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HomeMy WebLinkAbout020-1356-25-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT JJ /� Owner L /v Property Address� 9 9) ¢d� City /State Legal Description: Lot ,-., - )� Block -- Subdivision/CSM # AGOFFICE .ML 1 /4 A�L 1 /4, Sec. j[ l , 19N -RjW, Town of - '',PIN # ° - i'�1 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC,/ 2Dn/ Setback from: House ` Well -O 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: A Width 1� Length ��_ Number of Trenches Setback from: House 7 Well �_ P/L i s Vent to fresh air intake f 7S ELEVATIONS Description of benchmark s. Elevation A0- Description of alternate benchmark i / Elevation Building Sewer ST/HT Inlet %'7, ,e3 ST Outlet 971s" PC Inlet PC Bottom Header/Manifold _ .5'"� Top of ST/PC Manhole Cover 5' Distribution Lines ( ) ,y' , :; Z Bottom of System Final Grade Date of installation 6j;' Per it number / State plan number Plumber's signature License numbe 7� Date Inspector Complete plot plan or I r 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. AN VIEW i A sa .---?�7 ' i i � f�S I INDICATE NORTH ARROW I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344621 Permit Holder's Name: ❑ City ❑ Village [2 Town of: State Plan ID No.: Wanner. John I Town of Hudson CST BM Elev.:- Insp. BM Elev.: BM Description: t J— Parcel Tax No.: ,v a� . t� r (gam / — D C gm 020- 1356 -25 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S �. Benchmark SS /ere _o r Dosing Alt. BM Aeration Bldg. Sewer C, 30 g.�S Holding St /Ht Inlet 5,1 84 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG_ Ventto ROAD Air Intake Septic r ., �0 r NA Dosing NA $ Aeration NA Dist. Pipe Holding Bot. System 3:� PUMP/ SIPHON INFORMATION Final Grade Man facturer Demand cover Model Num GPM TDH Lift Fricti e H Ft Forc Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BE V TR@NEH Width t Length , N PIT No. Of Pits ide Dia. Liquid Depth - MM ENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufac er: SETBACK CHAMBER INFORMATION Type Of I t .-.- M umber. System: C&&W } ^, OR UNIT S DISTRIBUTION SYSTEM Header/Manifold (� Distribution Pipe(s) x Hole Size x Hole Spacin Vent To Air Intake Length 4.e-- Dia. Len ia. Spacing -10 r 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/ Trench Edges Topsoil [] Yes 11 No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1jj 1fj Inspection #2: ' ` Location: 991 Burch Circle, Hudson, WI (NW 1/4, NW 114, Section 14 T29N -R19W) - )9.19.2087 , 1.�`� " fkiY�JC. , �2t}l�j !z -6 -99 C --t� �P�✓i�r+) N - - i � SY �. „�. r eta. w• .� � -� (8 - zf 98� 1 PTn revision required ? ❑ Yes No 2 Use other side for additional information. 03 O O d 0 �/ SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION ' 1` 201 W. Washington Avenue ` P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code* Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not fiefs County than 81/2 x 11 inches in size. l ?-. P lI e '', i it� t Number , r • See reverse side for instructions for completing this application -- -� State Salutary Permit 3 �'T� Personal information you provide may be used for secondary purposes } COCN " C)F�ec)f if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ZON ;ate lan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF& Prope y Owner Na f4Qp LOCao Vj 1/4 - n° 114, S T , N, R E (or& Property Owner's Mailing Add ess Lot Number Block Number City S to Zip Code j Phone Number Subdivision Name or CSM tuber )o a II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Nearest Road C] VII age Ej Public &a 1 or 2 Family Dwelling - No. of bedrooms A Town OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo ®a© /...? — o?