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HomeMy WebLinkAbout020-1302-60-000 # � 3 \ � m ) ( \@ ! ' @$ 7 � §/ � § k _{ § / o )) z ƒ n. ) era . 2 7 \-0 ( 2�E . 3 � .2 e <zo ; »- « z / o « @ 2 § j § )zk \ ) � k k k g D ) C / kA ¥ § Q \ Q u z 2 z \ � £ z c \ U E c § o a E E t o k k \ § 2 2 2 z �� o \ g 0 0) 0) L) �� $ $ ° -i _ .2 = Cl) cl� \ \ \ _ -, ° § ° c § Z % t 2 z / / 2 = �$ §c § $ 7 0 - - § 8 ) § 0 E % A �k & 2 © 2 ) f § E N ) ° . 2 « 2p )g& I ®. 0�} �Z / 0 z f i \ 2 m e CL f maE.I C cl �))\ka0 / v a 2 2 4 fi ?F` r fi E�P O `T P 1013 o f f R Wisconsin Deparbnent o try, SOIL L AND SITE EV A L � D N --�- Labor and Human Relations Division of Safety & Buikliings in accord with IL 83.05, iMIS. Adm. Code ' Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan iWst include, but - CEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, sosie . dimensioned, north arrow, and location and distance to nearest road. EVIEWED BY DATE APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION R PROPERTY OWNER: �U,y� /,PD �filS �9tiD O PROPERTY LOCATION GOVT. LOT 6 _ 1/4 UE 1 /4,S 2 7 T 2-Y ,N,R /,f E (a) W �zi8 dip, ��` LOT # BLOCK N SUED. NAME OR CSM / PROPERTY OWNER':S MAILING ADDRESS } � 33� �ie.,PoB� s T r/ 5') / { Hi'(IS CPtins� Z CITY, STATE ZIP CODE PHONE NUMBER QCITY OVILUGE N NEAREST ROAD T I- AtAl- 5'5/0/ (G�) 22- 2 - o'koit /F LN New Construction Use (4 / Number of bedrooms Addition to existing building ( ] Replacement [ ] Public or commercial describe Code derived daily flow �aa gpd Recommended design loading rate bed, gpddt trench, gpdjft Absorption area required g . bed, ft trench, ft Maximum design loading rate bed, 91)(1/ ' trench, 90 1112 Recommended infiltration surface elevations) S� P a 3 it (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if appliFable It S = Suitable for system �� U p moutp S C] U Ml_ G HN ii ESSURE AT G ❑ U g- HOLDING TANK U= Unsuitable for s stem 1�r5 ❑ U O S etrl SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bwtdaiy Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch /a V Ground 3 Depth to limiting T is test site ASP ROV D np facto y j�► 7 m atem. Remarks: Boring # / O _ lDf�e 31.)— /)o 1W e S � �►'+ `� � S /&o le `� �/ s/ f S�,f' �► a r S n 3 3 75Y �� S 4, s aQ� cs 7 Ground elev. Yo s IV, 3,f ft. Depth to limiting fact i/ Remarks: _ / CST Name : — Please Print Q E T •u LQ P t' C (,t 7'–' Phone: f ' 3 �co – 401 'f 5— _ . � l' CSTA1 : 49 y�Z dress S 0 Nt I L � D • H UPSon) WAS ✓��� �o Date: q!� CST Number: Signature: J 1 , PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 PARCEL I.D.! /-a r` # 3 I f+ u m 3 (go ti i 115 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwifty Roots GPD /ft In, Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 3 o- A) 3 /2-- Q S —- s Ground /�' 36 Z, 5 Ye y�� elev. /oo Depth to limiting fac Remarks: Boring # 1 0 -/ 1- /D j e 3/Z Ground 1 1f ' %9 /6 ,Q -S /I S D , S ft. , t Depth to i limiting factor Remarks: Boring # Cs S G / f 5 - k 4, -11' 1 _ y ; Ye y /�„ �� CS � � 0 Ground , elev — /b S s r� . S 0 SF :k- ft. Depth to ' limiting i factor Remarks: Boring # Ground elev. it. Depth to limiting factor Remarks: cen eeenio neinm a o T F �h p do. Lo S0e ueVows I�� r ^T Ns L T - co/24 e /00,d v 3v . 