Loading...
HomeMy WebLinkAbout040-1253-70-000 o I o p ul N I � I 0 I N H b .:a .a z N o z LL Q j i Q I 3 _ 1 z rn � c v o z co z a m in oz;* c 1 N H m Q a) z I 7 = cu E N q C •}V � O � O a 0 o w a v_ 0 o za: z o N z O c N E F- N cm R a) I O L .. C ,..'. CO a a EI w N O co *a § 0 0 0 0. LL Z o •►w 3aaa CL o U J U rn rn aNi _ LO m is _ o °.. O O "1 N U O O t :a j O m o aNi 0) � v O O O 2 C O M O O E ® CQ Tr" FO M C 21, C n- O O V (D r LO O O U Cl) C 6 r N N W N ~ C N G 00 N 1� Q CO N y o I U co o :. z Y cn � m •io i ', £ a E 0 40 L , I ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address 3 /1 City /State e w y w IS - Legal Description: Lot 9 7 Block Subdivision/CSM # �� v' ' /a, Sec., T_,7^-RAW, Town of ,... PIN # y 4c SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Lax Size ST/PC / Setback from: House S Well P/L r 7 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 `- 75 Trenches Z Type of sys Width .� G Length Number of • Yp Y . Setback from: House 1 / -2- Well P/L _ i Vent to fresh air intake r Y Z. ELEVATIONS benchmark 7 - Pe t 7 " �t. ` s Elevation 167 c GE' )Description •f ti T� c Description of alternate benchmark _, , , lf' ✓J' 5 1 Elevation / ?- N Building Sewer /0 � O ST/HT Inlet & -2 Cf ST Outlet 0/ E PC Inlet — PC Bottom - Header/Manifold /Ca f 0 1-' Top of ST/PC Manhole Cover /G' L/- � Distribution Lines () ! i • 3 () c1 e( Y 3 ( ) Bottom of System Final Grade Date of installation �6� y' �Permit number 5 State plan number Plumber's signature r� icense number 27 � Date Inspector Complete plot plan � y � •S ' .l \n • � '� � S w N ° S " \� - � --- � �^..ar� D 3 '� ,�, �� � a— c� 1, C1 ``" � �° � � � � �� � � `� � � v � n �j � �n o '' 3 � � � � M C---�s a E _ _ '-�' � '1 1 � t a t 1 y: �� ' . � �' .,� � � l '� .� �� � � Asconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermi IX Personal information you rovice may be used for secondary purposes [Privacy La s.15.04 (1)(m)] 3 3 8 8 8 7 7 3 PerrrutrHild@C'S,�La; "GARY E] Cit T W V jllage Town of: State Plan ID No.: CST BM Elev.; j{{ insp. BM Elev.: BM Description: KK YY Parcel Tax No.: � 040- 1253 -70 -000 r . TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �.t O Benchmark /0" 1611, 6/ Dosing 4-11, awl - 3 , 1 01 l e l. 1� Aeration Bldg. Sewer �;�3 �o55 - . a z Holding /i�G Inlet �.4 fo2, �a TANK SETBACK INFORMATION Sn/ C Outlet $. Y6 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic S'p r a6 0 — NA Dt Bottom Dosing Header / Man. E 9• Z� I O I Aeration NA Dist. Pipe A T� I (o I • ® 3 .2 ; 44 V1 .8 Holding Bot. System w it. ct3 qB. 31 16 p O PUMP/ SIPHON INFORMATION Final Grade dJ,d,'� I o 16 6 Manu actur Demand, 10 4. $© Model Number TDH Lift Fri stem TDH Ft ForcemaKfLength Dia. Dist. ell SOIL ABSORPTION SYSTEM (z H" TREN width Length t%s PIT No. Of Pits Inside Dia. Liquid Depth DIME ION DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufactur SETBACK er: / ,�, v� ro !