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HomeMy WebLinkAbout020-1322-30-000 8�;o'. ST. CROIX COUNTY TONING DEPART AS BUILT SANITARY REPORT \ \ Owner OC ! ` Address 4� r z City /State Y' �1� �, z c� N } ax g / � L Legal Description: % / - Z \1 Lot ,Z Block Subdivision/CSM # A,-- >y ,4 „,�x—s `' Sec. / , T��N -R / Town of 7� 5� PIN # & -4, o SEPTIC TANK — DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size STRC from: House 2 7 Weller P/L Y.Z Pump manufacturer Model o C//Y' Alarm location ,/ I (HOLDING TANKS ONLY) Setbacks: Service road Vent to fires r intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: & Width /->— Length Number of Trenches Setback from: House _;7 Well P/L 7-1 ” Vent to fresh air intake ELEVATIONS Description of benchmark �cP �el Elevation Description of alternate benchmar Elevation Building Sewer J �/ ST/HT Inlet ST Outlet- F7. / PC Inlet PC Bottom. S Header/Manifold Top of ST/PC Manhole Cover T ' ''o� Distribu fi J � 7 ( ) ( ) Bottom of System Final Grade ( ) ( ) ) Date of installatiow /G pPf Permit nu ber �/ 5 State plan number — Plumber's signature g License number 'z L /l Ya Date /0 /�i/ ef Inspector complctc plot plan – NOTICE: Please provide the following: _ cvTT l e F> — — • A plan view sketch showing everything within 100 feet of the system. 4 7-,F D a • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. Q PLAN VIE f � r r Ind � ilia wFLG Per fcit LAE7 / "= 30 / INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count bT. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitagrPe,�r�iiLl�o.: Personal information you provice may be used for secondary purposes [Privacy w, 6.15.04 (1)(m)]. 3117yytt�� Permit Holder's Name: ❑ Cit Village Town of: State Plan ID No.: D ELTA CONSTRUCTION jj llJJ CST BM Elev.: Insp. BM Elev.: B De scription: Parcel&�d :1322-30-000 1 OC7 b <s -��1e hogEge mi TANK INFORMATION ELEVATION DATA A9800354 TYPE MANUFACTURER CAPACITY STATION BS H1 FS ELEV. Septic LJ Benchma ; ' L q /04-43 I UZ� Dosing w �&b 414, r�> �l 5�i !o/ qh:� Aeration Bldg. Sewer -qs q6. elk Holding Cpwt Inlet TANK SETBACK INFORMATION (P Outlet TANK TO P/ L WELL BLDG. Air Ve ritto Intake ROAD Dt Inlet S3 eptic .44, 2 w L NA Dt Bottom ly.31 92. /v Dosin �I 1Z� NA Header /Man. � 57.23 Aeration A Dist. Pipe g.ts $. 9 7. y Holding Bot. System 9C _gam PUMP/ SIPHON INFORMATION Final Grade 545 !a&,910111 Manufacturer Demand �f, m / 17Y Model Number CPO GPM TDH Lifts . /� Frictions •� Syestem_ TDH9y,kt Forcemain Length SD Dia. HH Lr` Dist. To Well SOIL ABSORPTION SYSTEM "/TRENCH Width r Length No. Of Trenches PIT ;,k 3 1 No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IZ �° DIMENSION SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER Mo el N INFORMATION Type Of Syst OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 6 Dia. Length ST Dia Spacing _ Se -Au {4 7 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: HUDSON 10.29.19,SW,SE 1000 SCOTT RD — SCOTT ACRES LOT 3 o4 loe� 4lt �-� jve,(( wR>!I>n.5{,~((•cof of � - � t S Plan revision required? (Yes ❑'No { G Use other side for additional information. l� G� L61 SBD -6710 (R.3197) Date Inspectoru Signature Cent_ i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E _ _ e E , e 4 3 i w.. .. .... �., , ..e �... ..