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HomeMy WebLinkAbout030-2101-60-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 344608 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: hen I Town of St. Joseph CST BM I_:. Insp. BM Elev.: BM Description: Parcel Tax No.: 00 . q' Q • (a a `� ,oa,K C�1" r$a^a 030- 2101 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI ELEV. Septic Benchmark D � 6 �� 9�,�t� g? . & -o Dosing Alt. BM r Fop C1 WA U Aeration Bldg. Sewer 0 �-A f_'K OF Holding St/ Ht Inlet $,(p2��� Y Z TANK SETBACK INFORMATION St/ Ht Outlet , 8� r it) 7 2 " to TANKTO P/L WELL BLDG. Ae lntake ROAD Dt Inlet Septic 140 2 2_( t NA Dt Bottom ! ---- -- Dosing NA Header /Ma Aeration NA Dist. Pipe D -5 3 to� Y (o Holding Bot.System fI, : •g j PUMP/ SIPHON INFORMATION Final Grade c. t (p� l Man ac n St cover 3 3 `( '� �'� • `f� Model Number GPM a toy, p r TDH Li L riction stem TDH Ft Forcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM ) BED/TRENCH Width Len th N Of renches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS 3 DIMEN I N SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING nyfaFt rer:� eta ` &if SETBACK INFORMATION Type of r / CHAMBER Model Number: System: U. oZ 8 OR UNIT — u DISTRIBUTION SYSTEM Header/Manifold u Distribution Pipe x Hole Size x HoI acing Vent To Air Intake Length ��� Dia. mg 1 45 1 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 El Yes El No E] Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: Cl(-/IS /c0 Inspection #2: Location: 458 Highland View, Hudson, WI (NW1 /4, SE1 /4, Section 29 T30N -R19W) - 29.30.19.825 Akk . W = ` dp Plan revision required? ❑ Yes No R I I � M Use other side for additional information. Oro I Ifo I b SBD -6710 (R.3/97) Date Inspector's Signature Cert No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .e,.mm, as a_ { e 3 i 3 t � a 3 E E a � . e m e. .. 3 ' v e. . _ e 6 # { s i e t .....�,.. y gym,.. �......... ..., . .., a. .... i i b i E t � 3 4 € �- «.. -�. ..,. � x.. ,� .. ,n.,.. .. h.,:.«.. mm . 1• .,,.t � _ �m� �« to-.... # ,i,., m. .r 1 � e i v r F ( g I L a 9 �. ..t..m...� amm e 3 r x eye i d � F i a i a r a a , a 3 g � i J- -------- , - . __»... .. . . ....,.�J .,«... ..., . m .......... _ P A..€ ., w a � r a # $ V E € # j ... v ... . .� e.� ..... ....; .a a. ...�. ..a' uro �. .. ... m. Q m. .. + g ... .m., ..�. m. € E � Safety and Buildings Division � SANITARY PERMIT APPLICATION . o Box Washington Avenue N 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application States SSaYUryPer Number 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 Property caner Name Property Location Lvr� M, S , 7 f T d , N, R k(or)® __ Property O ner's Mailing Address Lot Number Block Numbe �$ VI 2 City, St to Zip Code Phone Number Subdivision lyame or CSM Numbe , ZrI II B . TYPE F ILDING: (check one) ❑ State Owned 0 - its Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF r �h LA R III BUILDING USE (If building type is public, check all that apply) Parcel Tax Nu er Z`� v.�9,�as� 2�: P0 . 