t! �-
Location of Property 5 E 14 ,�g, Section T�N-R d W
Township a-r r'e
Mailing Address
KoL,r- 5 cry
Address of Site
Subdivision Name
Lot Number (( /�I , • '
Previous Owner of Property /V81 �°s`F W�Sco�S�N
Total Size of Parcel l✓ C e S
Date Parcel was Created
Are all corners and lot lines identifiable? No
Is this property being developed for resale (spec house) ? Yes _ No
Volume -795 and Page Number-3211- 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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTV OWNER CERTIFICATION
I (We) centt6y that af-t statement/s on this 6o,%m an.e tAue to the beat o6 my (ouk)
knowledge; that I (we) am (are) the owner,(b) ob the ptopenty degchibed in this
.in6onmation 6oAm, by vixtue ob a waA anty d ed tecon in n the 046ice o6 the
County Reg.usten o4 Deed6o.6 Document No. 4dV/oo and that I (We) ptesenzty
own the ptopozed z to bon the .sewage ddspoz sys em (on I (we) have obtained an
ea3ement, to nun with the above deachibed ptopenty, bon the constnucti.on o6 said
,system, and the .tame has been duty teco&ded in the 046.ice o6 the County Reg"ten o6
Deeds, ass Document No. o o ) .
SIGNATURE aF OWNER SIGNATURE OF CO-OWNER (IF AP ABLE)
to
DATE SIGNED DATE SIGNED
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LIMITED WARRANTY DEED 1i85PAGE 221
4 310Q:
This Indenture, Made this_ 9th day of July 19 87 , between Federal Land Bank of
St. Paul , a corporation, organized under the Laws of the United States, with a post office address of P.O. Box 199,
_River Falls WI 54022 party of the first pan,
and Timothy L. Thornsberry and Kristen L. Thornsberry, husband and wife
whose post offis'e address is
State of pan ies of the second,
Seven thousand two hundred & no/100
WITNESSETH, That the said party of the first pan,for and in consideration of the sum of DOLLARS,
To it paid by the said part ies of the second part, the receipt whereof is hereby acknowledged, does Grant, Bargain, Sell and Convey unto the
said part 1eS of the second part, their heirs, successors and assigns forever, the following described real estate, situated in the County
of - St. Croix
and State of Wisconsin to-wit:
Part of the SE44NE4 and the NE44NE4 of Sec. 15, T29N, R18W; also known as Lot 1 and
Lot 2 of CSM, Vol. 5, page 1357
z .
lin�
subject to all existing easements and rights of way; also subject to all taxes on said premises for the year 191_and following years; also subject
to all unpaid parts and installments of special assessments on said premises which have fallen due, or will fall due hereafter.
TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right,
title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to
the above bargained premises, and their hereditaments and appurtenances.
TO HAVE AND TO HOLD the said premises as above described, with the hereditaments and appurtenances unto the said part ies of the se-
cond part, and to their heirs, successors and assigns FOREVER.
AND THE SAID party of the first part,for itself and its successors, does covenant, grant, bargain and agree to and with the said part ies of
the second part, their heirs, successors and assigns, that the above bargained premises, in the quiet and peaceable possession of the said
pari_ies of the second part, their heirs, successors and assigns, against all and every person or persons lawfully claiming the whole or
any part thereof, by, through or under said party of the first pan, and none other, it will forever WARRANT and DEFEND.
IN WITNESS WHEREOF, the said parry of the first pan, has caused these presents to be executed in its corporate name by its duly authorized of-
ficers, and its corporate seal to be hereunto affixed the day and year first above written.
/it Presence of: THE FEDERAL LAND BANK OF SAINT PAUL
JF
Thomas E. Hass, Director of Acq. Propert�yf the
Name Title
Federal Land Bank Association of NW Wisconsin
BAN Acting as Attorney-in fact for the Federal Land Bank of Saint Paul
Op
'oe ,f, or:
CORPORATE
± :Z �• Production Credit Association
y
o 'er®
: y/ of
SEAL
a°0A. By.
D5140 5186 lrj �0'o0°o'° . Agh
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ST C - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
d
I a
OWNER/BUYER 1jMo-4Lt4 L • OfN$CJ gsvc� L.. r�Sberr'-J
ROUTE/BOX NUMBER f ,ids L-111 Kd • ) � 7 fir,' Fire Number
,CITY/STATE h.'a" V\j i . ZIP 54/0 ,-3
PROPERTY LOCATION: SP_ 34, A) Section, T jj N , RW,
Town of ac r e�J 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 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. 0
I/WE, the undersigned, have read the above 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- ro
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
715-796-2239 or 715-425-8363
Sign, date and return to above address .
