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HomeMy WebLinkAbout040-1225-20-000 .0 0 h 03 C) d 4i o0 0 0o a w ts I e c H H I i � I I o"i I h I 0 I z a I c z I LL c O 3 � I I I Cl) v a3i I Z H I rn Z " c �L V v _ v N w ! a m o I o z a 0 o m 16 Y) 4' a 0 z U E c4`h I ID z w N O) 3 V� CD I C I •� O CL z z N z y c N O N O O ` O d 0 0 0 G G a E Y �p N N O NN U co 7 y t F OO OO 09 U' N BOO o a z $ o m Naaa FL v 7 Y = O m N N N J U � rn rn J M O tr_ O o 0 C to t` E N N �p O O II O OD N a N N m m N N Cl) 'a d QI In N ` 7 � N @ U y E N v I) M V 0 0 0 1 G N C 0 O7 C -p N N N W N aD C N U' d 7 N N C ~ m a � w .c c c 0) n l jx� *4 N ` U M O V) O N U o rn F- M o Z �' Y (n _ a> d `1l1 E o 3 o �w �. '.3 ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT Owner Ct e - � �* ' ' r ="� <' � � • t ,� , � l `rte �► \•� � • Propert Addr ss 320 F , D} l�•< '; City /State S4 9g r i. H Legal Description: �o Lot a Block Subdivision/CSM # S '/4 NFU ' /4, Sec. 9, TaN -RAW, Town of IN SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC l000 / Setback from: House Well ` PAL Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: i re v\ (- h Width _ Length �S Number of Trenches Setback from: House 3 1 Well 80 + P/L SO ++ Vent to fresh air intake Sb' + ELEVATIONS Description of benchmark y L . <'* Elevation d 0, 00 Description of alternate benchmark b 6 j _ Elevation ) 0 Building Sewer M 1_ � )i . ST/HT Inlet ST Outlet "t .. PC Inlet PC Bottom Header/Manifold . 1 Top of ST/PC Manhole Cover Distribution Lines Bottom of System () "° » () µ`' () t Cb Final Grade ST cpox Date of installation Do/ 9q Permit number 3389 98 State plan number RK; Plumbers signature , j "� - -��ee License number (3 Dat V� Inspector �S {ti y Y Gc _. Complete plot plan II 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 m e, A dui S .T. Q/ r Q/ v U 52 v � INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 338898 1{ Perrrktl8ld_er� N96_'N, JAMIE El City ❑ Village Town of: State Plan ID No.: ��1jA� U CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: I wo 1 00 3� " PUC W i st Cd'IJV Lr 040- 1225 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6'a5D Benchmark 3 �` 'off• �y p Dosing �-� _ ' 2 ' IIYZ" o2.5fo a l ��q Aeration Bldg. Sewer 6 Il = YY 2} (o•q8 �. Holding St/ Ht Inlet �6 �a ,Scf R6• TANK SETBACK INFORMATION St/ Ht Outlet ���o:� �.$} qf 3$' TANKTO P/L WELL BLDG. vent to Air Intake ROAD Dt Inlet Septic >SO 35' NA Dt Bottom Dosing NA Header / Man. $' �'�L r $• Z 96 . /3 Aeration NA Dist. Pipe %. 0�/ 9q 2Y "E g.2t Holding Bot. System Io.oE I PUMP/ SIPHON INFORMATION Final Grade qg- Manufacturer remand Model Number GPM TDH I Lift I Fricti tern TDH Ft ea Force ma ength Dia. Dist. To we SOIL ABSORPTION SYSTEM 3` K }5 '+reK ku ( I Z LA - . 4 tP.c. -,) / N Width r Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth RO DIMEN N off DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING 4. � Manufacturer SETBACK _ CHAMBER °•� INFORMATION TypeO Model Number: System: ( J, 6 3 1 17 OR UNIT —(O DISTRIBUTION SYSTEM Header / Man ifoW Distribution Pipe(s) x Hole Size x Hole Spacing Vent ToAir Intake Length — ) Dia. Length Dia. Spacing r 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 5t v COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 9.28.19.1098,SE,NW 530 BRIANA LN — GLOVER HILLS IqZ a 24 Eta • , E > IV" CAX-,- u Bm = 6s#� szj -20-10) C Plan revision required? ❑ Yes `Z No ll Use other side for additional information. -7 - SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E , , i 3 t f E , , E { i i i ...m... � ._ ,.. ..,_ s „ems .. ,...... j b. ,., ..a .. „ _ .,. ..... .._. ..