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HomeMy WebLinkAbout040-1230-00-000 r ST. CROIX COUNTY ZONING DEPARTMENT \~ AS BUILT SANITARY REPORT r ,, , Owner B aal P aLKKC Property Ad ,dr City /State G(A 0X1 Mfil ffS/ Legal Description: Lot Block Subdivision/CSM Nll) '/� 5 Sec. T -RAW, Town of -Ffnl a PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer a Size ST/PC � Setback from: House .. Weli P2 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: 7K�Y1 dLWidth _ Length �--- Number of Trenches Setback from: House Well P/L - ,;";?o Vent to fresh air intake -7 �y ELEVATIONS Description of benchmark C g/n Elevation Description of alternate benchmark +u P A A-5; 6 - � D� 0 �� � D "� Elevation v 7, SO inS�O�G��a. rt70ai"� Building Sewer ZO5 ST/HT Inlet ST Outlet / PC Inlet PC Bottom _ Header/Manifold ID Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System Final Grade ( ) O ( ) Date of installation / /9'? Permit number 33897 / State plan number Plumber's signature qi/ License number 1' Date /2 /?."�/ 5 Inspector l� Complete plot plan 1 I NO'T'ICE 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. f �j PLAN VIEW x 12 v a �nn1 b INDICATE NORTH ARROW JN Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CR IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 338871 Permit S & mePAUL ❑ F] city Town of: State Plan ID No.: CST BM Elev.; Insp. BM Elev.: BM Description: RR Parcel Tax No.: /DD 16a l" o rer\ a� 040- 1230 -00 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r ZS chmark 9 5 Dosing ��jt/\ Z Aeration Bldg. Sewer 7 �� Holdin St Ht Inlet S� TANK SETBACK INFORMATION t Ht Outlet 6 TANK TO P/ L WELL BLDG. Ai to ROAD DL` Air Intake Septic / j A- f / NA Dt m j Dosing Header / Man. ,e Aeration NA Dist. Pipe z OZ Holding Bot. System /r " l' PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand /0 de Model Num er GPM TDH. i Lift Friction S stem T Ft x Fo main Length Dia. Dist. Toweu SOIL ABSORPTION SYSTEM BED THE W@th / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N 3 6 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer. SETBACK ;M ,- o r INFORMATION Ty pe O M odel Number: Y ,g�� \ l � r System: Ce 'v DISTRIBUTION SYSTEM Header /Manifold Gj Distribution Pipe(s) / x Hol Siz x Hole S acing Vent To Air Intake Length Dia. Length 0 / Dia. Spacing S ( 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.) LOCATION: TROY 16.28.19.1130,NW,SE 341 SOO LINE RD— GLOVER ST# LOT 65 qz O� covet( 5 4 "t rode he weed 41 1ew61e"" Q Plan revision required ?� ❑ Yes �❑ No Use other side for additional information. Z 7-P 7 L 'P SBD -6710 6:{:3/97) Da4 nspe 's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: m s € F , 3 ,.,,. e ..... ... .... r I - a e e E i e x , - � me, e ve me m , x S e 8 a x a s s s 3 e F 3 .,, mew.. S. ..... _: ... ..,.ve ..... a ..m e,e E � s e E .e m �, me mmm „ — , c � ee e m� w m f e m ..,.. ... e m e ' mm:e � e d a S L rt E 8 4 E s c` r i { 5 3 x s _ f i € 7 € i v em.. .. . ...... .. ekr .. .. ... � ... €° � _ - -- 3 r _ .... .. ... ......� i -p.. ee am em.e� my .,..<...... a a.M... ,..�e. ,m .« ,..mevP. e ........,... E a. _ �.. .... .. W..... ._ = ..e fl, ..,_s. m., w. *.