13,7 1- /d 0.60 - 1 30 ' B v S i35 3 �9 6 50•Lo7 L . ylo3' g p let / , 3 , y — �s 330. N EL. 969 Q V pONDING EASEMENT 0 N w o LO Q I = o LO I - 2.00 ACRES w I N89o39'42 "E 223.78 �i { `. N 87, t64 S0. FT. O �' � CHICKADEE -LAKE E ` f . m 230.5 w 0 ? �N89 ° 39' 42 "E - 4 i G S84030'57 "E 317.62' o ri I cD ? 616 0 w m cn LOT 32 N 1 m � I � 2.01 ACRES c CD LOT 30 r N w ro 87,649 SO. FT. D °' (D 2 00 ACRES 00 O 87, 162 S0. FT. I Z °° rn 15 f 2 FONDING / ' EASEMEN X88.8 " off_ . � /__..� .• /^� -p► t S 46 ' M � ao��y I �...V ' t J 1 \ <�� S 45 pp W �h ti� � 2.01 ACRES 87, 55.6, SQ. FT S44 3? 66.00 S76 2 7'' E q63 SCALE IN FEET 200 Wlsdbnsin f0epartment of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count !§T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarYNTSIl 0.: Personal Information you provice may be used for secondary purposes [Privacy Ir. s.15.04 (1)(m)). Permit Holders Nam C1 �yillage [] Town of: State Plan ID No.: N ELSON, WIL IAM ' 8 CST BM Elev.: Insp. BM Elev.: BM�scription: Parcel (T�a dg-1302-'60 -000 TANK INFORMATION ELEVATION DATA A9900018 TYPE MANUFACTURER CAPACITY STATION BS HI FS / ELEV. St .� �- (�l� t'►�� �� (J� Benchm li 111 1 �? Dosing A i i P,? m Aeration ,Bldg. Sewer- � 13 .� Y o . � >' . Holding - St/ Ht Inlet /� 7,p- � , (, (" ;O-.A TANK SETBACK INFORMATION I„ s 0 11Z BMX St/ Ht Outlet 9. 72',, TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Se ti N (o� 57 NA Dt Bottom Dosing Header / Man. Aeration NA 1st. Pipe !O i 9 Holding _ _ - -- - -- - - ----_ Bot, System f /. �� y qc . PUMP / SIPHON INFORMATION Final Grade, Manufacturer Demand Model Number -_ GPM TDH Lift Friction System DH Ft ead Loss Forcemain erlgt -h-- -- . Ff Dist.Toweu SOIL ABSORPTION SYSTEM ED TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth NI /g DIM SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE CHING Manu acturer: SETBACK CH ER INFORMATION Type �� �� . w M oe N System n , �,¢- OR UNI DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s). x Hole Size x Hole Spacing Vent To Air Intake Length ) � Dia. Length '`/C/ Dia. f� Spacing 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29..,A9,NE,SE 739 ORIOLE LN - HUMBIRD HILLS LOT 31 oy 5� ICS `A �"Fi / l, CK-4 - �fit✓vf a f� � y` W �� �k� {T Plan revision required? ❑ Yes VdNo Use other side for additional information. FT1 I I SBO -6710 (R.W97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t ,, f' a ' I, • WisConsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division I NSPECTION REPORT §T. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitaSy1WTt1,1P.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. Permit Holder's Name: © E] Town of: State Plan ID No.: N ELSON, WILLIAM IF1iuys CST BM Elev.: Insp. BM Elev.: BM_Description: ParcelVTaldg-1302-60 -000 TANK INFORMATION ELEVATION DATA A9900018 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Bench m Dosing Alf r3r� y �2 Irk S Aeration ° Sewer–, -55 /o i Holding -- St/ Ht Inlet // TANK SETBACK INFORMATION s rrf C9,,,, St/ Ht Outlet 9 . 778 /oaa TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Se ti 111 � 57 NA Dt Bottom Dosing — Header / Man. 09 Aeration NA ist. Pipe 609 /O Holding __. Bot. System //. 5? ft ,Y r 7 q� — W° 5 / 62,4 G' PUMP/ SIPHON INFORMATION Final Grade /099 .