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HomeMy WebLinkAbout020-1349-05-000 ST. CROIX COUNTY ZONING DEPARTMEN,' , ; ; AS BUILT SANITARY REPORT ° owner Property Address ZZq �a �J City /State Legal Description: Lot Block Subdivision/CSM # S"J %4 ;:.:� ' /a, Sec. Z, TAN -RAW, Town of k:, A5,- PIN -C)5 O!S SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer s rey cl Size ST/PC l v1 Setback from: House Well P/L Pump manufacturer h, pa� Model Alarm location 7 < & = (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width S Length / t'3 Number of Trenches :�:z- Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark ` /°!iG Elevation Description of alternate benchmark Q Z2 Elevation 91j. 03 Building Sewer ST/HT Inlet X SG ST Outlet PC Inlet PC Bottom ', Header/Manifold 9 Top of ST/PC Manhole Cover Z /,- Distribution Lines () 1 4 1 , () ( ) Bottom of System .2 Final Grade - / O ( ) Date of installation (� /0-MI Permit number y d �y State plan number Plumber's signature /�/�cC L icense number - 75 1 Date Inspector Complete plot plan � 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. PLAN VIEW I 3, 1. h� INDICATE NORTH ARROW ` Wisconsin Department of Commerce Safety4and Buildings Division PRIVATE SEWAGE SYSTEM / County: INSPECTION REPORT L/ 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)]. 344588 Permit Holder's Name: ❑ City ❑ Village [A Town of: State Plan ID No.: Town of Hudson rd CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: l W 07) 1 " U L - 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /6. Benchmark �•Zy �p�,Z 1 ng r� ! Alt. BM 7 Aeration Bldg. Sewer T Holding Inlet T 7. T (� • Io TANK SETBACK INFORMATION t 12 Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet -r A Septic i,j Z! NA Dt Bottom p //."1L �a,'J Dosing 20 ` NA Header / Man. Aeration NA Dist. Pipe +S.s 91 Holding B . System �=` S PUMP / SIPHON INFORMATIO 5q rw 4w �� 4al Grade ?$ ?6. -3 Manufacturer c l �S Demand St cover T� (°•�►� -�3 /S� �r7• y Model Number GPM TDH Lift ,t Friction 3, q System TDH'5,1 Ft oss Forcemain Lengthtl,Q Dia. IF �' I Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N I N / S - _ DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O f CHAMBER Model Number: Syste : (� (7 Q L!► OR UNIT DISTRIBUTION SYSTEM Header / Manifold , / r fr `? Distribution Pipe(s) 4 r x Hole Size x Hole Spacing Vent To Air Intake ` Length Dia. 1' Length Dia. Spacing? SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only a Depth Over I Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: t ° P -/ Inspection #2: Location: 719 Blue Jay Lane, Hudson, WI (SW1 /4, SWIA, Section 26 T29N -R19W) - 26.29.19.1881 OP L 14 & t,leJ �K '41 -e.wt VC,s , V, ►6Ilul ��� '`7�elav✓ 01 1eA „" 'Yt r; k X ct ( l o I'm-L9 f - t ►mac Plan revision required.) C] Yes ❑ No Use other side for additional information. 1 3 U W ki SBD -6710 (R.3/97) Date Inspector's Si ature ert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E s" s E } ...... �, ....A . ". mom... x...e.�.i ..� 1 } # k f 6 f E e E 4 § F § g m. _ W e t.. e § j i j , § a -- E - s 1 ' e z e " t � , ( 4 ° � N E § x � I Y e f x r x } r 4 $ t i t , x ( i � 6 D E RJ _ g 3 � _ e a e ' ° a x E 6 } 3 0 i { t S } m�..e .» ,......... .... ........, ......... ....u....