Loading...
HomeMy WebLinkAbout020-1286-30-000 s ST. CROIX COUNTY ZONING DEPARTMENT v AS BUILT SANITARY REPORT Owner o�Di�ZF r Address �JCNein /2itrtir City /State r Legal Description: Lot #13 Block - Subdivision/CSM # '5:r i x 1 n1Tt4 +FES '/, ! w '/, �f, Sec. 21 , T N -R /9 W, Town of _ 44joso"i PIN # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PQ — Setback from: House /o' Well TSo 'P/L, 5 Pump manufacturer — -Model — Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of 9ystem AfGt T ,tN«r Width 5 V Length T3 " Number of Trenches X Setback from: House le,,, " Well ro o ' P/I, .?G' Veat to fresh air intake ?7' ELEVATIONS Description of benchmark /o " so,,, , N wc� +'okE Elevation 4 Description of alternate benchmark _ ,u, s,a f o�� o� ,� Elevation 9"*,1 ? o Building Sewer g ' STlHT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold '710 T9 ' Top of STIPC Manhole Cover 1 7 1&1 , o Distribution Lines (A) 9ia . a ( 91 �D ' ( ) Bottom of System (A) 9/o o Final Grade (A) _ 9 /4/ , 6 a' (Q) �I'� c/. rJ Date of installation �l / / gPermit number 3L9 1?r} ty State plan number `j' ,_ a oy- 30 Plumber's signature License number _Sj Date ! ! 5 f Inspector Complete plot plan * s � 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 1 P AR Jk'/Aj �REi4 �oDHCr,on! REA � 1 1 y y� S fw(P � iN a — �a 4 I � � `IAN fS } p rt Al S 3SOVc fi9�uti,uT /Y, ,Vf -- - - -- - - -- - - -- -- - s' Sot TN 1 ,4 iAjf INDICATE NORTH ARROW Se,tt£ . ;,Wisconsfn Department of Commerce PRIVATE SEWAGE SYSTEM Y' Count Safety and Buildings Division INSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary tv Personal information you provice may be used for secondary purposes [Privacy Lagy, s.15.04 (1)(m)]. SCV IN)� PROPERTIES [��Ilage E] Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 1286 -30 -000 q / 7� !�/' (' . ✓c� r 020 — TANK INFORMATION ELEVATION DATA A9800103 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ l5G Benchmark 0' Dosi ng Aeration Bldg. Sewer Z. , / L/ ' Holding St/ Ht Inlet / 6? TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic 3 , >� S NA Dt Bottom Dosing NA Header / Man. 0%S o q Aeration NA Dist. Pipe P. �9, � °' 7 o Holding Bot. System q1' ', 4/ v, 7 o PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand aCwn { } j Model Number GPM TDH Lift Lrictio System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION �J v DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER r Model Number: System: y . a 6 �'6 U OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) 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 Systems Only Depth Over Depth Over o xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center a Bed /Trench Edges 3� Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 21.29.19,NW,NE 580 SCHOMMER DRIVE Plan revision required? ❑ Yes [/No / Use other side for additional information. SBD -6710 (R.3/97) Date ! In a is Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , I - SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05, Wis. Adm. Code E s.w.�vs CfD f �a�.wuesw,w,.rnv� '�1 ��- rr STATE SANITARY PERMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than ❑ -:�C-')-7 -7/,1 8% x 11 inches in size. ,C- Check if revision to pr sous application -See reverse side for instructions for completing this application. U �� STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. 9Ch0M7'y " 1 Q PROPERTY OWNER PROPERTY LOCATION --riry 4QFaarl�r v�y 1 /4 Iv,- S Al T J,.9, N, R 1 E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 38I- 11. TYPE OF BUILDING (Check one) CITY NEAREST ROAD El Owned VILLAGE : _ Public ❑ 1 or 2 Fam. Dwelling -## of bedrooms — PAR Ax MB ( ) 111. BUILDING USE: (If building type is public, check all that apply) ©ate .. )'�$ (p — 3� / ��• ��' /��� 1 ❑ Apt/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: onl Check one in line A. Check line B if applicable) ( Y A) 1. ® 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 ## — 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 �j Q O 0 . 