-7 Manufacturer Demand c,,}, Model Number TDH Lift Friction System DH Ft m ead Forcemain Le - ag - - -- Dist. To well SOIL ABSORPTION SYSTEM ED TRENCH Width Length ! No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I N /g DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE CHING Manufacturer: SETBACK CH BER INFORMATION Type of –71 ' -- OR UNI Mod e! _ N _ umbef. System DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) � x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. Length 44V Dia. �� A Spacing _ /.0,— .o 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 I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29. 9,NE,SE 739 ORIOLE LN 7 HUMBIRD HIL LOT 31 Plan revision required? ❑ Yes [(No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. • Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Visconsin 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 8 112 x 11 inches in size. S C C 2 v )( • See reverse side for instructions for completing this application State Sanitary Permit Number .3zf;(7sz Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pro Owner Name Property Location W; �'fl?Y►'t c.'S'v �C 114 s �- 1i4,S ',�7 T 2 `I ,N,R J KOr)W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number Hkds" w, s C/o ,e ( - ) l) - /LS d 14,� its 2 `�` ✓?dd II. TYPE OF ILDIN : (check one) ❑ State Owned ❑ It Nearest Road 13 Vll age ) 4 h Public or 2 Family Dwelling - No. of bedrooms Town OF /` /u di ,C ► b j G G III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Cl !(j ! AjQ(j 1 E] Apartment/ Condo 0 2 0 _ O 2 t° / II 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. ® New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System _Tank Only______________ Existing System ________ ExlstingS m 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 (A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 El Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPT SYSTEM INFORMATION: 1_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade // Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) G Elevation (0 U i� �/$ y 'Y& , (r, ! �•5' Feet /U Feet Capacit VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank (/ ) 2 0 i M i w c3 r, 1:1 0 [] 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ 1 ❑ 1 ❑ 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 Ors Signal tur %( Stamps) .ANIMPRSW No.: Business Phone Number: G C. u� c � � / �'23 6 7 Plumber's Address (Stre ity, State, Zip Code):,,/ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater D ate Issue Issuing A entSi nature (N to s) Approved p Owner Given Initial Surcharge fee) Adverse Determination �s 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. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit.. Check only one online 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 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. i Ne c' e '7�5 14 Id r v � ,�GI �� U d S� v� l.✓ s - � /o 2 L 2" ray I 0 1f" pR cw n 1 v r. J� �p w S � I/ / JJ k NY s _ _ s r F Chl.