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HomeMy WebLinkAbout020-1346-40-000 ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT 30Wj ONiNOz Owner AM 1/1 LL F iZ_ WHO is Property Address (O I LA 4 - r - 1= R-O D _ H& City /State +4 0 D 5 o N Ut.J I y� ,.. 03A130 k. Legal Description: Lot Block Subdivision/CSM # H O VII E- CT F, '/a 5411 ' /a, Sec. k, T 2 -9 N -R 1 9 W, Town of N 00 SO 1•l PIN # r3 4 yo -,0 o EPTIC T DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer WE 1, 5 F Size ST/PC / Setback from: House Well t oO / P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road �� Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: LE k H Width 3 Length —_ Number of Trenches Setback from: House /-/ Z Well ':;� -' P/L I g Vent to fresh air intake . QD ELEVATIONS Description of benchmark tizxS a ., ©( E F Lk) b N /S,/ r Elevation .w- Description of "alternate benchmark 70 f O F r, l a N !2.1 Elevation 1 e L J ** � s z z • �o�� 3 aW .z Building Sewer - 10 " ST/HT Inlet 2 ST Outlet 1 ' Y'C Inlet PC Bottom Header/Manifold H . JW " �� 5 1 op of ST/PC Manhole Cover 0 a y� Distribution Lines Bottom of System () 7, 7, 3 5 1 3 !r ( ) Final Grade Date of installation �� /�� /� Permit number State plan number Plumber's signature a License number Z ='� Date /� /J / �n Inspector Complete plot plan � I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW -►�.FNcq 3x7s• r t 'z -c ltr� n�►F3�R 5 '� fl � r y -1 - To T A H A/w'rh ut L, k ate, 77 s 44c- 3z /� it IVATF � t � 4 0 /fR R 4 0 JAI VE vV A V f J No?E:(,4s of 11 -►j -99 NoT WST4441 -b) 1 INDICATE NORTH ARROW I i • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338886 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.:- Insp. BM Elev.: I BM Description: � Parcel Tax No.: 7` t� 020 - 1346 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �`t . � Benchmark Aeratio Bldg. Sewer olding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. VAen take ROAD Septic �Q( �Z( Z� NA osin Header / Man. � /� 3. S Aeratio NA Dist. Pipe L , y' I)L V 4.P. 7 5' olding Bot. System Lam/ /� PUMP / SIPHON INFORMATION Final Grade a turer I Demand Model Number M TDH Li . Friction tem TDH Ft Fo main Length Dia. Dist. To SOIL ABSORPTION SYSTEM BED / H Width ) Length No- O riches PIT No. Of Pits Inside Dia. Liquid Depth , DIM Tren DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LE Man a�ture INFORMATION Type O CHAMBER M pU Number- System: ar, / V n1 y� A O IT r c. DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length J Dia. Length / Dia. Nk Spacing / ' + QQ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed 1 Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1DAC (( _ If LOCATION: HUDSON 11.29.19.1857,SE,SW 1014 LABARGE RD— HOMESTEAD LOT 14 r,) 3 0 d� ✓ y ✓e rAlc 3 / ,S� R,'A, 6a S /Z o/" y/ p C buy✓ sd,,,� s�o.� c �.� ��i►!�.'aY..� bflri� 7 ) l� g /� >�'�r -�✓.c cl., 5) r s 6, ` 54 , -�� Aft l6e INS' S #,,�,�" ' /Xer, ,S Q� >/ freo, }`�r e P /ssfl� d/ct(bl GvQ �'� c�7C / Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �.�. F 6 All, vtt- ? -?-- T-T- 4--h-l-A 3 f F E { i n. 44 _ 5 T E t tn 5 kl A .4.