1 6 1 . �a5 1 ❑ Apartment/ Condo Q3©— 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 RNew 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 EQ Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 ❑ Seepage Pit t Z X S 43 ❑ Vault Privy 14 ❑ > System -In -Fill A A �- IWdiy�✓ �crs ber -6 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Systemnil v. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/d /sq. ft.) (Min. /inch) p Elevation rOZ �✓ 7 2 ; Feet �G , 1 Feet Capacit VII TANK in Ca gallo Total # of r Prefab. Site Fiber- plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass App. Tanks Tanks tic an oF++eldlrrcTTank l I ^ 19 ❑ ❑ ❑ ❑ ❑ L amber ❑ I ❑ 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' Name: (Print) Plum is Signature: (N tamps) MPLW_H& A446.: Business Phone Number: ikt►1�, 65 Z 7e - 77 Z - 3C/ Plumber's dress Street, City, State, Zi ode): B� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issuing nt Signature (No Stamps) Approved [ Given Initial �/' Surcharge Fee) Adverse Determina (� ZZ eoo X. CONDITIONS OF APP / REASONS FOR DISAPPR V AL CI (77 6*.*, e(ec1. �s e k&" �a �'�` 4C11— Qo / 6�c c�s� ��e�! ca►.- �"c�s 4 w0fi� r�s. Z g � Lvtre ejofoi�{4q� 7�r a>n¢w 3yS1�.9. / `ll SBD- 6398 (R.11/97) DISTRIBUT N: Original to County, One copy To: Safety & Buildings Division, Owner, lumber 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 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-Oivision, 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI_ Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans ardspecifications 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. JOB � / r f P Lc sue+ TIMM EXCAVATING SHEET NO. l OF Z Route 1 Box 192 < WILSON, WISCONSIN 54027 CALCULATED BY ✓�- ��^^ �--' DATE (715) 772.3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ............... ....................,.......... < ...........:........................ ....................i.......... .... ..... ..... .... .... ..... ..... ..... ..... ..... .... .... .... ..... .... i 4 �� ✓U �: U Z ..... ........ P v 3 k fL4 W- �� i:. /r ti ..................... ..... ..... ..... . u. r s'e , ..... ........<........... ..... .............. / . ... C .................... �- .... ..;..... ........................ ...... . .............. .. ....... .... . AV . . ................. .... .sz . .... .. ... .:,,.— ... ,.. ..,,... ...... .... ... • f ,. s . ... PRODUCT 205-1 �Inc, Groton, Mau. 01471 To Order PHONE TOLL FREE I - 800. 225.6380 L JOB TIMM EXCAVATING SHEET NO. OF Z ' Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY r / �" DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ......... ...... ...... ..................... .... ..... ..... ..... .... .... .... ..... ..... . -- ..... ..... .... .... .... ..... ..... ..... ..... .... .... .... ..... ..... ..... .... .... ........ ........ .,... .. . !� ...... .................. t. .. ....... �.- . ........... . . ....... �,. �_ . . �r i y u v .. r .. ............... ...... 3 PRODUCT 205 -1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1 -800- 225 -6380 W.iscoilsin Department of Commerce D SITE EVALUATION Page _l of 3 Division of Safety and Buildings On Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - -- Parcel I.D.