` L �.m ? Y �� o ff" Q ''�-a� h P.;• 1�� � j r t u e,� U n�`� W=onsM Deparunent of Industry SOIL AND SITE EVALUATION REPORT Page 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O za - 1302 b APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IEWED BY DATE� •V R 0 1 PROPERTY OWNER: PROPERTY LOCATION l V)t Iv L SQIV G0YF+8T NEE_ 1/4 SE 1/4,S 7 _1 T Z.9 ,N,R 1 E ( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # c)_ 20- �_ t� ':�, 1 *QM wmt) l t_u Z " 'trop . CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD �-�SO►v Iti)I SW61(, ( 386 -)6sy 1 \U 2toL IE L AJtN K New Construction Use Residential / Number of bedrooms y [ J AdditiQn to existing building [ j Replacement [ j Public or commercial describe Code derived daily flow b 0 O gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft Absorption area required bS6 bed, ft 15L) trench, ft Maximum design loading rate , , bed, gpd/ft . ® trench, gpolft Recommended infiltration surface elevation s -S v P zt►` 3 �p () q 9. o O�wNts��� w ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable tJ P1 It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for stem I9 S El RS ❑ U IaS El OS ❑ U aSS ❑ U ❑ S krU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tra o -�S LO`ieZ -1z t I Z \5 - 10 `1 Z_ 1 b — Si II Zen 3bk yvt' Ground 3 z9 -US 1-S4IZ 2 0 y s � �a stA7_ mv'�v GS • •S elev. 1 ?.6 ft ft 45_g7 7 S y R y / 6 '�- S p S 9 wA 1 Deo to ' limiting facer Remarks: Boring # OAF 13 1 0 _zZ do y, 2 -2 - l Z� '�� i�� Z s bk m'�►-• w _ , s (� 4S - S3 S\r\4-31Y _ S I 1, sbk VnvV-l._ 0-S .y -S Ground elev. _9 6 � -S L/ 2 V l b — S Depth to limiting factor >C) G ,� Remarks: TName:- Please Print Arthur L. We erer P �� B ' 715 - 425 -0165 e firer Soil Testing & Desi n Service -P.0 Box g g g 74 River Fa11s,WI 54022 Sgnature: ! > Date: ) ` - cj 9 CST Numb 220254 PROPERTY OWNER 'N SOIL DESCRIPTION REPORT Page Zof_ PARCEL I.D. # D – 3 oZ - b0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Botnclary Consistence _ GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Roots Bed tench 3 0 -� l�`1 tz..� l z - s i Z•,� � b wi`F ek, - • s •,6 Ground rz Sly — 1 S O 3 3 1n �o elev. S I -S ft. Ll 38- vL1 7 -S q R Y1j, Depth to limiting factor Remarks: Boring # ,,., � o -a log �Z 31 Z - s i I Zw►s�k mfr CLV - `S `� Ground 3 tiS -ZS S L-i R 31 S O S g elev. y 7S - � Z . S `i 2 31 y - S 0 g ► 06.8 ft. g 1 I Depth to limiting factor > Remarks: _ Boring # 0 -9 1b al Z k"Ak 5 7- 9 -29 14 y lz .31 L — S i 1 Zrn s bk wJ` Cyv , S . 3 Z9 -yy �•S'I 9 y c -S Ground elev. y -�zs �•S`�2 Y�6 - S O sg J _ .1 \ ft Depth to j limiting factor > Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: ,nn PLOT PLAN Pa of 3 SCALE 1 "= SO Ap _z 0 I � e A J O J Q *I - e too. Q O?J z Y 11?zo►v V�, .4 �j 0.hl i�Z _ kZI- WI-la OV-3 10P OF S QL F:eJM POST. g.+ s - 10 aF- NT LefNST - L IF-.' F -"I. -1 e qb S . s' �,► N. wLl .l, it k It Sd' k t 0.r1 w 1 NWIUM kLZ" Co\,( . 0 O \s'S�ISVTIEI�I \mil PAS_ �� T= Web - TT) 'ill R„k -- v(E)vT Po)vD)JU6 Out: SYST15-1s 1Irk Z. 9c) —0 ( 715 ) 42.5 -n 65 140 0576 CST Signature Date Signed Telephone No. CST # Wwonsin Department-of Industry, SOIL AND- SIT.E:EUALUATION REPORT.