1 ? . Feet 9J Y Feet VII. TANK CAPACITY Site INFORMATION in allons Total ## of Manufacturer' Prefab. Fiber- Exper. New istin Gallons Tanks s Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber Vlll. 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 Si ature: (No Stamps) MP /MPRSW No.: Business Phone Number: oWv u — Plumber's Address (Street, ( City, tats, Zip Code): cJ IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Date sue Iss ' Agent Signature (No Stamps) Surcharge Fee) ® Approved [:1 Owner Given Initial ] �j, pp % /� G� !6l g8 p� S yZ� Adverse Dete rmination ` 00 X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) 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 nnay be renewed belore the expi=ation date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufaciurer'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. 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'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimersions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water sf�rvice; strQams and lakes; pump or siphon tanks; distribution boxes; soil absorption, systems; • eplacement !system areas, and the location of the tuilding served; B) horizontal and verti al elevation reference points; i C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and purnp manufacturer; D) cross section of the s,.il absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1933 Acisconsin Act 410 included the creatior of surcharges (fees) for a number of regulated practices which curt effect groundwater. The monies collected through these surcharges ;are- u —a d for nonitoring groE=n;fwater, ground- water contamination investigations and establishment of staridarrfS. SBO -6398 (R.11/88) r r SAFETY AND BUILDINGS DIVISION 2226 Rose Street Vhsconsin La Crosse, WI 54603 Department of Commerce CU Tommy G. Thompson, Governor 31- Mar -98 William J. McCoshen, Secretary ZAPPA BROTHERS INC SUPERIOR WALL PRODUC GARY ZAPPA 715 SIXTH ST N HUDSON WI 54016 SUPERIOR WALL PRODUCTS Plan ID 9820430 NW,NE,21,29,19W Municipality of HUDSON Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): CONVENTIONAL 650 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department. All permits required by the state or local municipality shall be obtained prior to commencement of construction /installation /operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, a Oerard M. Swim POWTS Plan Reviewer (608) 785 -9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, Wisconsin 54603 fA sconsin G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary G Page 2 9s 20430 A Sanitary Permit must be obtained from the County where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats, prior to installation. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic /holding tank that may be required for this project. See section COMM 82.20, Ws. Adm. Code, to determine if plan submittal and approval is required. The plumbing for this project discharges to a private sewage system. The approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. The discharge of hazardous wastes to a private sewage system is prohibited by state and federal regulations. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard by discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or groundwaters of the state, the owner will employ a properly licensed plumber to repair, modify or replace this system (including the possibility of installation of a holding tank with proper disposal) with such action approved by the Division and appropriate local officials. Cc: Jim Thompson - St. Croix County Zoning Office Pete Skorseth - Department of Natural Resources SBD-5524 -E (R. 2/98) File Ref: WSTANDARD PARAGRAPHS APPROVAL LETTER.DOC z INIA z -4 it Z ° ( D� y ul CD 3 cCLo ,ww Z Z to IA 6 7 O ^' CL 1 , r e G W �loll N N C0 CL ry . I CL ill \O 1 Nt Z - i ° n Ab - - r tlf\ m o � r � � i W o' 2 t N 1 o i ,O RECEIVED n MAR 30 1999 SAFETY $ / r- BLDGS. (iii .,� N VN N a 1 cz U e R a kA y z t- kA !! nn vl o a Rr g � O G ti '� ak o Fti�� 1 # yfw �Wl th NR A13 hi o n� o i I I A I � I i Eo r � a � r G n i O r a Z pz� s e r a r � ^ c� i a c 1 41 EL 6' _ -_ -- a 'C o � � b NZ: e 4 la ILA �, \ 0 y 3 G N , e a Z t � c N o M M e L43 k k 3 Q, Z N Wu c h x X O o L Q N a M 6 1 r 0 d Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT r"yQ _ ui Labor and Hurnan•Relations Division of SjUyty & 6uikGngs in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in si a e, 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. MAR 3 Q 1998 APPLICANT INFORMATION – PLEASE PRINT ALL INFO R A71 AFF� N REVIEWED BY DATE . �k � � ; r, ,�r PROPERTY OWNER: PROPERTY LOCATION n GOVT. LOT P4l.J 1/4 NC 1/4,S71 T Z9 N,R /1 E (or) W PROPERTY OWNEIT:S MAILING ADDRESS LO # I BLOCK # I SUBD. NAME Op CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ,MOWN NEAREST ROAD (�J New Construction Use [ J Residential / Number of bedrooms (J Addition to existing building j J Replacement [kf Public or commercial describe � oc�6A CTUnr vG da •g.+s7 Code derived daily flow X6 n gpd Recommended design loading rate n 7 bed, gpd/ft '� trench, gpd/ft Absorption area required 9,94 S bed, ft trench, 0 Maximum design loading rate C , 7 bed, gpd /ft L trench, gpd/ft Recommended infiltration surface elevation(s) 9/0 > d It (as referred to site plan benchmark) Additional design/ site considerations A Parent material 61ae,a_ 06-i asiv Flood plain elevation, if applicable oo A. ft MP LU .U:nvslu�it : Sfor system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK le fors stem CS [I U S❑ U S U 0 S El U 9J S❑ U 13 S R TU SOIL DESCRIPTION REPORT Depth Dominant Color Modes Structure G P D /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence ' Roots Bed ITmnch ' — , i� CG � D - lz 3 � L '2 �. K r►� o G �.- $. /22$ Ground $ Z� -3� 7.S d 7 d. 6 1 C f � -!r✓C 16Y," Depth to limiting factor Remarks: Boring # 7 g, x-23 S , L Z < c,�K �'!��� Li Ground elev. 17.Zft Depth to limiting 3 f actor j z .� Remar CST Name : — Please Print Phone: Add ress: P c y` f' 14o LE"o ,J 1 Spnature: �� � Date: 3 ? S �g CST Number:-, 44 PROPERTY OWNER SOIL DESCRIPTION REPORT Page L ot 't PARCELLD.iI �. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Eb 3ry Roots GPD /fi In. �Munsell Qu. Sz. Cont Color Gr. S4 Sh. Bed mnch !Z z4 /OY?.4 3 ��L Z G' Zak e rr CS ► � c�.� d.6 Ground gz q -far / We 4l4 /h 5 S m C W — ,7 p �r 915 9 h. g -1q9 10Y 4 3 MS C, n1 0, o _ Depth to i limiting factor I > Remarks: Boring # ' Q v -o I r qL 1 �mA t 4 3 S L Z c c, bt n��r GS $ kA- IZ 4 56 ni c w — o.7 'S Ground f elev. I S3 4 3 / Y�2 X15 ,mot : O it Depth to _ limiting ; factor Remarks: Boring # A - $ / 1. Z , �►1 �Ci 111 CS % Boom or soon S $� /9-3Z /OYpe4 -- S�Z. Z c �- r►►�r CS Ground 32 /oYR 4 4 — /zr5 <S ,ti,1 C w — o' I j o 4 IG'q ft Depth to limiting factor Remarks: J Boring# F A D-! ID ne / b �'LI� S I l 0.� r CS �r _ 2 >^. a,6 � 3� �� 3 S � c a �� � o.� . Ground z 2 DYi2 4 1'iJS � 67 '1 6 A elev. S ft 17Z-/ Y M SC , �O.$ Depth to ur<uan� > faces . Remarks: IM-S 30(R.05M) Wisconsin Deparbnentoflndusuy, SOIL AND SITE EVALUATION REPORT Page of - t Labor arW FIU3pn Pfelations DivWgp of Safety & Suildnps 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 I ST # 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. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT IJ L� 1/4 r44-: 1 /4,S Z T 2 ,N,R I C 1 E (or) W PROPERTY OWNERS MAILING AQDR9SS LOT # BLOCK #. SUBD. NAME 0 CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE LWOWN NEAREST ROAD New Construction Use (j Residential / Number of bedrooms (] Addition to existing building L ] Replacement (] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 6.7 bed, gpd1ft 0 trench, gpd/ft 2 Absorption area required bed, ft trench ft Maximum design loading rate p bed, gpd/ft OX trench, gpd1ft Recommended infiltration surface etevation(s) _'�_-r,-)U- J N9.1 a.4A ft (as referred to site plan benchmark) Additional design / site considerations 9 /7 3 Parent material Flood plain elevation, if applicable ft $ _ Suitable for system C ENTIONAL #UND IN•G OUND PRESSURE BADE U S YSTEM Q FILL HOL TMK U � ou Du o S - unsuitable for system EIS ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends a K rn C I 6.� O.g > 1 Z. -32 16-1p, 3 -5 L Z c; 0. rr,Tr 6_5 Ground �z - /01 ie4 3 Ms SG rn CS 01 elev fh S G 1 — 6 ,71 6Z 1� - fL 01 -160 7 S') f _` Depth rJ Remarks: Boring # U�16 / ©Y / 1_ Z bK MY Ctv I. 15,5 D,� 16 39 Id le4 M 5 Sco d b Ground 03161 �?ft Depth to , limiting factor Remarks: CST Name: — Please Print Phone: Add ress: Signature. Date: 3/2S q1% CST Number: �� a c° 0 Q Q x b "s v Gn c �.5 q N � > X1=4 o r' M a�i d 0 . 0 o � O • M Cq y P� o a .•+ � N � �i e+� � W W � � ,� zo. Z ° roi z �gS4� 1 c \ a N Z Cb �_ u vi fi 0 09 a� N 4' Ir e � a N i N Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of Labor arxl Human Relations Divikl of SaPaty & Buildings in accord with ILHR 83.05,__Wja Adm. Code y; { _� `• ' t COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches i s e,,,P(an mu t include buf ,." -� C�c) /x y PARCEL I.D. # not limited to vertical and horizontal reference point (BM), directio aid, a of sllq �� or dimensioned, north arrow, and location and distance to nearest r �" ° " i APPLICANT INFORMATION- PLEASE PRINT ALL INF0044Tl0 1-,.., 47�1 REVIEWED BY DATE PROPERTY OWNER: PP*QKR7af LOCATION p �, GO�Diw �) ;1l4 ''(� 1 /4,S7/ T Z9 N.R / / E(w)W PROPERTY OWNER':S MAILING ADDRESS L CK # JBD. NAME 0,R CSM # N &0' 12� A� A R K CITY, STATE ZIP CODE PHONE NUMBER ITY t vl 'GE J TOWN NEAREST ROAD ,[J New Construction Use[ J Residential /Number of bedrooms ( J Addition to existing building j J Replacement (A Public or commercial describe Code derived daily flow 6S� gpd Recommended design loading rate r.�.. bed, gpd/ft trench, gpd/ft Absorption area required .F S bed, ft trench, 11 Maximum design loading rate C> , 7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 9-1,o,90 _ ft (as referred to site plan benchmark) Additional design / site considerations Parent material g:5_ c nL Oun., , Lrj4 - josix vS Flood plain elevation, if applicable /LA. It $ = Suitable for system c0 VENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE s� Y S TEM IN FILL HOLDING TANK U =Unsuitable fors stem s❑ U S❑ U S❑ U QS ❑ U K� S❑ U ❑ S WU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Botx Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed lTw& [3 C.s C C $, - t &/e4 3 _ �.t± Zc Ground $ - Z'6 - R6 '7S P 4 3 -- ^� S /'� (� 7 (� 6 elev. 912 C fL 3�. - ic 0 6 Y Ah Depth to limiting factor t3.3 Remarks: Boring # 3 1 7 11-23 / "I*P4 3' S , ,K nor C4 Lo Ground elev. T 7.2-ft. Depth to limiting factor„ Remarks: CST Name:— Please Print ` Phone: Add ress: c) ` n"71 No L-o 'J i Signature: �/J ��- Date: 3 CST Number: �l c` PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z ,of 4 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed rWd J tJ - r Z i D Y 4 �- cr �' Y C, 5 i p '� 0 Ground 6 i 4 4A M 5 16,f 0 elev. Oi 9 ft g -i4 I Y►l. d .3 0? ' � `6 Depth to limiting fact , Remarks: Boring # A 6. 