� s.wb✓ INFORMATION T� ��� 3 peO 3D 2 I CHAMBER Model Numper. System: d� >/m) O UNIT ,`G u = ff DISTRIBUTION SYSTEM Header /Manifold „ Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake Length Dia. Len Dia. Spacing U 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 19.28.19.133 ,NW,SE 319 BIRKDALE CT —TROY VILLAGE LOT 87 Plan revision required? ❑ Yes )q No Use other side for additional information. O I o 3 OD r 6 Inspector's Signature Cert. No. SBD -6710 (R.3/97) Date Safety and Buildings Division V SC.O/1S %11 SANITARY PERMIT APPLICATION . � Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County v� +�� `, than 81/2 x 11 inches in size. 7 , • See reverse side for instructions for completing this application State Sanitaryfermit Nu� The information you provide may be used b other g ernment a9p programs Check if revision to previous applica[ion [Privacy Law, s. 15.04 (1) (m)]. (� ALEASkEd 1-C 1 l.Q(J Sta te Plan I.D. Number I. APPLI ATI N INFORMATI N - RINT ALL INF RMATI N Property Owner Name Property cation /kk/1/4:W 1/4, S l C 1 T ;? f! N, R /1 E (or)o Propert Ow Owner� ailing Address Lot Number_ Block Number s c/ * 7 State ip Code Phone Number Subdivision Name or CSM Number # h- I Ssor` (an ) yl'- 7-et i4 /r 11. TYPE F BUILDING: (check one) ❑ State Owned [] it � Near st Road ❑ Public 1 or 2 Family Dwelling VII age - No. of bedrooms own of 7 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 Y 6 — l 1 '" 7a 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____ _________TankOnly______________ Existing System ________ E xisting B) PIPA Sanitary Permit was previously issued. Permit Number 33 ; -g 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure _ 42 ❑ Pit Privy 13 ❑ Seepage Pit ..,�c�.., 4 ❑ VaulkPrivy 14 ❑ System -In -Fill �. ,?s { ��✓� f �'" �� 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 /s ft.) (Min. /inch) c/P!�' 4 It Etevat,2, 4 Q"o 7 3"t;; 7 s �s - t p' eet VII. TANK Capacit in gall Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Co Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or M IITg -rank e 4 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum s�N / ame: (Pz't) 7 Plumber's S at re: (No Stamps) MP /MPRSW No.: Business Phone Number: f Plumber's Address (Street, ty, State, Zip Code)<`.O" c C7 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sa nitary Fee (Includes Groundwater ate tt sue Issuing ge tSig twe oStamps) Approved Surcharge Fee) / ❑Owner Given Initial /pl Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: S80-6M (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Pluadw Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue I n 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 154 than 8 1/2 x 11 inches in size. v ` • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ check it revision to previous app r Rion (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N - - � Property Owner Name Propel �s ation /4 7 1/4, 5 f C( T ; N, R tJ E (o W Property Owner's Mailing Ad ress If Lot Number Block Number v P y, State Zip Code Phone Number Subdivisi n Name or CSM Number 11. F B 1 IN G: (check one) C] State Owned ❑ I Nearest Road V ❑ VIIIage y Public 1 or 2 Famil Dwellin - No. of bedrooms 7" Town OF C` III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 0 q� _ (;?