� a .� 6 i x � i c g a 3 t a g it Safety and Buildings Division Vi sconsin S ANITARY PERMIT APPLICATION 2 01 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce 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. C.(ZO 1 • See reverse side for instructions for completing this application state Sanitar Permit Number r Personal information you provide may be used for secondary purposes [I Check if revis to p�ous aPpLion (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property O n r Name t Propert Location G (�yb4 j� 1/4, S T �8, N, R E Property Owner's Ma Address Lot Number Block Neer 73 b x-12 F-D City, State / �� A A ' Zlp � 3 ( ]tone G Number Subdivi n Name or SM Numb r � 10 / V \ A �i II. TYPE OF BUILDING: (check one) ❑ State Owned r ❑ Cit Nearest Road ❑ Village Public or 2 Family Dwelling - No. of bedrooms wn OF 6 U NE p Ill. BUILDING USE (if building type is public, check all that apply) Parcel Tax Numbers) C � -/Z 1 Apartment/ ndo ©V o ❑ 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 ___,____ Exist(n�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 12Weepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit a X 43 ❑ Vault Privy 14 ❑ System -In -Fill hltl"G S �✓7 �, 3 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) (V 4? 4C 11evation ® .77- 5 Feet 97 Feet Capacit VII. TANK in Ga allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con" Steel glass Plastic App New Existing structed Tanks Tanks {� Septic Tank or Holding Tank `Z w �E(G s 11 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Tame: (Print) Plumber's ignature: (NOS am ) MP usiness Phone Number: Plumb is Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY pp ❑Owner Given Initial E] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin ent Signature (No Stamps) roved Surcharge Fee) � Adverse Determination 1 24 q X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.1 1/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a Licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 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. Vill. 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 3!Z, ob g r 0 s� �a Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of Labor cud Human Relators Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x s,iae Plan must include, but ST • e� c not limited to vertical and horizontal reference point ,�d'�dtion and 9'0 of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distan t9\9#atest road. 4zz) y )— Z =00 REV D B D E APPLICANT INFORMATION- PLEASE PR T::Ail. IiiFQ(i k i10N PROPERTY OWNER: PR LOCATION t� -SW ►�hnD Y S C� k E �` ' ' 199 �� 1/4 S E 1 /4,S / T N,R L' t E( W PROPERTY OWNER':S MAILING ADDRESS . a T , L BLOCK # SUBD. NAME OR CSM # ourtry — G wv�2 STk)lw CITY, STATE ZIP CODE PIiUN >NU Oc []VILLAGE ®TOWN NEAREST ROAD � C51P� � 1�I.N 5 S L Z3 (C�J � -�: - �- $ ? 