Loading...
HomeMy WebLinkAbout020-1122-70-000 1 G G 2 0 d c CD c (D o 3 Z v 5 q v' c M M K M O CD o f( o m o v o ~ c a N °C• 0o W n 7 m N 7 m N N ti C O Z o y N N Cl 7 (O -I O 3 cn U1 N O C (D co 7 O ^: 00 W cn D ( D c d u> D a m m (n o• m (n CL co > 0 @ (A W w N3 ° www : !pQ ID V \ O - CD O O � 7 O L W O N C N 2 r O. C) r to CD (D y co 00 U OL W N do 'o 3 ! Q 7 A Z 000 `• Q Cn 3 CO) CO) f/1 ° =r 3 N N N rn o' m N 'o a - O O °� o• Q M a a m (D y CD A A tl ! X �1 0 7 •• (D (D •• z v! o D? I D a? O v O O 0 o o (a (D m �• v t�l m (O N N W n a N d 7 3 7 z CD m (6 (D (O D 2) O Ul _:y: C V1 c v G a a A C) 0 (p N V m m (D m (° z a a a X ° o °o m co y X w z m < J D (D A N Q 3 > O d N n (D N a ( p N N C CL ?m z �`z a o CL CD o N z m .m o - E O 77 O O O OD S 9 x N C a 3. a f a I s' � CD O N O � A I y ti 0 0 CD m oo o O o O 0 C) i- I a CL z AS BUILT SANITARY SYSTEM REPORT OWNER -4 M TOWNSHIP SEC. Z_T� -RdW ADDRESS T/' /f /t 7Yu ST. CROIX COUNTY, WISCONSIN. SUBDIVISION � ^ LOT LOT SIZE 2 PLAN VIEW Distances and dimensions to meet requirements of H63 VF$YTHING WITHIN 100 FEET OF SYSTEM Irdi6atle o thj A ro • 5C L� :– _ BENCHMARK: (Permanent reference Point) Describe: T6 .> [ th � ^',/, � i �( Gas ^.�► :* 7 I` Elevation of vertical reference point: y Slope at site: SEPTIC TANK: Manufacturer Liquid Capacity: G`� Number of rings on cover Tans- manhole cover elevation: z Tank Inlet Elevation: Tank Outlet Elevation: 7 PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; total capacity of distribution lines gallon: size e of per- head_,. gallon per minute horsepower brand name of pump and model number ; Type of warning 3evice HOLDING TANK:. Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: N pits feet diameter feet liquid dept" seepage pit in et pipe - elevation bottom of seepage pit E: evasion feet. SEEPAGE BED SIZE: number (if lines width length7.7tile depth-3C SEEPAGE TRENCH: width length _ PERCOLATION RATE � AREA REQUI D (ri REA INS DATED PLUMBER 0 J B LICENSE NUMBER / w f ArA t� j G L r � N r( C, ta is � T 4 37% G / � / r `dLI I REPORT 01 I NS PLCTION INDI VIDUAL St WAGE SVSTUM s ayl i t a t t y P (1 11 irl'i t `7 S to tt` S v r.) t 4 '.c Alwzl.-RiL 1 v' A Ai I CAo(x Coup t(i I „ rr (, r, n S � -_ . __- +S_- �___.S e c �t.i. a n �f L u � _ _L�__ _ S ub d.i v.i 5 ,i a n - � S4' C C) C) gaffonA Numbers. oA compuAtment,5 1)( A t (I YIcC { nom: W Z 8 ui fdi ng-- — 12% H4 qhwa t( VAMPING ClfAM8ER S. i Z C. gaX 1116 mp Manit6detuteq. ModelI Numbot l(oI.DIN(; TANK Numbeti 1pa fmeytt6 'p a rn,,, (I m C tl At a 44 rl 6 Co Vt. rmn U4 ta vi 1 { c hum: w e tf ulct,�i n 12% 61ope H i g h w a t e A. AliSok'PTION SITE T r en c h (I ki c (I AA o m: L ef f 8 u if,di n g f 2% 5,e o r.) e. Hlighwate-li AlitiOkPTION SITE DIMENSIONS Width o6 tn 1 8 6. t Re(l(i0ted atuo,a 1 1 o6 each Zi n _ 6 t 0('Ptkl o6 Aock 1) v fow tile. 4�1, Numbcrs 06 Depth o6 Aoch, a —tike F to I n ta f f en g th o li n e,6 105 _At Depth o6 tite betow grade 4 Yl 0 A tance. be.twee-n -�.Lope o6 in. pest 100 At b 6.ottptic* on a - -- t Typo 06 Coven: P a p e rs () i i'l 1) 1 M I NS I ON.S o( a �t n or 0(i to (,tv diarnv.4e,Ii t n ev t v —7,r (I � fo W h absokption aAea t Atica ioqu4-�Led I N � III C 7 0 T 1 T L I A I I k o"J'ItT o "o DATE 198 II I1 r I 1 0 VATL 19n 75' 77 PL'B � � State and County State Permit # 16 Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: .5 B. LOCATION: '/4 " ' /4, Section =, T2JN, R E (or) Lot# _ City Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY. *Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY f y Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place, Other (Specify) E. EFFLUENT ISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Line1) Ft. idth Depth Tile depth (top No. of Tren hes Seepage Bed: Length 3 1 _ Width Depth :f I Tile depth (top No. of Line Seepage Pit: Inside Diameter Liquid Depth No. of Seepage Pits Percent slope of land Z, Distance from critical slope 0 WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if othe than present owner: I I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Ce tified Soil Tester, _ NAME e 1 A ' C .i A C.S.T. # S ��— � � �and other information obtained from J 0 " n r (owner /buil _ ,q Plumber's Signature 1 c ,e 3 I y 3 .- Z MP /NIPRSW# � Phone # / 7 Z �. Plumber's Address ° �+� � r to h ",( vr/ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. t E i i m.¢ r E } fi e � i S ' 1 7 r � i _-• � ..... ,— .. � ..... ..... ,�.a a . � _.m m .. � .�� _,..... e � .n ., m —et _ ., e a..., m _ >.� .. ..�.. �. «., m, .,. —... E E c ; E i S , . «,,.. nr E } r e 3 Do Not Write in Space Below OR COUNTY AND STATE DEPARTMENT USE O NLY Date of Application _ — Fees Paid: State County /I.?/ Date Permit Issued /Rejeeted (date) ��_� /— A ff/ Issuing Agent Name Inspection Yes2_1\10 State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 i EH 5 ' . WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH I i P.O. BOX 309 IS P.O. MADISON, WISCONSIN 53701 (n i REPORT ON SOIL BORINGS AND PERCOLATION TESTS 4 % S _6' G Q MAC' LOCATION: Is /4, Section � Ta�N, R ®(orlf�ownship or Municipality Lot No. , Block No. C/4 -�Y�G Ro�A6� Count - / / Subdivision Name y CE \ Owner's Name: Mailing Address: rOk.f' eon ,S s - TYPE OF OCCUPANCY: Residence X No. of Bedrooms __ Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT b DATES OBSERVATIONS MADE: SOIL BORINGS � ?" df! PERCOLATION TESTS 5 O SOIL MAP SHEET d SOIL TYPE 40 -9 /7A 0 SI`�� 1 AWL PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P 1 10�► �� ®rL ,q /�i �� � Gj � � •S P 338" 'y SOIL BORING TESTS TEST TOTAL DEPTH P GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES BSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- I T ,00e. 7 L6" 0., ' 6n A,y Q B— �D ' AlOA -lei 7 j(,'` 8' Irv 0 y L� �'k S41 �Gr.�SB'' S GT • ft B- S i Aidki C- 7 Q6 �' 6n TS /Y" 11VY 4 /Y ".i'4 4 61, PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square eet of-suitable areas. ,jndic� ,to number of square feet of absorption area needed for building type and occupancy. goo Sit, A+' 5!e ) ndicate scale or distances. Give horizontal and vertical reference points. Indicate slope. s -, MeA -f. ' G C/ t G 7R 2 s Q 3 w P c _ d ' r 0 w O n kop r" i To i L7 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) r Certification No. Address t O Name of installer if known .` CST Signature COPY A —LOCAL AUTHORITY j . r \ a. s. i Q� S r- cn. ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Al E Owner 5&VC_ 3 C/ e ;& 7 Pr0W Addres 8 C �ti Wd, �i�C /"To City /State _9Sd J Gt> /S. I : SOD �, Legal Description: _ Lot I J` Block Subdivision/C # �'4�� DG t= `� �N� "vGO� I o5 '/. '/. Sl= Sec. ? , T�N -RAW, Town of {� yl?5'o p -7 000 0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: 7 w � �sc� — i ep 0 o . NE w Tank manufacturer Col Size ST/PC ?.5 / Setback from: House Well PAL � Pump manufacturer V& Model Alarm location Lv , (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: . X 3 '7S Type of system: zS/t Width 3 75' 2 Length Number of Trenches Setback from: House 7lts D Well P/L 9 0 ' Vent to fresh air intake til ff - X00. ' ELEVATION S Z 3 = �o 0 . 