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HomeMy WebLinkAbout030-2110-10-000 ST. CROIX COUNTY ZONING DEPARTMENT ? AS BUILT SANITARY REPORT`'* Owner OA Ar DA /11 S Property Address 32 2. Bugg Q uA/. City /State UQS o Yy 'OFFICE �O�l1N Legal Description: y /' Lot Block -,A Subdivision/CSM # DEL/t 9A 544 ' /a ,Jly[' /a, Sec. TotEN -R-aW, Town of 5 7e i7o s l ze W PIN SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer Wj� H -- ' Size ST/PC/ d0/ a Setback from: House 2 Well PAL LM' Pump manufacturer Model 44 4 Alarm location HOLDING TANKS ONLY) Setbac Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: n CAt c 14 Width 3' Length 7S Number of Trenches Setback from: House _20 Well P/L 30 " Vent to fresh air intake ffO ELEVATIONS Description of benchmark T P a G Lo - r 5 ' ZA Elevation 00 "O Description of alternate benchmark �� n a I- /%2 a E Elevation /0 og Building Sewer _Z I" ST/HT Inlet Q, _/ ST Outlet �t - Z PC In - PC Bottom --,&— Header/Manifold ® Top of ST/PC Manhole Cover 11 Distribution Lines ( l) Z 0 y , `i 3 (21 _T4 Nom_ ( ) Bottom of System Z0 31 14 3. I- ( ) Final Grade (1) _ 167-- Z ( /0 7" 1-- ( ) Date of installation 2 Permit number 3 * SD 2 State plan number A(A Plumber's signature ?- - ozO: - icense number X ;Lf 7 Y l Date IAD / Inspector J c- � Complete plot plan � Aw• 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 �o- y. pf2tv�cv�y 3 f3r0 11ool-r Ck /.fou J LOfi `l/WC 30� /30 gh � �v � �r3 �_3 X7s' Tf7�ck�s INDICATE NORTH ARROW Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 Bo Washington Avenue 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 less County than 8 112 x 11 inches in size. S - Cro • See reverse side for instructions for completing this application State Sanitary Permit Number 3 yy. z 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. APPLI ATI N INFORM - PLE ASE PRINT ALL INF RMATION Property wner Name Property Location - ZQ va SW 1 /4, S T , N, R E (or Property Owner's Mailing Add r s Lot Num er Block Number 0TH S/, City, State Zip Code Phone Number Subdivision Name or CSM Number © ( 7 151 ,. II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road Public LK 1 or 2 Family Dwelling - No. of bedrooms Town OF s III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /Condo I d 3 6 '"/D 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. g New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an _System ________ System_____________ Tank Onl�r______________ Existing System ________ Existing System B) Pj A Sanitary Permit was previously issued. Permit Number 3 Y ys" Z 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 (A Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. A SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Fina! Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation loC/� Feet *7 Feet VII. TANK Capacity in gallons Total # Of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks ptic Tan c,04eWmr9Tank ` R1 ❑ ❑ ❑ ❑ ❑ Li er ❑ 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) Plu er M Signature: (No Stamps P SW No.: Business Phone Number: umber's Address (Street, City, State, Zip Code): _ Q -5_R4 4J14LLj6?4 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin Agent Signature (No Stamps) Wpproved E] Owner Given Initial Surcharge Fee) Adverse Determination fo L Z X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ��} rG V � S�PY� / Yaf GtA- (KG/�.it;S � .�. 7"'r�! dLL�.�y �r" >J� ✓�w�J� SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Division, Owner, Plumber l T 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. Vi I.• Tank information. Fill in the capacitjoof e`v`eN 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. Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.. CR( Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)]. 344502 Per rpit}{Ald9'; N IUNIEL ❑ City Village T n of: State Plan ID No.: CST BM Elev.:. Insp. BM Elev.: BM Description: 'j' J U Parcel Tax No.: c 030- 2110 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic " -e 0 Cj- Benchmark 51 b DbsLQ,g Al 9M . Aeration Bldg. Sewer 3 6op Holding 61 Ht Inlet U J� TANK SETBACK INFORMATION / Ht Outlet �. z� /0, (,, TANKTO P/L WELL BLDG. Air to i ntake ROAD Air Septic '7 /DO r AJ A Z / NA D Header / Man. Aeration NA Dist. Pipe Tt l� e fir, S 2 IZ.s6 0 q. Holding Bot. System L7/ 13. 1 / 2 z PUMP/ SIPHON INFORMATION Final Grade '(, } O Ma turer Demand G� 3.