+.j J. !A - f - A p 7TA A +-A -T- 1-d _ _ w -- E I I ww :' • € F d 6 r 5 —41A " tl e i F _ g l Frx Lb TV --b VA-1 e � E� ' 7 e f " { € i € { m.. o- a a , e. 4 { E k f 4 . . / o I q- s� afety and Buildings Division SANITARY PERMI APPLICATION 2 01 W. Washington Avenue Vi sconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. "+ yp • See reverse side for instructions for completing this application State Sanitary P ermit Number Personal information you provide may be used for secondary purposes heck it"'�evislon to pr o fo application [Privacy Law, s. 15.04 (1) (m)]. Sta a Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name ropectvLor.t,on Fg 1 1 45W 1/4, S T , N, R r E (or Pro erty Own 'sr a Address Lot Numbe Block Number ty 000="�. Dt , state Izipcode P onq NumbV11rDy Subdi ision a e or M mb r ( ) 7 7 I. TYPE BUILDING: (check one) ❑ State Owned ❑ It Near st Road E] Village G Public 1 or 2 Family Dwelling - No. of bedrooms UD Town of ✓ ` / 4 F . R O 111. BUILDIN E: (If building type is public, check all that apply) Parcel Tax umbers) G� 1 E] Apartment/ Condo ©��� `3 y� - `,� 0010 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 pVNew 2 E] Replacement 3 E] Replacementof 4. ❑ Reconnection of 5. ❑ Repair of an __System ________System _____________Tank Only______________ Existing System ________ Existing System B) A Sanitary Permit was previously issued. Permit Number Date Issued X949 V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trene-- 1' 22 In- Ground Pre ure �► «.► 42 ❑Pit Privy 13 nSSeepage Pit 11 1'(�" �ti .� 7-S 43 ❑ Vault Privy 14 ❑ System -In -Fill f /N VI. ABSORPTION S7STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ,,rrr�0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation , b oo C✓ • 0111111 7, 71 F eetl 14 f4 A Feet VII. TANK in Capacit Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber )S ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Prinjj Plumber's Sig atu o Sta ) MP /MPRSW No.: Business Phone Number: k - n W cL --- 1 Z 2 316 - 141 . Plumber's l �Addr ssatreet, Citcr, State, Zip Code). IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature jNo Stamps) *pproved [:]Owner Given Initial Surcharge Fee) Adverse Determination X. CONDIT ON&OF APPR VAL / REAS NS FOR DISAPPROVAL: I &_ -fo 5t:�&Xi .2� 446 lttf_ SBD- 6398 (11.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2_ Your sanitary permit may be renewed before the expiration date, and at a 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply.. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 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 other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; 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 modeLand pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings Division 201 W. Washington Avenue Ai scons i n SANITARY PERMIT APPLICATION P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County �^/ than 8 1/2 x 11 inches in size. ?fir• 6-6 i p� • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes El Check if`Z. n'foirev o us application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner N perty Lo ation 'iia t /a, S TZ-�, N, R/9 E Property Owner's Igng Address Lot Num er Block Number — Cit ,State Zip Code Phon Number Subdlvis n Name or CS umbe v ai+u w s Z�6 *46 d 11. TYPE OF BUILDING: (check one) ❑ State Owned 3 It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms V ow a n O G� III BUILDI USE (If building type is public, check all that apply) r Parcel Tax Number(s) I I. 2A 1 l $rj� 1 E] Apartment/ Condo b2._o -/ - 0 0 -00 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. VNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System____ _________TankOnly_______,______ Existing -ystem _____ -__ Ex---- System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trenchtt4e- A 22 ❑ In- Ground Pressure �' 42 [] Pit Privy 13 E] Seepage Pit AV 1At F'j t7'4kiek � 1C � � �� • Z� 43 ❑ Vault Privy 14 ❑ System -In -Fill �T +.