� .a ......�.,...,, l ,e.0 .e..., �... x _a.,., ., .. .,�.. .. .., �.._., . ... ...,.... �. >. ......> �..m_. _... .. ,.,.�..,2.... ....... ..... ...... ....._�..... �.... �e..,.e.. rnw,.vxa�.. ...�...A SANITARY PERMIT APPLICATION Safety and Ave Avenue Ah scons i n 201 W. Washington In acco r d with ILHR m. P 0 Box 7302 Department of Commerce 83 05, W i s. Ad Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less county than 8 12 x 11 inches in size. '7 • See reverse side for instructions for completing this application State sanitary Permit Number 3Y y 1 1 4 7 M 0 Personal information you provide may be used for secondary pure es [I Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). — 7 � L 6j4%e, I44� State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL ) INhRMATION Property Owner Name Property Location - v4 ti4, T g ,N,R 5' E(or Property Owner's Mailing Address Lot Number !:Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE BUILDING: (check one) ❑ State Owned ❑ it Nearest Road E] Village / ,4 Public 1 or 2 Family Dwelling - No. of bedrooms '/ Town OF .i .«. III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) � - 1� , lQ I 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Q 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 _ [�' New 2 E] Replacement 3. E] Replacementof 4. [] Reconnection of 5. E] Repair of an "_`System ________ System _____________ Tank Only______________ Existing System ________ Existing 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 aSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit r 43 ❑ Vault Privy 14 ❑ System -ln -Fill s X 113 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. /inch) 7/ �Sd _ pn l9.7 Yed /675 1 1 -? d , ,�� I r A ¢'2, as Feet Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete stCon- Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank X C ( ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber p 2 ❑ 1 ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsi for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: N Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): c s.4 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing n )Si nature (No Stamps) i O ❑ Owner Given Initial 1 oT� Surcharge Fee) /d Adverse Determination a� 100 '7 / w l r� 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 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. 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainstwater 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. p�lp�ex I 6 0 PC 1z PAGE GF PUMP CHAMBER CROSS SEC7101d AND SPECIFICATIMS VEI�1T CAP 'i"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG JUJJCTIOW BOX MAMHOLE COVER ?_5' FROM DOOR, WINDOW OR FRESH 12 "MIU. AIR INTAKE GRADE I 'i" MIIJ. I � CONDUIT -- _ ______ 18 "MIN. \ ---- - - ---- IAJLET PROVIDE I - - - -- AIRTIGHT SEAL I \ / * A I I I I ALARM i *APPROVED I oN JOINTS WITH I I ELEV. FT. APPROVED PIPE 3' ONTO PUMP OFF D SOLID SOIL CONCRETE BLOCK i RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL_ SEPTIC f SPECIFICATIOUS DOSE �® TAIJKS MANUFACTUR ���` ER: u/es7- IJUMBER OF DOSES: _ PER DAg TANK SIZE: Z-? ad GALLONS DOSE VOLUME ALARM MAMUFACTURER: /�cUelavyr� INCLUDING 6ACKFLOW: GALLONS MODEL NUMBER: CAPACITIES: A= ?1.3 INCHES OR GALLOWS SWITCH TYPE: �o I g = INCHES OR g GALLONS PUMP MANUFACTURE _�4 as��f1 S' c= � IWCHES OR � GALLONS I MODEL NUMBER: Z/JG <_ D- INCHES OR � GALLOW j SWITCH TYPE: - �.