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HomeMy WebLinkAbout024-1036-50-100 ST. CROIX COUNTY ZONING DEPARTM s AS BUILT SANITARY REPORT g �y� Owner d Property Address f'� i r City/State� r CRO r +' zap +v im Legal Description: Lot Block Subdivision/CSM # - t /4.. t /4, Sec. '�Q, T, N -RJ�W, Town of L IN a SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: W1 -Size Setback from: House �iS �Vel � l /L -a Tank manufacturer Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Ven esh air ' ake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM L I , Type of system: Width L =gth �� Number of Trenches 7 Setback from: Hous Zoo Well� P2 1`1 Vent to fresh air intake ELEVATIONS Description of benchmark U Z-1 W E evation Description of alternate benchmark ISERE-d Elevation Building Sewer ST/HT Inlet y ST Outlet / O tPC Inlet PC Bottom Header/Manifold / 7�1�' Top of ST/PC Manhole Cover _I__L — Distribution Lines ( ) () ( ) Bottom of System Final Grade () ( ) Date of installation 6 6 / ermit number 3 0 State plan number Plumber's signature _( /i icense number 4)/ ° 1 LI Dat Inspector l-d /1 7 Complete plot plan � x 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 ui b Ci' �. tl( U� U o Am INDICATE NORTH W 0 e dS c �p Ff P do aw Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CROEX Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 338919 Permit Holder's Name: ❑ City ❑ village Xj Town of: State Plan ID No.: CARPENTER, PAT PL. VALLEY CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: la U o o ; 024- 1036 -50 -100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY S ATION BS HI FS ELEV. Septic C Z3 141 chmark z �� Dosing Bft\ ' Q, Z7 13L3 Aeratio Bldg. Sewer E Hoing St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to i ntake ROAD t�t Z3 �r ir wpm Septic :i" 3 0 ' 41KC)l NA Dosing Header / Man. Aeration NA Dist. Pipe r� _�j Hol Bot. System PUMP/ SIPHON INFORMATION Final Grade anufacturer d S 'AF 3 Model Numbe GP Z '� �/► z / .Z TDH Lift L oss fiction m TDH Force Length Dia. Dist. To well IL ABSORPTION SYSTEM lU c BED Widt / Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DI O DIMENSION SETBACK SYSTEM TO P 1 L BLDG WELL LAKE/STREAM LEACHING Manu f c rer1� INFORMATION Type Of f _ CHAMBER Model Num er: System: l N OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) y x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. �'1 Spacing ( Z 60/ I 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.) L CATION• PLEASANT VALLEY 30.28.17.233B,NE,NW 127 CTY RD W — LOT 1 VI.. 5 1 �' Z = q roa v�q� '*Or /Po' 43 / 5 me le elS Plan revision required? ❑ Yes ❑ No Use other side for additional information. 00 SBD -6710 (R.3/97) Da a nspector's Sign re Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f 5 t e 1. m 1 �o € E 3 e. r s * £ s i s 3 { r } ; Ae t t 3 r be .�..._ . LJ _. . a E s E t . ........ ,,. � ...... ... ......}. te a.._. _ ..,, .,,,.e„ ..,,.�.. ... �.. _. .. _... 3 4 � � t a e 3 E E 3 { � 4 t } m �rt 1 � 1 r } ; a F 3 x 3 1 } Y ve sz . } Safety and Buildings Division - SANITARY PERMIT APPLICATION 201 W. Washington Avenue C P O Box 7302 s ons�n In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. X • See reverse side for instructions for completing this application State Sanitary Perm - y ou may itt Number Personal information p rovide be used for seconds y p y second 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 INF RMATION Pro rty Owner Na a Pr pert Location �,� �� n fa �'r0,,� 1/a, S T �� , N, R /'� E (or)>� Property Owner's Mailing Address Lot Number, clock Number City, State Zip Code Phone Number Subdivision Name or CSM Number R A 44 L! c � n � ;S -3 G ( 444) 97 ;Z _ 3 y 11 . TYPE OF BUILDING: (check one) ❑ State Owned ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms n Town OF �°� ,0s, _/ 7� III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo ©� 3 - S d 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 Q Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 Q 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. S New 2 ❑ Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an ______System ___�____ System____ ___�_____TankOnly______________ 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 Q Seepage Bed 21 ❑ Mound 30 2 pec�fy Type 410 Holding Tank 120Seepage Trench ,� 22 C] � In- Ground Pressure �j 1� �0 M42 ❑ Pit Privy 13 E] Seepage Pit 54- ad,e�2s r " &�Z43 C] Vault Privy 14 ❑ System -In -Fill ap O K /f. .r T1�.S / s D R - 3 9dwwber s r ekii L VI. ABSORPTION SYSTEM INFORMATION: �'j a�.$ r ,�•E,grie h 1. Gallons Per Day 2. Absorp. Area 3. Abso 'p. Ar &af 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (s ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) g Elevation / 6 00 1 ' 40 -a e#1 I . s ys - 1 OZ 97 Feet 9 Feet j Vil. TANK Capacity in gallons Total O Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank I /;? S / &) f �_ 5 Er ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I I 1 ❑ 1 ❑ I ❑ I ❑ 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) Plumber's 'natur�(NS:�amps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zi de): 7 0 7� IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) [� Approved []Owner Given Initial Surcharge Fee) J� , / - / ,/ i Adverse Determination //Cc X. CONDIT ONS 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 umber is to fill in name, license number with appropriate refix (e. . MP etc.), P y 9P P 9 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 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 c� C 5 ri ol 1 u ` 1 � � � o � N , Q � 1 n s I \ 9 ll q � r r C91 Sr�✓� t� r n dcR, •SyrT �► Frosh AM Inlets And Obsecr.11on PIAO Awo od Veal Cap Mialm m 12' AYew Flool owed* I t _ ♦t c f P � n - i - PAdifOSed t Y� n ?in Ilt PIrE TO BE AT LEA57 '> 1 CNE .. - AUU AT I- EAST20 lA1cHE5 811T KIO MORC THAW IMCN£5 DEI.OW FIMAL GRADE NJ MUM OF-PrH OF EXCAvATiou n om OKI OVA 1 6RAa€ WILL Sr- _-.�? . IA1cHEs NNNinuh� AEPrN OF 9xcavAnQN FROM WILL BE INCH1 =s sl�rv�o: LIGEIJSC �Jl1M8ER: 7 DAT ----- ---- -- r , Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor 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 S not limited to vertical and horizontal reference point (BM direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dis 1� e d. civq- Wit -So - wo -- D BY DATE APPLICANT INFORMATION -PLEAS SIT "ALL fN ON 4 PROPERTY OWNER: r' r` �. , PROPERTY LOCATION 1 114 _S>a 1/4,S 30 T Lb ,N,R \1 E ( W PROPERTY OWNER` MAILING ADDRE LOT # I BLOCK # S C S ►"1 NAME OR CSM # 1S1 0L(FIZZ eL \ Vt,L t� 3513 CITY, STATE ZIP PHO R []CITY [3VILLAGE ®TOWN NEAREST ROAD Bv RY.ISb���' M 5 . (� New Construction Use [ac[ Resider tsdo� y [ [ Addition to existing building j J Replacement [ j Public or Comm Code derived daily flow 6 40 gpd Recommended design loading rate - bed, gpd/ft j-S trench, gpollt Absorption area required So o bed, ft2 � trench, ft Ma)amum design loading rate bed, gpolft ' S trench, gpolftt Recommended infiltration surface elevation(s) S ?