— 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 81/2 x 11 inches in size. Plan must include, but' not limited . to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R 1 Df3Y D�tTE PROPERTY OWNER: PROPERTY LOCATION O tV GOW- L � t 1 S Z 1/4,S Z1 T Z. g ,N,R 1 Q E ( W PROPERTY OWNER' :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONENUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD 1c�N\�St)N LJ) S 1 401.0 (11,S) ag(b - 6 Sy ��U\7- SQ o2L ,. � A11� K New Constnxtion Use K Residential / Number of bedrooms y [ j AdcrWgn to existing building [ j Replacement [) Public or commercial describe Code derived daily flow b r3 O gpd Recommended design loading rate bed, gpd/ft • 0 trench, gpolft Absorption area required O dSb bed, ft -150 trench, ft Ma)dmum design loading rate • , bed, gpd/ft ® trench, gpolft Recommended infiltration surface elevations -S " `t' ` 3'ZP () � s. o p�NLr« w it (as referred to site plan benchmark) Additional design / site considerations Parent material S P<►l�� -f o1j_T1nJ s N Flood plain elevation, if applicable 1 R\ It S = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem P1 S ❑ U 0 S ❑ U as ❑ U ®S ❑ U E.S O U O S 9U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cortsistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twdi >� ) o - \S t.o-t%Z 3Iz — stl Zm m'f1r- c,w - €�... Ground 3 ?1j- t(S •S `? tZ '5 It/ 5 � Z aSb4c m v � GS � •�! S elev. � oe.(. ft .YR Depth to limiting facto Remarks: Boring # 1 0-1 vo y, W_ Z l z [3 Z zZ. -� 1t) \ - t \Z 3 b — s i l zhi s �"c 3 4S -S3 - 1 .S`iV..31y — S 1 sbk vn •14 -S Ground elev. if S3_9C - I-S 42 Yl b - S � oz.s R Depth to limiting facto 6 Remarks: TName: Please Print Arthur L. We erer P 715 - 425 - 0165 ,egerer Soil Testing & Design Service -P.O. Box 74 River_Falls,WI 54022 Sgnature: i Q :'_ Date: )` ` 9 9 CST Number: 2 20254 r! PROPERTY OWNER SOIL DESCRIPTION REPORT ..Page? of 3 _ PARCEL I.D. # OZ.Z - 30Z - bO Boring # Horizon Depth Dominant Color Mottles Texture Structure GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. CDnsisfienca Y Roots Bed rrf6r& Ground 3 3l Y elM 3 1N1 I -S ft Ll 38 -12.3 7 -S R Y/6 Depth to j limiting factor > V?_ 25 Remarks: Boring # - -a tD`-11Z 31z — 51 ZrnSb1'r v� `Fh Civ S . .., Z -�5 Lv�t R 3l6 s i ) Zrilsb�c >n`F}- ew -S - Ground 3 1S -ZS S L-t R 31 \S O S `3 1,. 1 CS ., i• �. I b6•'t ft. g Depth to i limiting factor > �zb Remarks: Boring # 1 0 - 1 o�-f 31z — si 1 Z , bk M `F_ cam, - , S • , b El 9 -2q 14 y it- .3 11, — S i 1 Z1� S bk 1'►'1`Fh c» . S i . 6 . Ground 31y elev. � os.o ft. Depth to limiting factor' Remarks: Boring # I Ground elev. ft Depth to limiting factor Remarks: ­)n PLOT PLAN E 3 of 3 SCALE I"= 50 I �l v `or %r L I 4VII Lj a J I A.3 i 0r �I ( T AM +Z , - l0 3. $ u,) '►UP OF POST. t �}ov S t 10 IK kT LAP, aT - L %' Pw - a FD S wit_ K �?LHeE VA tyC1w►uM qz, co\AQ2 CARNZ Ots'f�18vT1El \�tp S Swp T tw1Slft c--AA MTri poyvb) CUM sVsMD -I 3t Z 1 � qq -o ( 715 ) 4 2.5 -fo 6 5 1400576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer W ' �n 1 T -el i's 0;q Mailing Address f S t l d r C. rz c. Property Address 7 U` r , l e L O-►. e (Verification required from Planning Department for new construction) City/State 1 u d r e t-✓ . Parcel Identification Number L 2 0 LEGAL DESCRIPTION Property Location +1 c ' /4, '/4, Sec. Z , T -R 1 �T W, Town of )` / d5 ✓t_. Subdivision / a m h . ' a d l -� ��S L -!L� . Lot # Certified Survey Map # 5 `� 4 , Volume , Page # Warranty Deed # L 7 � %Z ` / , Volume 13J1 , Page # 1 -/ 33' Spec house ❑ yes ID- 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 the St. Croix County Zoning Office within 30 ` d d ays of the three year expiration date. 