X Li uid Ca acit :
urer: q p y el: 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: Trench:
i
Width: Length: Number of Lines: Area Built
Fill depth to top of pipe: r/ A
Number of feet from nearest property line: Front, O Side, O Rear,Pt
Number of feet from well:
Number of feet from building:
( nclude distances on plot plan).
SEEPAGE P T
S ze: 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 TAN
Man acturer: Capacity:
ber 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:
Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
1
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT SC
i
OWNER TOWNSHIP SEC. ��� T,2 N-R W
ADDRESS l�j, e LfJrS, ST. CROIX COUNTY, WISCONSIN
I-3 S__
SUBDIVISION �L//� LOT 'e! LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of II- HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1000
l
Pntc
INDICATE NORTH A ROW
�t) r
BENCHMARK: Describe the vertical reference point used 7e o /'/l
Elevation of vertical reference point: lei r,Ao Proposed slope at site: 3��
!0/7'D zz)cS i
SEPTIC TANK: Manufacturer: j''2e, ('AS7— Liquid Capacity: /6<vc
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: le ,1 33
Number of feet from nearest Road: Front 10 Side 0 Rear, 0 1 feet
. From nearest property line Front,O Side,0 Rear, feet
i_
Number of feet from: well 30 building: `
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE STDE
ilk
INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395
To be a cornplete and accurate sail test,your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or cornmercial 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;
B- Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9. Complete all appropriate boxes as to dates,names,addresses,flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information {such as flood plain,elevation}does not apply, place N.A.in the appropriate box;
11, Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10") BR — Bedrock
col;, Cobble (3- 10") SS — Sandstone
gr — Gravel (under 3") LS — Limestone
*s — Sand HGW — High Groundwater
es - Coarse Sand Perc -- Percolation Rate
mad s Medium Sand W — well
fs Fine Sand Bldg — Building
Is — Loamy Sand > — Greater Than
"sl -- Sandy Loam < -- Less Than
*l — Loam Bn — Brown
*sil — Silt Loam BI -- Black
si — Silt Gy Gray
*cl — Clay Loam Y - Yellow
scl — Sandy Clay Loam R — Red
sicl — Silty Clay Loam mot — Mottles
sr, -- Sandy Clay w/ __ with
sic — Silty Clay fff few, fine,faint
*C - Clay cc — cornmon,coarse
pt Peat corn — Many, medium
m Muck d — distinct
p — prominent
HWL — High water level,
Six general soil textures surface water
for liquid waste disposal BM — Bench Mark
VRP Vertical Reference Point
TO THE OWNER:
This soil tail re=,pon, is the first stop in semc ring a sanitary permit, The county orthe Department may request
#ica ion of this soil test in the field prior toy permit issuance. A complete set: of plans for the privato
c 'Jr! system and a p;rrr it application must be submitted to the appropriate local authority in order to
or'Oain a per,rit. he,amtmr; p-,rM0 rnust be obtained and postecl prior to the start of any c°onst=action.
lOdvly oN SjTE !/ /f%t�}Tio.� w i-t�. T. N t L Spl 1
DEPART =NT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
�� DIVISION
INbUSTF? ,
LABOR AND PERCOLATION TESTS (115) MADISON WI 537907 9 53707
HUMAN, RELATIONS
(1-163.0911)&Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MtV1TC P7Ttt�F-Y: LOT NO.:BLK.NO.: SUBDIVISION NAME:
sE 1/ 1/ /� /T ap N/R ICE (o W &AAREN 2 A+R qlAj ' s 72 IF-- G- CS Al
COUNTY: BUYER'S NAME: MAILING ADDRESS:
7-6�elvSBE.Z°tQ 2D S c-4 y. RO• T T �o. 'ROse TS wIS
USE — Z DATES OBSERVATIONS MADE
IFNO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE D SCRIPTIONS: PERCOLATION TESTS:
Residence 3 N. XNew El Replace I cTox)c .Z/' e;7 soaE 27
�1�, f iAA1lE-4(•T+fN V p
RA 109irtgrgite suitable for system U=Site unsuitable for system
CO E TIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
Es Qu M OU ES ou EIS au ❑s ®u �NeA4_0 �F ?o AMNo ti 6.
DESIGN RATE:
Fu'f.',erc olation Tests are NOT required CG If any portion of the tested area is in the
er s.H63.09(5)(b),indicate: ss �Jl.. Floodplain,indicate Floodplain elevation:
lNG� PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR„TEXTURE,AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
/•o' 1?0-sr, s I, r,s • .'r%� z.S • o
B- 7,�6 ��•3y - � PO4ft-rS of S P_X7AuSE S/ M s+4Ir=,�, S.