� ri NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE _6PM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEAICE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , , . , FEET + _� �_ FEET OF FORCE MA X %3.6 2. F /oo FzFKICTION FAcTOR. FE TOTAL DYNAMIC HEAD = -?a,d 5 FEET IMTERNAL DIMEWSIONJ: OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH Jf SIGIJED: �� ^ '` — LICEwisE NUMBER: ,g t79 PG DATE: �� - -_ I V L.. Gould iuba E fi i 3871 EPO4 EP05 'L APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- components. tic cover with integral handle • Homes Motor: Available- for automatic and and float switch attachment • Farms manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- Solids handling capability: automatic reset. plastic Semi -open design 3 /4 ° maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING L • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. 9 Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding _ • a size: NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo - Dischar g plastic enclosed design for (CSA listed model numbers • Mechanical seal. carbon- length, 16/3 SJTW with end in "F' or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET - -_ - - -_ stainless steel. 10 _ -- • Capable of running dry p 9 — - -- _ - -- - - - -- -��t —S GPM -- d without damage to 9 30 -- com P • u mp: Sol ds handlin ca abili 25 25 Fr s 9 p ty: o %" maximum z . a •Capacities: up to 60 GPM. 0 s 20' - - - - -- — — -T - - - -30 _�t - -- • Total heads, up to 31 feet. • Discharge size:1 1 h" NPT. z 5 • Mechanical seal: carbon- 0 15' - - - -- - -- - - -- - - - -- -- - - _ __ rotary/ceramic- stationary, _j 4 BUNA -N elastomers. o EPOS • Temperature: 3 10 - - - -- - - - -- — -- -- -- - -- - -- - 104 °F (40 °C) continuous i EPO4 -- 140 °F (60 °C) intermittent. 2 I I 5' - -- - -- — - - -- - 1 i I 0 00 10 20 -- — 30 40 50 GPM 0 2 4 6 8 10 12 ml /h CAPACITY ©1995 Goulds Pumps, Inc. Pffactive Mav 1995 Wisconsin Department of Commerce t�Qtt- D SITE EVALUATION 'Divisidn df SaIlty and Buildings i Page of Bureau of Integrated Services /', ita'66CbrdanCe %vvi#h`'s. ILHR 83.09, Wis. Adm. Code �s��. County Attach complete site plan on paper not les ( ikaf 8 1/2 xIl[go�g size. Plan�nust include, but not limited to: vertical and hoantal reference point (BM), direction. and St . Croi x percent slope, scale or dimensions, north rb4/,an l tiwErd ce to nearest road. � Parcel I.D. # S7 ;ROX APPLICANT INFORMATION - PIerint aIfdrNn keAee b Da te WR J Personal information you provide maybe used fors orlc#a'Ry PQNX Ivv cy 'Ca�v;'s, 4 (1) (m)). Property Owner \ ;; r "7 �' �� Property Location Richard Stout �' ! � i Govt. Lot _5',�J 1/4C�,�/ 1 /4,S �V T ,Z cJ ,N,R / E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail �_ Brown's Ridge City State Zip Code Phone Number ❑ City ❑ Village k] Town Nearest Road Hudson WI 54016 (715)549 -6731 Hudson Meadow Lane ® New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 450 gpd Recommended design loading rate 7 _ bed, gpd /ft -8-- trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft 2 Maximum design loading rate ' 7 bed, gpd /ft2 • 8 trench, gpd/ft Recommended infiltration surface elevation(s) T.2 s ft (as referred to site plan benchmark) Additional design /site considerations 1S• 0_0 Parent material Glac ial D zoo s i t 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 KI S❑ U I ® S ❑ U ®S ❑ U I ER S ❑ U ❑ S 10 U ❑ S [ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 —6 10yr3/2 Sil 2mabk mfr cs 1F .5- .6 2 —30 10 y r4/4 Sil 2mabk mfr 5' .6 Ground 3 30-9 10yr4/6 Ms osg ml .7. .8 elev. A.- /_ ft v Depth to limiting" ,fa c tor 96 3W. r Remarks: Boring # 1 -6 10yr3/2 Sil 2mabk mfr cs IF .5'.6 2 2 -40 10yr4/4 Ls 2mabk mvfr cs 3 40-95 10yr4/6 Ms osg ml .7 .8 Ground Blev. Depth to limiting factor _gL— in. Remarks: CST Name (Please Print) Signature Telephone No. William Sbhumakier (715)386 -3121 Address Date CST Number 1 070 Scott Rd Hudson WI 54016 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page of J' PARCEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 0 -8 10yr3/ Sil 2mabk mfr cs IF .5 -.6 2 1 8-4C 10yr4/4 Ls 2mabk mvfr '�-4- ',�5 Ground 3 40-S6 10yr4/ Ms osg ml .7 ;.8 elev.� Depth to limiting factor 9 6 in. 4Z Remarks: Boring # 1 0 -10 10yr3/2 Sil 2mabk mfr cs 1F .5 '.6 o 4 2 10 -44 10yr4/4 Ls 2mabk mvfr �.,4 ;'S 3 44 -96 10yr4/6 Ms osg ml .7�.8 Ground elev. Depth to limiting factor 9 6_ 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 0-12 10yr3/2 Sil 2mabk mfr cs IF . 5 , . 6 5 2 12- 4 10yr4/4 Sil 2mabk mfr cs .5'.6 3 44-96 10yr4/4 Ms osg ml .7 .8 Ground elev. Depth to limiting factor 9 6 in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) � 1 o�gin a�y»2 Wisconsin Department of Commerce S .�' SITE EVALUATION )b > Q (—' '-Division 6f Safety and Buildings o ;:� ?S ,r Page ( of 3 Bureau of li`Rtegrated Services in o , .ui[ifFYs: ''Ll~iR 83.09, Wis. Ad m. Code U 5E� . 4i. `:� �A COCA- �•-' • Attach complete site plan on paper not less than > 1/ 11 inc°t�r�i�e Plan'n?S County ��►V include, but not limited to: vertical and horizontal�` rot eience poinh� ) tfi ction and percent slope, scale or dimensions, north arrow, dAd Iota ' s�` nd distance to near�st•ad. ( Parcel I. D. # APPLICANT INFORMATION - Please � jj t all infao *n. Reviewed by Date Personal information you provide may be used for second 5.04,(1) v Property Owner 'i r P perty Location Richard Stout M - Govt. Lot _5 1145'0 1/4,S .740 T ,N,R 1 E (or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail 5 Brown's Ridge City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road Hudson WI 54016 (715)549 -6731 Hudson I Meadow Lan New Construction Use: Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 5 0 gpd 563 Recommended design loading rate 7 _ bed, gpd /ft gpd /ft Absorption area required 643 bed, ft 563 trench, ft 2 Maximum design loading rate - 7 bed, gpd /tt - 8 trench, gpd /tt Recommended infiltration surface elevation(s) 9,r >' q.?, 26 41 g.5. 