� i S VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. e 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) [ (in/in R 7 # Elevation, ,Feet /B +0 Feet aclt Ca VII. TANK in allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks eptic Tank �� ❑ ❑ ❑ ❑ ❑ ift Pum T on amber 4 1 ❑ ❑ ❑ . ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum berkSignat re: (No ps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Streeett, it tate, Zip Code): So W1 IX COUNTY/ DEPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing.AgentSignature (No Stamps) I� PP roved ❑Owner Given Initial A Surcharge Fee) �c� ) Adverse Determination J /lam X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. 4. Changes in ownership or plumber requires a5anitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a// septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 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 other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; 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; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i 5041 AA L L e- /0/4< </`�d rl 7f�X 4 2o-Og 4 - va - 7.0 7 IM. • 5 c �� �' ! /�, '' ,- ,�7- ��w�� -e� ��l �as.a --�� 420 � a 3 � / r` tr v Y c p n) 47 R. Wrofc ��- re T,# G � n A � l r nz c c z r E a �, (d x T 0) N O N O N Q (U IZ N O C T 0 C ? i O� j C cU Iz co Z cu N L O CL D o Q) x g io L cu E v• o V xt a 0 J Q a . >= L »= C L - x M m a> N o c U c p . l U C a C (10 w ca N N 0) a o�° >> o o � V N N> (tf LL E O 2 U a U (n c • • • • w . p V ` �I ca c \ e � a 5o L N 1 1 / W N to ^Ll / O lo- - n •a W a S ~ N Y c0 3 O E g R r , 'o ob 7 -6 is w L 0) cn W uj M rn E CD o °D ._ - M lu , N x m _ J 'I 3 a a w O cz � mW T r c: m 7 4, J I . Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental BY Design Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County �/� r include, but not limited to: vertical and horizo oint (BM), direction and J �v percent slope, scale or dimemsions, no d Ia d distance to nearest road. — Parcel I.D.# APPLICANT INFORMATIO �! for ease p,�nt afi"' ' o ation. Personal information you provide may t �4•aW a. 15.04 tt) Cm))• k', Re�Vjewed y Date ., 4Y, Property Owner k. s Properly Location MILLER, SAM' } ? Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Addre :: ;.. >> ST CRC .`; , Lot # Block # Subd. Name or CSM# TROUTBROOK RD COUNTY 14 Homestead City ( 1 1 %&%upRtie? City Villa own Nearest Road Hudson 38.6 Labarge ® New Construction Use: C tuber of bedrooms 3 ❑Addition to existing building F Replacement F Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdff .8 trench, gpd/fF Absorption area required 643 bed, ftz 562 trench, ft? Maximum design loading rate .7 bed, gpd/fF .8 tr ench, gpd/f 2 Recommended infiltration surface elevation(s) 97.75 ft (as referred to site plan benchmar Additional design / site consideration Additional system imformation to report completed on 8/19/98 t Parent aterial Loess o ver glacial outwash Flood lain elevation, if licable na ft le for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank table for system ® S ❑ U ® S ❑ U ® S ❑ U ❑ S ®U [IS ®U ❑ S ® U SOIL DESCRIPTION REPORT Borin Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/fI2 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench 1 1 0 -6 10yr4/2 - sil 2msbk mfr cw 2f .5 .6 2 6 -12 10yr6 /6 - sir 2msbk mfr cw if .5 .6 Ground 3 12 -88 7.5yr5/6 - s Osg ml - - 7 8 elev 99.8 ft 6epth to lirrkn6 factor >88 �• Remarks: a� (y 2 1 0 -90 7.5yr5/6 - s Osg ml cvvv - .7 i .8 Ground elev 101.6 It Depth to limiting g ,v factor >90 i Remarks: LI(v .2 g't ti CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental BY Design Date CST Number Ref # 