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HomeMy WebLinkAbout020-1300-90-000 /¥ /a . \ o G � \ m \ . / , � � . 0 k z U, § \ » , \ / f E § / $ » \ k ° m = f ) § k \ § 2 k k k { ) E % Q kco k i ) a � \ . § \ ) i Lo ' § 0 CL C) (L - k � \ \ E � } . e a a a ° co \ 0 _ © Q = E E ƒ 0 E = E CL ° w U) ) 0 k # ƒ / ) @ ' 2 _ . N % ° Cl) � 9 co ` C 3. / \ \ n § 2 Cl § / t C. \ I - C-4 2 m o 2 & ) £ \ � « . « . 7 �k 0C _ 2 ." a ; \ ( ) a § Q v a o co L) OZO� c3aa - �o� of i7z9.t9. 1973 S 'I'. CROIX COUN'T'Y ZONING DEI'ART�IEIN'I AS BUILT SANITARY RI:I'QR'I' Owner Address g� x City /State `u ,n, Xjj f F?� Legal Description: L' Lot _L?f Block,_ Subdivision/CSM # (� _�o��e' ' � T N- /' /' Sec./ R[�W Town of '�— � ���s�ti PIN # ell SEPTIC TANK — DOSE CLAMBER — HOLDING TANK INFORMATION: Tank manufacturer 1; r ;;_, Size ST� /�.,�/ Setback from: House , Well;: P!L Pump manufacturer Model — Alarm location (HOLDING TANKS ONLY) Setbacks: Service road t to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: T / lea zr Ty •f system: Width 1 Length �_ Number of��es Setback from: douse Well 1 ° P/L, Vent to fresh air intake x ' ELEVATIONS: Description of benchmark /D Description of alternate benc Elevation E ' Elevation Building ewer r g ST/HT Inlet _ I Z , ST Outlet , PC Inlet ----- - PC Bottom c c Header/Manifold Top of ST/PC Manhole Cover Distribution Lines( Bottom of System ( ) ME O ZZ Final Grade Date of installation Permit numb c / State plan number Plumber's signature g - License number Date / // 7 1 / 1 Inspector Complete plot plan i 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 AMA 'A � 2 �y� r S� INDICATE NORTH ARROW Wisconsin Department•of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count y INSPECTION REPORT ST CR OIX 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)]. 324703 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: WERT, DARREL HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020 - 1300 -90 -000 TANK INFORMATION ELEVATION DATA A9800594 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , �� t 0 3= .� �ov `'D Dosing 3. / Aeration BI g. Sewer I . �g Holding S t Inlet �_ 5V TANK SETBACK INFORMATION St/ Ht Outlet ' 7$ 3 ,Y TANK TO P/ L WELL BLDG. Airs to ntake ROAD Dt Inlet irl Septic r NA Dt Bottom Dosin NA Header /Man.< ID g i� E la - Aeration NA Dist. Pipe Holding Bot. System ( 2 to PUMP/ SIPHON INFORMATION Final Grade 5.5-Z Cl 7, 1;. � Manufacturer Demand 5<<Z�' Yg•, ? Z Model Number GPM DH Lift Friction System TDH Ft Forcemain Length Dia. ti Dist. To well L ABSORPTION SYSTEM E / TjtIENf f' Width r Length t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Typeo model Number: System: � Q Z OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing Q 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.) 3 LOCATION: HUDSON 17.29.19,NE,SW 430 BROOKWOOD DRIVE — PARKVIEW EST LOT 138 AN 30 r Plan revisi required? ❑Yes X'f No � cj? � Use other side for additional information. j 3jAL � I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. M SANITARY PERMIT APPLICATION 2 01 E.WashnlgtonAve. Divisio afety and Vi scon` in In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary�Permi Number The information you provide may be used by other government agency programs ❑ Check it revision to prbvis app cation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Pro arty Owner Name Property Location L �1ia ov 1/4,51 T ,N,R 1,7 E(orar�V Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OP IL DING: (check one) ❑ State Owned ❑ " Nearest Road E3 Village Public 1 or 2 Family Dwelling - No. of bedrooms 3 VTown OF `l�- f� ixr, -c 4e- 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 A o m0 - 9W 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, V1 New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System ____________________^ Tank Only______________ Existing System _________Exi S ystem - - B) A Sanitary Permit was previously issued. Permit Number 3.� 6z,y"Z Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 PSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure : z 42 ❑ Pit Privy ` 13 ❑ Seepage Pit 1! ��. 