4. a 4 -- 5 56 ►�+ w — p, i �,,� Ground elev. ft $ -, s3 i 6Yje 4 3 r^� 5 ,tif 1 ? Q Depth to limiting fact Remarks: Boring# / ,� !Sr CS 3 Ground 2 , 9 %6> 1 SG rn C L 1 0 ,1 2 � b elev 1"� S �C? 0, - 7 ' 0,9 9 �' It �� -� i Depth to limiting factor Remarks: Boring # Ground elev. )ZL / 3 _ � 5C, r� 10,Z 9 1s .1 ft Depth to limiting factor i R .lam Remarks: SBD- 8330(8.05/92) Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of `'t" Labor and Wuman Relations Divt§ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S-T (f'f6 � 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. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT Pj 1/4 rIL 1/4,S L, T 2 ,N,R / E (or) W PROPERTY OWNER' :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OF) CSM # n 1 �,�►e'-)-x 'V>!ii? ;; �,rt� ARK CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VIL GE PFOWN NEAREST ROAD t New Construction Use [ J Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 6.7 bed, gpd/ft (- ' S trench, gpd/ft Absorption area required bed, ft trench 11 Maximum design loading rate 0 bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) 1 69. 1 A,4 N it (as referred to site plan benchmark) Additional design / site considerations 9/2. Parent material Flood plain elevation, if applicable ft TIM S - Suitable for system Q MOUND IN•G OUND PRESSURE GRAD U S ❑ U LL B L S N j U- Unsuitable fors stem EU i ❑ U 91S ❑ U I 0 U E SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxidary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench -. L Z , � K, ; v; �r't- C 5 1 ', JZ -32. /L�Ya� 3 5,L rriT I 0.5 O,d Ground 1 ' 1 V If f ewo , — I.S:) , e 9 8 SCE 7 (� Depth to limiting f Remarks: Boring # A rte y 1 e' - � ILA y►�� s .._ /%, � Ground elev. - ,+ /6Y,Q 3 �"; Depth to limiting factor Remarks: CST Name - .— Please Print Phone: A ddress: FM Signature: Asti Date: 3 �+� CST Number: ;,�� PROPERTY OWNER SOIL DESCRIPTION REPORT Page_of. PARCEL I.D. # 4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bcurxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed niu Ground elev. ft. Depth to lilting factor Remarks: Boring # E3 Ground elev. it Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to IimiGng factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: FSBD- 8330(R.05/92) H N C O a •b� a can � ,`'. _ � ' .. -� • � _ , rl . 0 O ` 00 � PO � ra � z 1 . ,: • ` /� ' zg. x «c z r . �2 0 'o rE. Q .� a Z OV A 1 7 0 N , m , I C13. •_ _ � .... • ..•Cj �•�_ cam -�� ! .. j ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer SCV Industrial Properties Mailing Address 7145 Sandburg Road, Minneapolis, MN 55427 Property Address 580 Schomm Dri '. (Verification required from Planning Department for new contauction) City/State Hudson, WI Parcel Identification Number LLGAWIFACRUMM - e��✓ Property Location ,�y,� /., �/ , h, Sec. �.�, T�N R ZY W Town o f Subdivision —PT 1?aarx 4/ ffa ze c Lot # �. Certified Survey Map p . Volume , Page # Warranty Deed # 5 - 7 7 2`6 ­ 7 , Volume 13 , Page # a '7(,,a"7$, Spec house O yea © no Lot lines identifiable IN yes O no S Improper use and maintenwoof your septic system could result in its premature failure to handle wastes. Proper maintenance tourists of pumping out the septic tack every three years or mom, if needed by a licensed pumper. What you put into the system can affect the ftmcdou of the septic tank u a t+eatateat stage in the waste disposal system. The owner a to submit to St. Croix Zo t a certification form, sig ned b the owner and by a property guns um8 Department g y master plut�rabar, journeymao�phmsber, reatrictedpiumluer or a licemed punrperverifying that ( t) the on -site west ewaterdis sal Po system is in proper operating condition and/or (2) after impaction and pumping (if necessary), the septic tank, is less than 113 full of sludge. Uwe, the uudm4ned have read the above requirements and agree to ttau taro the private sewage disposal system with the standards art forth, hetein, u set by the Deportment