�C� f 3 _'7/ Model Number M TDH Lift L Ion stem TDH Ft Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM r5 BED /;PONCK Width r Len No- Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 3 7S 1 Z I I DIMENSION SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu ac rer: SETBACK MB INFORMATION TypeO .} )- / Mode Number System: l� ✓ "��(� ' LD /(/'� IT e DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) r x Hole Size x Hole Spacing Ve t To Air Intake t- Length --� Dia. Length � � Dia. � Spacing 0. 4/4 AM � �Q f SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over [ Bed th Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 6.29.19.905,SW,SW 322 BUCK RUN — DEER HAVEN LOT 4 O 3 2' p { Uy S PWr'I i j, S amic Gya S - �` fi e ed &04 �,� 4v�o� /� e ii J r Or i 1 `y � � laf — So �Azy lltCrdel �G fi,lftav A oaw VC �.l'-((Ja/r � a evision req�ed E3 Yes ❑ No Use other side for additional information. Z Z l c d I 4 G /V SBD -6710 (R.3/97) Da a Inspecto ' ignature Cert. No. � A = ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i , e e _ i _ e _ f E t . , 8 i e e. , e a t E F e 1 F i 3 e _ = e a M } , , E � r F e a e i 1 e e me ,E B [' j 1 { 4 � e , i a �e- mm z ,v S I , _ ,.. a ..... ,_ , e , _ .. ....... . ............. .. .. ...,., ,,,, ...... .. ..,. ,. _ .., ,..... � R . &.... r l 0.F i 7 e t f � N 1 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. sco P.O. Box 7969 In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. . • See reverse side for instructions for completing this application State Sanitary Permit Number The information ou p rovide may be used b other g overnment ag ency programs y p y y g g y p g E] Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location 5& 1/4 Saj 1/4, S T , N, R Z2 E Property Owner's Mailing Ad ress r Lot Nu er Block Number //19 342; A Cit tate Zip Code Phone Number Subdivision Name or CSM Num er yo (7 s) e - - ll. TYPE 0 B ILDING: (check one) ❑ State Owned C1 City Nearest Road p Village Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town OF rlbsg C III. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 03o - - 2-1 1 6 -10 —006 1 ❑ Apartment/ Condo ) 9 9 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 ______________ 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 mSeepage Trench 22 ❑ In- Ground Pressure , r 42 [] Pit Privy 13 Seepage Pit 2 ` -5 x S 43 ❑ Vault Privy 14 ❑ System -In -Fill i o tr 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) Elevation Q IF (� , Feet Feet VII. TANK in Ca g clt allons Total # of Prefab. Site Fiber- Exper. INFORMATION g allon s _ Tanks Manufacturers Name Concrete con- Steel glass Plastic App New Existin structed Tanksl Tanks Septic Tank or Holding Tank 0 00 A;;- r 5 1dJ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibili for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print PI b is Signature: (No NqMPMRSW No.: Business Phone Number: 17/ ,l Plumbers Address (Street, City, State, Zip Code): r IX. COUNTY / DEPARTMENT USE O ❑ Disapproved Sanitary Permit Fee (includes Groundwater pp ate I ssued Issuing Agent Sig ure (No Stamps) )�A roved ❑Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: VV SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber I INSTRUCTJONS ` 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. �I 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 numbers) 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. I' A. mite line B if permit is for tank replacement, reconnection or re {V. Type of permit. Check only one on line Complete e p p air. p 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. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), i 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 1 r , I Z L f i r ' , I f r ; ; { ` I , t -r- /r E /do_0 r JAL EL - - - - - -- , I , r r I , I -- - - - -- t , i _ _ I i _. E I — , , i 1 i — • ! ^ p I E ! , 1 , 1 L in f � - I : e I � � 9 , , . 1 f i 1 r ! , -_' - -� -- , I — r — 'I i-T Y � ! t , f � ' , I P , T k E E • , a - t 8 ' i — °r _ 1 . r ---- - + - , E VAsconsin Deparknent of Industry SOIL AND SITE EVALUATION REPORT Page Of Labor and HuM m Relations Division of Safety & t3uikli gs in accord with ILHR 83.05, Wis. Adm. Code COUNTY complete site an on St . Croix Attach co mpi plan paper not fees than 61/2 x 11 inches in size. Flan must include, but not limited to vertical and horizontal reference point (IBM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030 - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Daniel C . Davis GOVT. LOT SW 114 SW vas b T 29 ,N,R 19 1(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 