7 �' Description of benchmark 3 of t$d s �T Elevation Description of alternate benchmark Elevation ocD sEprrc 1' • m/ A- Building Sewer ST/HT Inlet ST Outle � t PC Inlet PC Bottom Header/Manifold Top of STAW Manhole Cover Distribution Lines (I) �q 1fCa (2) �J 9. 2 z_ ( ) Bottom of System () l rg• / ( ) ' 7. y S ( ) Final Grade () ID 1 2 . s ( ) /0 '2.. D ( ) D ate qg S I 3 076 �/ ate of installation / / Permit number 3 State plan number II Plumber's signature License number 2Z (03 7 5 Date 3 / 1 � f f Inspector Ro b ) Complete plot plan R r 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 I INDICATE NORTH ARROW 0 h / s .h SCALE • /� �� IE ; EX /ST /AJG- _ c NE 5 ¢o Pvc ov fLt'l' Ulbticht & AsaOCiates UA ►� $ /0 I �0 /' y& Private sewage Consultants j_ 4lAy 130 �� �--, os 0-toll Rd. NW 7� Z� O Nudsoa, Wi 54016 �� gl ,NET 1"� g� du ,Wee- P'GT4je p , _____ o -c TOP N NOTrs i sm # f /i i i 3/+/ P► �'''C 00_ y 10 N. Uj ^. NQG(V U�/ I I,�,,I 1 SiDt- coi of X - - -- i 1 1 C/� .PotC r 1 ' y 541a� 13/4 4f I fl frr .�,p �Cba. = ioa.0 D� S ysr • T /O� _ ,O IrIM 4- -rd I / �.� �sT U /Jf' / ot,� �a�cT ovTcfT < 1� �� �a .38 /d S,T"• /02 PO D �v 7So :5 *r . /oil . 3 V ion .1d /o y. 70 0 • 1G�AL. /14C4 qeti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT 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)]. 307(o!o S- Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: BM Description: Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: l - o o4� 3 , " Nee r _�u44a5 S OZp — t /2-Z 7D "6 TANK INFORMATION ELEVATION DATA egg TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic '75 Benchmark q.�G moo& (gyp 1n1 , G l000 A0- t3 - 83`f Gm Aeration Bldg. ewer g� to -1v 102••3 Holding <apw Inlet �•7`>� ID TANK SETBACK INFORMATION (27,111 Outlet (� /b2 oq TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake AJ I LA, Septic NA Dt Bottom rv„ Dosing NA 4 42 ry 9•a c n ,6 8 Aeration NA Dist. Pipe -te "`t­ 64-1 9 e 3 "45 z - 7 99 Holdin Bot. System �►`� /0. 98•dC o-z- 4 7 ?.q PUMP/ SIPHON INFORMATION Final Grade 7.CAI 10/. Manufacturer Demand 6.I e 3¢ /01/.7¢ Model Number GPM V ?•fZ !o/ J TDH Lift Friction System TDH Ft Forcemain Length Dia. hi Dist. To well SOIL AB TION SYSTEM BED RENCH Width Length , No. Of Trenches PIT No. O Inside Dia. uid Depth DIM N 3 7 DIMEN I N SYSTEM TO P / L BLDG WELL LAKE / STREA LEACHING Man SETBACK ture . INFORMATION Type of CHAMBER w Mod umb System ��a� 1( R UNIT DISTRIBUTION SYSTEM rq b1L Distribution Pipe(s) f � x Hole Size Lx Hole Spacing Vent To Air Intake Length Dia. 1 1. Length (0•L Dia. -✓--f— Spacing �b� !e fi 2 r SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over f x ed xx Mulched Bed /Trench Center Trench Ed es ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �?6 rVk+t 1 r 1 14ve_ f x; 541 rev st; rye d can K- --cq V isil e b v / / wt hr /2 . 0- &6e,( -A 144 W &S iii lle4( /,j Ae Seev44 -axk wl rs seer ak&0j'7 &,(m✓e_ awrd4 wl tw -!C "✓e–✓' , 5 MM T4 0 Plan revision required? ❑ Yes W No Use other side for additional information. �J ($ �� L�s�l ? SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION P �X��hi 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 57 C R O 0(_ than 8 vZ x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number 307(� The information you provide may be used by other plej age �y'.