-« � „e. �......., , .,, .,....._ ... .. .�.- a ... .. e { .... ... a .._ r 1� I f f, , � r e 0 _ , _ t _ z s s a , i 0 e e a. S 1 ° 5= e e. e a r , m F t 3 q F s - r SANITARY PERMIT APPLICATION 20 1E Wa hn Ave. Aftconsin sion In accord with ILHR r Wis. Adm. Code P.O. Box 7969 Department of Commerce 83 05, 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. • See reverse side for instructions for completing this application State San 1 Permit Number �Q�S The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pr9perty Owner Name Property Location � S ova 1 /4, S �� T , N. R E (or� Property Ows Mailing Address Lot Number Block Number T� _9 'T J City, State Zip Code Phone Number Subdivision Name or %M Number D ...t' ( ) 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road Lj Public 1 or 2 Family Dwelling ❑ Village - No. of bedrooms 3 Town OF ,P; DT• 111. BUILDIN USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo z.2- -3 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, 0 New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5 _ ❑ Repair of an ______System ________ System _____________ Tank Only Existi ______________ Existing System _________ng 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit ! 2 43 ❑ Vault Privy 14 ❑ System -In -Fill Z VI. ABSORPTION SYSTEM INFORMATION: 11 9 j _T41 1. Gallons Per Day 2. Absorp. Area 3, Absorp. Area 4. Loading Rate S. Perc. Rate 6. S stem Elev. 7. Final Grade Required (sq_ ft.) Proposed (s q. • ft. (Gals/day /sq. ft.) (Min. /inch);+' Elevation 4447 Ca a t Feet Feet cc VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con steel glass Plastic App New Existing structed Tanks Tanks Se tic Tan ❑ ❑ ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ I ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No t s) 111IP)MPRSW No.: Business Phone Number: .za. D -3 07 's A dress (Street, City, State, Zi ode): ol 2 vs jEaa, el 23 IX. COUNTY DEPARTMENTrUSE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuinq Agent Signature (No Stamps X A pp roved ❑ Owner Given Initial M0 � Surcharge Fee) Adverse Determination • X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL erk C4, SOD -6398 (R 11/96) DISTRIBUTION: Or4nal to County, One copy To: S fety & 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'pur'nper 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 Burtdngs 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. 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 sizf- A;g`iyfforrmation.__ _ ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wiscon'sirt Act 410 included the creation of surcharges (fees) fora number of regulated practices which effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards_ 1 ( 1 1 + . r L l DAVE riGER ■ V PUMO � ucen Perk Tester i Plumber ' mevts KO #3233 #3209 ROBE -j I CONS M 54023 i90 > Z,7T *.3 5CA4 ! " =3d' A = om - ,o p of 'rL S� L�CorL' J f} S JG( 1 05' O s T �ieiv e O S - � ©uNDr O = Bodo 6�#L S. %. �� = 96.9 � > /Sfl � �Lfi• 7 mom. ilC���..dlF I j I I � #y *� s TEL AQh, kV77 R 1�1 I M AII FOGERTY P N- :.it.