2� `�_- 1 l?.A S� U nl� �-��'D [ New Construction Use [X] Residential IN imber of bediooft 1 4 [ ] AdditiQn to existing building [ I Replacement (] Public or commercial describe Code derived daily flow 6 k� 0 gpd Recommended design loading rate S bed, gpd/ft , b trench, gpd/ft Absorption area required VZA)o bed, ft to 0o trench, ft Mabmum design loading rate S bed, gpd /ft trench, gpolft Recommended infiltration surface elevation(s) ° Lq -o - °tZ S ft (as referred to site plan benchmark) Additional design / site considerations S�� "'rt To 1Aj I T• - L_Q (`c. Parent material p S 0\-) S'r y d� n� N Rood plain elevation, if applicable N A ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable for s stem 0 S El U ® S El U ®S _ 11 U IR S ❑ U ❑ S RU I [IS U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourrlary Roots GPD /ft in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed rRer& ;`tiYv'iRdii2frtiy '� e- a � 6- Z 3 L Z — SL I 2,''c= "bvr' wL`F Ll Qz 3/L S Ground 3 Z$ -S3 `� 3[ y S I 1 CS b� W v L w _ , �{ 'S elev. 9 8.S n Y. S3 •S g9 1,, } - • 5 € Depth to limiting factor Remarks: Boring# 0 -7 lo`t� 3 cz - si) Z�'sb1� ff cS -S .� E Z 2 -l$. LU`l2 31i, SLI Z ►nS b1t �.�t �W S 3 1g -�lo �.SY2 31 y s l e sbk rt U F� cI-J �� -5 ' x Ground elev. 4 �[�-t� S yR y/� _ Ogg ��� - • s ' .� a� n Depth to limiting factor - > LOB Remarks: CST Name: — Please Print Arthur L. We erer Phone. 715- 425 -0165 Tess: (egerer Soil Testing & Design Service - P.O. Box 74 River Fal1s,WI 54022 _ Signature: / , J< 4 c 9 - - Date: � `�� ,� c, CST Number: 220254 I PROPERTY OWNER \- E SOIL DESCRIPTION REPORT Page Z. of 3 � PARCEL I.D.# o�LO- \ Z3U -UO Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground 3 2� SS 'S `c2 Sly S 1 C S�12 )n ti F1 L° v •� S gg lev. I ° f b 3 ft. L4 SS -la 1 S `BIZ y/6 — S3 Depth to l: limiting ' factor � > co 8 T 1 i Remarks: Boring # S1 C cs bk , >�►U`fl►- , _ .� - Ground LL 1 53 - 110 - ? S `yR yf — SS VYl — . S i •s Depth to limiting i factor 2llp` E Remarks: Boring # I. M >:: �° lo`1R 3/L, w Ground \ 3 1 ft. -S y P - y /6 - `Fs C3 S 9 l -• s I- 6 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: _. rnr1 n ^�(1f+ ,r nn PLOT PLAN Pa 3 of 3 SCALE 1 "= SO' c�v.iTuv�Z �- go 0 3 SO CL 16 3 . l .1616 V O L�1 -IAZ 3 o ti o 11 `rTZ.�,, Ch � , q � �1R.9� 5 0 3' 3 BM*j �.�� �Z .l�O.OGly t� "H16t{ 31�` ply . pVC PLPC wl�T�1 . �-1•oU S E I , l� L" L TO B � > S o ` �Z -ey"'I �� e�S . S L ►yr�1� ly 1 � STPSt�z � !` � r11 ` Z,k:.�r- tr�t:��� Z- 1�Z�/:..� ��N 3'X f oo' �0�•� � � h.�r[7 - ��IGN C�+�e(`� S Lb � t�ttib�2 L�`RCN Ctf•14� BIZ s 3 `N114v. 6 ` P1�f�2T. _ qq��3 (71 ) - I4 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of = Labor and Human Relations DivisWn of Safe Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but r S • L not limited -to vertical , and horizontal reference point (Blu), direction and % of slope, scale or PARCEL LD. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER' PROPERTY LOCATION I. � - ►� i FN�,3 \. - � P, S C" Irt-E -G8V �, 1/4 S i 1/4,S / 6 T ,N,R t°L E ( W PROPERTY OWNER' MAILING ADDRESS • LOT # BLOCK # SUBD. NAME OR CSM # 3 6 `l9 t�Ls �b lZ e1� 6S - G t -0 v�­t_ W r 4 - PfDA. CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD G'PC1V� ►�tN S5 L - (tsn LSV- B - )Zl LWE Cz-a [� New Construction Use [k] Residential / Number of bedrooms L{ [ ] AdditiQn to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 6y0 gpd