_� ! w 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 WNew 2 ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an ______System________System __Tank Only Existing System ________ Extstln�5ystem 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 RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 9i t i 43 ❑ Vault Priv 14 ❑ System -In -Fill r Al " 2 - 1 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate. 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Feet rtr�/ , pFeet Capacity "- VII TANK in g allon s Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App New Existin strutted Tanks Tanks / Septic Tank /��� l Lt/ �G S�(� ❑ ❑ ❑ El 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ 1:1 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 2 7(S- 3,-/00/ Plumber's Address (Street, City, State, ZI p Code T.. `' IX. OUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin gen Signature (No Stamps) `. - Approved ❑ Surcharge Fee) Owner Given Initial ��OZS G Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) 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 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 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. T f in bin ry Check on on n complete of bedrooms if 1 r 2 mil D Type o building being served. C c y e and p # b oo s o Family welling. 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 D ILHR' 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. �. T . _ - . __ ._� -, •-._. _ � tom'... i Yl 3 � 6 , - 1 , CD � 1 ,Br M 1 v �7 s I oy r __ - -- - - - - - -- - -- - l__ I I 1 I S • �o ' I I { i � - I - - - i1 1I U 4 I � I r 1 { ; I 1 I i 1 I t I 1 ! : : C9 _ , i I 1 i I _ I C r I I I i , I . 1 ...... I : _ y 1 � y ff f I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 0 Labor and Human Relations Division Safety & Buildngs 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 S'>7- GVLO\X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 O� � "Z53 -� O APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION NIEWD BY DATE tl �b alb PROPERTY OWNER: G P�XL`-t p PkEK PROPERTY LOCATION C/ p M C bcih ►r« D �. '5 691.9T MW 1/4 SE 1/4,S 1° T Z$ ,N,R t of E ( W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # vti� 6 o 1 S C"L A V t_ - 8 - 1 — Two V t LL (S Z AND CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN rREST ROAD lt�UETR GV4Cr - 1tlGtfiS,ImN SSO - ) 6 (6S 1) WSS_ Sl4.Z 2�cDV1�� e.T (�Q New Construction Use [x] Residential/ Number of bedrooms 4 [ ] Addition to existing building [) Replacement [ ] Public or commercial describe Code derived daily flow 60 o gpd Recommended design loading rate • 1 bed, gpd/ft trench, gpd/ft Absorption area required g S8 bed, ft - 1 S O trench, ft Maximum design loading rate bed, gpd /ft • `b trench, gpd/9 Recommended infiltration surface elevation(s) S ZIE­ P ►rtG F '-b it (as referred to site plan benchmark) Additional design/ site considerations R.'C wi-t r-A t'_1•►D S kFl:� Pf4 6 E 3 Parent material P ly OUTkj f\S � Flood plain elevation, if applicable ►y A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT-GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem Q S OU I RIS OU I 23S OU 0S 11 0S CRU OS W U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Z �, 1. 