{.y� ncy programs El Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. K"t/ p � State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name I . p v S EFFi 5 P Property 1/4, S 7 T 2 q T , N, R I 1 E (or) Propert Owner's Mailing Add -IA..-' Lot Number r S Block Number City, State i �/ • �` Zip Code Phone Number Subdivision Name sis�SM- Number 1J9S1� wt (7t5) £ !E R tt?G -F' PE F BUILDING: (check one) ❑ State Owned ❑ it� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] vlliag of HU D.S" k- p,,r-M y 4 A III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a e ;29 . N J C" oio -tlZ2- 70000 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 ❑ New 2. X 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 Z K g tDL WIA " /N '[ ? 7eie-5" Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Trench S 22 ❑ In- Ground Pressure - ` '' 42 ❑ Pit Privy 13 E] Seepage Pit FiF4e_ B I K -I5 ' :2 V t E � 43 ❑ Vault Privy 14 ❑ System -In -Fill 7 eAjdzl . 0AX0 -- Co a.. LD�.3 �r 12 4' VI. ABSORPTION SYSTEM INFORMATION: - 1 lG Z Z S J* 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 1 6. System Elev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation � 7 � O /� g7' SO Feet 10 !• S Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing c structed Tanks Tanks I GX�rST�I"� Septic Tank or Holding Tank - 750 (cco 1 790 Z ❑ ❑ ❑ ❑ ❑ I ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, 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) MFYMPRSWNo.: Business Phone Number: RDISlel.T M R i 1��f' '2 CO3 7 S 7 15 ' 3 a G• €Il b Plumber's Address (Street, City, State, Zip Code): 655' O . ti�rL Q� • d�" /� _ (J _P-S6 ,0 4f,' IX. COUNTY/ DEPARTMENT USE ONLY T ❑ Disapproved Sanitary Permit Fee (Incl Groundwater ate Issued Issuing Agent Signature (No Stamps) ® Approved ❑ Owner Given Initial I surcharge Fee) / Adverse Determination {� X. CONDITIONS OF APPROVAL / REASON FOR DISAPPROVAL: SB[)6M (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber I F7, , yvE6L qq ql.0 i i c 6 00 :L FC LTL 13�4C dap OvrG-c:" I ecu 7So . I Pa c is 7"_ a ' P °2 � 5,6p7 4- T,tve Cv /'ESA ����� 'PROF vA 10 113 1 •�-, �� o - OF t32- O 1 5' SST T o�O O� I � '�� I �, ► ���'� $ TtZ SO 10 i L I 3 s ysl. r Ito v EAJ 7 ��` t & a$s ue G OOON'tip ts 17 ' \,0 9 F �V '`� _ � 7 �•� �it�3liv�r' � lr� pd�s� ®Ne�� a X40' 5 Sv���yoRs 666° o,,�"'' ce3� X 3rn 2 �v � Ap pp�y . /00 d s U & 6-'5 r &o 7AF4) C5 /p v-4 Lo ��� l o f 7, 50 r Iff N oe 1ve27Z - CA20 55 SEC TioA-) 2lS /�U 6- Iff N 3� O R �• a rMWIM 13 Pi rvate Ne rr ad• o �g ' 6 Sor wrs 3 3 t Wisconsin. Department of Industry SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of Division of Safety and Buildings _ in accordance with s. ILHR 83.09, Wis. . Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5 Gp�r X include, but not limited to: vertical and horizontal reference point t o n and �\ percent slope, scale or dimensions, north arrow, andllogalon and earest rod q. Parcel I.D. # O D • //L.Z 7 DODO APPLICANT INFORMATION - Please pilot 611 In1`d ki� n.* � ' t- Re vi wed by Date CY Personal information you provide may be used for secondar} pur�pses IN , 1 5.04 (1) ( �. Property Owner 1� i ZONINGOFFI C (Prg*q, ovation vt. of S9 1/4 S, 1 /4,S 7 T 2 ,N,R �/ E (oro Property Owner's Mailing Address jzf# Block# Subd. Name of E6M# 3 SS e* 4T•Tk LX • t S RiAG6 City State Zip Code Phone Number Nearest Road to; 1 9 7 /S) 3 V6 ',y(o ❑ City V•llage� ["Town Y('/I'W rrl_ V —IA-) . ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building replacement ❑ Public or commercial -Describe: A JA R = tiD ti Code derived daily flow gpd 2 3 5 0 2 Recommended design loading rate bed, gpde a trench, gpd/ft Absorption area required , _ bed, It trench, ft Maximum design loading rate Abed, gpd/O gpd/ft Recommended infiltration surface elevation(s) See- � _ • 3 ft (as referred to site plan benchmark) , 14 Additional design /site considerations exl:s l;o6 -' •W..ST I • IV LODF' r LSD% es Parent material Flood plain elevation, if applicable S = Suitable for system I � Conv ntional , Moo In -Grou ressure AT Syste 'n Fill Holding Tank U= Unsuitable for system [!Is ❑ U u s ❑ U L7 S❑ U E r ❑ U [�] S❑ U ❑ S SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots U in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ' , � 10YA 3/3 .51Z- Ar* e A/* die .2 f • z ; . Z 7• z7 io 3 /�f Ground -- S/ � 2 -fs e /s* 6e c� oaf • s /Q /L S� n►+7�i S' . L ;. 3 �•3 y � elegy, ft. - 7 ;. Depth to limiting factor Remarks: Boring # O. /0 Ye 3 � 2:.. YAP Y/� �� S -- . z . r8 �© 9 s D, S Ground Cr elev. Depth to limiting � fa for in. Remarks: CST Name (Please Print) Signature Telephone No. R - 7/5 3 96 a sLme r lt4se t- Address Date CST Number }f� !S - `t CST - xg92..— Wlbricht $ Pctvate Sewage ConsultMts // 855 O'Neil Rd. �1` �.rlST7''V G — 's! s7 >�'K 44w /j_ Hudson, Wis. 64016 AlEpr 1,0 Tyr �� � • �rs� 31•9 st�• kA- sy9rsxi 6e - .1 � L°A.5 ts- YAtd s u V. �'� 3' K 5 Goy �iFG,�. - 7�� �ti T,�ir�ivG— /2- i PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.01 440 IS �� ` IO�F 112-1 7 D a 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 s 0 , 7 elev. Depth to limiting fa for y �in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor ' Remarks: Boring # 4C , Ground " elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) q 1.0 yy �,PMs / 6w, � i �� 6 67 � ,tip �,�►�� • � w I Es ERL. /1 p 2 P i Ts R , to eS 3/ 5 D l I f3Z ! 15 ° 15' s ET : To of so (00 Cu 7 ot= Fo y y Rs y foa ( Ip "c?o r ) 36%5 ohs r Lo ApPP�y , /ao -a ' 3of 3 �0eV 7 AEAW -c. �l3 9 7, 50 p y ST. CROIX COUNTY ZONING OFFICE 3 Q3 e , 4 , j - MLy 4 ^ - � H oosd.o I CERTIFICATION STATEMENT 4. FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the T ROY SErFI,064- residence located at: S 1/4, ` 1/4, Sec. ? , T 2 ' 1 N, R 11 W, Town of t4V�S�.v Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced �7 Did flow back occur from absorption system? Yes No (if no, skip S next line) Approximate volume or length of time: gallons .3D minutes Capacity: /CfV29 9 - W . Construction: Prefab Concrete '� Steel Other Manufacurer (if known) : Cd 4> ,07(Z Age of Tank ( if known) : Iq e 7.1L -B e ( j ,91 3EP-T — ?R- 3 R t C 6 , T - " (Signature) (Name) Please Print M,45re ,Olv y41c -Z z C.0 3 - 7 5 (Title) (License Number) tq'R'F (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) --- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspection opening over outtlle—t baffle). Name RoBEP- � 2 tlbl�IQ4 I Signature MP /MPRS 5/88 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 7� Z ow 7' ,Po ner /.iffier Y , Mailing Address 303 X�4 / ^ TG,V M{ I Ple, C�/ %„S' • S �O /gyp Property Address sue (Verification required from Planning Department for new construction) City /State b ZO• 11 .2 2 -7opo0 Y Parcel Identification Number LEGAL DESCRIPTION G Property Location s G '/4, S� '/4, Sec. 7 , T 2 '` N -R W, Town of �A-!