� 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. VL New 2. ❑ Replacement 3, ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System ----------------------------------------------------------------------------------------------- B) M A Sanitary Permit was previously issued. Permit Number 3 Z Date Issued 0 V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 D4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation T S Feet Feet Capacit VII. TANK in allons Total # of r Prefab. Site Fiber- Exper. INFORMATION g allons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta ation of the onsite sewage system shown on the attached plans. Plumber' Nam : (Print) Plumber' Sign re: (No mps) MP /MPRSW No.: Business Phone Number: l S' Plumber's dress (Street City, Stat Zip Cod ): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sagitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) `Approved []Owner Given Initial QP �y Surcharge Fee) C ° Adverse Determination v • r'Z�° r �J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4199) - 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administraliive - 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 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. 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. V1i. ;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 8 112 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 (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. / A d� � � as- 98 Wisconsin Department of Commerce SOIL /AND S� EVALUATION Division of Safety and Buildings Page of r Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Re iewed ��0011by f ��WW `�� (� �� Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f"'l ► . X1.1. ^^ -- /2 — � o _q Property Owner Property Location Govt. Lot 1/4 1/4,S T N,R E (or& Property Owner's Mat rig Address Lot # I Block# Subd. Name or CS # City Stat Zip Code Phone Number ❑ City VE1,111age 0 Town Nearest Road 1 All j New Construction Use: Residential/ Number of bedrooms _5 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate Z bed, gpd /ft trench, gpd /f1 Absorption area required bed, ft : = /_ trench i 2 Maximum design loading rate _ 7 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material AIL - )A59` Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system IXI S ❑ U 2S ❑ U XJ S ❑ U I W S ❑ U ❑ S 29 u ❑ S 29 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD 1ft2 in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench c 1h t �y A s Ground' G e � llev.. � Depth to limiting facto >in. Remarks: Boring # 3 al Ground elev. 2.6 Depth to limiting factor �>./d' in. Remarks: CST Name (Plea Pri Signatur Telephone No. Address Date CST Number x' SOIL DESCRIPTION REPORT . , PROPERTY OWNER - 4 1-J� 1,�Z Page 4-1— of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench i Y c Al Ground elev. Depth to limiting factor � ffJS in. ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 1 Ground elev. ft. Depth to —4— limiting factor in ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r C" l7c�Jk� � �tirC� � y i s �s -9s I q 17 A Safety and Buildings Division V i sconsin SANITARY PERMIT APPLICA 201 W. Washington Avenue -T�I P O Box 7302 Department of Commerce In accord with ILHR 83.05, W +s. Adrli_E6"_?_ Madison, WI 53707 -7302 •" Attach complete plans (to the county copy only) for the sySterrt, on pap* a1ti �s county than 8 v2 x 11 inches in size. ' `` �`' StateSanitar Permit Number • See reverse side for instructions for completing this application -" y 3 � Personal information you provide may be used for second purposes C] C eck if revision to pre vious application [Privacy Law, s. 15.04 (1) (m)]. g TI / / / e0k �-I rG f W J� f State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF . lATI N Propertp Owner Nam ``Property LocatlIgn 1/4 2 S T , N, R or Prop e ner's ling Add Lot Number Block Number — C it , tate Zip Code Phone Number Subdivisi n Name or M Number ( ) A 11. TYPE OF BUILDING: (check one) ❑ State Owned U UC Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ,� 5 Tow OF / 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) `t I .) -2A .a� ' I oI - 1 E] Apartment/ Condo oAO — /36 -1 — . 