€ m.�,{ i S 8 .. ®.., ., ..e j i F em m t F e 3 i E j r m � 3 { k a e 3 1 � g e 8 3 ... . .... ......n: , a. ..m....a.a ... .,.., ... _ _ .. ,a .. f m , , "i { p e 3 e r E P �[ f , n E h d c E 3 { I [ fl P 3 Y { r , m. , ^ p ^ Safety and Buildings Division v� ■■•.r.r. SANITARY PERMIT APPLICATION Bureau of Building water s 201 E. Washington Ave - In accord with ILHR 83.05, Wis. Adm- Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 54- ��aih • See reverse side for instructions for completing this application State Sanitary Permit Number 3 3 B'�W The information you provide may be used by other government agency programs ❑ 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 2* ner Name Property Location G IJ tJ !J SL 1 N w1 i4, S T '2 , N, R E (or)W Property Owner's Mailing Address ,?t Lot Number Block Number City, ta L Zlp C s o ode Phone Number J Subdivin Name / or M CSM Number l �i)0Sa 1 � W � � [ D ( �lJ ) l ZO 1_ V V II. TYPE OF BUILDING: (check one) ❑ State Owned i age Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Vill Town Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 9, dig 1 ❑ Apartment / Condo 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. Z New 2 E] Replacement 3 E] 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 1 1 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12)R Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 X 7S 43 ❑ Vault Privy 14 ❑ System -In -Fill ,$ 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/da /sq. ft.) (Min. /inch) Elevation s a S '7 3 r Feet Feet Capacit VII• in gallo s Total # of Prefab., Site Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass App. New Existing strutted Tanks Tanks epticTank or 600 jo 00 U AL I lit ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber — I ❑ ❑ ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri Plumber's S a / re No mps) Business Phone Number: 3 * Z_ Plumber's Address (Street City, State } , Zip Code): 1 J IX. COUNTY / DEPARTMENT USE ON LY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing / � ent Signature (No Stamps) Surcharge f ee) Approved ❑Owner Given Initial ��asc7b /� Adverse Determination X CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to Courtly, One copy To: Safety & Buildings Divi. ion, Owner, Plumber ' � r INSTRUCTIONS 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 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 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parEel 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. r - 44 O I � A T 6 e Q A v I v v > a O v J=3 lu � V Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page —/_ of 3 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. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and r G //o/ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 6 1 , 4 6 - /,=), T - 2- APPLICANT INFORMATION - Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). z 5 Property Owner Property Location A � / � A Q � Govt. Lot S � 1/4 1 /4,S 9 T 8 ,N,R i (owo Property Owner's Mailing Address Lot # Block# I Subd. Name or CSM# .? 6 AW rr Z City State Zip Code/ Phone Number 8-6ity Town Nearest Road Cora,✓ r s o�� c � s � .�� - ..