# 030 - 2101 -60 APPLICANT INFORMATION - Please print all information. - -- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Re EI ate j> Property Owner (Revised 7/26/99 supplement to Property Location NW 1/4 SE 1/4 29 30 19 W Counce, Stephen � � Govt. Lot S T N,R - . - _ -- - _ Proper Owner's Mailing Address Lot # Block # Subd. Name or CSM# 458 Hig hland View D rive 25 1 L Highland Hills City State Zi Code Phone Number [ ]City j Village XTown Nearest Road Hudson WI 5016 612 -560 -4792 St 612-560-4792 Highland View Drive X New Construction Use: Residential / Number of bedrooms 3 j JAddition to existing building Replacement Public or commercial describe Code Derived daily flow 450 g pd Recommended design loading rate -7 bed, gpd /ft' - trench, gpd /ft' Absorption area required 643 bed, ft' 562 trench, ft' --N*mum design loading rate .7 bed, gpd /ft' - tr ench, gpd /ft' Recommended infiltration surface elevation(s) r 88 ft (as referred to site plan benchmar Additional design / site eonsideration i nstall 2 - 27x 56.25' Si er, Hi- capacity "turtle- shell" trenches (9 shells each) Parent material sandy /loamy 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 for system ® ❑ U X S❑ U X S❑ U S I:- ] U S X U S X U Horizon Depth Dominant Color Mottles Texture Structure iConsisten Boundary ' Roots GPDIft' Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -9 10YR 3/3 - sit 2 f sbk mvfr cs 1 f/m .5 .6 2 9 -22 l OYR 4/4 - scl 2 m sbk mfr gs 1 m 4 5 Ground 3 22 -27 7.5YR 3/4 - A 0 m I mft gs lm .3 .4 elev 95.0 ft 4 27 -68 IOYR 4/4 - sl 0 m C mfr as 1 m .3 .4 Depth to 5 68 -122 10YR 3/4,4/4 - mcos 0 sg ml - - .7 .8 fco- -- - - - -- - - t limiting -- - - . - -- factor > 122' Remarks: occasional gr, cob, st 2 1 0 -8 10YR 3/3 - A 2 m gr mvfr cs 2flm .5 .6 2 t 8 -26 i l OYR 4/4 - sl 2 m sbk mfr cs 1 m ! .5 .6 Ground 3 26 -43 7.5YR 4/4 - s 0 s ml cs lm .7 .8 elev _ - _ - r _aw 96,1 ft 4 43 -55 7.5YR 3/4 - sl 1 m sbk mfr 5 Depth to 5 55 -132 10YR 3/4,4/4 - mcos 0,sg ml 7 ,� .8 - - - — - - - - - - -- -- -- limiting factor > 132" I Z�!}� (� L. Remarks: some gr -- - - - -- - - - - -- - - - - - - -- - - - -- - -- - - - - - CST Name (Please Print) Signature: ` e No. Henry F. Grote 7 6 ,� Certi> ed SoTT P.O. Box 57, Knapp, WI-54749 - - - - Address g Date i ay CST Num Ref # 525/1999 222774 1163 PROPERTY OWNER Coanc Stephen SOIL DESCRIPTION REPORT Page 2 of PARCEL I .D.# 030- 2101 -60 - f { y * Certified Soil Testing , Depth Dominant Color Mottles GPD/ft Bed Trench Structure Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots - 3 1 0 -4 IOYR 3/3 - sl 2 m gr mvfr cs 2f1m .5 .6 s. >. 2 4 -11 1 OYR 3/3 - sl 1 f sbk mvfr cs IM .4 5 Ground 3 11 -57 ! lOYR 4/4 - sl 2 m sbk mfr cs lm .6 elev - 96.1 ft_ 4 57 -69 7.5YR 4/4 - s 0 sg ml cs - 7 .8 Depth to 5 69 -82 7.5YR 4/4 - sl 0 m mfi cs - .3 .4 limiting - - -- - - -- - -- — - -- - j factor 6 82 -112 10YR 3/4,4/4 - mcos 0 sg ml - - 1 7 .8 112" - - --- - - - - -- - - -- - - Remarks. Enis area U& TOr Conventional, But system size g nee s m cease ;cos �s eeper an o er pi s 4 1 0 -3 10YR 3/3 - sl 2 m gr mvfr cs 2flm 5 6 i 2 3 -9 1 lOYR 3/3 sl 1 m sbk mvfr cs 1f .4 .5 - + _ - - - - -} - - -- - - - - - - - - -- - -- Ground 3 9 -21 7.5YR 4/4 sl 2 m sbk - - mfr cs l m 5 6 elev - —. -- t 95.5 ft _ 4 21 -30 7.5YR 4/4 - is I m sbk mvfr cs If .7 .8 Depth to . 