��sed Perk Tester & Number 0323 F�e € rty eighi� Road J)SERTS, WISC O-'> " ,I 5402: Phon 749 - S56 n �r y0 � Y FND V IFFY 3 j 6 I 3 i Y { PAI; F F j PUMP CHAMBER CROS5 SEC'1o1,1 AMC) SPECIFICA-rIOkiS / VEAIT CAP 4 "C.Z. VENT PIPE WEATHERPROOF APFROVED LOCKIAIG 25 =ROM DOOR. JUMCTIOAI BOX MANHOLE COVER r'+r WINDOW OR FRESH 12 ° MIU. AIR INTAKE GRADE F� I 'i" MI►J. CO►JDUIT __ IAILET PROVIDE _T AIRTIGHT SEAL *� A I I I I I I I I I I I I ALARM D I I( I i c *APPROVED f i ON JOINTS WITH i ELEV. FT. APPROVED PIPE - -j 3' ONTO PUMP -� ` OFF D SOLID SOIL COAICRETE BLOCK RISER EXIT PERM1TrED OIJL'J IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS yy-� DOSE TANKS MANUFACTURER: �r/���s' i.IUMBER OF DOSES: z PER DAy TAIJK SIZE : fidD GALLOMS DOSE VOLUME Zzs° ALARM MANUFACTURER: S �C,EGTjCO INCLUDING 6Af LLOV: 2 S 7 GALLONS MODEL IJUMBEK: Ap I_ /do,X />� �rr 7� CAPACITIES: A= ? —I IMCHES OR y/ GALLOWS SWITCH TYPE: 2CC INCHES OR - GALLO►JS ek PUMP MANUFACTURER: �' ®uC /.) C= �S INCHES OR 2 7d GALLONS MODEL NUMBER: _ F� �Y /I D= 2 IAICHES OR 24 GALLONS SWITCH TYPE: 441- 12tplzr/ NOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 30 GpM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE 15ETWELU PUMP OFF ARID DISTRIBUTION PIPE.. 3 ' FEET + MIIJIMUM NETWORK SUPPLY PRESSURE . . . . . .. . . FEET + l FEET OF FORCE MAIN X /3Y F Jp a rtFRICTION FACTOR.. 3 FEET TOTAL DYNAMIC. HEAD FEET INTERNAL DIMEIJSIOMS OF TAUK: LENGTH ff ;WIDTH �� ;LIQUID DEPTH SIGIJED: LICENSE AIUMBER'. q DATE: ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerffiv OE(' M C aT-i Mailing Address 2a2 � � � 5 Property Address Z&jd (Verification required from Planning Department for new construction) City /State "Of G✓.= Parcel Identification Number LEGAL DESCRIPTION Property Location SW '/4, -54 '/., Sec. /O . T R-Z!? _W, Town of Subdivision SCE Lt 2 S _ , Lot # Certified Survey Map # �h�,�� , Volume, Page # & -- • Warranty Deed # 5L E: , Volume F? 7 , Page # 3gC� Spec house ❑ yes 0 no Lot lines identifiable p yes ❑ no SYSTEM MAI 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 113 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�b [the three are iration date. 721-- s�`'�i l SIGNATURP 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 de r bed ove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * * ** 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 WARRA*STI UF:ED Document N. tuber Return Address MAY 10 I 1 :G0 A. r. Parcei I.D. Number: 020 - 1011 -00 .Joseph A. Klewicki, a single person, conveys and warrants to Delta Construction, Inc., a Wisconsin Corporation, the following described real estate in St. C roix C'ount\ State of Wisconsin: Part of SWI.'4 of SEI.4 of S,:ctior. 10. Township 29 \..rth- Range 19 West. St. Croix County. Wisconsin. described as fellows: Lot I of Certified Suney Map tii- -d April 24, 1996, in %'ol. 11. page 3083. Doc. No. 542664. This is not homestead property. S Exception to warranties: Easement restrictions and r1_hu- of-wav of' record. if an%. Dated this g day of '\ 1996. seph A. Klewicki ACKNO\N'LEJX; -\IENT STATE OF WISCONSIN ) '\ ► ss COUNTY ) Personally came before me this day of ` ? 