� �o A ,0�,� ® New Construction Use: Residential / Number of bedrooms 2 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow SO gpd Recommended design loading rate . S` bed, gpd/ft . L trench, gpd/ftz Absorption area required 5 7 , 040 bed, ft 7SO trench, ft Maximum design loading rate . S bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) 91! f/ ft (as referred to site plan benchmark) Additional design /site considerations ��.✓ /�iEtO 6IEGtavrs.✓O t�tl�vcv�s Parent material 6 i rs✓q.fy Flood plain elevation, if applicable: AhA ft . S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ U © S ❑ U ® S ❑ U 1 [0 S ❑ U I ❑ S 5 U ❑ S RU SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench r e Ye S Ground y I1 0 .t �/ s L,7 4 .5 S elev. , c 9P. y ft. e /I s s / ' s Depth to -' -s . . .$ 1 : n �- limiting G S/ -88 6Y�c factor 7 88 in. c Remarks: Boring # s / O- o zy rr S .� .11li ✓Y LRiJ, p , ,ysc B Ground S - S o �c elev. _ C -88 a r•[ - ✓ -' 6 Depth to limiting factor > '"_ in. Remarks: CST Name Please Print) S' nature Telephone No. 8.� P6 /o Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER �� /� //L /cN.�AOfa Page e? of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color GL Sz. Sh. Bed , Trench a y - / s Ncr,I ✓Y - Ground 3 !- /,.4/,( -' / — g elev. ' Z tL Z 7 SYX S Depth to -� -1 -J8 o Q S - ' �s limiting factor X 88 in. q S I VAre Remarks: Boring # a Ground ,t_do 7. SIQ elev. I eft S' jb -,to z Y/I . - Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft2 ,�6�A,✓0 in. Munsell. Qu. Sz. Coat Color . Gr. Sz. Sh. Bed Trench Boring # o. /f ar ,z - Ground 0-74 , Sri! - elev. 9d, ft. S l -ts a Y f s' Depth to limiting , factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) 4 0 a I NI \ `TI G i V � Q► Q � v Kb M /\ M ►. A. � o a ^d d o � o� a u `v It y u ® i 4 \ V to \ 11 N � $ b- b V i Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Wkings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inch s - �. P s n e, but not limited to vertical and horizontal reference point (BAS, dir o of sbpe, PARCEL I.D. # dimensioned, north arrow, and location and distance to near d. ��11 .� APPLICANT INFORMATION - PLEASE PRINT ALL RMA7 WEIVE REVIEWED BY DATE PROPERTY OWNER: 'SAS B p f " J) . G E1 S G P 0. LOC 10 M, FOR T 5 , 4 NW 1 /4,S 9 T Z8 N,R 1 `1 E( w PROPERTY OWNER':S MAILING ADDRESS BL SUED. NAME OR CSM # ZON 4 OF=rsc G LO V 1 u- S CITY, STATE ZIP CODE PHONE NUMB /-' _ ElCffY E MOWN NEAREST ROAD 1` DS OI�i�wl S v rS L ( - )I S)386_ 1 £. o `t �l2.lfflvR LkQt Dd New Construction Use pQ Residential / Number of bedrooms uuh"ow (] Additi(rt to e xisting building I ) Replacement [ ] Public or commercial describe Code derived daily flow \--SID gpd/e ®loo" Recommended design loading rate o . bed, gpol11 0 • b trench, gpolft Absorption area required — bed, ft2 _ trench, ft Mapmum design loading rate bed, gpd /ft O- a trench, gpd /ft Recommended infiltration surface elevation(s) 5171E� ►.,oTk� oQ P+t 3 . ft (as referred to site plan benchmark) Additional design / site considerations �z��►►��a Parent material o JIL-Jks- N Flood plain elevation, if applicable N. A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem W ❑ U RI S E] U EN O U [@ ❑ U f$ S O U EIS MU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed T rench Z S) lcs \ bh vn\)t_ e..S - o•Y 0.5 Ground 3 17 9 5 t o y R �1C� S O s g vh l - o -� °- S elev. \%V It Depth to limiting factors u - Remarks: Boring # , 0-8 lo-11Z 2-1Z L ZrnSb1 -t `F>^ Cr-v 3u� } sl 1 cs6 w,v�� zs °�`�` °•S 2 3 16 -4 1 wi R Vf /( S O S Ground elev. % -p fL Depth to limiting factor 1 �+ Remarks: CST Name: — Please Print Arthur L. We erer Phone: 715 425 - 01.65 egerer Soil Testing & Design_Service-P. Box 74 River Fal1S,WI 54022 �a PROPERTY OWNER GnS S )1yGM — FOR.D SOIL DESCRIPTION RE ' PORT Page PARCEL I.D. # Boring # fHorlzon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T ... 