30 - 55 7.5YR 3/4 - sl 2 m sbk mvfr cs I 5 6 limiting-- - - -- - g -- - - - - factor _... — - - --- -- — -- - -- - - -- - - - _ -- - - - 6 55 -125 IOYR 3/4 4, 4/44/ mcos 0 s mi 7 8 - -' - 125" Remarks: S ome gr Ground j elev I Depth to limiting factor Remarks: Ground elev a Depth to . limiting factor Remarks: d --l- 9J d L A ,,A `y ( te r �0 � c J j a fr ..� r. •mot' � _ .� f � � � d' .�_ ry C4 eJ -4- o 3 � A . `A f r �, ! ✓ t d � C1 4 d oy ap Wis*:onsin Department of Commerce SOIL AND SITE EVALUATION Page ._1___ of 3 t Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8 x 11 inches In size. Plan must Count include, but not limited to: vertical and horizontal reference point (BM), direction and y St. Cr percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - - -- Parcel l.D.# 030 - 2101 -60 APPLICANT INFORMATION - Please print all information. I ____ --- - - - - -- ---- - - - - -- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � Dal /l Qj 7� i0 Property Owner 77 p (Supplement to Steel report, 11/12/9 Property Location Co unce, Step p ' Govt, Lot NW 1/4 SE 1/4 S 29 T 30 N R 19 W Property Owner's Mailing Address lot # Block # Subd. Name or CSM# 4 Hi ghlan d View Drive 25 1 1 Highland Hills City State Zip Code PhoneNumber ❑ City n Village ZTown Nearest Road Hudson W1 54016 612 -560 -4792 t.Joseph Highland View Drive New Construction Residential / Number of bedrooms 3 ❑Addition to existing building Use: Replacement F Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 7 bed, gpd /ft' • trench, gpd /ft' Absorption area required 643 bed, ft- 562 trench, fe aximum design loading rate .7 bed, gpd /ft _ • tr ench, gpd /ft' Recommended infiltration surface elevation(s) L 91. j] _ ft (as referred to site plan benchmar Additional design /site consideration install 2 - 2.7'x 56.25' Sidewinder, Hi capacity "turtle shell" trenches (9 shells each) Parent material sandy /loamy 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 for system M 1:1 U ® S U X S❑ U X S U �__ S 29 U LJ S X1' U Depth Dominant Color Mottles Structure GPD /ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture 1 Gr. Sz. Sh. Consistence] Boundary Roots Bed Trench 1 0 -9 10YR 3/3 - sil 2 f sbk mvfr cs 1 f/m .5 .6 ass .,, 2 9 -22 10YR 4/4 - scl 2 m sbk ! mfr gs lm i .4 .5 Ground 3 22 -27 7.5YR 3/4 - A 0 m mfi gs Im .3 .4 elev - -- -- — - - - - - - -- - 1._ -. ----- - - - -- _ 95.0 ft 4 27-fig 10YR 4/4 - A 0 m mfr as l m .3 .4 Depth to 5 68 -122 10YR 3/4,4/4 - mcos 0 sg ml - - .7 .8 limiting factor I I > 122' I Remarks: occasional gr, cob, sc ��. 2 2 8 26 -- B -- lOYR 4/4 - - - -_ - - - -- _- sl - I - - - -- 2 � - mvfr . c ' � ^ � 1,� S i .6 sl 2 s bk mfr 6 m Ground 3 26 -43 7.5YR 4/4 - s 0 sg ml cs 8 elev 96.1 ft 4 43 -55 7.5YR 3/4 - sl 1 m sbk m'I" Ina 5 > Depth to 5 55 -112 10YR 3/4,4/4 - mcos 0 sg ml - S� Cgoa °,9 .8 limiting i factor Z 'DPP 112' - -- 1 0 Remarks: some gr CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715- 665 -2681 Cer t i fied or estmg -- - _. -_ ___ Address Date CST Number Ref # P.O. Box 57, Knapp, WI.54749 525/1999 222774 1163 PROPERTY OWNER Counce, Stephen _ SOIL DESCRIPTION REPORT Page 2 of .3 - PARCEL LD.