3 U o -vZ \Ott s 1 e w►�h k� Z Vi - 3 1 \1 3 S W\ > C""j Ground 3 3 778 ! `1 R- Y/ L — S ©s elev. \ 1 ;4 _O ft Depth to limiting Ck factor Remarks: Boring # , 2 Z Z 9 —z.f,- Z.S�2 3! � i s � s wl 1 e►ti — =, I .� i Ground 3 -83 ► � z V w, _ S O S ` 1 elev. / �' Qe-B Depth to limiting, fact 2 rye Qk Remarks: T Name: — Please Print Phone: "' =` ;? �� j Arthur L. We erer 715 -42 y ress: ! egerer So'1 Testing,& Design Service - P.O. Box 74 River Falls,WI 54022 i1 Signature: Date: CST Number: f 11- 2_Z= -9b M00576 PROPERTYOWNER Ck-11 PE:2 SOIL DESCRIPTION REPORT Page?- of ' 3 PARCEL I.D. #t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou clay Roots GPD /ft in. M unsell Qu. Sz. Cunt Color Gr. Sz. Sh. Bed rends 3 �o4� Z! z - s ' Z �F-s� vvti�Fl s - • S `v N z Cl -18 3/y — s 1 %-sb�L lm ���- cl v _ • y .s Ground 3 1$ -log tb elev. 1 k�•O ft. Depth to limiting I factor k _ Remarks: Boring # `� Z �o - -> • s � tz 3 f — l s o s >� 1 �w — • � _ . � 3 2S_Io lO`1R ��� S CD 3 y» Ground elev. ' N ft. Depth to limiting l3' factor > tOZ k Remarks: Boring # o- �z �o�c vL z-l. z s 1 � Z "� sb� wl`�- e-w -- : s `• . �, S Z Vz - - i IZ L y m I �,, — :� ' • �a. 3 v `.t R- V/6 - S d s M Ground A -118 t _ ! • � elev. M4. o ft. i Depth to limiting - factor = > La ! _ Remarks: Boring # k 13 I k Ground elev. ft. Depth to limiting factor Remarks: cnn oa , jnin nr.n-, PLOT PLA Page 3 of 3 SCALE 1 "= 30' S"Rz -�T P?M R Ls3 � � � I s• z s l ��� � � I •�� �� � � �'�° ° l oo 7 b l J 2b L I I J r C3M1� -2. j I3 � I ll�� I I p �L.ggl9 I Rl- �L'ttivr�„� Vi x'11 K 44 n O I I II � I (Ir a J� Sol, 8 ►_'I Ll �n \ �vCE' Pual \ \ L3 �..,100.0� ot.11bP oP 1'Iplfl. G1u� UGit�T PosT. - -- i %r W q ci S _ `RI 1'V'LGN a PftcLYy St D�JI�vD� L�Ci. -4 CLLR W1 B �TR.S F1�tz.E (Z � N1 w► ��� , 11�.� CAS Rl � E A 'F �llvlhlUWt OF Z4y ) jM' ( 715 ) 425 -0165 1400576 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 8 Buildngs in accord with ILHR 83.05, Wi Adm. Code COUNTY S'r - c-R0 kx Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 014 O- \ZS3 - O APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWEDBY DATE I�f o(e PROPERTY OWNER: G PC\P -r p PkM PROPERTY LOCATION C./ p "C 'ZQ" r _ b *Zii l 60W. L N W 1/4 SE 1 /4,S 1°l T Z ,N,R 1 E( W PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR CSM # 60us A\) E. 8 I — � VILL G Z- K& CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN rREST ROAD lt�UUR GRO\E k*1GWrR, IAN SSO�6 (� I) ySS. 5142 R�D�LIE 0-T. K New Construction Use pq Residential / Number of bedrooms 4 [ J Addition to existing building ( J Replacement [ J Public or commercial describe Code derived daily flow 60 g gpd Recommended design loading rate - bed, gpd1ft -9) trench, gpd1 t Absorption area required `R S$ bed, 11 - 15 t3 trench, ft Mapmum design loading rate bed, gpd/ft • `b trench, gpo1ft Recommended infiltration surface elevation(s) S 0E- p IE 3 ft (as referred to site plan benchmark) Additional design/ site considerations REZ4" m kffS.3D S C� Pfti ti F 3 Parent material Flood plain elevation, if applicable ►v A ft S = Suitable for System CONVe4nONAL I MOUND IN GROUND PRESSURE AT - GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem 42 S U 0S ❑ U ®S ❑ U 0S ❑ U ❑ S CRU ❑ S Q U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cor>sistence Bw - daty Roots GPD /ft in. Munsell Qu, Sz. Con, Color Gr. Sz. Sh. Bed ITrench o -lZ v Z z �Z -3Y �.