2 Z 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. W New 2 ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ------ System ________System _____________ Tank Only --------- _----- Existing System ________ ExistingSystem 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 5d Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 4 V It Priv ❑ 3 au � n d ❑ Y 14 ❑ System -In -Fill ' FG VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required Sscl. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min /I ch) Elevation ,� Feet Feet Capacity VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper- INFORMATION New Exist Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App i n strutted T nks Tanks Septic Tank or Holding Tank ❑ ❑ 1 ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamberl ❑ ❑ ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plum er' Name' (Prig) C / Plumb s Si at e' o W s) MP /MPRSW No.: Business Phone Number: L $ '.� Plum er's Address S,tr�eet, 'ty, State, Zip C de): C IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved GZ m iLFe e (Includes Groundwater ;//, Issuin � Si nature (No Stamps) []'Approved ❑OwnerGivenInitial P Surcharge Fee) Adver Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) 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: 1. "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. 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 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. 1 1 � 1 .TV,,1 i / odc��,� t� 3 s' n S y yg i 169 ioe Wi: consinbepartrnent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distanpe.1' near,tist' 020- 1021 -00 4 . REVIEWED BY DATE APPLICANT INFORMATION PLEASE P-HIN,'t -ALL INFORN1S4r N �( PROPERTY OWNER: ]', '�!r ;'�; PROPERTY LOCATION Kernon Bast �, OVT. LOT NW 1/4 NW 1/4,S 14 T 29 ,N,R 19 € W PROPERTY OWNERS MAILING ADDRESS /.,'!� � � t� # BLOCK# SUBD. NAME OR CSM # 948 LaBArge Rd. �� : � OT 25 na Grass Range Second Addn. CITY STATE ZIP CO E ; ` PHON CITY ❑VILLAGE]fOWN IN ROAD f3udson, WI. 54016 Hudson LaBar a Rd. * I New Construction Use [x] Residential r 16r,tSt [ ] Addition to existing building ] Replacement [ I Public or commera hd Code derived daily flow 600 g pd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) area 1 =98.1 area 2 =98.6 (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U E1 S CR U El S CRU ❑ S EI U E S ❑ U [I S [R U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bourxy Bed Trench 1 — 10 10yr3 /3 none 1 2msbk mfr 2 10 -21 10yr4 /4 none sl lcsbk mfr gw if .4 .5 Ground 3 21 -30 5yr4/4 none co s Osg ml gw na .7 .8 1 4 4 30 -84 7.5yr4/6 none ms sOg ml na na .7 .8 Depth to limiting factor +84" Z� Remarks: Boring # 1 0 -12 10 y r3/3 none 1 2cpl mfr gw 2f np 1.2 2 12 -35 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 1 35-84 7.5yr4/6 none co s Osg ml na na .7 ? Ground elev. 1 01.4 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. e New R' and WI 54017 Signature: Date: 8 -25 -98 CST Number: m02298 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page 2� of 3 PARCEL I.D. # 020 - 1021 -00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD /ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 11 -17 10yr4 /4 none sil lcsbk mfr gw f .2 .3 Ground 3 17 -21 10yr4 /4 c2d 7.5yr5/6 sil lcsbk mfr gw if .2 .3 elev. 1 4 1 21-27 10yr4/4 none sil lcsbk mfr gw na .2 :.3 Depth to 5 27 -84 7.5yr4/6 none co s Osg ml na na .7 .8 limiting factor AJ + Remarks: Boring # 1 0 -10 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 4 :> 2 10 -24 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 24 -40 10yr5 /4 none sil lcsbk mfr gw if .2 f43 Ground elev. 4 40 -84 7.5yr4/6 none co s Osg ml na na .7 .8 1 Depth to limiting 5� 1(�0• g Z.Y fact 4 Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 :`.6 2 9 -31 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 31 -46 5yr4/4 none co s Osg ml gw na .7 .8 Ground elev. 4 46 -84 7.5yr4/6 noen ms sOg ml na na .7 .8 10 h, Depth to b limiting 4 OtO factor +84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBO- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Kernon Bast New Richmond, WI 54017 MPRSW -3254 Nra4NTa4 s14- T29N -R19w (715) 246 -6200 town of Hudson lot #25- Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 2 pvc pipe C el. 100 Alt. BM.