# _ 030 - 2 101 -60 Certified Soil Testing Depth Dominant Color Mottles Structure GPD 1 Horizon Texture onsistence Boundary Roots - - - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -4 10YR 3/3 - sl 2 m gr mvfr cs 2flm 5 .6 � 2 4 -11 10YR 3/3 - sl 1 f sbk mvfr cs lm j 4 5 Ground — — _ 5 - 6 elev 3 11 -57 1OYR 4/4 - sl 2 m sbk mfr ! cs lm - — - - -- t -- - - -� - } 96.1 ft 4 57 -69 7.5YR 4/4 - s 0 sg I m 7 I .8 l cs ! - Depth to _ 5 69 -82 7.5YR 4/4 sl 0 m mfi cs .3 .4 limiting — — -- - - - -7 - t - - - - factor 6 82 -112 1OYR 3/4,4 4 - mcos 0 sg m1 - I - .7 f 8 > 1 �i 2" { i Remarks i s area or co ven Iona , out sy5MM V zing necus to Be increase a; cos is 3eeper Man otner pits ! Ground elev Depth to limiting factor Remarks: ! Ground elev I I Depth to limiting - - -- -- r �- factor ! L i Remarks: t Ground -- - -- elev � i ! i Depth to limiting factor Remarks: ` Qj ; o 4- o L A d � I o i • � d d ri '"Q'i c dt J f 1 d °s rq C2 �' o C6 t ..�- Y (1�.• C4 ,�• d � J V tj $ 3 .� r P 1 0 , i kA d - z` s n LA � �C4 n L LA _ J C- 1 �lv . Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations ti Division of Safety 8 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 P dimensioned, north arrow, and location and distance to nearest road. `"°�" APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION EWE[ZBY PROPERTY OWNER: PROPERTY LOCATION r �, Joanne Persico GOVT. LOT NW 1/4 SE `fiT S c - kA49 ) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. 1;A R .� r 400 S. Second St. 25 na H' h CITY, STATE ZIP CODE PHONE NUMBER [ [ EVOWN , Hudson. W1. 94016 7(15 ) 386 -9060 St. [ New Construction Use k ] Residential ! Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpolft .8 trench, gpolft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 ed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 94 1 al t. are (49- ft (as referred to site plan benchmark) Additional design / site considerations site requires extra rock to bring pip o od d = th _ Parent material pitted cl a i a1 dri 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 for s stem ®S ❑ U Ocs El U RI S ❑ U [ S ❑ U ] S ❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITw& 2 10 -29 10 r4 4 none sicl 2msbk mfr gw if .4 .5 Ground 3 29 -57 10yr4 /3 none sl m na gW na .3 .4 elev. 9 9.4 ft. 4 57 -98 7.5 r4/6 none cos osq ml na na .7 s .8 Depth to limiting factor +98 Remarks: Boring # 1 L I-8 10 r3 3 none 1 2msbk mfr 2f .5 .6 '` 2 ='` 2 -25 10 r4 4 none sicl 2msbk mfr if .4 .5 Ground 3 5 -56 10 r5 4 none sl m na 9W na .3 .4 elev. 4 6 -98 7.5 r4 6 none cos osa ml na na .7 .8 9 9.4 ft. Depth to limiting factor +98 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. A4., New Richm nd WI 54017 Signature: Date: 11 -12 -96 CST Number: m02298 PROPERTY OWNER Joanne Persico SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Lot #25 J Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench +ti...3.... << 0 -10 10 r3 3 none 1 2msbk mfr cs 2f .5 .6 2 10 -26 10 r4 4 Ground 3 26 -60 10 r4/4 none sl 2csbk mfi 9w na .5 .6 elev. 99 4 60-100 7.5 r4/6 none cos oscl ml na na .7 .8 Depth to limiting factor +100 Remarks: Boring # 1 0 -9 10 r3 3 none sl 2msbk mfr c1w 2f .5 .6 2 9 -30 10yr4 /4 none sici 2msbk mfr gw if .4 .5 