$`i►Z 3 1 l/ �S t) Sg Yvi C �'j — • . �' Ground 3 3 Y_77 S l0 `1 R- V I L S ©s elev. \, .O It Depth to limiting factor Remarks: Boring # . I 3 - s3 I o`uZ k1k - S O Sg Ground elev. g2-5- n Depth to limiting' factor Remarks: CST Name.— Please Print Plane: Arthur L. We erer 715- 425 -0165 i Or egerer So'1 Testing,& Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: Date: _ �Z CST Number: 1 M00576 PROPERTYOWNER -I.WpER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour�y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rend . � o - 9 l 0`� fit.. z. l z. — s ' Z �-s b v►'�'�'h � c-S - . S : 1, z q -If3 �•s�rcZ Sty — s) eabk m C • y -s Ground 3 1 4-)0b t b l i R V% — S U s 9 1v► - • "1 ►:� elev. ` •G ft. Depth to i limiting factor > Remarks: Boring # o -t� lo�t\Z zl z s i t Z'Fs�,l� vn�� 0- w Z �b ZS z.s�m. 'Il — Va o s m 1 �w — •`� -� Ground 3 23 -1 o z. elev. ° Fl. S ft. Depth to limiting factor - > tOZ Remarks: Boring # i o - kU t vt- z-L S 1 Z >n s bl z S I �Z - 30 - 1 - rz 31 y n 3 1 3b -\\ S t rz . V/U - S c� s 0 , M I — --1 . Ground elev. 1 0.1, O ft. Depth to limiting i factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: cnn 01711A I nr n'" PLOT PLAN Page 3 of 3 SCALE V'= 30' - - - -- -Z QlR.ttibfvk —Q C.OUV -T Po sT 3 � -tj 0 I quo o Lo a h Ir I I -) �Azt svv BED Pfi LVdT - 2-S ' PV4M `MJ E.,GM o h „�Q D I ( r I I �' Sob Z o • Ila lO-W dY`•lt�l - T�.10 OtJ SUP OF ,�t l . GS�s�ri1 L.IG� osT . 1 8 - Rtka 3' x Is Lolh C- yw -11 s t DQ.�1l�D LAC t� Cl�t -R w! B QTR s t�tz C� CZ� yj ail evfl� 'F'� l � lWl vw� of 2-4 O cl�– Z$ -53� c715 ) 4 ?5 —o165 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design 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 eference point (BM), direction and St . C roix percent slope, scale or dimensions, north a wt; end location and distance to nearest road. Parcel LD.# APPLICANT INFORMATION -Ole fiq "11 inform 'on, Reviewed By Date r Personal information you provide may bo u 1t lsecond Privacy l aw . 15.04 (1) (m)). Property Owner <r; + Property Location Continental Development ;`' �r 0 r -.•., Govt. Lot - NW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address - �3_ (,ROIX °b Lot # Block # I Subd. Name or CSM# 12301 Central Avenue NE - tt1�230 CC�s��1TY �`�� 87 Troy Village Second Addition city Stat 2 C� eG ,.;��. ❑ City [❑ Village Town Nearest Road Minneapolis MN , ' " f / Troy Birkdale Court L/�Sj New Construction Use: Z Resi er of bedrooms 4 j Addition to existing building Replacement D Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate •7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 857 bed, f1 750 trench, ft' Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar Additional design / site consideration I Parent material Loess Over Glacial 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 S❑ U N S U N S❑ U I ® S❑ U ❑ S NU ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/f 2 Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed ! Trench 1 1 0 -10 10yr3 /2 - A 2msbk mfr cw 2m .5 .6 r� c 2 10 -23 10yr3 /4 - is lmgr mvfr cw lm X 6 Ground 3 23 -38 7.5yr4/6 - gcs osg ml cw - .7 .8 elev 109.06 ft 4 1 38 - 110 1 7.5yr6/4 I s I osg I ml - - .7 .8 Depth to limiting factor >110" Remarks: 2 1 0 -10 10yr3 /2 - sl 2msbk mfr cw 2m .5 .6 2 10 -26 10yr3 /4 - is lmgr mvfr cw lm • .5 ' $ 6 % L � Ground 3 26 -100 7.5yr6/4 - s osg nl - - 7 8 elev 106.63 ft Depth to limiting factor >100 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson `� --� 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 1/30/98 MO2605 10 PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL LD.# Environmental By Desi Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. Bed Trench 3 1 0 -15 10yr3 /2 - sl 2msbk mfr Cw 2m .5 .6 2 15 -34 10yr3 /4 - is lmgr mvfr Cw lm .5 .6 TG� Ground elev 3 34 -100 7.5yr6/4 - s osg ml - - .7 .8 108.35 ft Depth to limiting factor >100 Remarks: 4 1 0 - 12 10yr3 /2 - sl 2msbk mfr Cw 2m .5 .6 l Ch1 2 12 -28 10yr3 /4 - is lmgr mvfr ew lm '� .5 $ .6 Ground elev 3 28 -100 7.5yr6/4 - s osg m1 - - .7 .8 110.4 ft Depth to limiting factor >100„ Remarks: 5 1 0 -11 10yr3 /2 - sl 2msbk mfr cw 2m .5 .6 o c—) 2 11 -33 10yr3/4 - 1s lmgr mvfr Cw lm ��.5 ".6 Ground elev 3 33 -100 7.5yr6/4 - s osg ml - - 7 .8 107.95 ft Depth to limiting factor >100" Remarks: Ground elev Depth to limiting factor Remarks: E BY DE 51GN 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: NW'/, NW/, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 87 SUBDIVISION: TROY VILLAGE 2 ADDITION '� 7S f P gq t 3g g � a �' s� $GALE 1 ” =40 Tom Nelson BM 1 West Line Post elev. 100' cs tm o2605 BM 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND • OWNERSHIP CERTIFICATION FORM Owner/Buyer Y I c D c4 ' ,V A i) I 11 0- "'e Mailing Address G y 15 L a A V Q- - Property Address ca u (Verification required from Planning Department for new construction City /State _ fi v w s 5 �`� Parcel Identification Number G 9 Q 12 5 3 - 7 0 LEGAL DESCRIPTION Property Location iJ A/ '/4, '/4, Sec. _ ft , , T 2 $ N -R 1 W, Town of T r �T Subdivision "` k , Lot # 27 � v � �-� �/ i l � ay, � 2 - �a c� � t�U �� Certified Survey Map # , Volume , Page # Warranty Deed # i�7� �3 Volume Page # G Spec house ❑ yes 9 no Lot lines identifiable ® 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 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 da f the three year expiration date. SIGNATURE OF PPLICANT 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 erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ' ATE SIGNATURE O PLICANT • * * * * ** 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 s s GI3 1111 1359wir 51.11E LIAII r ` !) `r I�CN ,Irl F(40.1 Z — 1996 POCUNIUNi No. `� _ WA11tiA111Y DEED - 'Troy I)e v e i o ppi (I Nt rorporation, a Mitr rsut. torioratioi raIitoc _ _._ ! f R tTS1Ll-R OFFICE - - - -- -- - - -- - 5T. CROIX CO., wt rortvC Y'• nf1 warfants Io _.. -- _ -- _ -- Qi6 "iti fur Rjgt, t . 