1129 30th. St. 4 na I Deer Hay CITY, STATE ZIP CODE PHONE NUMBER EICITY E)VILLAGE 97OWN NEAREST ROAD Hudsonr 'WI. 54016 p15)381 -5264 St. Joseph 30th. St. .1 New Construction use pc) Residential / Number of bedrooms 4 [ j Addition to existing building I I Repiacement ) ) Public or commercial describe Code derived d* Now 600 gpd Recommended design loading rate _ bed, gpd/ft gpdrft Absorption area required 857 bed, ft 750 trench, 9 Maximum design loading rate __ bed, gpd/ft gpd/ft Recommended hAtration surface elevation(s) 103.2 alt. are - -101.45 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outvash Flood plain elevation, it applicable na It S : Suitable for system CONVENTIONAL MOUND W­GROUND PRESSURE AT -GRADE SYSTEM IN FLL HOLDWG TANK U - Unsuitable $or Sy stem ® S ❑ U ®S ❑ U ®S ❑ u ®S O U ®S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch 1 0 -8 1Oyr4 /3 none 1 2f P1 mfr cs 2f .3 ->;<1 < � 2 8 -19 10yr4j4 none sil lcsbk mfr gw if .2 .3 Ground 3 19 -27 10yr4 /6 none S1 Icsbk mvfr gw na .5 .6 10 j'�2 ft. 4 27 -84 7.5yr4/6 none ms Osg mvfr na na .7 :.8 Depth to limiting fac tor 4 #1 i Remarks: Boring # 1 0 - 10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 } ;> 2 10 -15 7.5 r4/4 none is Osg mvfr gw If .7 .8 2 } y 3 15 -% 7.5yr4/4 none m8 Osg mvfr na na .7 €.8 Ground elev. 1 Depth to limiting factor +96' Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 Address: 1554 200th. New Rich nd W15 17 Signature: Date: 7 -23 -98 CST Number: mO2M PROAER1yOmit DAn Davis SOIL DESCRIPTION REPORT Page 2 of 3 PAW& I.D. # 030 - 1024 -70 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisdence Bo ncWy Roots GPDlft in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh, Bed Trends 1 0 -9 10yr3 /3 none 1 2msbk mfr gy 2f .5 .6 2 9 -17 10yr4/4 none sil lcsbk mfr gw If .2 .3 Ground 3 17 -90 7.5yr4/6 none ms s0g mi na na .7 .8 elev. 1 05.7 ft Depth to S Crmiting WIN f� +90 w Remarks: Boring # 1 0 -12 1pyr4 /3 none sit 2msbk mfr. CS 2f .5 .6 s _ 4 2 12 -36 10yr4/4 none sil lcsbk mfr gw if .2 .3 3 1 36-84 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 1 04.2 ft. Depth lo Gmits� factor +84 Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr es 2f .5 ' .6 5 2 11 - 20 10yr4/ 4 none sil lcsbk mfr gw if 11.3 3 20 -80 7.5yr4/4 none ms Osg mvfr na na .7 .8 Ground elev. Depth lo limiting factor +80 Remarks. Boring # Gmwnd elev. ft. Depth ' liming bft i7nrn�rLa STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave, CSTM2298 Daniel C. DAvis New Richmond, WI 54017 MPRSW -3254 SW4SWk S6- T29N -Ri9W (715) 246 -6200 town of St. Joseph lot #4 -Deer Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be wuitable 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 out lot survey stake @ el. 100" Alt. BM.= top of lk" pvc pipe @ el. 108.60' 0 POP .4� 3 s� Gary L. Steel 7- -23 -98 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor &xf Human Relations Divisi o Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Jjjla' COUNTY ..� St. Croix 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. 030-1024- APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE 8 0 PROPERTY OWNER: PROPERTY LOCATION Daniel C. Davis GOVT. LOT SW 1/4 SW 1 /4,S 6 T 29 N,R 19 itc(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1129 30th. St. 4 na Deer Haven ZIP CODE PHONE NUMBER CITY ILLAGE 9JOWN NEAREST ROAD CITY, STATE ❑ ❑� Hudson, WI. 54016 (715)381 -5264 St. Joseph I 30th. St. [)j New Construction Use [x] Residential/ Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate bed, gpd /ft gpd/ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate __7 _ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 103.2 alt. are= 101.45 (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 ®S ❑U ®S ❑U ®S 11U ®S ❑U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoLmdary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. FBe Trenc h 1 0 -8 10yr4/3 none 1 2f 1 mfr cs 2f .3 2 8 - 19 10yr4 /4 none sil lcsbk mfr gw if .3 ee G��round 3 19 -27 10yr4 /6 none sl lcsbk mvfr gw na .5 .6 10 7ev2 ft. 4 27 -84 7.5 y r4/6 none ms Osg mvfr na na .7 :.8 Depth to limiting factor ` +84 Remarks: Boring # 1 1 0-10 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 ' 2 2 10 -15 7.5yr4/4 none is Osg mvfr gw if .7 .8 .................. 