Recommended design loading rate 5 bed, gpd/ft b trench, gpd/ft Absorption area required VW (3 bed, ft to 0o trench, 1`1 KWmum design loading rate bed, gPd$ - � trench, gPdtfl Recommended infiltration surface elevation(s) °04 _o - °tZ- 5 ft (as referred to site plan benchmark) Additional design / site considerations SC's "V To w S Z VL1 �, t�%j V_k) 3 Parent material N Rood plain elevation, if applicable A It S = Stitable for System CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system IDS O U ® S O U ®S O U [RS El U ❑ S [$U [IS P U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barxiary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ::; rerlctt `:_ VI l0`-t Z 3 L Z "A'F C-S 1 � • S � � Ground 3 2. 9 -S3 S e lev. fL J Depth to limiting ffactor� , Remarks: Boring# p - 7 1r-)tZ I Z •S .� Z �� -S Ground elev. VA q� ft Dep to limiting facto 1 LUF3 Remarks: CST Name: — Please Pratt Phone: 1 Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O.. Box 74 River Falls,WI 54022 _? SgnaUue:4 _ - �� Date: ` `�� ✓ �' CST Number, 2 20254 I 'ROPERTYOWNER SOIL DESCRIPTION REPORT Page? of 1 .aRCELLD,# r \'LSO -UO gyring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, Consistence Bour�ary Roots <;> Bed Trench a s �`! • •� s'► 1 Z t� s b k w �►- cw - 5 , � 3r 3 2�` SS 7 •S y IZ 3!y S 1 C S�k 1n V Ft^ L°_ Iv • S 3 ft. ST -lu$ Sylz U /t, _ o s9 �� _ •5 ,,� ;epth to inviting 'actor } i Remarks: coring # ax. D — lD�llZ BIZ _ So ` Z � 5 IT CS 1 sit Z►� s �k �vl `�1r Cw - • s I •� around \ S Uk 1viU`eh Cw •�(, •S. lev, S3 -lto S yR y/ _ g _ ft. S VYI S Depth to imiting i actor I ll0` Remarks: 3oring # Ai— s Z !8 -q2 1(J `1 R 3/L S :around 3 y 7 S `72 3!y — S �. \ C S��z mv`Ft. 3 j -tt. y 63 -1r -I -S yR L/A - _ Y �S G g 9 S Yrt I • )epth to :imiting Factor Remarks: 3oring # :13 i "round Aev, ; ft. Jepth to imiting !actor Remarks: �. PL P LAN Page 3 of 3 . a ' SCALE 1 "= SKY . c�v�Ruv,2 et_ looms 3 S 0, 0 O Lam- W 2 3 U O O v O 465 8�"1� / - Q- .10.0` a1v tD "`ct't61{, 3111 ` CIF .PVC l�IPL �.j�T?I . S �1 ►Vci )U ZrCOY�1'��JD Z �ZEW� �� ruf1�� 3� (i1U JYJ �j I`aI 1 - 1G N C` S 1 b� 1tiJ 1lv15�1 2 L �C.N C ti14` 1 ''1 i`3�lZ S 3 `MI 6` ��2T'. L -b��; �v�►c: �.�2���s�+� �l l '�>?`j ( 715 ) 425 -n16s 14 00570 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE E V A L U A,Tk E P OI R T Page \ of 3 Labor and Human Relations i : Division of Safety & Buildings in accord with ILHR 'U ts� ,.- fldm Code. • i� COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches i ze':'Plad rnust:ih6lude, but `a not limited to vertical and horizontal reference point (1310), direction rad % of slope, scale or 4 CEL I.D. # dimensioned, north arrow, and location and distance to nearest ro t APPLICANT INFORMATION- PLEASE PRINT ALL INFOR 1 N IEWEDBY DATE PROPERTY OWNER: 10 1 ` PROP a �kAT113t+L 1 /4,S b T ,N,R 19 E( W C. BKE' pm 1� u1S Sc L Z PROPERTY OWNER':S MAILING ADDRESS bT BD. NAME OR CSM # — 11 O N . " A-1 1j S T', G LOU C Sm w Lily y tt0l P V4 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD RLULsS 9kl _L5 1 kj1 S OZ.Z -. (71S) 112.5- 8 161 p `f I SOO l.lwE RAAD New Construction Use.