\juTIE cy.1 N'� - -'S ft (as referred to site plan benchmark) Additional design / site considerations 'It h 4 It Parent material L-C'Tm - Om ER S* � S tv L Flood plain elevation, if applicable N It S = Suitable for system CONVENTIONAL. MOUND IN- GROUND PRESSURE I AT -GRADE S%TBA IN FU HOLDING TANK U= Unsuitable fors stem 0 S O U I EIS O U I RS DU [IS ❑ U [IS O U [IS O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour by Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch o-I.I 11 3`1i2._ zLZ si 1 z �� `�n e,w 1 S -b Z 11 L��t Q 3! z s l l Z Ground 3 2 3 10 ti R �d 6 wi 'FI- - q �rZ 3/ _ s I l as bk >n v f> e,ti, — •`{ - S Depth to S 6 b -10 7. Vz y1 M v 14 S limiting laclor p , 0--o yjTKi NS R Ft .S - .5 ! S Remarks: Boring # p t LD — S1 z�91� wl ac,., 1 •S `•b z �o� .�1� s i I z S�l � � A s 3 z,4o I - 31L — s ► , 1 Z�ri weft �S _ • S •� Ground elev. c� bo 1 1 u` t rz t -S It Depth tD limiting factor ? � t °15 Remarks: • T Name: — Please Print Phone: Arthur L. We erer 715 -425 -0165 V egerer Soil Testing & Design Service -P.O,. Box 74 River Falls,WI. 54022' Signature: Date' CST Num � ter; _ �(,�. � I .� Cf9 - 5�, - ic) - 9 220254 i PROPERTYOWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL LD.# IVJU Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou fty Roots GPD /ft u sell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1� c . S w rnv 1w, •6 v s k � v fit- c.w 1� • �l � S Ground 3 y SI `11Z 31 SO ZM s �1r elev. Cl 1, 4 Sl - --'•S`Ivz-Y /` m vJ-- C-.') — •� i• S Depth to S b9 m v'Qti- t • S .� limiting factor i I 4 i Remarks: Boring # 1-31 i i Ground i elev. ft. Depth to limiting factor f Remarks: Boring # ["w. i Ground elev. ' ft. Depth to limiling i factor 1 Remarks: Boring # l v,? :� Ground 4 elev. ft. Depth to limiting. factor Remarks: 1 PL PLAN Page 3 of 3 SCALE 1 "= 30 U T +\j E / 3 3 , 6 1 °1 0 bo b y � aby 8.Z LL tiV � S 5 'rit W. • tizQ-4 r PtLn\� L-2iY Uwe it, F' NCR ST��L PV �11'� Net\(Z poa T. M C m tm"b� "-L ? LOO LET' 2, Leas L y nzL vct S, c1+ I')< 60' LotJG Z , Mik) . 6' P6'Mtr F,vp Z4 `' O P?i' TM ovry r., SwPE EDGE w LTIi N1 G N C Pr1��Cl`f y s� u��ni��iZ - i�E STlzu0-710ty , 94 ,- S 6 ( 15 ) 423-01 1:4 00576 CST Signature Date Signed Telephone No. CST # Wisc onsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labdt and Human Relations Ovi lonofSafety & Buikfings in accord with ILHR 83.05, VYts:,Adm. Code COUNTY Attach complete site plan on paper.not less than 81/2 x 11 inches .insize. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and %of slope, scale or PARCELLD.# dimensioned, north wow, and location and distance to nearest road. 0 _4 M 5 Sta )o APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY_: DATE PROPERTY OWNER PROPERTY LOCATION I ppn - CPrN2 V)i�)Q`VU�'i K)F_r 1/4 ,SW t /4,S 30 T Zb ,N,R V1 E( W PROPERTY OWNER'S MAILING ADDRESS. LOT # 1 BLOCK # SUBD. NAME OR CSM # 1S Q l.0_� I csm Vu\. 13 N 3S'i3 CITY STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE ®TOWN NEAREST ROAD vRluS�lt,� MN SS3o(. WZ) 94Z- 34.S k_�PShlr UM.•L.