3 15 -96 7.5yr4/4 none ms Osg mvfr na na .7 �.8 Ground elev. 1 Depth to f limiting fa cto r Remarks: 1.; %`t cqu Rax 0 i CST Name: Please Print Gary L. Steel Phone: 715-246-6200 i 1 Address: 1554 200th. Ne w R ch nd W I 5 0 7 Signature: Date: CST -u 1 8 7 -23 -98 I PROPERTY OWNER DAn Davis SOIL DESCRIPTION REPORT Page 0j' -, PARCEL I.D. # 030- 1024 -70 ' Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bartc�ary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh F 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 9 -17 IOyr4 /4 none sil Icsbk mfr gw if .2 .3 Ground 3 17 -90 7.5yr4/6 none ms sOg ml na na .7 .8 elev. 1 Depth to limiting factor 9 11 Remarks: Boring # 1 0 -12 10yr4 /3 none sil 2msbk mfr CS 2f 4 2 12 -36 10yr4 /4 none sil lcsbk mfr 9w if .2 .3 3 36 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 1 04.2 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr Cs 2f .5 .6 5 2 11 -20 10yr4/ 4 none sil lcsbk mfr gw if .2 .3 3 20 -80 7.5yr4/4 none ms Osg mvfr na na .7 .8 Ground elev. 10 ft. Depth to limiting factor +80 01 1 1 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Y STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Daniel C. DAvis New Richmond, WI 54017 MPRSW -3254 SW4SWq S6- T29N -R19w (715) 246 -6200 town of St. Joseph lot #4 -Deer Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be wuitable 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 out lot survey stake @ el. 100' Alt. BM.= top of 12" pvc pipe C el. 108.60' 0 s INA j 2 4a U 3 2 C�c Gary L. Steel 7 -23 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ��A L DA 6 1 i s Molllts Addi«eas AV V.. 30 Property Address 3 t/C (Verification required from Planning Department for new construction)_ City /State P&050,V Parcel Identification Number 030 — 1 0 A V -?Q LEGAL DESCRIPTION Property Location %4, 5W r /4, Sec. T�' N -R��W, Town of s�� c�S�D/� Subdivision DEER fIAUeN , Lot Certified Survey Map # , Volume , Page # Warranty Deed # , . 5 E /0 1 , Volume - L3 2 Page # _ D q Spec house 06 yes O no Lot lines identifiable ; yes O 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,, restrictedplumber 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. 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. � �O &/ SI NATURE 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 11 AA z 0. (0 A ' (a //y / 2 S P ATURE OF ICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t'` r� STATE BAR (� SCON IN FORM 3 - 11 5!gt0 QUIT CLAIM DFED t)rJcuMENT N REGIPE i`S OFFICE ST. CROIX CO., tv! ; NOV 06 199$ .�. quit - claims D and K Constr_ucti of Hu the following described real estate in St. Croix Cot.m}; State of vtliscoGsin' THIS SPACE RESERvED FOR RECORDING DATA .4AA!E AND RETURN ADDRESS i�?- - KRISTINA OGLAND Zilz, Estreer, &, Oglavtd The West Half of the Southwest Quarter; the West P.O. Hu, 359 Half of the Northeast Quarter of the Southwest Iludson WI 54016 Quarter and the North Half of the Southeast Quarter of the Southwest Quarter; all in Section 030 - 1024- 80 -.00; 030- 1023- 90 -OuO Six (6), Township Twenty -nine (29) North, Range 030 - 10 24- 60 - 000 Nineteen (19) West. PARCEL IDENTIFZAPCN NUMBER Excepting from this conveyance a parcel cdi land in the Southwest Quarter of Section 6, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commet,cicg a, t }te West Quarter corner of Section 6, as the PLACE OF BEGINNING; thence Fast . ast on the center line of Section 6 for 1897.4 feet; thence South parallel to the West . line of said section for 1147.88 feet; thence West parallel to the center lire of said section 1897.4 feet ,o the West line of Section 6; thence North on the West section line of Section 6 for 1147.88 feet to the PLACE OF BEGINNING. Excepting therefrom Lot 1 of Certified Survey Map in Vol. 9, Page 2590, and Lot 2 in .� in Vol. 11, Page 2987, and Lot 3 of Certified Survey Map in Vol. 11, Certified Surrey Map Page 3253. {➢ This _ LS- -nnt _. homestead property )S. OCKX tis nut) Y Dated this day of October A.D , 19_._. r — \E - - -- (SEAL) (SEAL) Daniel C. D a As - -- Karen P. Davi (SEAL) , (SEAL) AUTHENT " ACKNOWLEDGMENT l Daniel C. Davis and state of Wisconsin, ' Signature( s) — ss. _ 7 Karen P. Davis, husband and wife, _ County authenticated this ay of Octobe 19 98 Personally Lame before me this day of —� -- -- �19__., the above nirned - a Kristina la - TITLE MEMBER STAT BAP OF WISCONSIN 0(ntx, — autE,:,rized by §706.06, Wis. Stats.) to me known to be the ptrsrm __ -- who executed the foregping instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland 'l� Ntxar} Pur'ic. ____ ____ �nunt�t SS u. •' H WI 5 4.5,___.-- ___ -- � (Signatu es may be Mollie tne�ted or acknowledged. 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