5' ft (as referred to site plan benchmark) Additional design /site considerations Parent material G I a r• i a 1 Dc po s i t 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 I KI S❑ U I ® S ❑ u [:R S❑ U 1 0 S ❑ U ❑ S I ❑ S J] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 -12 10yr3 /3 Sil 2mabk mfr cs 1F .5 .6 2 � 12-43 10yr4/4 Sil 2mabk mfr cs .5' .6 Ground 3 49-95 10yr4/6 ms osg ml .7 .8 elev. ft. Depth to limiting factor 9 6 in. Remarks: Boring # 1 -12 10 r3 3 Sil 2mabk mfr cs 1F .5 .6 2 2 12-64 10yr4/4 Sil 2mabk mfr cs .51 .6 3 4 -1 10 10yr4/6 Ms osg ml .7'.8 Ground ele Depth to limiting factor 110 in. Remarks: CST Name (Please Print) Signature Telephone No. W ll al th111'r ..� _ Address Date CST Number 1070 Scott Rd Hudson WI 54016 v PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page--- 9 ' L PARCEL I.D.# I Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 -10 10yr3/2 Sil 2mabk mfr cs 1F .5:.6 2 10 -34 10yr4/4 Sil 2mabk mfr cs .5'.6 Ground 3 34 -98 1 Oyr4 /6 Ms osg ml . 7 , .8 elev. ft. Depth to limiting factor 9.8 — in. Remarks: Boring # 1 -10 10 r3 2 Sil 2mabk mfr cs 1F .5 ;.6 4 2 10-42 10 r4 4 Sil 2mabk mfr cs .5 .6 3 42-1)0 10 r4 6 Ms osq ml .7 - .8 Ground elev. 7 � . uQ ft• Depth to limiting factor 10 O n. 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# si�� �h1D6/! Ground elev. / o�ft . Depth to limiting factor in ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) t oy 1/A9/ -2 " ", P6 f i� �- G�'.`Th �a� /a- d o� G ,gym i 41r a a oq � 2 ;5• I�� r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address . /,5 :1 - 6-, 3 Property Address 71 l Ate - (Verification required from Planning Department for new construction) City /State �i/ 1,V, 4Z Parcel Identification Number o 2- 0 - t '54 - os LEGAL DESCRIPTION Property Location s� ' /a, s' V., Sec. 9 4 -- T N- [-W, Town of � a Subdivision Lot # � . Certified Survey Map # , Volume , Page # Warranty Deed # T S . Volume / 3 3 , Page # Spec house ❑ yes EJ no Lot lines identifiable 9 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. Itwe, 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 the St. Croix County Zoning Office within 30 days of the three year expiration date. p � , _I� / SIGNATURE OF APPLICANT DATE OWNER 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. &��4u,,Jt 1!5 SIGNATURE OF APPLICANT 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 r 0 t VOL 1:3:313 PACE 17 io ffj 581.439 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED 1 DOCUMENT NO. C�Lle sin le person —__— - -�-� - on - i- �"� -�- REG ITT E -- -- -- -- ST. CRO!X CO., wi _ - -. -- — RsP'd kr Rote9rd . conveys and warrants to Richard 0. Stout and Janet P. Stout JUN 2 2 199$ - - h u band and wifer.-aa atlrvivorship mnri ta 8:00 A --" - - - -- TwS SPACE RESERVED FOR REOOR30.11 CATA -- - -- __ hayF AhO ° ADDRESS the fullo\ting &e -nbcd real estate in _ St. Croi County CF f, L� State of Wisconsin. r 020- 1072 -60 ?A ;CEI DENTiF-CATION NUb16ER That part of S�Stlk, Sec. 26- T29N -R1914 described as follows: Lot 2 of Certified Survey Map recorded in Vol. 11 of Certified Survey `taps, page 3036 as tk)c. NO. 538112. Together with a 66 foot access easement from Kinney Road to the Easterly boundary of the above described property. ` a ��G TRANSFER i y This _i:5 not —__ homestead property x= i, not' Exception