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. V z r, JC 1 1;7 l l 9 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 Cow (N (p O L.UI HI.RCJ 87,369 SO. FT. iD 0 N87 ° 52' 18 "E / 330.79' w / � I rn ' EL. = 969 pONDING I v EASEMENT • — w � / LOT 29 N ..........................W. 2.00 ACRES w Q O 87,164 SQ. FT. p i lhl8e 39'42 E 223.78' - - i - I I � CHICKADEE -LANE SEC CORNER SECTION 27. w �N89 0 39'42 "E 230.51' w I V 0 S ° 30'57 "E Z y 0 3 17.62' I con I ....................... _ _ . 0 ' N I (0 6 6' W �( I 1 � ! LOT 32 LOT 30 10) 2.01 ACRES 2.00 ACRES 1 D m ro 87,649 SO. FT. w to 87,162 SO. FT. z CD '4 z m ° m O > 2 O • 0 m ; ° r I , w (D m 0 0 i W -n Q pONDING / X EASEMENT /� _ N s45°5dodw LOT 31 _ z a \ 1 ' � 86.82' 5y e t ' 2.01 ACRES y r O� 87, 556 SQ. FT. N W r. 344 ° I0'00 "E 66.00' w S � 6 ° 2�4 1 � E 463.13 , , 1 Z 8 8 0 w a � 00C(J-%1CNT NO. WARRANTY 00D STATE BAR OF WISCONSIN FORM 2- 1982I� S'782 III REGIS(0'S_b0ICE Humbird Land Corporation, a Minnesota +'- fooration �� S T. CROIX CO,. WI . a.�'d Aur noM1 MAY 01 1998 V „Ilvr•ys a lld warrants to WtJ,l T. ,Helm and Trisha J. Nelson, 8:00 A Husband and Wife�.,� ..... ..... _........... _ �U l���h►1 / _ J� � .!/e yy � ^^ .. .. ... .... ............................... the follawinl; described . e;ol estate in ...... St. -Croix - _. .C�ur.ty, -- State of Wisconsin: Lot 31, Humbj'rd Hills Second Addition Tax Parcel No:.. Town of Hudson, St. Croix County, Wisconsin TRA%a ER This _is _not re '- P pertc. (I)QK (is not) 1•:xcclltiolt to warranties: Easements, restrictions and rights-of-way of record, if any Mated this .. 27th _ da of r A i 7 P . 19..98.... (SEAL) HUMBIRD LAND CORPORAT ....._ .._......:.ION . (SEAL) • _. -.. - ..._.....- ...- ..... ........ R by Austin J. Baillon Its ---- - -- President ---------------- -- (SEAL) ................ !SEAL) _._ AUTHENTICATION ACKNOWLET GMENT Signature(s) STATE OF WISMIFX)MX MINNESO* -- ----•--•-- -_ ....................... o_ -•--- •--- ----- --- --- -- ---- -- ss. Ramsey i ai.+iheniicated ibis ._....: . • .................... .... . ., ..... . ................C�unty. 0 -- ---- Persenaliy cane before me this .......day o f ...................... .......... ..................... - - - - --- Avc?.1..... 19...98.. the above named ' Austin J. Bailion of President •________ -- o.' ' "" Humbird Land Cor oration TITLE: MEMBER STATE BAR C_^ WISCONSIti ---- -- - - p-......- ..... ............................... (If not, ....... -------•-•----- - -- authorized b Y 6 70G.OG, Wis. Stats.) _--------- -------- - --- •- - .....----•- , to me known to be the person ._.... - - - - -- who executed the furetiuim: instruns nt aml acknowledge the sense,. THIS INSTRUMENT WAS DRAFTED BY HUMBIRD LAND CORPORATION /. - - - -__ ' + Paul A. Baillon . + _ .. . ... Notary Public ... t .. ... _ -- ... + Wa 5t11n�C7T s•v'J�IYV►"dyyY l,. a,iyyp ackno,cle l _u. L.,tl, My Conunisslon is Perm tncnt.. .. not, state cp�ratt °17 MN (Signatures may be authenticated or are not neceesary.) date: .. January 31 • "fOmr. of f+cr.wn• aiRnir.,; in nny cnl•ncity ah•, �, I,I hr tl'� c•I __ - .),, ..� — - - -. ___ ___