of Commerce and the Department of Natural Resources, State of Wisconsin Certification stating that your sephe system bas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the th eapbstion date. ?r finc APPLtCAN ' DATE OWNKR C9B17lIC.An0N I (we) ewdfy that all statements on this form are true to the beat of my (our) knowledge. I (we) am (are) the owner(s) of the property de cubed ab , by virtue of a warranty deed recorded in Register of Deeds Office. SIC CANT DATE 4000 Aa hftandw that is this repteae Odmay result in the sanitary permit being revoked by the Zoning Department. 4 •• •• ladwk WO dft ttppllattlon: a stsntped waaanty dead from the Register of Dee& office a copy of the certified m;ttrvey map if reference is made in the warranty deed UUCUNILN I NO 51 A I I. tfAli UI W15L:0N51N I UIIM 2-1982 ^) " '• r WARRANTY DEED 577280 LIL 131 5 °v1276 � R��5 OFFICE SAINT CROIX VENTURES, a Minnesota general partnership REG1S7 ST. CROIX CO., WI Ree'tll /et Aaeut'd APR 15 1998 conveys and warrants to ROBERT E. DOWDEN 1.45 PM Re shr of Deeds RETURN TO 6 ro It ll­ 9 G S. Tk, gC.tk 5 z the following described real estate In St • Croix County, IV, P. S ' State of Wisconsin: Tax Parcel No: AN UNDIVIDED 10% INTEREST IN AND TO: Lots 12 and 13, St. Croix Industrial Park, Town of Hudson, County of St. Croix, State of Wisconsin. TRANSFER F E This i not homestead properly. (is) (is not) Exception to warranties: Subject to conditions, restrictions, reservations and easements of record, if any. Dated this _ 3 d day of / r .19 98 (SEAL) SAINT CROIX VENTURES (SEAL) • B Gregory L a A en e ra 1 Par t (SEAL) (SEAL) Bruce A. Christensen, Trustee for the ** AUTHENTICATION (SEE REVERSE CKNDOWLEDGMENT Ma "ESOTA Signature(,) STATE OFM SS. Hennepin County. � authenticated this day of 19 Personally came before me this 30 day of 1'�are k - .19 98 the above named Gregory L . Harvey, a general partner of Saint Croix Ventures, a Minnesota general partnership TITLE: MEMBER STATE BAR OF WISCONSIN (If not to me known to be the person who executed the authorized by § 706.06, Wis. Slats.) to a the same. THIS INSTRUMENT WAS GRAFTED BY ' rte DAN R R sTR ANn BRUNELLE & HUCH, LTD NOTARY PUBLIC MINNESO _ 3939 IDS Center, 80 South 8th Street �' J0.3 Oft M Minneapolis, MN 55402 -2129 Notary Public County, -*A4: 4' (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, stale expiration are not necessary.) dale: �� J� °_•1 'Names of per suns signing in any capacity snould be Iypea or printed below their signatures SB2 NTF 0021 W ARRANTV DEED STA'e E BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307.0208 ON No. 2 — 1982 o i Lq nd RJPAPN viosmin • onene xwioe M --� ONVU Is a 3DOa NVa .ter • awes 841 sa6pa LMOUVe pue 4uawnajsu i 6u Lo6aJOJ a44 palnoaxa oqm uosiad ayl aq o4 umoul aw off. `dLgsjau4jed Lejaua6 elosaUULW a `sajnluaA XLOJO 4uieS jo jaulaed Leaaua6 a `uasualsLJ40 6LeJj •g jo Illauaq ay4 aol juawaaj6y 4snii OLge3Onaaal uasua4SLJ43 aua6n3 ayj joj as ;snii `uasua4sLay3 •y a3na8 paweu anoge aye `8661 �b� 10 yep o£ sLyj aw aaojaq aweo 4LLeuosJad uldauuaH jo 44uno3 SS( RJOSaUULW Jo ale4S ,.�.�.• "7 1uaw pa LMOuVV „J I , �...rw....,., w w•rr.....saM+rrn _tvr ., ' -JauVed LeJauag a `uasuajSLJg3 6LeJ3 •g jo 4�jauaq ayl aoj juawaaj6y 4snal aLgeoOnauJI uasua4SLJg3 aua6n3 ,� LL WARRANTY DEED' If V1_ Ilk r �`7r128� k�` 1.I 1 SAINT CROIX VENTURES, a Minnesota general partnership, 7APR ��� Ri OIX ReoO WI il conveys and warrants to INDUSTRIAL PROPERTIES 15 1998 a Minnesota general partnership 1.45 P. L Ro I.tor of 00944 RETURN 60,- r� rs �% rA r f the following described real estate In St. Croix County, /�' A / . /� (� h'�d - oz/ :� State of Wisconsin: Tax Parcel No: AN UNDIVIDED 90% INTEREST IN AND TO: Lots 12 and 13, St. Croix Industrial Park, Town of Hudson, County of St. Croix, State of Wisconsin � TRA NS FER FEE This is not homestead property. (is) (is not) Exception to Warranties: Subject to conditions, restrictions, reservations and easements of record, if any. Dated this 30 �( day of 1 ' 19 (SEAL) SAINT CR IX VENTURES (SEAL) Grego H vey (SEAL) n A Genera PArtner (SEAL) Bruce A. Christensen, Trustee for the ** AUTHENTICATION (SEE REVEM&aJAIDGMENT Signature(s) STATE OF�V! ss. Hennepin County. � authenticated this day of 19 Personally came before me this 3 a� day of ,d!22� —.19 98 the above named Gregory_L Harvey, a general partner of Saint Croix Ventures, a Minnesota g partnership TITLE: MEMBER STATE BAR OF WISCONSIN (11 not, to me known to be the person who executed the authorized by § 706.06, Wis. Stals.) foregoing instrument and ac THIS INSTRUMENT WAS DRAFTED BY _ D 31.2000 AN ROGER STRAND BRUNELLE & HUCH, LTD ' NOTARY PUBLIC •MINNESOTA Commatba ExDnK Jaen. 3939 IDS Center, 80 South 8th Street Minneapolis, MN 55402 -2129 Notary Public County, vWi (Signatures may be authenticated or acknowledged. Both My Commission is permanent. 1 not, state expiration are not necessary.) date: �� ,.X2QL�_rp) Names of persuns signing in any capacily should be typed or prinled below Iheir signalures SB2 NTF 0021 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307.0208 Form No 2 — 1982 ** Eugene Christensen Irrevocable Trust Agreement for the benefit of G. Craig Christensen, a General Partner .....ter+ ,w,IMµ,MlM • � w ... •..,� Acknowledgment L�y.� ► State of Minnesota )ss. County of Hennepin Personally came before me this 3a d— day of 1998, the above named Bruce A. Christensen, Trustee for the Eugene Christensen Irrevocable Trust Agreement for the benefit of G. Craig Christensen, a general partner of Saint Croix Ventures a Minnesota general partnership, to me known to be the person who executed the foregoing instrument and acknowledges the same. DAN ROGER STRAND NOTARY PUBLIC • MINNESOTA o t a ry Public W C WM"EW=Ja&31,2= �I DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -19x2 DUIT CLAIM DEED ®0 577287 oar � F ROBERT E. DOWDEN R os"d . %r R4 00M Quit•claimsto SCV INDUSTRIAL PROPERTIES APR 15 1998 a Minnesota general partnership 1.45 P M Re etw of Nord l the following described real estate In St. Croix County. State of Wisconsin: RETURN TO y )-t JL �•� � T C �`Y.3! y: Tax Parcel No: AN UNDIVIDED 10% INTEREST IN AND TO: Lots 12 and 13, St. Croix Industrial Park, Town of Hudson, County of St. Croix, State of Wisconsin $ , TRJNSFER FEE - ' This is not homestead property. (is) (is not) Dated this 3 - day of , 19 8 . (SEAL) A/ (SEAL) Robert E. Dowden (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Minnesota Sionature(s) STATE OF Vftft *X N ss. Hennepin County. 4$?_ authenticated thi day of 19 Personally came before me this day of 19 98 the above named Robert E. Dowden TITLE: MEMBEASTATE BAR OF WISCONSIN (If not, to me known to be the pa R STRAND authorized by § 706.06, Wis. Slats.) foregoing Instrument and OTARY PUBLIC • MINNESOTA THIS INSTRUMENT WAS DRAFTED BY BRUNELLE & HUCH, LTD. DS Center, out t Street � Minneapolis, MN 55402 -2129 ' Notary Public &_e a County,ia (Signatures may be authenticated or acknowledged. Both My Commission Is permanent. (it not, state expiration are not necessary.) date: ' 3 4 __ Name, o1 psi son %,,gn.ng in any capacity ,nouio be typed or printed below their Signatures. S133 NTF 7776 N�7e UAIt AF W114440111111111 e•, u y , Allli jeLA'M WEED rnaaa ri.. 1­1611t Nel ;n tea /orrna.l'.(9. r.OAdN,@ratw�do tiJ154 t01 -0tree I Z I • O _._._..�..._._.------ _. _._._. a t I lO $ I I LF a • I 1 I � 1 I E-- I 1 I I 1 � I�_________J 1 I I so AAW Cram, "loop 1 I 1 j I 1 - - — — — — — - - - - - - J . _._ -.. u _..1 . L._.._. I ' ' c • ; •d' � 1 lO "a � I 1 °°L � � — `� --r•— a �.� � ------- - - - - -- I I i i i i I cs IT 1 I 1 