[)q Residential / Number of bedrooms L{ [ ] Additign to e)asting building j ] Replacement [ ] Public or commercial describe Code derived daily slow b%0 gpd Recommended design loading rate bed, gpolftt 0 . 5 trench, 9pd/ft Absorption area required \ S%o bed, 11 `Z1ao trench, ft Maximum design loading rate O •y bed, gpd/ft 0 - S trends, gpd/(t Recommended infiltration surface elevation(s) SFe Pk6L 3 of 3 ft (as referred to site plan benchmark) Additional design / site considerations R_E t()Nj H CAD 3 'MEkJO tttS , 6-; S ' X 9 0' Law C , Parentmaterial Se"tI MlD►T overt S; 4 0u11oJtNN Flood plain elevation, •ffap*able N •A • ft S = Suitable for system MOUND IN414DUND PRESSURE AT -GRADE SYSTEM IN Fill MMOM TANK U = Ursstritable for stem ®S ❑ U ®S [] U l� S ❑ U ®S ❑ U ❑ S ®U ❑ S QI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cortdstence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Beal Tw& o_6 lrw OS o -S o.6 Z g -ZC� toKR 313 - s tI Z en s bk rite � o.s r'A 4:•.aviv Ground 3 76 -x[0 7- S 'I ft 31 S C SV12 W, - Cl,' Cf.v - 0- o- S elev. o..S 0.6 Depth to limiting facto 1 5 Remarks: Boring # y ,,, q s o. S u- )py2 3tZ - Slti z� Z - Z �oz7 10`i2 3I3 — SI l Zvn 5b4 s►f'Ft. 0_5 - o•S v. 3 Z7 -VO 31 — �S CSbk 1ryfU o-S 0 -6 Ground q el ev . ft 4 4o-8y - Li P_ yl6 - S O s9 wf 1 - °'� °•$ Depth to limiting factor Remarks: T Name: -- Please Print Phone: Arthur L. We erer 715- 425 -0165 Ad dress: Soil Testing & Desi,gn Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: G q -30Z- 6S �- 3o LS M00576 I ' PROPERTY OWNER B`f — Ctt11 SOIL DESCRIPTION REPORT Page 7 of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdaly Roots GPD /ft in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trendt o_8 o Q L Z S z -� 5 b 1t y, o• 5 °' 6 : >< o. L Ground 3! elev. S o S'3 Depth to limiting factor 7 � °I' x i i Remarks: Boring # ��< I o -10 lo1 r 3/Z a s - o.s o.6 Ez ti �-� v Z 10 3b 1 0`12 3l3 SI Z 'FSbk �`F�. CS o'.S % r14 36 -�y > -s `7R �� S) 1 as��r �►:.�� Ccv 6- o.s Ground elev. bY -7Y �•$ yR Yj�, 0.7 R $Z, o ft. Depth to limiting factor Remarks: Boring # k o -� ti��2 3iZ s l� Z sb `M`Fti. �` _ o.slo•L 5 2 -ZZ lu•-tR j[3 S1 l Z`� sb►: 1M'F1. C$ - u•s i u.� .: Y> :4:: 3 Zz 3Y �•Sy 3/ — S) 1 C s 'bh *'f I- Cl. wL los Ground elev. 3�-�'O �• S 1 a Y1 — `FS s9 w, o. S 0. b a ► ft. Depth to limiting factor f .► Remarks: Boring # { Ground ' elev. it. Depth to limiting factor Remarks: SBD- 8330(8.05/92) w PLOT PLAN Page 3 of 3 r T 6 y SCALE 1 "= yp ' T �S 3Sa 00 , ot-� \ ARAN R \fit lUI�TE TrL&J e.l}eS 3 RT S'x 80, L V,N6. c• g,Z et. 983 6 �// 8.►� 3 �T S' tTi 97$- f� t� `28Z °- 0 0 0 0 0 •3 X1983 3 NOTE: House to be at least 25 1 from trenches. Well to be at least 50' from trenches. °<9 4.3 NOTE TO INSTALLER: Place trenches maximum 36" deep at the upslope edge. Determine trench elevations at the time of construction. 9y -3oZ- 65 �. J- 34 �9-3 (715 ) 425 -0165 M 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. E PRINT ALL INFORMATION REVIEWED BY DATE APPLICANT INFORMATION P LEA S PROPERTY OWNER: PROPERTY LOCATION SW C. M. B4 E Pr><�p 17 L'lJl.) \ S S c L Z NW t/4 1 /4,S b T Z8 ,N,R E( W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM - I1O N, "Pit S T. 65 — GW)C12. SM W Ll ftfl CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD RLUL'IL GV- LL5,IJ[ Sti LZ. (71S) 1 1I.S — B► 61 O Y goo %.LIVE RARD �() New Construction Use.