1996. the abos e named .Joseph A. Klewicki, a single person, to me known to be the ptr`.on( -who executed the foregoing instrument and acknowledge the same. 1 Notary Public / AA 0, c County, R1 My- commission expires :2 A boy CoW rs No tary public THIS INSTRUMENT WAS DRAFTED BY: St ate o ta r Wi s Consin Attorney Kristina Ogland Hudson, WJ 54016 ,tt i S "E BEING LOT I OF CERI IF IE0 SURVEY MAP RECORDED IN VOL . II, a ` " PG. 3083', AT THE CROIX COUNTY RL - OF DEEDS OFFICE. v �' c rE.• � 3 ' Aex PLAT LOCATION �N , Is y 4 a lul!IVF s_cax * 1rccA7,z irtTi[- rtes - -_ -' -- I Allen C. lfyhectm rm2lotcr. l 11lscvn2tu Land Surveyy r, h,:roby c. t,"L In Cull ca.,plia:,ce vith the provta!' of Cr+gtat 316 of the 11ts< a., Lf fi atutea, an-1 under the direction of Dolts Construction, Inc., o+nec c INO dr.cribtd on this plat, I hsra autw dl ♦td�l and mpp+d .I -- --- - -NE _-- ACT +.S; the•. Ouch plot correctly represents the exterior tw,dsrlar an ,p a111Iivialal of the land vvrve'edj and that this plat Is located in pm o� p the awI /4 of the a[1 //, 111 S ectloo 10, T2 91f 81911 To- of Ih:•!ar1 a Croi,l County, 111ecc. girt; being Lot 1 Of Certified iisn y ,p 4• Rscor•.l Vultas 11, Per 1001 at the at. Croix Ccuuty tleylat.r or Do%%2* of yy further descclbed as tollo.s: A 2 v X Jr_ ^q at the 21/4 Corner of aiIt.tten 10; thence 691 ^ 13.11'1, alo,• •] -_ scuth line of the altl /4 of said section, 1110.11 rent to tlr, sso-t I1 GG - -SW - - -- - -SE - th„ 9141/e of thA 9Rt /41 tbonee W00 slag esld seat lisle 1C T . , 1 [set to the ntth It" of the of aDa•w said lot 1j t n hon::• ItA)b21 ,y, I u -_d /'­ 0v "' t"1 "'.'. alc.,y ea.d north line, 1310.'11 feet to the north - aatth 1/1 line of a p p dl f • -tlI se•-t lun; thonc•a 900 ^75.1(•11, al" said north - a with Iln4, lo19.1�t Cc C Q � G «vt toar.[a -. ! the pp.l,gt, ,.0 -.t tdl Alli ka9• Above descrllr...3 parcel cortatnu 31.70 17 __. --- 11, 341, 179 Sq. it .) . /FCt�lr w tcVrT .CACS ■ U a :n ! O i 2 I LOT 3 st 1 l . "1 .. -.. �. S.fd. �t �. � � , P.2 3� d ., 1 33 ' Ile: o ...,. -- - «s 8 1'34 Lot 2 E. ,2 srsul k cc• rto tL •,2, 91 N99�4i 39'w 134£.3 � Eor COIn.En -- - - - --� uul o.ruu 1521 i s Ices. 32' .1 arrt 12o so b' I T ! 1 ( C. 2.w acao Ir q+,??% MIT t r. Kett i R 8 sso so. rr• i n,o z so�i�. 1 1 C1 7 '1�. 13 K. Etc. ts-T. 9 R I 11 $as VCI . K E.C. uf. ♦ 1 L Kati 33. KK) - In 10. SO. IT. 3.0 Iay CO. /L a aO,SS! S0. IT. Es r / 52 ` 1 h1 f r 1.N K Et,. es-T 1.14 Y. ^ Itf, {71 f0. FT. a1, 112 50 /T. 1 M _ I = CC C)t to: a s\ R, I y I r r iNiN l A OI Z 7r«L • aN.O �n.t • 1r1 so - ® w I_ 11 , A / / ! 2 L - TO J q ;,:, 463 „• ��/ / •` ` � , y 1 - 9 14.90 wo.Doo to Fr 1 � Mf%11_11 • M _ fa7. 1 �/r'- , � ` 1 ` ' T t/ / � � 1 1 I u �,���t __ - - - .- {.,.[�•' - l� _ - - �)c_ `'� l .., �� t '/ � ' T•� t so�K•ts I Y `f � t �1t___ �\ e ♦ ' ti 1 04 K. nC. C-1. 6, «. cy s,oso so ` / - -- -- 0I 6 -�•�\ To UL ' p1 i3'L' . � wl I / t Is 4.04 AC E4 Ins,,,, 30.K 11 112 .C. EXC. FS 30 .c•rs •• - � ,V i �; ^ flo. 612 so. IT. - a k - � 100.242 SO. FT, w I 1 `f _TI j S \ EI ` f.1f AC Li? FSw• ~ y 7( a.ar 4C'i1 1.Sa aCKl T ©�I\a 6. , •1 so. Ir M • Itt, ear )O. IT 111 74. •'r �. r i I 4o' 33' Yt7L 473 x 1 swi • ,2, x 3 is If so t tl �) Ke sn. rt I.s/ K.E.0 t$W LOT s ra.eol T. so • I - s / t « y _ c lays n• t s' sou - oo' - ._.L 1 f e, tl•i ... te.) nu' so - 583 IJa3 • 'fi sEcl- ,311 H.l 11T i 148 'JNi LATTE L� �A_IC!? I ii s'DO, VSOS D.'UV ID .� CC NTr SCCI" COFI_9 u!