1432 120th Street, New Richmond, W1 54017 9/14/98 227387 63 PROPERTY OWNER MILLER SAM SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Environmental By Desi Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -12 10yr2 /1 - sil 2msbk mfr Cw - .5 .6 2 12 -106 7.5yr6/4 - s Osg ml - - .7 i .8 Ground elev 103.5 ft Depth to limiting factor >106 O� Remarks: 4 1 0 -12 10yr6 /6 - sil 2msbk mfr Cw 2f .5 ; .6 2 12 -100 7.5yr6/4 - s Osg ml - - .7 .8 Ground elev 105.2 ft Depth to limiting factor >100 Remarks: 5 1 0 -5 10yr6/6 - sil 2msbk TM, Cw 2f .5 .6 2 5 -98 7.5yr6/4 - s Osg - - .7 ! .8 Ground elev 107.6 ft Depth to limiting fa Remarks: Ground elev I Depth to limiting factor Remarks: ' ' ' • ENV B ■ DE 1432 12gh STREET, NEW RICHMOND, WISCONSIN 71.5 -246 -2454 PROJECT NAME HOM£ST£AD PAGE 3 DESCRIPTION SE Y SW %, SECTION 11 T 29 N, R 19 W TOWNSHIP Hudson COUNTY St. Croix Wi sconsin �Qc�2 QS ---- � • �- Cat b� r Sate. - S C^ �1�Crn"A �'4 vF SCALE 1" = 40 Tom Nelson BM 1 , Fr-e. 6&Se r 6b6r)on 100 227387 BM 2* as¢ oFA w( ri65on Xisconsirr DepartmentofCommerce SOIL AND SITE EVALUATION Page 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and _ St. Croix percent slope, scale or dimemsions, north arrow '3 1 r i n and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION j ai�i f ation. Personal information you provide may be u Cdr secondary Purses ( " s. 15.04 (1) (m)). Reviewed By Hate Property Owner t �.�° Y, �� Property Location MILLER, SAM _ Govt Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address — ; ; y q i - - Lot # Block # Subd. Name or CSM# TROUTBROOK P " 5' r r "'" � 14 Homestead City ate Zip ;ftCneNumber /. ❑City ❑Village ®Town Nearest Road Hudson / r '�+492; Hudson Labarge ❑ New Construction Use: / bedrooms 3 ❑Addition tQ ex +sting t�uilden9 ❑ Replacement ❑ Pub I , rcial describe Code Derived daily flow 450 gpd Recommended design loading rate . bed, gpolft� 2 trench, gpdfft= Absorption area required bed, fts,�7� trench, fts Maximum design loading rate - bed, dlfP tr ench, gpd/fF 9 9P 2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmar Additional design / site c nsideration Parent material 0 t'_ / Flood plain elevation, if a licable l f/A.—... ft S= Suitable for system Conventional Nkund In Grour4l Prewwe I AT G, ade System in Pill Holding Tank U= Unsuitable for system ❑ S E U ® S ❑ u ❑ S ®u I ❑ S ® U EIS ®U ❑ S ® U SOIL DES REPOR Depth Dominant Color Mottles Structure Consistency Boundary Roots GPD/fts g� Horizon Texture in. tviunsett Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z 1 0 -19 10yr2/1 - sil 2msbk mfr cw 2f .5 6 2 19 -37 10yr4/3 - sil 2msbk mfr ew if .5 i .6 Ground 3 37 - 48 7.5yr5/6 - s Osg ml ew 7 8 elev --- f 4 48 - 96 7.5yr6/4 - s Osg ml - - .7 .8 Depth to limiting factor� Remarks: 2 1 10 -24 . � 10yr2 /1 ( - sil 2msbk T mfr cw 2f I 5 6 _ 2 2435 10yr4/3 I - sl l msbk mvfr cw if .5 ; .6 Ground 3 35 -48 7.5yr5/4 - sil 2msbk mfr cw if .5 .6 elev inn 1,8 4 48 -60 7.5yr5/4 fl f5yr5 /8 sil 2msbk mvfi cw - - -- - -- Depth to 5 60 -98 I 7.5yr6/4 I - I s I Osg ml I - I - I .7 .8 limiting t - - � x factor � TO' � Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson `� "� 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 8/19/98 227387 65 PROPERTY OWNER MII,LER, SAM SOIL DESCRIPTION REPORT ® Page 2 of PARCEL 1.131 Environmental Bv Design Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -27 10yr2 /1 - sil 2msbk mfr cw 2f 5 6 2 27 -43 10yr4/3 - s1 2msbk mvfr cw 1f .5 .6 elev In 'b _ 3 43 96 7.5 r5 - ml - - 7 8 y /6 s Osg DeAto. limiting factor Remarks: rf .