[)q Residential /Number of bedrooms [ [ AdMgn to epsting builds g Replacement [ ] Public or commercial describe Code derived daffy flow boo gpd Recommended design loading rate bed, gpdI% c . 5 trench, gpd* Absorption area required \Soo bed, ft «o trends, ft Ma*rstrns design loading rate 9 -y bed. WW 0 - S ate, gpd/R2 Reoorr mersded infiltration swface elevations) Sty P. k C L 3 o F 3 ft (as referred to site plan bemlimark) Additional design / site considerations IRU 01 M elvD 3 `� �-�. M t+a$ , SM.N S''A 9 l av G . Parent material Se'%� t MesT ov n Stay oU'TLUk N Flood plain elevation, d appltcetsle N - • ft S system CONVNTIONAL MOUND N-GRDUND PRESSURE AT -GRADE SYSTEM N FLL HOLDNG 0S ❑U I ®S ❑ U I W S ❑U ®S ❑U ❑S oU ❑S I$I SOIL DESCRIPTION REPORT Depth Dominant Color Moules Texture Structure Gonsistem Bour ry Roots GPD/f Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tiench ' o_g lo-.tz 3IZ si 115bk w►'f� CS _ o.S o.6 Z g -10 �Z 4z 313 si[ Z►►, 3 s mkt, &S o.S bA Ground 3 16 -x!0 7. S V 2 3l S 1 S bk ws 'F1^ Cjv 04 U- S elev. q B, 6 ft. yu-$`� 7.S RJ 4/l6 0. -N o. b Depth to timitirg factor 7 8� Remarks: Boring # ' 0 -10 ►py(Z 3 — s l ZTsbh wi'FL 4,S o.S 13.6 Z Z lO Z7 10`12 3t3 — S7 1 Z t S b4 rn +I. CS — 0-S a. 6 3 Z� -�[o �•Syli'_ 3 — �s 1 csdk m y �u - o- 0.6 Ground 0 elev. 4 4o-9y S y rZ 4!6 °1 e3.4 ft Dep1h to limiting facto Remarks: T Name: — Please Print Phone: Arthur L. tJe erer 715- 425 -0165 egerer Soil Testing & Design Service —P.O. Box 74 River Falls,WI. 54022 *nature: Date: CST Number: G y -3o r;'s 1 -34 M00576 PROPERTY OWNER B`it:! ZCWJi' - SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. #! Depth Dominant Color Mottles Texture Stricture Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 [� Z�' s o. C Ground 3 Z6• 1. S 4 1Z 3/ — S � � CSbk �,, �y � _ O•�/ o.S elev. (:'L k4 L43 - ) I Sy2 li — S i Depth to limiting i factor '1 q Remarks: - -- Boring# I p_lo 10`yR.3 /Z Sl Z`� �H CS – o.SEo.L .:f 10 -3b 16, 12 313 Sl Z Sbk w�`FF• cS o,s o' 6 - IV s*bVr W-�j cr." o. v b S Ground elev. y W -W 7• S `1 R V14 S SQj yii u a 4 gz. o ft. } j Depth to limiting factor Remarks: Boring # c• S �• a: 5 : Z -zz 1�1• -tR CIS sl f Z�3�* \^'► C S 3 ' 22 3V Sy 3 ) _ S) CS 'b1z NCI- C1.J — o•V ioS Ground elev. L1 3y-o - 7-S 'J R V1 — 'FS SS IM — o • S o. b Q '1$• 1 ft. Depth to limiting ` factor Remarks Boring # Ground elev. ft. Depth to limiting factor Remarks: S90- 8330(8.05/92) PLOT PLAN Pa 3 of 3 a- Y 0 SCALE 1 "= yp ' T � S 35 4, oo, IEL g- g 6 ,� 0.1 R�'c�St- W1`cfjZi Ttt.�1'Wes pt 3 RT S ' K 60 ►-ON6 . 8.Z I!L -ws 6 � �// 8.� 3 '�T S' x 90' Lti1�►G L a f E!L X38 - Z 0 0 0 0 0 •3 tTL 9$3 3 NOTE: :douse to be at least 25' from trenches. Well to be at least 50' from trenches. 849.31' ON NOTE TO INSTALLER: Place trenches maximum 36" deep at the upslope edge. Determine trench elevations at the time of construction. 