3 Z ►ti, s bk >v► `F� cw 3 Z 11 -Z ��`1Y2 3L 6 k tS � S 1 Z `�''� 6 1M'�t- o. S o. ! h Ground 3 Zy -°!2 Lu`tR y l(. - S s A � v+ z 1 0 7 0% ft. i Depth to r limiting E factor i i 0 k Remarks: Boring #� I C3 - 0 -1 G 10 `' z l -Z L Z►.a gb�2 �" C L" 3v`� D. S ; o Z 1 ZL uz `tR jj6 — L Z�s �� m � cs 0, S r o. 10`r R YZ1. - S O Sg — rJ.1 ;0,$ Ground elev. ar � Depth to limiting factor Remarks: Boring # I a -LZ Ib�ttZ zL2 — L Z w, sbk ) c—tj 3u-P r.S' 0 f { YY.• S Z 12 -Z1 10 `-t 2 3 L Z`�S � c g 0- S o L' Ground 3 z�`96 �o�t e yl� - S d sq � 1 — a•� I a _ elev. ! b0 ft. Depth to limiting ;3'1 facctor�,� Remarks: Boring # R r Ground f ft. + Depth to 4 it limiting f3 is factor P I. Remarks: PLOT PLAN Page 3 of 3 SCALE 1 "= SD ' PVC P1 0F WAFT TH S , g.� Z'L loo - t M 1 3 ``C�2 ►� R'CE, B ` p b b / do % le - Per LLT"T. Z s ` F-lu ! Si S�.T'tl)L1- :fit . ��`� w�LL i< tit •a + s�' - « .. G� m I 'I CS LLPcC� 1 ti, C-b} S �(2 8 Yn I-k � 1"1 V M S 2" t LrP w'MKP j `1 k+ Sv �� h$`t 2� SItU` .)►`l . �T��2 w! ln1E ,S`I S76�-9 E LA M 170AJ �T 'T1 t'lE O!= CUA.i g�12..0 c�Ulu. - � = - ( 715 )-425-0169 _M OD 576 CSTSrnafure Date Signed Telephone No. CST # -- -- Wisconsin Deparhnent of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Belabors Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY T __ Attach complete site plan on paper not less than 8112 x 11 inches in size- Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: r�Q$1 R . G El S S ! K) G tm PROPERTY LOCATION t �y�� • a��1 LQ , M1, , F0 2D e8V:F.-WT 51�_- 1/4 NW 1 /4,S 9 T Z8 N,R c l E( W PROPERTY OWNER' - S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM If y S O t'3 , c-, ub vQ'V_� R.bktp 7- — 6 Lo U 1-�1 \,l- S CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OrOWN NEAREST ROAD �SO1v,wJ SV0L(, ( S)386- 131'1 `Z `-( g21Pj1vJR LKIitt Dd New Construction Use [JQ Residential / Number of bedrooms Add" to existing building j) Replacement [ ] Public or commercial describe Code derived daily flow V- gpd/eE Z(j%) ► Recommended design loading rate . bed, gpd/ft 0• b trench, gpd/ft Absorption area required -- bed, ft2 _ trench, ft Maximum design loading rate 0- bed, gpd$ 0- a trench, gp(w Recommended infiltration surface elevation(s) 52F ) ao P►Y6e 3 . It (as referred to site plan benchmark) Additional design / site considerations 'RZ tr., S �z �nr'i>✓tt� Parent material s Flood plain elevation, if applicable N- A ft S = Suitable for system CONVEYP.ONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable for system COS [] U O S ❑ U WS [] U ®S ❑ U [2S E1 U O S Dail SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roofs GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rRench -' L Zms vr,��- C,r.�, 3v'F o.5 0.6 Z 10 -1`7 to �t fZ 316 — 5 1 Cs �lrt tin v'�� c-S o• y o. S Ground 3 n -95 lrJ y tz YA S O S g elev. 1 01- 3 ft Depth to limiting -7Ci S a Remarks: - Boring # , C ) 1C� 2C 2 3 U f a • S [o- -- Sl �sek Yhv�� 3 16 -9 t o `t rL VA - S O S vn Ground elev. l - O ft, Depth to limiting factor Y Remarks: T Name: — Please Print Phone: Arthur L. We erer 715 425 - 0.1.65 ress: _e e-re.r _So l at_ing_& Design Service - P.O. Box 74 River Falls,WI 54022 - -- PROPERTY OWNER GnS S) "LM �-D SOIL DESCRIPTION REPORT page of PARCEL I.D. # Ir ;� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft ` c In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r , c Bed Trendy.. , Z w, s b k Yom► 'F� Cam, F [2 L 3v o -S o - � • ;'' -, Z 11 -Z, to `1 V2 3L6 _ S1 Z�3 V'nJ1- C o.S o. w Ground 3 Zy - lk `f R VA. - S p S wl e ft. Depth to limiting f factor Z �� h l Remarks: Boring # ;';,� o -► to �t tZ Z 1 z — L z►.l s byz ►� -�`f'H c�.