5 sS/ 7ia- > s .1a 4r S"I, 1. 33 s� , 1.33” 'AAA. S
B-2, 75 rS of CS 7. O '-3A"DCP 410 4!/E 4-iN e-
/ S
i • 03'0 S'/ 2.0' G/• Q,� . S;/ �, Jr0�"k. of c�. Sly 0p
B-3 1•0 �,80 it 3. 5 • -4.aF L+Qa - A+LD - WJDCD
8 s/ e '
OP-20. S! )
3 s �
B- > 7 S 3a-.gfS" 3t. 3 3
. C, ' 4;, E 3p /•trk, o
?4N fSAMD+ED s
H•X . ,tc. 6-R f N 7 -7.4,v
S, �co�u�ltiNS y�a BdNl�S oL oR/3�v, fcr:t S/
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 PER INCH
P_ / 3. 3 A-4-- Q I / 12-11 G I /4 13-3
P_1- . s 7to— o 6P ( 1,
P S,S i4 t / D
P- / -Z
2
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. ?DEG/n S iF3• Q
SYSTEM ELEVATION
. = _ _
_ � r
E
s � .,
�tF S 10 U i7�f/�/L
-. 0
A t N
m !of _. _ .
QT
�--
�; OES iG,cJ -
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:
HOMESITE SEPTIC PLUVBW CO. 911A, / / Il IP
N.WIS.540
ADDRESS: ROpI?RT tJLBRICHT CERTIFI AT N NUMBER: PHON NUMB ptional):
NIS,.' STIR PLUMItiER C.N0.3301 MARI Zf��� 3 �O
;ONN CST SIGNATURE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN
Pr o�e c t I.D.
NOMESIIE SEPTic FtUMWNG C&
L EGTND RT.a VNEII NO.,MUM,W4 5"
RNERT ULSWT
o - Ba c kh o e ''its MS. NSTAUER&pE R M W No
X = Perc Locations C.S.T. 2482
Q = e:xisting Well
Vertical Reference Point ; -Top OF Gie6Aw 61Fe7wG PQX
Elevation of Vertical Reference Point /00 • o
Lot Line
N�
SCALE:
No. poi - Lioc yq
93
3
70
x
� r
. B o
`?epUceKE�T" 1}R£I�-
3 �
rn �
UEeT. �Ef
?b,4-) 7—
i
��T; rr
�;
Pa
M
PiLL�44i"� a s �
COMP14ERCIAL TESTING LABORATORY, INC.
t14 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715- 962 - 3121
800- 962 -5227
I ST. CROIX ZONING REPORT NO.: 15355/01 PAGE I
ST. CROIX COL TY REPORT DATES 12/26/91
COURTHOUSE DATE RECEIVERS 12/20/91
HUDSON, WI 54016
ATTNS THOMAS Co NELSON
OWNERS Tim 6 M~r is Thornsberry ` ` 6T �/1 35
f LOCATIONS 966 Hay , o erts
COLLECTORS M. Jenkins
SOURCE OF SAMPLES Outside faucet
COLIFORM, 0 /100 ml
a' INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 7 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
CoLiform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
i
9 10 i
LAB TECHNICIANS Pam Gane va "
WI Approved Lab No. 19
u
Means "LESS THAN" Detectable LeveL Approved byt
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
/16t ,{A ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms , and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
WATER TESTING--------------------------------FEE.$ 25.00
(For nitrates and coliform bacteria)
WATER TESTING--------------------------------FEE:$175.00
(VOC'S)
SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00
PROPERTY OWNERS NAME: t S K� �,5 I �tarNSy
T J
PROPERTY OWNERS ADDRESS: 9 6,_ CITY: Zob�r�-s
Legal Description �) E-_1/4 , 1/4 , Sec. 1,5-- , T_I=Z_N-RAW,
Town of -&rc eve ,Lot: No. ,Subdivision
FIRE NO. 66 LOCK BOX NO. be. Q
Color of houseL•, . CTS Realty sign? E5 Firm: (o
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e. , COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: i✓\C' 2r �Q„y7�
Telephone No. -cart- g'Z3 _ 3F4—/-- 0
REPORT TO BE SENT TO: 2 as S4. Bo alb
f
CLOSING DATE: 2_
signature:
- r
ST. CROIX COUNTY
WISCONSIN
ZONING,OFFICE
z � ST.CROIX COUNTY COURTHOUSE
-ti 911 FOURTH STREET • HUDSON,WI 54016
_- (715)386-4680
�JW
Dec. 19 , 1991
Terry LaPlante
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Mr. LaPlante:
An inspection of the septic system on the property of Tim &
Kris Thornsberry, located at 966 Hwy . 65 , Roberts , WI , was
conducted on Dec. 19, 1991. At the same time a water sample was
obtained for testing. The results of that test will be sent to
you as soon as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis .
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years . Therefore , the
prolonged life of this system may be dependent upon proper
maintenance of the system.
i ere l , lj
7;2 s Mar . t�� ,
i
Assistant Zoning Administrator
cj