{ [� New Construction Use [aq Residential / Number of bedrooms 4 [ I Addiikq to e**V building (] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design Wring rate - bed, 9VW , S trench, 9pdt Absorption area required Sa o bed, ft2 kz-od trench, ft Ma)dmum design loading rate bed, � 9PcW - 5 trench, 9p Recommended infiltration surface elevation(s) S � ►vuT QQ N 3 ft (as referred to site plan benctinark) Additional design / site considerations vt N ti I Parent material L(Nsnn - omm SkK&s S TQ tv L Flood plain elevation, d applicable . � • It S 7Uns%Wtab item COW13MONAL MOUND IN- GROUND NK PRESSURE AT -GRADE MTIM IN 1U HOLD TA U stem IRS O U 0S O U ,1R) S O' U 0S O U 0S IOU 0S ® U SOIL DESCRIPTION REPORT. Depth Dominant Color Mottles Structure GPD /ft Boring Horizon Texture Consistence Bar>d3y Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench k I O-LI toLjtZ ZLZ sl Z- `3� `�nv`Fh ew 1 •S '� t Z L l�� Ground 3 2L 10 4 R 116 - sl 1 Zm 3 w i iv- C_ w • S _ c ft b b S�2 3l S 1 1 b m V' �, - •� 5 � 3 -� v � - s k Depth to YZ Y I r, - .14 S limiting ` factor � 0 N S R 1 -S `1 1R, / S` S Remarks: Boring # 0-9 I IIHR3 1 Z s�i Z`F9� V , qtr "_L' .S _ Z 9=2,7. t.o`12.� /L st Z�S�1z tine 13 3 za_bo to — st'I Z� w,ff �S _ • 5 •� Ground � l s MT tt bo 1 o`t P- Yl6 — s i 1 e Sbh Depth f1D limiting faClDr -Remarks: CS T Namw- PlasePrint Arthur L. We erer 715- 425 -0165 ,egerer Soil Testing & Design Service- P.Q...Box 74 River Fa11s,WI 54022 Sgnam Date: CST Ntanber. _ w l .�� 9°t - L { - - 19 -9. 220254 i PROPERTY OWNER __�- pC1Z.P�h1�Z SOIL DESCRIPTION REPORT Page- _?of 3 PARCEL 1M. # _ D L4- MA So —IAO Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. B Consistence Boux>ary Roots ed Tnch � Z �- m y cw t v 'S r:. u I S I � C s� 1z >h V 'fit- C-w 1 � � � • S Ground 3 y SI lA `liZ 3 L elev. Ct.v 9 8-S ft. s1 - 69 `S - MY/` -- 1`�s o� mv�►� cfv — -4 j , s Depth to S V1 8 V) `-t. 1 m v limiting f factor ?� a Remarks: Boring # 13 -_ J Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to j limiting factor Remarks: Boring # Ground elev., ft. Depth to limiting. factor Remarks: cnn.n1) �nin n In PLOT PLAN Page 3 of 3 SCALE 1 "= 30 ' t Q. 3 U Tzz' tNE / , 3 S 3 , / e ? di LiAie b° 1 r g.l � 9by B.Z • ' c H�11 --I 3h4" bIf} PUC ` m Glf , 31v" D) R . p Neat Sit,.. \�L C 1~-LPE mef-2 mt'zh C MuvND) NIL ? .COO' ae\eT - Z, ti►�►s�ct�. y �t -�s, L--f� 3'x bo' LGhjG, Mini. 6' Vn -fttt-r F z� ��? � `RtE ov►�►...,SwPE EDGE w i� L-11 CJ�a�C stDFww6� L�CId D��ZMtNE - M-. 014 LFu "DAD sT - PVT T>M or - c� STlz uc�or� , 99 -S 6 -� tzti �'►'� ", r_ ( 715 ) 425 -01 MQ 0576 CST Signature Date Signed Telephone No. CST # W 1 scon5'M Department of Commerce OIL AND SITE EVALUATION Division bf Safety and Buildings + ( Page of B,�Yeau of Integrated Services \ _POAia ith s. ILHR 83.09, Wis. Adm. Code ` County Attach complete site plan on paper no 4od!nta I �an 8 1 x,�'r) s in size. Ian must include, but not limited to: vertical anrefbtkr�ce (BM), diTp 'on and S' C percent slope, scale or dimensions, n ow, and location and distanr<e~to nearest road. Parcel I.D. # APPLICANT INFORMATION ` @se priA_i ormatio�' Re ' wed by Date Personal information you provide may be used�(o� s�&ondg� g1tWq�gp icy) a+y,`s` 15.04 (1) (m)). I ? 12 1 ot Property Owner ;`' Property Location 001- Govt. Lot /U Uj 1/4 .S F_1 /4,S T? ,N,R 7 E (or)( Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 3r 1 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ��-E (IS 1 (7`5 =75 ea cz f (( e- lec( ( j (� New Construction Use: EgResidential / Number of bedrooms S / Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (' 00 gpd Recommended design loading rate s `7* bed, gpd/f? ___ �trench, gpd /ft Absorption area required 1500 bed, ft / 000 trench, ft Maximum design loading rate gp gp g g bed, d/fl trench, d/ft Recommended infiltration surface elevation(s) 96 • 3 0 ft (as referred to site plan benchmark) Additional design /site considerations Q G V' 4oQ(' el -e y 4'/• 30 Parent material &A0- 4" 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 ❑ S [?U Q9 S El ❑ I [is [9 U ❑ S Qi U ❑ S 5 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 I O -$ 10 r 3l t l 1 rnah k . h�Cr C m Z S Iv Y r y16 S `f nab MP- CS Ground 3r L-S t C elev. Depth to limiting factor ,9'q in. Remarks: C• rfs; I � {CQ 6 ecR CC S_ L O v-J y Boring # l o-4p to r_311 —� S r►1 -G'r c Z._ & g m-` s c5 [ Ground elev. Depth to limiting f ain. Remarks: C re v •e 4 IS eJ rOc-k 1,3-e tow S� CST Name (Please Print) Si nature Telephone No. Address Date CST Number o ecao4 r- �� C l / me c✓� G� C - �'- ? S O ct SOIL DESCRIPTION REPORT PROPERTY OWNER I O Page o PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 iG r3l1 S . C ,�,as '� C �S'"• Ground _� ` �! elev. Depth to limiting fa for Mn. Remarks: C re (31-d rOC-k t3 e plc,-," 7-6 1 Boring # r , 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 # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # ........................... .......................... ........................... .......................... Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) V / t3I1 hC� A16 5, z. N J h lo ■ `. � � `1 �• 3o si ° a tI s �, ► 9G. o —' �-- — ._C r �!:« S /off — 133 i A � Q„� L N • C • ISM �. j - BEARINGS ARE REFERENCED TO THE N NORTH - SOUTH 1/4 LINE OF SECTION BEAR N00'20'26 "W o Z 30, ASSUMED TO 0 O° Z D Js- (3 o m +co o z Z �=`� GiyA � Z rn m O m 4 r M 'T a Cr 0 co ' � .o '. 'G�\��•�2s 0 4 -D 7• o o v o r' N C O R) y N X99\ �� II m 00 00 F`�`�r 6, F p0 p 61 �! . 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D C) o \ ~� m J C17�� Z ~ b z z z Z z z= Z N • O'rZ► o -I CD "aoowU N ;� N p �� Cb V OO Ui O L4 O Un (n °— i frl O ; b 01oN� r� V '� M -- -m m f V I tp D Ny mmm O iD v Z� z Z 1p b z a? m NJ -N (A� n �N � / a1 (, N � W 2 1:0 N O OIV Q ° C O r� cD 04 Ln 0 N V O Cn Un O N V m r- Z 00 A �` z Z O p G� m C �D o mo• � rr- 2 O li z N P L4 � N D �1 m m Ln 00 O • 00 L4 n m (n O Z %, D ` ►�" +-4 Q0 czi \ = m ITI o l r 1 v o> m d1 m o E v O m n m N 0 o FA Z me m z zzzz z -' ° �\ °o < o ?; O z m m T7 D -v m p, � ?� � - P W V) 2 n Ag m CZ N 00 IV N m m 0 mm Z o f c0 Q? c0 c? \ z m rl) 41 rn �� 1 8�0 6 ° X 0 m mm m m m <3 „zb,6Z °OOS) ° o ° Z tl z z O m 2 Z zz z z z i UNPLATTED LANDS C) Z ----------------------- m O (n O (n O y = A O- a•o�°� m N L ( (; N \ cs cD cn rn - co �, j mom m THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 9B -71 i • • a0znpp .zo3 pzpog uMol elpzxdoadde pus a0i33O Bu AlunoO xto D •IS aqq gopquoo Tooard Aug BuidOTanap ao BuiSpgO.znd aaojeg • (• oq' ' TaOZpd oq ssaoop 'azis IOT mnmtuTm 'spupTg9A " O'T) suOTgRTnb9a pup SOTru 'sMPT dTgsuMos pue Aquno, 'alplS 0:3 goaCgns sz (leTd) dem sigh uo UMOgs Taozpd gopg IM 1 'NQsanH f , 1HVZ Co 91OVS IM 'uospnH J+ st119nOQ�y • 0ui 'S InuTPM ZTZ Bui�Catizn S Pueq N q S 00,9/44 4 0 aaTgRZ • r spT6noa uT AaTTPA Iusspa 'amps Buzddew pup buTAeAzns Td 3o uMOL agq pup xioaO •IS 3o Aquno, aqj 3o aousuT Uozsi � niPS pUpq aq� pup sagngvqS uisuoosiM agq 30 t E' 9£Z ueu -rpzp pg0 3o suotsino.Td quaaan0 9 q:1 4ITA pa ATTn p 3 anpq I �q� :pagtaosap pup peAet xns Arepunoq ao- uaa�xa aqq 3O OTPOs 0:4 uoz - 4pquesaidea goaaaoo a sT d PW AaAanS p9TjTjza0 stgq qpg� Ag - F - 4a O osTp 'I •p.TO09a 3O Slusu9no0 PUP SUOTjOTZgS8a 'sWamassa TTP pus '(uMu) ApMgBiH *xru,L Aquno0 a o3 AeA- 3o- lgBFa oq loelgns ST Taoxed pagTac)sap anogv ('�H 'bS 9ZT'69S'T) saaov ZZ0'9£ suipluoo Taoapd pagTjosaa - BuzuuTBaq 3o quiod aqq ol :4 SS'6581 'auiT g:tnos pips BuOTR 'M &&TT16So68S 90uagq :I, /THS aql 30 t' / - EHM aqq 30 