� /� �iDG� Subdivision Lot # �S Certified Survey Map # , Volume , Page # Warranty Deed # s q 0 Z0 Volume 1 S Page # �� 1 Spec house ❑ es [-no Lot lines identifiable � � Y le [H'yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set,b)t th"epartment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that ur se0ti 'system s been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of thre expifiation date. SIGNATURE OF APL DATE OWNER CERTI�ATI I (we) ce y that all s tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the a esc d abo e, by irtue of a warranty deed recorded in Register of Deeds Office. 3 / �Se SIG OF A LICANT DATE * * * * ** Any information that is mis- epresented 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 WARRANTY DEED Document Number ,, _ 1 75 pv M I G Return Address i MAY 1 f p 11:45 �A. n Parcel I.D. Number: 020 -11: - -70 —� Thomas J. Hogg and Sharon L. Hogg, husband and wife, conveys and warrants to Troy D. Seffinga and Theresa L. Seffinga, husband and wife, the following described real estate in St. Croix; County. State of Wisconsin: (See Attached Exhibit "A ") A t� S3 °' This is homestead property. S ' FEE Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day )f April, 1996. (SEAL) Q�L' /U" r SEAL) Thomas J. Hogg a Sharon L. Hogg ACKNOWLEDGMENT STATE OF WISCONSIN ) Ss J{ G� COUNTY ) Personally came before me this ° / _ day of _, 1996, the above named Thomas J. Hogg and Sharon L. Hogg, husband and wife, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. c F� No tar ublic .� County, WI ;TAT^ . (J A A 175 PA c , EXHIBIT "A" Lot 15, Eagle Pidgce, Town of Hudson, St. Croix County, Wirccnsin, Except that part described ns follows: Conmencinq at SE corner of said Lot 15; thence S88 °10'30 "W along South line of said Lot 15, 104.74 feat to point of teginning; thence continuing S88'10 11 W along said South lire of said Lot 15, 335.35 feet; ther.ce N66 0 12'40 "F: 61.50 foot; thenca ,97'0!5' 11 "F. 279.28 feet to point of beginning. TOGETHER WIT AND SUBJECT TO a non- oxclusivc easement for ingress and egress and utilities lying 33 feet on each side of, measured it radial right angles to, the Following described centerline of said easnm.ent: P,eginning at intersection of c.,mmon boundary line between Lots 14 and 15, .15 shown on Plat of Eagle Ridge Subdivision with Ely right of way l:ne of public road °-hown as Xrattley Lane on said Plat; thence N66 1 12 1 40 11 R 234.04 feet along a: common boundary line betsYeen Lots 14 and 15; thence continuing 56 °12.'40 "E 61.50 feet; thence S97o06'i1'E 70.00 feet to point of germination of said easement centerline. Said na:nrrent shall not extend further Fly than a line bearing N2'33'49 "E 33.CO feet from said point of termination, and a line bea i;: S2'53 "W 33.00 fee~_i from said point of termination. i� MOP, 7 1 CI r ts[11 t1 f WIL FY S 11 L WA" K FRX NO. 61243UU212 P.02 IN OF HUDSON. S T CROIX COUNTY WI SCE y 4 . e A i t] N ' N 87 E 440.18 W 'P ' 340.25' 4S�Q4 4L 50 95. 116,0, --. y • a� O Ilk 15 �. 1.01 ACRES ~ aC} n' 1.22 ACRES � Z90 AC RES l zo t�- ��.� 2�.• - � q. N88 °19'30'E 440.09 4�0 2 •A `V/"� — ?.'�� 97.19 ' • 238.16 104.74 '�- 3.74 ACRES 3 LL 1.97 ACRES 455 2g a 324 99 , -12 '3p J r . fJ �`S L09 ACRES w � tA f xrg'� ry�g. * O' " 29 a.51rj' N ed� 2 S• M 6r _/N. 'A 4R n tDae I