Ground 3 30 -72 10 r4/4 none sl I 2csbk mvfr qw na .5 .6 elev. 4 72-12C 7.5 r4 6 none cos oscr mi na na .T .8 9 Depth to limiting factor Remarks: Boring # 1 0 -8 10 r3 3 none 1 2msbk mfr cs 2f .5 .6 S 2 8 -30 10 r4/4 none sicl 2msbk mfr gw 1f .41 .5 3 30 -70 10yr4 /4 none si m na gw na .3 .4 Ground elev. 4 70-11C 7.5yr4/6 none cos osg ml na na. .7i .8 98 ft. Depth to limiting factor +11 0" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: I SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Joanne Persico 1554 200th Ave. CSTM2298 NW4SE4 S29- T30N - R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot # 25- Highland HIlls Second Addn. N 1 =40' BM.= top of 12 pvc pipe C el. 100' Alt. BM.= top of wood'-_ corner post C el. 105.00' Z 7 �r f� F � 71 5` ` 17� 20` V A9 L. Steel 11 -12 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 03a ZrU05iu►�,k A j � (MVI V P ar k l � 5'5`Id4 Property Address `/ (Verification required frod Planning Department for new construction) City /State Lc,dAgY! 6'G'� , Parcel Identification Number LEGAL DESCRIPTION Property Location A/ 1- %4, S '/4, Sec. Z , T _eL N -R W, T own of C�5'/ Subdivision ALA 1 z�j al`l-" --I - I- . Lot # . Certified Survey Map # . Volume , Page # Warranty Deed # J L"' 9b 3:5.5 , Volume 1 , Page # S � Spec house ❑ yes W no Lot lines identifiable JX 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. 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 .three yeavex—pi*on date. SI&AT411 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 th describe e, by virtue of a warranty deed recorded in Register of Deeds Office. § fG14ATUR1NOF 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 40 WARRANTY DEED 590355 Document Nunif,•r ryt S , Return Address U0 T 3 U 1998 Parcel I.D. Number 032-2101-60 0 6.0 Highland Hills, a Partnership, conveys and warrants Lo Stephen I Counce. Sr., a single persen, the following describe(] real estate in St. Croix County, Stite of Wisconsin: 41, Lot 25, Plat of Highland [fills Second Addition to Town of St. Joseph. St. Croix County. Wisconsin. I his deed is giv en in fulfillment of that certain Land Contract between the parties hereto recorded September 30, 1998, in Vol. 1361, Page 328, as Doc. No. 588084. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of-«av of record. if any. Dated this 4 day of October, 1998 Highland Hills, a Partnership V JoAnn Persico, individually and as Po\wr of AttorneN for Bruce Peterson and Roger Ruelin ACKNOWLEDGMENT STATE OF WISCONSIN ss COUNTY Personally came before me this day of October. 1998. the above named JoAnn Persico, individually and as Power of Attorney for Bruce Peterson and Roger Ruelin, to me known to be the person(s) who executed the foregoing instrument ind acknowledge the salve. 7 Notal ft County, 'XI :'vly cot fni'4 e,� res — I C -- - - -- THIS INSTRUMENT WAS DRAFTED 11)'i Attorney Kristina O �iavd H udson, W1 54016 r � R MATCH LINt— _ 1r S05°29'57��E N I 1..� 1(.i) 1( — _ 187.3 I ODPo Ir ou TOOT 1 � ;s � ' I (�d ►�, I( W � S05 °29 57.�E _ — 192.9� _ � 8.5' •P m .p p I N ) _ . �- 1 1 — L QN 1— 1( �y 1 -1 10 OD ® N W NW _c�U.p O / p1 N N CD Q N N p� - - . 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