auiT ggnos aql Oq g St"OSS 'Hy8£,6ZOOOS 90uagi :1993 00'589 'HuTT16So68N* a0uagq :gaa3 68'66L 'Hu99.9TOS9S 90uagq :gaa3 96'SZV 'HuTTs6S aouagi !:1 TE'S 'au'rTaelueo pips BuoTp M�S£�Si�O00N a0uag� :�aa3 TS'6�� auiT.zaqua0 puP 9tizn0 p rPS 30 Dag aq1 BUOTP 1 ATa9q :1aOu eouaq:4 ' :4aa3 OE'ZEv seanspam Pug HuLS,TSO9ZN Baegq pzogo asogM ' uVO IST S5 seanseaui OTBue TelIU90 asogM 'ATi9ls9A anpouoo 'atizno snipea aoo3 ST p 3 aanIptizno 3o luiod aqq oq jaa3 60'T£9 'auTT=aquao pips BuOTe 'Hu6Z.6ZOVSN eouagq :1993 9T'TTZ '9uTT29IU90 PUP atiTno pips 30 Dag aqq BuOTR 1 ATa9Isp9ggaou aouagq !jea3 ZZ'OTZ saanseem pup HULS�ZSOE9N sapaq paog0 asogc� „9S , 9tio8T seanseem aT6Up Te queo asogM '�Ta9IS9Mgq.zou 9ns0uoo 'atizno sntpea goo3 ST*VV9 p uo iuTod a Buzaq '�Mu dpMgSTg xunTy ��uno0 3o aUiTia�u90 ag1 of 3 993 SU VE 'HUVO60000ON aouagq :gaa3 £S'088 �V /TMS aqq 3o V /TaN PTES 3 9UTT ggnos aqq BuoTp 'MUOz,Ls aouagj .6utuui6aq 30 quiod age Pup /TMS 941 3 V /THN piss 30 aauaoo gseagqnos aql oq 3993 9E'LTET 'uOT109s pips 3o auTT T ggnos / - qqzou age 6uoTp 'Mu9Z-OZOOON 90uagl : OE UOTgDOS pips 3o iauzo0 v /TS aqq qp BUTOUammo, sp a Taosa :utsuo0si 'A�uno xzoz :SAOTTO3 P q. P M O O '�S '�aTTp.A �upseaTd 3o umos '14L 'N8ZZ 'OE uoi�OaS 3O V /THS aql 90 � /TMN aq:t 30 lied pup y aql 3o V /THAI aqi 3o lied ' IMS 9 4 1 3O V /THAI aqq 3o lied P paddrm pup paptnip 'padaAans ansq I 'UOSJOAI aTRa 3O uoij0aaTP eqq Aq legq A3Tgaao Agaxaq laoAaAanS pup-1 uisuoosiM p9aags ',zalgpZ • ssT6noQ 'I 1 1 995 - 9 - - R ti ST CROIX COUNTY :SEPTIC WANK -MAINTENANCE -AGREEMENT AND WNERSHIP - CERTIFICATION FORM Owner/Buyer , YL L, Mailing Address 1 4 �VQOY1 Gvdt w A t y\1'Y V� 'S6506 Property Address (Verification required from Planning Department for new construction) / eZ 7 C y Ra l ) S- w`¢- -. City /State 41 -t c t,� g �1V (-0KG1f�'t Parcel Identification Number _ 1,o 3 LEGAL DESCRIPTION 4E Property Location NVJ ' /., Se %4, Sec. �O , T Zi N -RAW, Town of e Subdivision Lot # Certified Survey Map # � �� �, a S Volume 3 / , Page # 3,5 �, 3 . Warranty Deed # _ 9 L/ 7 7 to Volume j 4 , Page # �- Spec house ❑ yes 0 Lot lines identifiable 9 ❑ 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 wastewaterdisposal 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. Uwe, 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. — C)VOK , 4 �'Jm 'J'& 1 /30 SIGNAYGE OF AP L C 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 described above, by ' e of a warranty deed recorded in Register of Deeds Office. SI A OF APPLIC 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 VOL 13 9 1 pu 594�7Es 59477 State Bar of Wisconsin Forst 1 - 1982 KATHLEEN H. WALSH V WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIUEI) FOR RECORD THIS DEED, made between U.ale..W.....Iversen., . a..singl.e... 12 -30 -1998 11:50 AM person, ..and..Ebb.a..Kral,..a. married.. person ................. WARRANTY DEED ................................................. ............................... EXEMPT # ... CERT COPY FEE: ..................... ............................... COPY FEE: .. ..... . TRANSFER FEE: 162- ..... ............................... ........ Grantor, RECORDING FEE: 10.00 and Patrick. .. L Ca Carpenter, PAGES: 1 husband and joint ................................................. ............................... ................................................. ............................... """"""""" """ "" """ " "" " """" " "" """""" "" " " "" THIS SPACE RESERVED FOR RECORDING DATA .............................. I..... ... ............................... , Grantee, NAME AND RETURN ADDRESS: WITNESSETH, That die said Grantor, for a valuable consideration Title One Premier Group, Inc. 706 19th St. So. conveys to Grantee die following described real estate in St. Croix Hudson WI 54016 County, State of Wisconsin: 024- 1036 -50 -100 PARCEL IDENTIFICATION NUMBER That part of the NEJSWJ, part of the NWJSEJ and part of the NEJSEJ Sec. 30— T28N —R17W described as follows: Lot 1 of Certified Survey Map recorded in Vol. 13 of Certified Survey Maps page 3573 as Doc. No. 594225. This ... is ..... homestead property. (is) (WhFt) Together with all and singular the hereditaments and appurtenances thereunto belonging: And ... Gran tom ........................................................................ ............................... warrants that die tide is good, indefeasible in fee simple and free and clear of encumbrances except easements, roadways and restrictions of record. and will warrant and defend the same. Dated this .............. ........................... day of .. De, cember ......... ........... ............ 19 98.. (SEAL) (SEAL) * ..................... •--------------- •-- ............ ---------- (SEAL) (SEAL) . * ..................... ............................... *. Ebb a „Kra 1...........'..........., �.... '.t AUTHENTICATION ACKNOWLEDGMEItT .. ' Signature(s) ..................... ............................... STATE OF WISCONSIN ................................. ............................... 5 .�... St.....Cx'.o].x.......... county✓ authenticated tiffs ...... day f ................... 19 .... Personally came before me t'ris� .`.... •I - t Y y fr } � ' y �r.�` day of December ............... . .... � 985 'aiybve named ............... ............................... ................... Dale. ,W,..Ivers,gn, n ....................... TITLE: MEMBER STATE BAR OF WISCONSIN ............................... ............................... (If not, .................................................. ............................... ............................... authorized by Section 706.06, Wisconsin Statutes) to me known to be die person s ............ who executed the forerug instrument andHowled a tie same. 4Q��� . . .. THIS INSTRUMENT WAS DRAFTED BY i ............... * Kathleen R. Videen ..................... ............ I .......................... ..... Eau - Claire Wisconsin ........ ..... Notary Public . .....Polk ...................... County, Wis. (Signatures may be authenticated or acknowledged. Both are not necessary) My commission is permanent. (If not, state expiration date: • Names or persons signing in any capacity should be typed or printed below their signatures. June 24 w l L) L-., Gl . 177CJ l-d_ 11 r '—LA I I VI\ 1 L1 131 42 v r, f7 ` t� z BEARINGS ARE ERENCEO TO THE— NORTH – SOU 11 i� /4 LINE OF SECTION a (A ^ 30, ASSUMED TO BEAR N00'20'26 W Z -r Li N w p m v r+v � Ln M °Q' $ ~°� ° - s�� c S���'.� \ N , COQ m 4 �, o ry rn in �q, F;y� w c' ©�i rri 461 w ` \ N00'20'26 - W r�+ N00'24'28 "W �? fit.•' —�_ 00 I �.L1.� 3951.33' 2 p N > (1317.40') rn > N N NORTH – SOUTH 1 /4 .LINE o z Z ~ cp a� w to v cn cn En om N .