„'v[1•r rp;v0 a�n[ r:...t+ 61SR':'V:1•IWFL' .1A;:v'TIC.fi p- t.S?.e+'g�] Q1RYH_R1Zb WE 1�110 1 ns'u•u•r 11.11' a �r11 !I sl.u, cuff son 11831 MAIL a:'4 C1.10 1IC F 1 3 1 n t U l/ IL IL WLTI MI 811116 11411 uf;*It >' stir P"I St r. "t"' ie6 y.61 ie5 rte s C 111'fi'll'1 111.17' t 0l( i:'U•1 III. N' 1.1 1 1{1.11• IIN 111 111 1;1 111.11' 1 nI °)ru•f ul.u• t r.is•n•r 1.1' 1.4 1 111.14' 12111' nl°sr71_,•I lsf fl• 11' u• 1 .i• n�..Ew ,�T rr.. •„oa .r-........,� W �.,, 1 tlf•.1.11'1 14 f.)• ;'11'1 1.11 ..6...... ...n ....... ... ... r 1 ZA s C TOTAL DYNAMIC HEAD 3 S 5 O O N (J 0 !n O J Co w O Cn f r N N yy m cn CID Alf cr _• G7 O 0 0 to O _ U �__� N - + ` 1 y. ffi ^? cm i. • cn cr j r µ Y • • m r• a mp CD 1 g F y O I 1 CD Cl m { i � 1 • • <L cND OC CD O. s CD CD i N 7 co i D _ S -{ m ca CL CD co g3 cno�c� E TOTAL DYNAMIC HEAD ■ =n X .�� m x S o a o -, f _ cn 3 1 o� a I mo. J �CDD 3OQ W g_ ` <n CD — Vl o I • gf r � 1 Y = � a ro CID E? �f T • tn. > r° o c° m W• C _ H I v rr _ N m�?Cn 01 S g4 a • 1 m •• c a ^ CWD �' O. 0 8I Ln • • c F d C CD It ;I - -� ;t • CD �� tnvoiy� i 3 l $ s _ _ nom _�, m' CD r7 7 - n �5, c e� m co CCD Q 3 e cn CD D 3 a c/) CD TOTAL DYNAMIC HEAD m s 1 o n co 3 S a _ N o m H a� CA U1 0 CD 3 � I N. CD H o l' r Wisconsin Department of Industry SOIL AND SITE EVALUATION i. ebm arrj Human Relations Page _� of .3 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 include, but not limited to: vertical and horizontal reference point (BM), direction and ,- r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location E 6 Govt. Lot 1/4 C 1/4,S a T ,N,R E (o& Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# .?D A - R' -3 v o City State Zip Code Phone Number Nearest Road 4 0A l War O ( ) ❑city vin iP Town fcoTT z . ID New Construction Use: m Residential / Number of bedrooms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow , 4 ' 0 gpd Recommended design loading rate bed, gpd/ft 8 trench, gpd/ft Absorption area required nn? bed, f1 ­ 7-n2 trench, ft Maximum design loading rate • 7 bed, gpd/ft gpd /ft Recommended infiltration surface elevation(s) 4 2 3 97.3 , 3. y s 97 ?' ft (as referred to site plan benchmark) Additional design /site considerations / &V E Parent material ?Zz ezOr Flood plain elevation, if applicable &a ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system Z S El ZS El OS ❑ u JZ S ❑ U ❑ S jZ U EIS ' Z U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -?M i 'C S �7 2 - a- - 5 L s Ground 3 0 IS 0'- --- elev. /dk�ft• Y IL YZ IOR p S — O' c Depth to S 7 - S G L — — • y limiting factor in. Remarks: 3" Ze f, Boring # e fF le - L L a 44 ET s- 6 t p,� 3 0 - S G Ground ,t- /d - S!r 0 L- RS elev. S F /� n. - s AA L Depth to limiting factor -" In. Remarks: ' Al CST Name (Please Print) _ Signature ') Telept'lrx y� Y 7 Address Date er AV 4; GtQ Os.3 7 2 s sc, I PROPERTY OWNER �6LTi'� COX/ST SOIL DESCRIPTION REPORT Page Z of = PARCEL I.D.# La7 Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 97, z L z7 - 1' Ground —3 _ elev. Depth to s /o - 6 _ limiting factor in. Remarks: ex CLve Azt l Boring # %y 2— d — S1'L cS 5 9M Ground — 0 —6 .._-- S ,L G M -- elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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