to warranties Existing highways, easements and rights of way of record. Dared this - - - _ 18 day of — June . A.D , 19 96 - -- - -- — (SEAL) / - -- (SEAL) -D avid J. eja -- (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Slgnantre(s) _ State of Wisconsin, -- — — s c GZ•G y Counq' z «t11he1111Cllltd thlI, day of 19_ Personal! :a• ^c fore me this _ —_. —__ day of June 19 98 the above named - -- - - ' -- - - - - -- — - Richard J. le a a 5inZl e_pers on - x III LE, MrMBER JAI E BAR OF WSCONSIN _— — �---------- - - - - -- -- authorGed 1 '� v70t' Ot'. Wis. 11.115. `\`\ ,`: to 1111 kno'kn to .C:: f5on - -- who , `x"u:cd lhr lolet;u,itn flea P 11 4 striinwn and rdSe the same •'TU WAS �O� e`er --- - - - - -- - -. THIS ;NRMFNT AS JRAFTEO BY - Z�t.torney_. Day id- ._Estreen r T AUREEN --304 Locust.- Street,.- ffiidaon, A j �XISHEI t't e.., i...__._..._5 � -� G24L.� ..._ c+ �k1, 1it.tu+�i dour h Ngnaturrs may r .urihenuratrd or .I" nawic4ed , 1I v 1101 i 11,9 FOFW{5���� - -- .:oar..., i i. ' a•:q : .ca ..qv..n ,ho .:J b. •, �xJ ., i`,cl:d !klo,. �}Hl���: \� �1ArF. N. \w OF \ \'ISCONSIN .. .. \ \. \NRAN Il M 1 l) Form ]u. 2 - 144 • '' ' F ' ~ .� � � *�«�� /����� `r�r� BAR OF: wwuwox roxw 2 ^�����-"^� ^ WannANTY DEED 11, �. ���� noouw�wr wo VOL 'y.�P8[�'� _--Utjt;biQ J-'�^-���m���ndK�����[�-1�'����l�'��-bi�--_ I- _ - -_Ale- nnd in hex—Qum- rizLt -__-_____-. --_--_� _'_- _ '~ ---'--- ---'--------- ----'---------------- ------- � ]��H '.`", and °°'`~ = -'~�~�~�-'�-------'----'---'�----------'------ -- 8 °� � == � ___ - ------- __-__ --' '-- ----- -- --- ---------- '- --------- -- -- xPAcE "Estn'E,^uA.�~.�z^a.*��"^ .^"- `°a,E`"R,aoRE,t; the foo.,"m o^| '^,a/. , -��^-f���L_-_�_-____- r^«»'/� State w of 02 0-1 . 972 -30 T- at part of S- Sec. 26-T29N-819W described as follows: Lot l of Certified Survey Map recorded in Vol. 11 of Certified Survey }keps, page 3036 as Doc. No. 538112. Together oidh a 66 foot access easement from Kinney Road to the Easterly boundary of the above described property TRAN SFER FEE nx` is- not xv.,'auJr^Yen/ unx I., "w' Existing hig'hwuys, casements and ci;-�hts of way of record. Dated 'h.°�*____-_�_-__ da ,r _-__--_June �n. 1 -----__-_ --_'_(oau -_ --- _(ScAu _-acAo / AUTHENTICATION ACuN0\vLsDGmsNc 6o,e of vvmcouom. a�"/"m"` -----�------------'--------- '------ S _ _-zc ,-,-_-_ __c^.m». 1111 111(, _----.|^,../ �v__- ,"s`�^./� z,' /v»o ��----.|^/.`/ � m'^h^"n^"xu Bnovn �� ----- Lil�tarid xm1'xife' a^' .**x MAUREEN K. ^ -- '- - - ' l, -- /\ /7 '``u,r`=x �w^,v� J. � s�+*�" i�� 3U4 Lorust Stre-et, HUd�on �.- " ^ � ` ^� �� � /^ '^ | � [ 1 t") I a o I 1- ,4 332 46' o H I N14'29 �JI O u' � --I f .- ,9 Ai % I No 1 9 00'L62 M „8b,S£.00N to , I CD �i W b / TMS 3 H1 30 t , /13S 3H 1 30 3 NI1 1S3 a w I b b /IMS 3H1 30 b /iMS 3H1 30 3NIl 1Stl3 ¢ Z II' TAI (U ° 3 CD �° o f z 3 Lr) Z ww Qp J ❑ H m I y �._ 1 OD Z M r+ ❑ N I a o° c a z �Y) I y 3 O Ld Q i 00'009 M„ 2S,20.EON L ,06'EES o F 7 I w 66.10' N ui ° I No Z 3I �\ I ° O ~ 1Z `c°u -i ti X °� U 2T'6bi 3 „84,5£.00S L,J :� � ¢N i 1 ` II ¢ z b �^ o ACCESS t21'61ri M „84,9E.00N ; w M „8b,9E.00N 89'Ebg M „8b,SE.00N / I _\ I N n 1 N F- \ w . 4 J CV) c . 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