� l z �.s l /�►s6 c F ,S Ground g �It - 10 -32 7sv fz s/ S Gs y / c cj s Depth to f .(3 Z f;7, s'C I c a r ► L`�J P factor S'vG 7•S 1's OS J" I r- - 7 1 v Remarks: I G mund elev Depth to limiting factor Remarks: Ground elev Depth to limiting. factor ( I ( l I I I I Remarks: I E BY D 1432 120th STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 PROJECT NAME HOMESTEAD �' . �� PAGE 3 DESCRIPTION SE 4 SW Y4, SECTION 11 T 29 N. R 19 W TOWNSHIP Hudson COUNTY St. Croix �bfi l� 2 L,, 4 1 Li lot ►3 SCALE 1" = 0 Tom Nelson BM 1. S csTMo 2605 BM 2. p � „� p {� � s �-«� ► v � . 2S r - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer f; LL F /4....._ Mailing Address a& Y .# / _7 � Property Address ( ©1 L d Z NC6 RZA-D (Verification required from Planning Department for new construction) We City /State U y OS cam. 4' 1 Parcel Identification Number D 'L b — LEGAL DESCRIPTION Property Location S E_ '/4, S 44 -- ) '/4, Sec. l , T Z-R N -R / 9 (W Town of L)PS 'Subdivision CT O � I O , Lot # 7 Cerdried Survey Map # q d 1 5< 3 , Volume 7 Page # 3 Warranty Deed # S 4 11 7 - 3 , Volume Page # Z Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days -Aaf the three year expiration date. ATURE &F APPLICANT DATE +0 -WNER CERTIFICATION ' I'(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop6hy. describ a ve by virtue of a warranty deed recorded in Register of Deeds Office. � , �,, � � / y ( A�TURE O- . PLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ` t l `1 a n • f• l �T.III. B.11t (IF 11ISCONSIN F�01:01 I 19o2 n . .IA ! N: ,CN,r. , �N RL;:ORn.Mr OAT♦ ( La iwae i and nl tweet ; 2ona lc ( : _ l l i e This Deed, :•d Naot R. l.il ie, hushand and lirun:,,r, 10:30 A. a nal Sam E. Miller, a single pecsou , Gr•Intee, W itnesseth , That the aid (;rautor, for a valuable considerat•un , � t Croix Rarunn ro estate i S. ., .o.l� t„ (;r:utter the fullowu.� des.rlbed real es at n (' ,ult�, State of Wisconsin: See attached description. `i TRANSFER This i s not .. homrst, -Ad property. (IN) (13 not) Together with all and singular the hereditamenta and appurten -nets .:.ereunlo be. •nging; And Ronald L. Willie and Naomi R. Willie ttarrants that the title is goud, indefe_1b :e in fee srmple and free and elear .,f eneumbrl,o,es except easements, restrictions, and rights -of -way of record, .,nd wi!l t, anent and defend tl a -ame. hated till. day of March 1J 96 (.SEAL) N e'r`r c� L• tti � Cc'�c . (SEAL► Ronald L..Wil,lie (S-AL) % :!t'Y/tG- /�_ ! .l /..GGLCL (SEAL) . Naomi R. Willie AUTHENTICA ACKNOWLEDGMENT Sibrnaturc(s) ..... STATE OF 1%ISCONSIN sa. . ... ................. . .......... .. ..._................ ......... .. -- .....Sat.. CtQlx ....... County. n authenticated this .._ day of __ ......, 19..... Persona,, came bef..ie me this .!r1.`.....day of .a.r. C h., 19 �? .. the above named ............Ro -na 1.d..- L.,..Wi.11 i.e.- .and ................ .• -- __ .... ._ . ... _. .............. ............ N.ca.Om> . R,._.[JL ............................. TITLE: N1E]IBER STATE B.\ It (W WISCONSIN ............ ........ __.........._............. ............... . (If nut. _ . ...... —. ......... .......... ........ .. authorized by ; 7W.C4, 1Sr;. St.,t.,.) g to me known ta, i,e the per =,-n - .. .... who executed the foregoing instr .went and,%kttowledge the same. THIS •, aTRUMi. N'r WA$ C,. 'J . Fj IfY ; �•.[•\.