•o c `� • `'C Iy Cl` ". m f� ^ w co y ppA w P�7fTl + -k 11 • � O V t Q 1r � D C() OX ID -np V " � N i s Ln C -4 cJ+ o cri �,; c3 vt z ° 0 f `• j„ W'y r 46 Ali 1? , m i az rib car Fq r y x Z M a) li --�— —fi' a Z N - p0 w� N v� F cnm o • y m a► °' M 2 to r+i Q c P4 z z z z -n —„ N C71 V G71 V Q cNO� %lc m •t rn M 40 Z z 0 N UNPLATTED LANDS ----------------------- T� cn so tJi so U1 c m THIS INSTRUMENT DRAFTEO BY MICHAEL ERICKSON JOB NO. 98 -71 Voi.13 Page 3573 Submit to non - enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin - municipalities for new 1- PERMIT APPLICATION Safety and Buildings 1?ivision and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) - SEE INSTRUCTIONS ON BACK OF YELLOW COPY. Personal information you provide may be used for secondary purposes. [Privacy Law 15.04. J)(yn)] Last Name First Name Middle lfiitial V Street Address _ ti U(st l.. l CC City State Zip Code Telephone No. (Iilcdude at+es Building Address Subdivision Name Lot # 1 - Legal Description - 7.,� " I N , Parcel No. 114, 114, . Section -✓� T , R tv - m.1 Family orced Air Furnace ❑ Radiant Baseboard or Panel {3 Heat Pump` ❑ .2 Family Boiler, ❑ Central AC ❑ Other. Nat. Gas L. P. Oil Elect. Solid Solar Space Heating ❑ 0. ❑ Q ❑ Water Heating ❑ ❑ ❑ ❑ ❑ Site Constructed Concrete ❑ Masonry {. { �TI+t "Wood Manufactured &Other (speci Living area-= S Feet. $ I vouch that all the above information is correct, and understand that the issuance of this permit islfor finitEcagi 6W only. I understand "that onsite constriction inspections will not be performed by the municipality, but that the Uniform IDw Cede, Chapters Comm/ILHR 20 -25, sti(1` applies to _all 'new 1- an d 2- family dwellings and must be complied ;with. ; I adOswui that the issuan permit does no e ' ve me of co m Hance with other applicable codes and ordinances. A licant's i ature bate Si ed MUST BE COMPLETED BY THE MMCIPALITY BEFORE FORWARDING PWK PLYTO THE STATE DIVISION OP SAFETY AM#IF INGS 13. Town ❑ Village ❑ City ❑ County of: SBD -8254 (R 10196) White - Issuing Jurisdiction Pink - State W1t4in 3 -Days ., Yellow - Applicant 0?'- S c - x .r'1 a3.3 1 rLGNS . s The owner, builder or agent shail complete and provide all required information on the application form down through the Sig to ;Appl ,!A9c Thsjdatai dfor statewide statistical gathetita; on new one - dad two,-farqily dw :as Nell local; 444pWstration. Whep. gpmpleted, submit to local municipality having jurisdicd PEkMIT RD)MeM:.. 1 _ • Fill in building address. • Fill in.legal description of lot,. subdiv'idh nay, of number and block number. x PROJECT DA,A,. i' • Fiff in all u aged pro�ecidata blop 1� the required information: ALL, DATA .�; L BLOCI�S l�tfi l✓ ' FOLLOW Type - Checoni ybeing TO: � 1. e , "i -Famil " or _. } == " � Y if that is what is built. In other words, b do NOT'use this firm if only a d ached garage is being built, even if t serves rves a one or " 2. lfiAC m Chef t of -lam not an 1nta1 ses air conditibnin s +check. "R t B a aid or Pam "tf ` is no cefiwa soiirde.�eat. t 6. Livings Area J - "Include any finishu�cluding finished" in laments { t. a ± For two - family dWellitrgs, inch intal.cgntbined area. ` }J y K � 3 7. ate t �nclu4e the thicticin, bat not cost - of labor la�tl , . 3 SIGNATURE: o f per',/,• _.. .., t - �N _ • t ti.. form.. rr - UIN� J�L4?N► , , - � r, ;, � � �.�„ ,� , .� �,y � r� �; �` � � 5 This must fie completed by Rte AIJTHORM HAVING JURISIDICTION.: �, $qkz : X 114• 1 check off MUNICIPAi�: TY STATUS, such as =town, village, cit or coup i1 j!Il TNIIPA ►L�` OF DWE,I�I.QCATION. If issued b # t 3 ll t� a specific munu� }p l n> w4 dwel�inn will be built x " C4 xt* Itf Fill in.namc of person issuing. _.; uutg permit and date biplding Permit issu+� �y <' - 0'�g �?` � PLEASE R>� kNk COPY WITHIN 30 DAY&"TER ISSUANCE T ' si x �tw3sl P 0 Bvx'79 id