The URL can be used to link to this page

Home My WebLink About040-1233-20-000 ` ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT 7 7 * {� 199 Owner U,A Property Address ST C � City /State �� 1cE / Legal Description: Lot 5,Z,�_ Block LEA Subdivision/CSM # a t /4 ,�' /a, Sec. 3 , TZ8 N -Rff W, Town of _tea v PIN # D;/o - �� 3 - �O -00 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer G! /� =�,�'s Size ST/PC Setback from: House_ Well P/LQ07` Pump manufacturer 44 Model Alarm location , (H OL.DRL TA NKS ONLY) Setbacks. Service roa . Vgnt to-ftsh ai r intake W ater_ ,__i one - Meter location ovation SOIL ABSORPTION SYSTEM Type of system: Width .3 Length 7 -5 - ' Number of Trenches -2-_ Setback from: House Well PAL 2Q Vent to fresh air intake ELEVATIONS Description of benchmark %P o,- /R AkS WPZ1 ,e Elevation 0.0 Description of alternate benchmark 741e o I�AS��k= &7 / / >/ft L oN tU�4cre ,rElevation /OS, /S — Building Sewer ST/HT Inlet ST Outlet _/ .b U PC Inlet A PC Bottom _ Header/Manifold 40. Top of ST/PC Manhole Cover D Distribution Lines ( 1) A00, ,2 - 3 100 -13 ( ) ` Bottom of System (1) Final Grade (l) A0 Y - (2) �/0 V 5 ( ) Date of installation / Permit number State plan number Plumber's signature - License number .92 /7 y f Date J l l Inspector 1K &i 1 K (�Y �t� Complete plot plan 1 M f 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 IV 0 ti5 g ` l S l V� �GufL= 7 GL S �17,' /a� o F T2AN Fa2 �r�� INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division 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)1. 344612 Permit Holder's Name: ❑ City ❑ Village q Town of: State Plan ID No.: Town of Tro CST BM ev.; Insp. BM Elev.: BM Description: Parcel Tax No.: �.�' M.ol TANK INFORMATION 6 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (ZCPID Benchmark D,c( 6D Dosing Alt. BM Aeration Bldg. Sewer �, 3 Z /03.(3 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD 13+ 11111:t L Air Intake Septic > 5-0 g _ NA Dosing NA Header / Man. 70, zi ' pa. —T o. Z Aeration NA Dist. Pipe ��' a. Z app . a I Holding Bot. System b PUMP / SIPHON INFORMATION Final Grade S b 8.5 Manufactur (�, oy, 1.3 St cover Model Number GPM TDH Li L oss rition Syst TDH Ft H F cemain Length Dia. Dist. To well SOIL ABSORPTION SYSTE TREN Width ngth No f T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMIEFY511 NS T 5 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING '� � Manuf ct er: SETBACK - INFORMATION Type of "' CHAMBER M el Nu ber: System: C&AA ' Z — OR UNIT DISTRIBUTION SYSTEM 5 1 Header /Manifold q Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. q- Leng Di a. Spacing > (C; 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.) Inspection #1: / / Inspection #2: Location: 517 Trillium Lane, Hudson, WI (SE1 /4, SW1/4, Section 3 T28N -R19W) - 3.28.19.1158 ao Plan revision required? ❑ Yes X No Q f 1 Use other side for additional information. /� ! SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. I a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i ¢ a �P E a t € e - - ¢ € m� _4_ _'L — m, fr. Y v t ..m. _ 41 , t .r �. ¢ ( @€ 9 ':.. w m.. �.... . r .. {.« aa. �.:i � .............. f........ . ,. ..�.�- . ........._ ... ._m .°. ...gm� .�. ,e. °a.,,.p .« .. ........,..,�. s x t i a ¢ i e ° r € ' € t 1 1 i F i ➢ � __. ' r E a ¢ F € «.,A: »... � . a � ..« .,. .. �..«...�..m a....... °m- w z a 3 � a e »a ¢ i ? g _..._ .., .,..__ _. ., ..,. _ _...,. ..�... .,. .�_ ._ ... ....,m.... -,. _a. �.�. �.... ,.,,.. °.e m.. �- .. .. _.._..., a ....�._ _, .. ._...... -- .,, W .......... _. ._.._...,,.,,e _.. _ w ............. _. �,.