�, 3v �, s :, o, r 1 `iR X16 1 L 2;fS�k (Z. { ri s , sg �► — �.,o,g Ground r,l elev. \, .tJ ft. Depth to i limiting factor s f L I r • Remarks: Boring # !; ' I a -1Z l0-[2 z[z — L Z wt sbk Yn JV cw S9 Ground elev. { g ft. Depth to ;` ! limiting ( ti factor Remarks: Boring # FM !.I Ground elev. ft. I' a. Depth to limiting fit factor l f" 1 . ,sly Remarks: I PLOT PLAN Page 3 of 3 SCALE 1 "= L T L.. Iba.p oN �}(GZ{ 31Y PbC P(DF WAFL Tt4 S°ts.6b� -- t!L too ° i f � i t'Z. 4 — ti0 �� tiJtTLL •� et to I $p' .t `I << v Q1 �o� To 11�► S.�LLtT2 : Sv1T��� �rl� Srtt�i -.�►� . ���x..�� cn�E s�ts'T�1 ��-- l�v�4fi�a�u PrT Tt F'1E b!= c-u>v sl c- T�U1u, ` 9s -�s -Z 715 _0 0.05 76 D Te �STSLgnaure ate signed _ lephone =No - GS:T # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,.1AM I � �' yrA. -rl E ?ICA A ED60A] Mailing Address ZZ� y � p 0 6 OX (, s Property Address OCIEZ S' xel" INE (Verification required from Planning Department for new construction) City /State �SOV 0 S Parcel Identification Number OW LEGAL DESCRIPTION Property Location SF- ' / <, NW '/4, Sec. T Z8 N -R o T� Subdivision C�GOVE•g At L5 3 a� Lot # 2 Certified Survey Map # 5333 27 , Volume , Page # Warranty Deed # ,599 y3 q , Volume 1 q 10 , Page # 5 Spec house ❑ yes 1A no Lot lines identifiable $4 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, restrictedplumber 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. 05 - 1011 / I 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. f off/ o SIG ATURE OF APPLICANT ATE * * * * ** 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 04 12 J/99 F RI 06:14 FAX 6129429214 ERICKSEN ROED &ASSOC. 002 I VOL 1410PAu566 �a994S'9 na"U1 Wr N0. M ARAM VM KATHLEEN N. WALSH REGISTEr OF DEEDS ST. CP'O.X CO.. WI RFCEIMEI FOR RECM Milo A. Gray and Roberta J. Gray, hvshaad an4 wire, Grantor, conveys 03-16-19" 1.30 WI and warrants to Jamie nd KichaCda� and Katie Rieh#rdsea, husband a rite as survivorship marital property, Grantee, the following described real estate in St. Croix County. state Of Wlsconsin! EMPT i Lot 1, Glover Bills in the Town of Troy, St. Croix County, wi■cenaln. MH MPY FEE: COT FEE: TIMMWER FEEt 94.20 "=IS FEE: 10.00 ' PA6FS: I �, WL 6- 25 -10 ' This is not homestead prOpertY. Pssee Identification Nu r (PINT Exception to warrantieat All easements, restrictions and r.yhcs•of -vaY v4 recoed, if snY• Dated this r day of March, 1999'. (SgAI.I (sEALI „a A. Grsy {s (SEAL) its J. ray A97MUTICATIOw AC L Signaturete) STATE OF WISCONSIN 1 1 se. z T r , COOtrcr I 19 o al y case before se thi day of authenticated this day of , Ig t e abo.•vre� named M o A, I V � . Gray ��� A•�y to sw known t0 be the petsoniel rho a foregoing inetrv. eat and acknowledge iaRy L • r- W : A • ITLE; No 19R STATE BAR Of WISCONSIN /- • � It ncc. authorize y S70 s. Seata. Yt ..• �' TES! INSTMU WAS PRAFTLO 11V! : jq T' Public My comm ission 1s permanent. IL9 neF. 1��� inseph 9" sales "' 3 Redli. Beskar. Bales _ Krueger. S.C. P.V. 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