43 ❑ Vault Privy 14 ❑ System-In-Fill 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 ` elf 0 7 7 F Feet J 9, 1 Feet Capacit VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Ta Q _ ❑ ❑ ❑ ❑ ❑ ❑ 1 1111310 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No S ps) MREMPRSW No.: Business Phone Number: Plumber's Address (Street, City, 16ate, Zip de): d 140,6e r- w E7 Z IX. COUNTY / EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fe (Includes Groundw er ate Issued Issuin ent Signature (No Stamps) Approved F1 Owner Given Initial / !,(/� pp Surcharge Fee) �� l Ad verse Determination ( U(J 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Div O wner, P SBD -6398 (R 11/96) DISTRIBUTION: Original to County. One copy 70: Safety &Buildings s on, O ne , lumbe r '417 kA rA �_ I © C t� TO t-i 4k4 4 4L, A�N Qla 44 oc 6.1 CA*O 4 -2m c 4W) Wiscgnsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings , Page 1 of - Bureau of Integrated $ervices , in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and .5 Z F p= percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # p 2.0 - �M –QG APPLICANT INFORMATION - Please print all information ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location EL C P Govt. Lot OE 1/4 1/4,S T 2 N,R E (orpl Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /0 7 .1 .E. .q >r,E 7-4 111$7 1e le?"ll 4vl_l rFs City State Zip Code Phone Number ❑ City ❑ Village 2 Town Nearest Road XAZ ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow V5 gpd Recommended design loading rate —_ bed, gpd /f? trench, gpd /ft Absorption area required j y3 bed, It S L3 trench, ft Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) A lne 9,A /1V 9 ft (as referred to site plan benchmark) Additional design /site considerations /9 ZT Parent material '� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 0 S ❑ U WI S ❑ u 3S [:1U ❑ S ❑ U I ❑ S ❑ U ❑ S 7 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Al 5 F �.y 2 // - s L n,f /z s l r . 4 Ground 2 6 -- S C .S G m L — d elev. Depth to limiting factor :�.sy in. Remarks: Boring # - �. / o -to /D - 31 2 - L 17 im 5i' , L' w FX S r 2 2 d -�s 7, — S G S/z)c of FIZ Ground `l /02 7 s - `/ �- elev. , 8• ft. Depth to limiting factor 7 Remarks: CST Name (Please Print) Signature Telephone No. Address i Date CST Number i • SOIL DESCRIPTION REPORT PROPERTY OWNER �� » Page -- of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 134 2 V s 7-5 - r/ — F'9 C Ground elev. . 8 eft. 7, s- y 6 s 7 Depth to limiting factor ULM. �a Remarks: Boring # o -� -z .z — SL c � � ✓rr F .D ,.O L Ground _ -- S o SG IH L elev. I Depth to „ limiting s?j• $ factor 7 0 in. Remarks: 41 - PAM o vE,� fX -� r lv�v5 Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # P ' 3 _ _ — L / SAX sr, !i S • > . 6 Ground 7, j - S elev. , Depth t0 limiting (07 3 Z factor 7_Y in. Remarks: _ S Z4 K-1 C V IV T, Boring # I Ground elev. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) i . 1 1 � T 1 _ 1 h Zpaw z3 tk � o L4 Tj a alt �_ x `�'► ------ --- �\ Z L ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer �t Mailing Address (b r '/ ( Z VV Property Address 3 O 01C,4_014 e (Verification required from Planning Department for new construction) City /State ,rn, Z� Parcel Identification Number LEGAL DESCRIPTION Property Location/ ' /,, '/,, Sec. /? , T,�_N -R / P W, Town of Subdivision ��,,( l�i' �u� ,�' ,/a/ Lot # 13d' Certified Survey Map # , Volume , Page # Warranty Deed , Volume d'�loD ,Page Spec house ❑ yes no Lot lines identifiable 0 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 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 by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date.. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I ( we) certi that all statements on this form are true to the best of m our knowledge. I we am (are) the owner(s) of ( ) Y Y( ) g ( ) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 DOCUMENT NO. WAPAAUTV 860pni 338 DUD THIS e►nct ececprto rw accomme er.,a � STATIC BAR OF WISCONSIN FORK ! — ON I REGMWS OFFICE Edna G. Smith, a/k /a Edna Smith, a single R. CM ()., .. ... ...Sri .......................... ......... aKwd ......... ................. ........ ...... _ ....................... ........ . AN 0 419�J o:a o o M conveys and warrants to ... W!Y n� ......... Wert,— and. .aexerl.y...1d�.rt.....a /.k /.a. Beverly...,A.�...... .Wert,- humbbamd...and - Wife- .49...tenanta- AA .............. � oiOwd� _ . COMMan..and..not..as...jo ' nt... tenants ........................... .. .... _ .................. .. . . . . . .. .. .................... ............ *t TURN TO Gwin a Gwin i .............................. . .... ............................... P .O . Box 106 . ..... ... ............................... ( Hudson, WI 54016 O followinE described real estate in ...........Sir CrOiX ...County, St•.te of Wisconsin: Ta: Parcel No: .............................. �! ,j (See legal dpsoription on reverse side) i IRAN fu /d #E K M Pi j • t �V A parcel of land located in the Northwest Quarter of the Southeast Quarter (NW1 /4 of SE1 /4), the Southwest Quarter of the Southeast Quarter (SW1 /4 of SE1 /4), the Southeast Quarter of the Southwest Quarter (SE1 /4 of SWl /4), the Southwest Quarter of the Southwest Quarter (SW1 /4 of SWl /4), the Northwest Quarter of the Southwest Quarter (NW1 /4 of SW1 /4), and the Northeast Quarter of thq Southwest Quarter (NE1 /4 of SW1 /4) of Section Seventeen +(17), Township Twenty -nine (29) North, Range Nineteen _(19) West, in the Town of Hudson, described as follows: Commencing at the East Quarter (E1 /4) corner of said Section 17, thence Westerly along the East - West Quarter Section Line 89 18, 41" W, 1, feet (previously recorded as N 89 53' 20" W, true beaging, 1, feet), to the point of beginning; thence S 00 03' 03" W, 1,747.21 feet (previously recorded as S 0 05' 20" W b734.97 feet) more or less to a point which is also N 00 03' 03" E, 880.11 (recordeg as 880) feet from the South Lige_of Section 17; thence S 89 09' 27" W I &I to said South EAST—WEST 1/4 LINE OF SECTION 17 EI /4 CORNER 'ION 17R N88 °54'54 "E N88 0 54'54' E SECTION 17 945.02' 4339.28 CERTIFIED SURVEY MAP VOLUME I, PAGE to 7 ul O (DO C. NO. 329659 ) N -- — - -- - -- 0 O (S89 "W) S88 735.48' 125.00' 402.24' W° LOT 134 1.91 ACRES 83,092 SO. FT. M LOT 135 M K) 2.11 ACRES 92,088 SO. FT. W I .0 M o rr) I —I ro L) I I o O _ Ld 1 N NTT 48' � " / � I 342 .32' JI OI oI zj co LOT 136 c6 1.35 z1 Oi 0 i 58,740 A CRES T. SO.F 1 — 1� � ,N -- -- - 0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y ' Safety and Buildings Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaruP 3 �urfitNA : Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. *ft ft tS L Permit Holder's Name: �ttij$y �(illage Town of: State Plan ID No.: ERT, EL E. N V CST BM Elev.: Insp. BM Elev.: BM Description: Parcel bt V .. 300 - 90 - 000 TANK INFORIkATION ELEVATION DATA 800464 TYPE ANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATI St/ Ht O et TANK TO P/ L WELL BLDG. vent to ROAD Dt Inl Air Intake Septic NA Dt ottom Dosing NA eader / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer De and Model Number GPM TDH Lift Friction System H Ft Forcemain Length Dia. H Dist. Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK \EACHIN SYSTEM T O / L BLDG WELL LAKE / STREAM G anufacturer: INFORMATION TypeO MBER Mo el Number: System: NIT At DISTRIBUTION SYSTEM Header /Manifold Distr ution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade System my Depth Over Depth Over xx Depth Of xx Seeded/ Sod %d xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (In decode discrepancies, persons present, etc.) LOCATION: HUD N 17.29.19,NE,SW 430 BROOKWOOD DRIVE Plan revi on required? ❑Yes ❑ No (� Use other side for additional information. I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Vi sconsin SANITARY PERMIT APPLICATION 201 Safety W and shington Ave sion In accord with LH h i . m. Code P.O. Box 7969 Department of Commerce R 83 05, W s Ad Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other g overnment agency p rograms Z0 The information a y p y y 9 9 y p g C heck if revision to previous app nation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 1 /a 1 /a, S T , N, R� E Pr perty wner's Mailing Address Lot Number Block Number /© 7 1 _ is A- f City, State Or Zip Code Phone Number Subdivision Name or CSM Number I. TYPE OF BUILDING: (check one) ❑ State Owned !t� earest Road ❑ VII age Public Ea 1 or 2 Family Dwelling - No. of bedrooms Town OF X0 OrtJ !!