�...z..,.... �._ _._,_ Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue Department of Commerce In accord with Comm 83.05, W f ryt.29d r <a / Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper4ot less C#4 my than 8 1/2 x 11 inches in size. 'f'E3,/ 'A t �. _Rp " "' G L Sfa anitar Permit umber • See reverse side for instructions for completing this applicbtron y I t Personal information you provide may be used for secondary purposes t H 1 t ; Gh4k if rev li to previous application [Privacy Law, s. 15.04 (1) (m)]. ,i ` ST CROIR ' Ian I.D. Number Or XT jk y I. APPLICATION INFORMATION -PLEASE PRINT ALL Property O ner Name Property Location ' L e- u4 L/4, T , N, R 9 E (or W Property Owner's Mailing Address a Block Number L I City, Sta a Zip Code Phone Number Subdivision Name or CSM Number BIOS CV/ 5 y0 ( ) 170a c, 11. TYPE OF BUILDING: (check one) ❑ State Owned 11 It� Nearest Road Vil age , Public M 1 or 2 Family Dwelling - No. of bedrooms Town OF D v LL 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3 , ? , f 1 - I S$ 1 ❑ Apartment/ Condo 0 Y — LZ3 3 - D -,000 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. C' New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -- S ystem System Tank Only -------- - - - - -- Existing System -- _ - - - - -- Existing System ----------------- ------- - - - - -- B) A Sanitary Permit was previously issued. Permit Number 3 Date Issued 9—,P—,9y V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 0Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit L (7 X r „L 43 ❑ Vault Privy 14 ❑ System -In -Fill Z VI. ABS ORPTIO N 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.) P oposed (sq. ft.) (Gals/day /sq. ft.) in. /inch) .Elevation u �. iFeet Q 4y, Feet VII Capacit TANK in gallo Total # of r Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st noted Steel glass Plastic App Tanks Tanks El I eptic Tan ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews t shown on the attached plans. Plumber's Name: (Print) PIu 171bty 's Signature: (No Stamp /MPRSW No.) Business Phone Number: D6,v,4, 5:7,-�Ir7 I &j. �S Sf° KGs/ Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agentsignature (No Stamps) [ZApproved []Owner Given Initial Surchar fee) / Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: f5 re Stew zvA5 gerllel- i4 3r v, t1✓ `' - f �r I �v J:S r S ��n S �c Y.l SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: safety & Buildings Division, Owner, Plumber INSTRUCTIONS x 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 6y•a licensed pumper'WKi -never 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, 606 -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 tobe 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 al/ 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 manufacturq.�;.Pj,,Vp.,� section of the soil absorption system if required by the c6unty; "E7 soil test data on a form; and F)* all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated pra6ceswhich can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I 1 — I __— j i j •. f +e1 G- - t- i i .`1 E� 1�rQvZ t� , � l i 3 i� - -- -- - - - -- - . , : k i ' b 1lde : i Sr _ So -, 2/ 7 411 i i t r I ' I r I I i 4 t r , I ' T f , 1} i ' i ! ° i I , t ` ` t — 1 { I i 1 i — , I I , a i i F F J e t I I i i tt t Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Sifety and Buildings Page of Bureau'of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plah ipttst C ount y include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to neare$t'road,• Parcel I,D. # APPLICANT INFORMATION - Please print all information. Revieweoby r Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1j (m) );,, Property Owner Govt Lot ',. 