9y -3oz- 6S CIaL 1' I- 3o-�S (71 ) 5 -01 6; M00576 Telephone No. CST # CST Signature Date Signed Tele N 01/0111995 06:41 7152737753 NELSON PLUMBING PAGE 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 'r c Mailing Address ri/ /V s� 2 Property Addres 1 ® 1--1 A) E A - D (Verification required from Planning Department for new constriction) ;j� City /State Parcel Identification Number C') SAO L Z 3�> -- ©O -0 0 0 LEGAL DESCRIPTION ) j Property Location V '/., gf Vl, Sec. ZL—, T.Zg Cj N -R / r W, Town of ' d� Subdivision cl- O UCIZ 4 5 1 M , A 0 P , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # AgE Volume , Page # ( 2 Spec house 0 yes no Lot lines identifiable W yes 0 no SYSTEM MAINTENANCE Improper use and maintenanceof 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 iw 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, restrietedplumber 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 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the statndatds set forth, herein, as set by the Department of commerce and the Department of Natural Resources, State of Wisconsin. Certification staina that septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys f th ee year expiration date. qq 10' 1 S GNA OF APPLICANT DATE OWNER CER'T 1CMON 1 1 ertify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e _opc4 c bed above, by virtue of a warranty deed recorded in Register of Deeds Office. al SI NA',1'UU OF APPLICAft DATE sass *• Any inforamation that is this - represented mna result in the sanit �s��• fury pemrtrit being revoked by the Zoning Department. •' Include with this appllestlon: s :tamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed WARRANTY DEED 600286 KAT4LEEH H. WALSH VOL �� r „�f42-3 REGISTER OF DEEDS Document Number: ST. CROIX CO. WI RE:EIVU FOR RECORD Return Address: PU �1 U � � + ' " 1 ` � �` 03-29-1999 4:00 Pll 1W t j J � �' j � No Parcel I.D. Number (PINI: Y CERT COPY FEE: D la 3Q — 00- CU C) 4 T�RA 1 77.00 RECORDINS FEE: 10.00 his Deed, made between C. M. Bye, individually, and Dennis R. and Sandra C. Schultz Revocable Trust, Dennis R. Schultz and Sandra C. Schultz, Trustees, both with full power of sale or encumbrancing, Grantor, and Paul and Linda Paschke, Grantee, Witnesseth, That the said Grantor, for a valuaKle consideration , conveys to Grantee the followi-i , described real estate in County, State of Wisconsin: Lot Sixty -five (65), Glover Station Fourth Addition, Town of Troy, St. Croix County, Wisconsin. This is not homestead property. Tegether with all and singular the hereditaments and appurtenances thereunto belonging: And C. M. Bye, individually, and Dennis R. and Sandra C. Schultz Revocable Trust warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this /o ay of _ F='e r_ U a Jr.,/ 1999. C. M. Bye Dennis R. Schultz y. a ACKNOWLEDGMENT DRAFTED BY: STATE OF w�seo�us�w _) ) ss. C. M. Bye, Attorney at Law S7 Ct2o[�_ COUNTY) River Falls, Wisconsin Personally came before me this _ day of 1999, the above named C. M. Bye, -' Dennis R'. Schultz, and Salr�„ca C. Schultz, to me known to be the pers�edia e l uted the foregoing instrument and ackr �e �?re'�0P�re. N�TAR Notary Public, .57. 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