6 a Gary Edwin Clipper and Leslie Jean Clipper, SEP 2 4 1998 � husband and wife + 9:00 ' Il,n Inlhn•,a +q ri c[i abed real eaate in '� t . _ C roix Stain of '.ViSCr»rSirt -- - - -- fTf TI /ntJ -..--- - -- - -- - int 87 of thrt Plat of Trnl• Village in the Town of Gary and Leslie Clipper Troy, St. Croix County, Wisconsin. 14927 Wilds Parkway fitbjec.t to TTr'clar.a'.ions of CoVrnants, Co1,rlitirms Prior Lake, MN 55 and Restriction for Troy Village, record -d io - - -_ - - - Vol. 1241, Page 7 a: thx-. No. 9551961, and - - -- - - -- 011(":! i)CClRra01h11 OE (:r)l f COiir':rA Ct7VE'llatltf;, r'arr I Idenlilirnlprt Number 1PIN): Conditions an'l Easrment.s, recordedAtt Vol. 1211, F`nye 301, as ioc. No. 5515 all . s appearing in the office of the Rrgist.er of Derds for St. Croix Comlt.y, Wisconsin, and Sur -1i oth-r easements, reservations, rnsLrietion-, and reservations of record, or in its( and obligations contained in the Purchase Agreement for this lot. �R VSFER ( I FEE I' t _-iS not .. -_ _._ IL;mn.ln,ntp +nl•n+ty - ( I ; F><erl In Yo'�irn.HinS_ - nat'd it 23rd do r,t Se temper 19 gR L.L` r�tc ._i /� -- ISEAL) -- - -- — — - -_— - - - "— (SE AE) - _ _ I Kathv M. Co , Vice Presid(?nt 1 Troy 1)0velo1 ment Corporation - R ( - - - - -- - - -- - -- - - (-;VAI.l — — - -- -- - _ -_ — — - - -_ (SEAL) AUTIIENiICA110N ACKNOWLfIJGmFNT ' \i T\T \'F,SOTA gign.ihur(') ---- - -- - -- - - -- -- S 1A1 E SE'��PJF -1�1 } SS aulhe++licalcd ibis day ni - . -_ -- _ _ —. 1O _ r Frcnnnity ca•nn before r his 23rd rt.iv of September _ Ihq At•nve named Kathy M. 'Coftk, Vice PrESldPllt Troy De_velopmenL _Corporation IIItr nlr.tnF91 S IAIE PAfI or .JI` — __ _ _ _ _ 1 + n e ,, +n h tl n rnr nn _ _ -. -- who ernruted the h 706 Ili WiS `;tnl�) f seas +u indnnnnf f arnkarkr.owledge the carne. - IU M11C fil . !tf'it VjAq .(lore - 1 (if PPOY UEVELOI MEINT COP PO _•.:'70N Narcv '.. ^lift fJnlnry f'+ +Jc An (` 4u.n!rnna n,ay t.n iiillinit4ntnl or acHnpv.ln<hJ ^d. fr ^Ili are net My f�or•.n�i is pefrna +tent. (If not, state — pfration T dIln aTl? -:arV 31 ' k tiln (10111 rtry tlr rte nP r s 1 NIr M.l� Srnrr rt nr Pn ,''N ,,.. •n, F N --LIFT 'Vii(3ry Puc IC 1?I ^eSG13 ANOKA COUNTY ".ly Comr Iss;or, Exor.'e; .'- 20, N 0 8 °00' „� 44 1.7 1 61.75 , E 427,66 \ O � M „ZZ 1Z 265.91' \ � iii -• � ;0 v2 OW 4• Oo --IC - - - - - -- •�� 2 Z pw� 2 p(0 O / I r $° �° D '4 0) 0 0)w 00 1D g V�00 nN O$ \ m I U1 Zr ��$ m ;0. \ \ 100 O (.4 N 000 o yo n tr I I \ rn Z�0 N 14 0 p , V \ c I 2 38.3 � f 1� vot 306, E I N 00 °00' 00" E �� �•• °' 1'� 1 00 I I 186.04' 06„ N 00 0 00 ' 00" E 196.64' �'' •°� c O N �� . t — �; 46' E 71.22' 125.42' Z 00 0 \ \` o, 2 $° n N t� z 0) m 1 7— p � � (A 0 1 GJ .v O z gi N N 02 °00' 00" 00 D° i� v1 i$ �� - oi . • �' CO N p O� 261.30' e t � (.I 0) t 00 � I$ () • I rn . rr, ((A t O t rn o N t - — •� 2 0 - - .r - - - �•� �N � 14 >> , „ M * I gyp. 6z azii 14 00 " E \ - �- - S 02 °00' 00" W 285.30' 2 �o• _ ST. ANDREWS DRIVE - - ,6z N N 02 0 00' 00" E 285.30' 10 �-- 9i► 6� g �► 145.30' 140.00' £S 00 L -- cD W Z CA p Z D� W ...� � � z � � �W s m� `° (p''ct`'n w� r°v� `'��; o �, �$ o ( n �° OD OJO S s mss, g DN cog > Ln g Np 0) g � 4 cnr rn nN � �tn 8 yN `8 DN o w m 0 in N ' s fn 144.91' _ 134 140.00' 107.27' ' ;l