114�A) 1/4,S,3 T N,R Property Owner's Mailing Address 'Lot Block #' Name or CSM# City State Zip Code Phone Number Nearest Road ❑ City ❑ Village CW Town _3d 71 pQ New Construction Use: Residential / Number of bedrooms _ Addition to existing building Replacement LJ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate ._. gpd /ft - 45 trench, gpd /ft Absorption area required bed, ft 7s trench, ft Maximum design loading rate bed, gpd /ft -e trench, gpd /ft Recommended infiltration surface elevations () � �8 ft (as referred to site plan benchmark) Additional design /site considerations /4 �F S -e / a' 7 0 Parent material _ &.4 7-s 4 Flood plain elevation, if applicable _ ____ ft I EU -Suitable for system Conventional Mound In- Ground Pressure AT -Grade System Fill Holding Tank - Unsuitable for system VS El ['�S ❑ U [�S ❑ U 1 12s ❑ U E-1 S [in U ❑ S & 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 LU -fie 2, ) �r elev nd 3 6 �b /', .0 � ----- �L w�Sd {"rt tj Depth to ^��5' ZJ �� / /y-1 4 limiting S/�/.�9 /i ��b `�� S �S 1 f/ y factor Remarks: Boring # C3 r ' Ground drr- r 1� /?� �f o �S el Q . �t. l , Depth to limiting factor 4- 1 2 !!e _ in- Remarks: CST Name (Please Print) Signature Telephone No. .�- Address Date CST Number SOIL DESCRIPTION REPORT 3 ; PROPERTY OWNER r Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 .?� 6) !ZZ/ S �� {'►� W elev. /aft. Depth to limiting : f , factor Remarks: Boring # Ground efev. Depth to f limiting factor + /./ 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 # Y oe 3 S P56,� -- 3 �e� --- sa l �✓ —� -7 Ground 39, elev. /0 JI& t Depth to limiting factor 6! Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) i I 3 _ D TQ _ I " II i f � w (3C i i % �oa 4 0. : - — - Lcl TP90 I i _ _ ', - _ _ t _ i_ . _._ _, i _ .. A i �. a 4 - � _ � � ' f� �� _ _ _ - -. _' _ i !, ___ 1_ � ! I :, �} � —-- _. � i �, •. __� -- - _ _ i i ' I �, �. i 4 I t 4 _ �__ _� — _ - { i' �:F � � j __ — - - - � _ � � � � I I __ -- � _ �. - — _ __ i � �, � � I E _ __. _ _ ,- ' — - — - , _ i ._ I - :I � � -- __. ',, i ; 1 � � ,._ _. , - __ i i i__._ ;- 4 i I �� _ ,_ ___ r _ - __ - � � ' } i i _ .- � �' - -- �. i �,,. i �. '� � � I '� � � � _ . - - t - - -- � --- - — ',. � i 4 I �. I � �� , I ' I .' - i it �I � i r �. � � ' �� I �� i i i '- i �. � - '�.. i i L '� �- t } � � � i I r SANITARY PERMIT APPLICATION 2 01 E.W shingtonA Viscons In accord with 83 O5 r . P.O. Box 7969 Department of Commerce t h ILHR , o 'O Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the sy n p wot ount than 8 vi x 11 inches in size. k g�rj . �, M t • See reverse side for instructions for completing this app I c{�, on l Pe rmit Number A(lr 3c1V& !Z The information you provide may be used by otheryQvernm t agency p ms r V ck if revision to previous application (Privacy Law, s. 15.04 (1) (m)). L�/-7 /� /1v� p,> a Plan L.D. Number L APPLICATION INFORMATION - PLEASE PRINT AL Property Owner Na �' Prop L 1-42 "VAY'r $ 3 T o�8 , N, R pQ E (o& Property Owner's Mailing Address iiu 8 Block Number L City, State Zip Code F(P' one Number Subdivision Name or CSM Number #u UJf ya /G > u yr P YB II. TYPE OF BUILDING: (check one) ❑ State Owned 0 c1t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] it Town of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Jj_ Zfi • I`l , II s$ 1 ❑ Apartment/ Condo 40 — 19 33 — 2 0 -000 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 Zj 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 Q Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 WSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit � � nn 43 ault Privy 14 Q System -In -Fill oZ 3 x �'r'�/Itjojlo — oZ, ❑ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade � Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation It; vO 75' 6 3, 1 9 ,C , 4 Feet 9 Feet Capacity VII. TANK in altos Total # of Prefab. Site Fiber- Expec INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank p c - 9 ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber IV4 I ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibiliU for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) I PI b 's Signature: (No m Business Phone Number: i - mss/ Plumber's Ac dress (Street, City, State, Zip Code): 8 GL& !27 4 IX. OUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D a ssued Issuing n Si nature (No Stamps) Approved E] Owner Given Initial _-. Surcharge Fee) Q 11 - ! Adverse Determination W • I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility'statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 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. i - i t i 1 I , /X1c /G771�4TOIj - - -- - I. i r rt , - - - -- - - - ol -� ; . _ -- -- — -- - -- T 1 ' _ LPT C //VL' I , 1 , r 7 �_ __0141 , -- , e t 3 i j • { i I i i • , t t t , 1 tt , _ i I t I , o , ' i j i i , t , i + i + 3 , • F i 5 � l ` t ` - . i r t I i f � + ♦ { i , _ -- _ Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT e. , of 3 Labor and Human Relations Di -ision of Safety 8 Buildings J � .. , . in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but c REQ E[b roi r' not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or L I. n uV 3 Q 1995 dimensioned, north arrow, and location and distance to nearest road. Pe nding ~` APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION ED BY COWNTY D __ � .. PROPERTY OWNER: PROPERTY LOCATION /S Richard Stout GOVT. LOT SE 1/4 SW 1/4,S PROPERTY OWNERS MA!I_ING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM j 1353 Awatukee Trl. �„S• Z na Country Wood CITY, STATE ZIP CODE PHONE NUMBER QCITY OVILLAGE EFOWN NEAREST ROAD Hudson, WI. 54016 (715) 549 -6731 Troy Tower Rd. (xj New Construction Use j Residential / Number of bedrooms 3 [) Addition to existing building [ ) Replacement ( ) Public or commercial describe Code derived daily flow 450 9pd Recommended design loading rate - 7 bed, gpd/it •8 trench, gpd/ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd/ft - 8 trench, gpd/ft Recommended infiltration surface elevation(s) 96.6 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S - Suitable for system CONVENTIONAL MOUND 71css GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem El S❑ U L3 S C3 U ❑ U )1 S❑ U ❑ S 12 U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence I Bouncky Roots Bed Trench 1 0 -6 10yr3 /3 none 1 2msbk mfr I gv 2f .5 .6 2 6 -15 7.5yr4/4 none is osg mvfr gW if .7 .8 Ground 3 15 -80 7.5 r4/6 none cos osq ml na na .7 .8 elev. 99 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -9 10yr3/3 none 1 2msbk mfr 9w 2f .5 •` .6 2 2 9 -26 10yr4 /4 none s i t i f sbk mfr gw 1f .2 . 3 3 26 -36 7.5yr4/4 none sl lmsbk mfr qV na .4 .5 Ground elev. 4 1 36-80 7.5yr4/4 none cos oscf ml na na .7 .8 9 9.8 ft. Depth to limiting factor +80 Remarks: CST Name.— Please Print Phon � . I15- 246 -6200 re Gary L. Steel Address: 1554 200th Ave., New Richmond, Wi. 54017 10-25-95 cstMO2298 ii Signature: Date: CST Number: PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page? of 3 PARCEL 1.0: pending Depth Dominant Color Mottles I Structure I GPD /ft dary Roots Bed ITrendt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 U-6 10yr3 /3 none 1 2msbk mfr gw 2f .5 !.6 >`v 2 8 -15 7�.5 r4 4 none scl 2msbk mfr if .4 .5 Y / 9w Ground 3 15 -23 7.5yr4/4 none is osg mvfr gw na .7 ; .8 elev. 1 4 23 -84 7.5yr4/6 none s osg ml na na .7 .8 Depth to limiting factor Remarks: Boring # ;,,...:__; 1 1 0-9 10yr3 /3 none sl 2msbk mfr gw 2f .5 .6 4 2 9 -14 7.5yr4/4 none is osg mvfr gw if .7 !.8 3 14 -80 7.5yr4/6 none s osg ml na na .7 .8 Ground elev. 9 Depth to limiting factor I +80 Remarks: Boring # ; � ; ,�, n ., : . ;; >; 1 1 0-9 10yr3 /3 none sl 2msbk mfr gw 2f .5 .6 I mmHg 2 9 -16 7.5yr4/4 none is osg mvfr gw if .7:: .8 3 16 -84 7.5yr4/6 none s osg ml na na .7 .8 Ground 1 e0�• fit. I I Depth to limiting fa'A Remarks: Boring # :ih:C:•i:ii: ::..: ................. ::.....:...:. I Ground elev. j ft. I . Depth to limiting i factor Remarks: SB"330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 SE4SW4 S3- T28N - New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 t lot #51- Country Wood N 1 =40' BM.= top of 1 steel pipe C el. 100' Alt. Bm.= top of wooden post C el. 10 ' 7 )0 Z� rb kq) (A �l Gary L. Steel 10 -25 -95 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dt &,ae a (Vtid1hig Aalo mstj . Property Address TR /L L I u /? LN (Verification required from Planning Department for new construction) City /State AuDSaat �1i` ,�yo�ti Parcel Identification Number O ya /933 ;k) -Dt� LEGAL DESCRIPTION Property Location %4, 1 /4, Sec._, T��N -R_W, Town of �/1d Y Subdivision 4QUIV WOO _ , Lot # �• Certified Survey Map # L' oom -6► Wao — ,Volume `o , Page # _ • Warranty Deed # 664, Volume /yy.2- _ —, Page # 3 7oZ Spec house ❑ yes �no Lot lines identifiable RKyes ❑ 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 masterplumber, 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 9MM ATURE bF 1KAF LWANT 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 vi a of a warranty deed recorded in Register of Deeds Office. q ATURE OF APPLMANT DAU1, * * * * ** 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 STATE BAR OF WISCONSIN FORM 2 — 1982 60Es9S0 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. �i�}42 ST. CROIX CO., WI RECEIVED FOR RECORD -- R- ICH.ARD O. STOUT 07 -19 -1999 8:45 AM WARRANTY DEED EXEMPT R CERT COPY FEE: conveys and warrants to n(1NAT•L1 R NCIVACK , a Sin COPY FEE: P TRANSFER FEE: 156.00 person, RECO RDING FEE: 10.00 PAGES: I THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in R t —CRni x County, State of Wisconsin: River Valley Abstract & Title, Inc. Box 149 Lot 22, Plat of Country Wood, Town of Troy, P.O. B F ox149 ,WI 64016 St. CRoix County, Wisconsin. 040- 1233 -20 -000 PARCEL IDENTIFICATION NUMBER This iS n0t homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 16th day of July A.D., 19 99 Richard Stout (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. ,qt- _ rRn i x County. authenticated this day of , 19 Personally came before me this 1 6th day of July 1 1% 9 the above named Richard O. Stout TITLE: MEMBER STATE BAR OF WISCONSIN NOTARY PUBLIC (If not, VVIO 1%1 authorized by §706.06, Wis. Stats.) to me kno t MA o cuted the foregoing in str ent nd ack e. THIS INSTRUMENT WAS DRAFTED BY Janet P. STout wa u ee r. Hu �. yh (11 Not Oak Public, 5/ County, Wis. (Signatures may be authenticated or acknowledged. Both are not M commission i permanent. (If not, state expi necessary.) ;•) Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DFE) Form Nu. 2 — 1982 Milwaukee. Wi" R 4/ • ! Realren ,4:.tBG,;:i: i ended In Vol 'lolunrc - -_- of `cam - ----P s 25 u 3.65 ACRES Register of Doadj 158, 880 SO. FT. VAN V a 3 , �2 E N S6 °,3 241, 618 • 00- 3' F 2 I N6� 24 3.61 ACRES / 157,092 SO. FT. / � 33' I 1 1 \ -- N85 I i' 42 "W 4 22.26' — 1 1 _ \ ; 0//'42 "W 3 87. 26' 35.00' � Ago � iso 3g, .00, "F�° � 3 F. 2.26 ACRES �� \ d W 98,560 SO. FT. ` 6 2� N 8 0. l i� y60 pft pCT " CR ® 66 I'�1 CA C- 100,696 0. FT. I -1 z 8 S88 30'54"W 569.94' . a g 0 " O �• `�� 'b 21 / 7 w 3.43 ACRES / FD II� g 149,446 SO. FT. / O V W Ir_ O S89 Ib Imo'