= top of 2 pvc pipe C el. 101.70 �o ate TV Gary L. Steel 8 -25 -98 r S f CROIX COUNTY SEPTIC T,',NK MAINTENAI'4CE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Dep artment ii,r new construction) — pa p - /3.5( -_z S City /State a � Parcel Identific:rion Number � — ^ = _ LEGAL DESCRIPTION Property Location 4 L ' /a, '/4, Scc. �, T N -RW, Town of c Subdivision ��{��'`� _ , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # l�f� 38 , Volume , Page # Spec house ❑ yes, no Lot lines identifiable 4 yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prope; maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put iiuo 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 ner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site was Le waterdit.posai 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. f /we, the undersi;;ned have read the above requirements and agree to m;iintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commei,"e and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has een maintained must be completed and returned to the St. Croix County Zoning Office within 30 Z ft three year c p'rati date. in ✓�/1 1 / SIGNATURE OF AP I.ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the brst of illy (our) knowledge. I (we) am (are) ti ;e owner(s) of t e roperty describe bo e, b virtue of a warranty deed recorded in Register of Deeds Office. SIGN TURE OF AP L CANT DA "C;✓ " * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. '* Include with this application: a stanihcd warranty deed fi,,m (lie Rc8ister of Deeds off a copy of the certified survey map if reference is made in the warranty deed �b ., _ti AY -R �.1 �NI �1IT 3iN, ���N' ' TN, A� �!524 3t!';�T so t . I "At)PArl *V4 V)"L %% LX�L STATE BAR OF WISCONSIN F +ARM 2 - 1982 iIIE C WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCU.MEr4T NO, 5T. CROix ca., wI This Heed, made between KSRNpN •3, BAST and RECEIWJ FOR UM 06 - 1944 11:00 AM DON J. SPEER-BAST husband and wife, - - - WDARAMFI GEED EM ODPY FEE: r:om• and warrants IQ JOHN R. WANNER an KRISTINE K. CORY FEET WANNER, husband and wife, T ER FEE: 107.70 - -- ----- REMIND FEE: 10.00 ,Grantee, Wit nesseth That the said Grantor, for THIS SPACE RESERVED FOR RECOROING CAM val uable Consideration, conyeys to t he Grantee NAME AND OETU ADORE" d : the following describecal estate i St. Croix -- - County, 5taw of Wueortsin: Lot 25 Grass Range Second Addition, Town of Hudson, St. Croix county, Wisconsin. 020 - 1021 -00 P-CEL I E TIFICATfQN NwraeR Thin i S riot_ homestead ptopeny (is) (Is ru t) Exeeptior, to warranties: easements, restrictions, rights -of -way . Dated 1116 _ day of August f - ter J. Bast nonalda J. Speer -Bast (SEAL) (.SEAL} _ -- (SEAL) AUTHENTICATION ACKNOWLEDGMENT Sigttarurc(s7 r _� Seale of Wisconsin, ss. - — _ St, CLD1X_ _ r..ounty Authenticated this — day of _� 19 Person m Personally tame before e this day f August 99 the above y 19,..`_, gamed -- tiernon J. Bast and upraida J. -_ - - Speer -Bast _ Ill LE. MEMBER STATE BAR Cif= WISCONSIN ( ' nal - aslthoriud h;� &706 06, Wis. 5tats.) - -- to me knows to be the rson S w ♦� _ ho e!retutcd the foregoing instrunten- d ackna.lydgF the same, THIS INBTAVMENT WAa DRAFTED Br Kernpn J. B ask DIANE M,BAnFION _ 94 — N lit S La Barge Rd, Wfeconsrn - _ Notary blic, —, c tr county, Wis. iJignatus may authenticated or ackndged lk+ owle. rh art, s m sot My tomissign m is perarcnt. fete of ([f not star. e expiration dale_ necessary) u} ' N,nrs nl - per—s iving In any oprtty s* ­u by ryExd o: vinrrd below lht it 7VAWFA. WARIIANTV DrEC 5TATF DAN OF %I SCONSIN yam, tqy Slaw Ci m F-- No- e - M2 IAMaNMM. Wm �FrG "a .4 I'lii 1 a 56 3 ACRES z.. 2 111644 SQ. FT ky RS' t C10 61pS9,,SQRFT, 41 oi� c � c p titl 5' 3 r i C) 7 ' . O s. 6 a , /}� pa �'✓ ., 447.00'' c9 w ACRES a85F E` 446,7 2.875 _5,P46 SO- E T. � yea ��I a � -� STORM -40 RETENTION 1' 1/ a 35 82' H.W. 2�pp aAGR - F`T� s —'� ' �' � S C8 N� 6 3% A3 Q� � a ,5' I2'5'�W�471.3�6' p. ON R= 80' A. 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