/t om Z III. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment /Condo O V d 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 Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 E] Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit /Z X 3 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 �' . 7 Feet , p Feet 1 1 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 structed Tanks Tanks tt� Septic Tank YJ 1:1 1:1 1:1 1:1 11 p Tank /Siphon C amberl ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation 90he onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No amps) PRSW No.: Business Phone Number: lumber's Add r ss (Street, City, S f , Zip Code): e-r wt d �3 IX. C OUNTY7 DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (NoStamps) Approved []Owner Given Initial Op Surcharge Fee) �� Adverse Determination y `/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-BM (R 11/96) DISTRIBUTION: Original to County, One copy To: Safety i Buildings Division, Owner, /loetber Z h ti m e Akj 0 O _ o n u i 1� FOGMT PLU tscensed Pork Piumbor $3233 g Road b��'O r 91Is7�i�7,�k'I M1M :TOy„",d� Phone 749-3t6 7-1 n ` 3� Y ,r _____ 1 , __ _ _ wist on §in Department of Commeyce SOIL AND SITE EVALUATION Division of Safety and Buildings_ Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County / include, but not limited to: vertical and horizontal reference point (BM), direction and G r 0 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel l APPLICANT INFORMATION - Please print ll information. Re by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). t 43 7;e> �Gi C1 Property Owner Properly Location / Govt Lot 1/4� 1/4,S / T ,N,R ! E (or Property Owner's Mailing Address Lot # Block# Subd a or CSM# �'71 City State Zip Code Phone Number Cl City vtl ge Town Nearest Road t �New Construction Use: [ytesidential / Number of bedrooms T Addition to existing building 0 Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate + bed, gpo4l gpd/ft Absorption area required bed, ft trench. ft Maximumm desill n loading rate ? bed, gpd/ _-'X__ rench, gpolft Recommended infiltration surface elevation(s) ACT X /, ft (as referred to site plan benchmark) Additional design/site considerations v� Parent material Flood plain elevation, if applicable ,/f✓ ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U Unsuitable for systems ❑ U S ❑ US ❑ U ,�S ❑ U ❑ S U ❑ SU 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 / r -14' 6 Ground e v. Depth to limiting I a for Remarks: Boring # J / rn Al) 14 Groun ' 7 Depth to limiting factor "Waln. Remarks: CST Name lease Print) gnature ;y',r3(e Y T No. Address ' Dash Number 7- ` L DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground '��� r✓ Q / ' V. tt. Depth to limiting fact r Remarks: Boring # Ground 9 ev tt ; Depth to limiting fa Remarks: 3.� Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # L C2 Ground 9 tt. Depth to limiting r Remarks: C3 Ground elev. tt. , Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name Delta Construction Byron B' Jr. Address 206 2nd St. s Hudson Wi 5 4 0 1 6 CST #3479 Lot 1 38 Subdivision Park View Estates Date 8/17/97 NE 1 /4 SW 1 /4S 1 7 T 29 N/R 19 W Township Hudson ❑ Boring Q Well PL Property Line County S T. CROIX , BM or VRP Assume Elevation 100 ft. of Power Box System Elevation 95.9/94.2 * H R P Same as B 125' Property Line Brookwood Drive Pro 4 Bedroom House Area N 5 ' 0 B -1 235' c 30 Property r 80 Line r B -3 B- Pn A B -5 45' B.M. 15' Rep A 80' 50' 75' 15' B -4 85' 95' Property Line I