� C. .L. Gay lord ,._A.tto.rney. .... ..... River Falls [yI 54022 y �-�� Notc,� c I II �. • c�. "S Cnunh, Nis. 1 ' cJ. Path JIc (`onunnEim, Syr firnighhnt. (I" ndt, .tare cspiration I be aut}.lntir:,ta',I ur „ .n „wlcu„ r , ..r: clrt Ixt" .c,r�.) date' > _•_1 i!I`_ 19 4 � -) I. th. ., it A?;HA \71' DEED art. 1. Vt Ile” w'I�,11 \.IN ' \t, i, �� L. ':•I R:., ..61'; Ire. 1'Uk11 Na. i -178: }I,.ar� lea•. Mr A parcel of lane located in the SE -1/4 of the :t -1/4 and the S� -1; 4 of in part cf the S6 -1/4 of Section 11, Township 29 Korth, R;,nEe 19 teat. 70i.n of Hudson, being further described as follows: beginning at the S -1/4 corner of said Section 11; thence Kh9 29'03"1;, along the South line of the SV -1/4 of said Section 11 , 237&.39 feet; thence NO2 2 &'06 "1;, 1322.62 feet, to the North lire Of the S 1 1 of th e S1,' -1/4 of Section 11; .:, �_•j "� e1Cn:_ said north line, 2446 feet to the North - ;cuth 1/4 line of said Section 11; thence S00 34'16 "1:, along said Korth -South 1/4 line, 1325.6:, feet to the point of bEginnini. Par( -El contains 73.31 azres (3,193,674 Square feEt) and subject to all ease. of record. Together with and subject to an easement for ingress and egress located in part of ehe Ei; -1/4 of the S1: -1/4 of Section 11 and in part of the SL-3/4 of the SE -1/4 of Section 10, all in Township 29 Kurth, Range fol 19 Nest, TowTTof Hudson, beini further described as �oas: 19 West, at the 5-1/4 corner of said Section, 11; t nee h69 29'03 "1;, along the 5 uth line of the Sl: -1/4 of said Sec::_•. 2376.39 feet; thence NO2 "1: 1256.54 feet to the point of bcginnint; thence continuing NO2 , 66.06 feet to the Korth lint of the S -112 of the Si.' -1/4 of said Section 11; thence Kb9 35 11 1.', along the Korth line of the S -1/2 of the St' -1/4 of said Section 11, 179.28 feet to the NE corner of the SE -1/4 of the SE -1/4 of Section 10; thence N69 41'39 "1:, along the [north line of the SE -1/4 of the SE -1/4 of said Section 10, 1318.24 feet to the VesI line of the SE -1/4 of the SE -1/4 of said Section 10; thence S00 25'39 "t', along said test line, 66.00 feet; thence S69 "E, on a line being, 66 feet distant Southerly and parallel to the Korth iinc of the SE -1/4 of the SE-1 /4 of said Section 10, 1316.32 feet to the E line of said SE -1/4 of the SE -1/4; thence 569 "E; or. a line bEink 66 feet distant Southerly and parallel to the Korth line of the of the SW -1/4 of said Section 11, 162.54 feet to tY.c oint of beg,innini. Parcel contains 2.27 acres (95,9..6 Square FEEt� and is sut to right-of- for town road .� subject to all easemc (Scott h.oaCj ar. nts of record. I d t]7.M' `11 tnMt'w'1 N.6S' p.711r 3!1010'10'1 11M!'w'1 r .... 1 ul.w' n�11'u• . ' ' • = 1•ll ) 1!1.10' 17 211.M i/01i U 193 M.7/• 1 iN/11'31M N: . I7).N' 16 613 (A.44 1.31' wh)'61'1 6111/1.11.1 I 19.11 l!1 111.w' U1 Sp.M' i1 149 In.61' 110.3' 61 / Iw01f'll'1 •••• f 111.1' 11 121.10' 3011'110 A6 611.11' 164.113 NS W%4 j 1 /31.10' )S 1 13.10' 84 WD27 110.9' 31.0' 111 1/1 1 121.10' 01 p1°ll'Sf.f 1 WHO N•N' 1M1 MASON .° 1 UI.N' 1f 713.10' 11 A1011'q S'1 1!1.16' 110.3' °weN'IS'1 111011'1'1 S 1 03.11' 711.11' 1100143' 113 U." U.01' 841 D1011'17'1 j Il•U 1 131.11' 11 713.W 31°11'31 A7017'617 141.11' $7.33' 171 NN41'1 1'1 3.11 1 10.11' 17 1' $1.310 010143 IIA3 131.11' W.01' 101001'01 U1 � � 19.16 1 111.11' 10 U3.w 11 1 "016' ".Y1 847."' 1N.0' $04vu'1 "1 710.10' 11 SoMm 11s96 15.13' 13.-7' 341 847 tJ ,'10.11 1! 611 327.31' 131.31' 11101YN'1 110o,45.1 V 0 1 10.M' " W01T13.f'1 311.11' 361.31' 1)1 319011'11'1 ( l0 1 1q.M' 31121'111 glhl'1S'I 199.11' 139.1!' US 101 UNP TATTED ! ANDS warm t,H1[ cr rw svt co TK omm 969' 35'50' [ 24 570.00' 10.00' 4w M' •10.0 Wo. em ACKS s P V ti� (o1�31oMM Mo 7'7: 1 7334 4Q11 3173 42.34 1311 i 10z.t3r a 106,)06 >q.1'T) ! ® 1 2.2 s .[ 8 1' M 6 014 Y - tp7�W7Mn1 �'• IIN. 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