Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1335-50-000
ST. CROIX COUNTY TONING DEPARTMENT AS BUILT SANI'T'ARY REPORT Owner 5 1 4 fi'I Azll e fle— Address ?y3 a&,// rAiT o City /State Legal Description: ^ Lot 3S -- Block Subdivision/CSM # � b L A ND S � %. -�-F, V,A [ ,, Sec. ?-7, T-? -RZV(20 Town of tf y DSoN PIN # O EPTIC TANK DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer (Sk a Size ST/PC 11 Setback from: House Z Well S / P/L I SAS la So, 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 system: ? — F E Cj 0 _ Width �_ Length ( C , Number of Trenches 2- Setback from: House t Well g P/L /,/ Vent to fresh air intake ELEVATIONS Description of benchmark A/ ( L IAJ E I DE K. Tti? [ Elevation 's Description of alternate benchmark Ty,,;�) e , Ic e, k - ,c` ' Elevation �,Sz of Building ewer q � � ` � - 1 5 � g ST/HT Inlet 7, OS' ST Outlet 7r -q 7 PC Inlet F 9 "ZS R H Sl SZ PC Bottom Header/Manifold Top of ST/PC Manhole Cover 3 Distribution Lines (' ', 2. le 9�'? 3 Bottom of System Final Grade ( ) (o , 17, ' 6 . 3 Date of installation 7 / 7 / Permit number , 3 1-T9 7 9' State plan number Plumber's signatur "c -'aka License number 5 Date 7 /7 /FS Inspector Cornpi<« pio( plan or NOTICE Please provide the f6llowing: f • 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 ter. 44 IV 1t) ,a w r 4 L-Ttrk�NP , Nf — 7 L'3P1 T V 15 -- ��--- -- - -.� __._.. � �E 1 10 0 J 3 Zb.-K CeD.) �l N a i LA) —F,QF D INDICATE NORTH ARROW Wiscortsin Department of Commerce Count PRIVATE SEWAGE SYSTEM y: Safety Ind Buildings Division INSPECTION REPORT ST. CROIX 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)J. 315879 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ' / , f1 020 - 1335 -50 -000 TANK INFORMATION ELEVATION DATA A9800267 7 /O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 41 Y Aeration _.. .W W M. Bldg. Sewer Holding St/Pf Inlet t` TANK SETBACK INFORMATION St/ Outlet Q' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet - -`� Air Intake Septic / /( NA Dt Bottom Dosing NA Headers - -- ' Aeration NA Dist. Pipe Holding Bot. System /_3c �3, 01Z) ' PUMP/ SIPHON INFORMATION Final Grade Sn ' Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft L oss H ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT" No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS - ••... SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIUG — Man SETBACK CHAMB _ `_"` INFORMATION Type O rty Model Number - - - - -- - System: R 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 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.) LOCATI6N• HUDSON 27. 29.19, SE, NW 743 WI LFRED RD— BADLANDS PRAIRIE LOT 35 �s���`1,�. /w'£A. T� � l�r. -7 �,�;. /�'Vl(y- (_ - �� �/ "4 C, c'�✓� �' �, • "�� f _ � , -� r ' - � < �. /�)' c C..�-t - Plan revision required? ❑ Yes ❑ No (� Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ^:� „,: •o� Safety and Buildings Division �•� SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �I , C f p t n than 8 12 x 11 inches in size. 1 • See reverse side for instructions for completing this application State Sanita Permit Number The information you provide may be used by other government agency programs E] Check i14�is'ion to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location In EA. �j f. 114 W 1/4, S Z 7 T 29' . N, R/ `j E (0 Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 4.,'12S0A/ 44-11 syo (3X ) 2.7 .BAD LAYD 5 Aif tZIF II. TYPE OF BUILDING: (check one) ❑ State Owned cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ E] T own of lJ .$ D N �(LL Flt an R O, 111 BUILDIN USE: (if building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo D ?_ 0 1 A 35 - sue 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2_ ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System 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 ❑ Specify Type 41 ❑ Holding Tank 12 'Seepage Trench 22 ❑ In- Ground Pressure _IX t0�/ 42 ❑ Pit Privy 1 Seepage Pit 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) i Elevation q.57-0 O -- 9 Z � Feet '94 4 Feet VII. TANK Capacity gallons Total # Of Prefab. Site Fiber- plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Exist' strutted Tanks Tanks tic 9 t 00 UJ9F !sEll- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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 St m s) 1 MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State Zip Code): n 0 4v bl rO I DCF, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Datelssued ssuing ntSi a No Stamps) Surcharge Fee) X Approved ❑Owner Given Initial cV I Gj Adverse Determination D 1 �{ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO -6398 (R. 0 DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divi ion, Owner, Plumber 5 0 1 C1'1 (LL L E rl l3 r� t� LA A/ P 5 'c /iy "- y 741 3 c.c.J /[G. /zE 013 7 X bL0 •1335 -54 0 J L OT u N v 0 v S ---- = - - - -- -mss' w L L� 3 ( ! NR IL 4� _ x o7N Cl- V 1-4 14I o N o p z � 0 ? O fi 0 F I co l W I ,p n dI w at � I CL U V O il t W � I I � I p tit U z i 10 h VI W , 4 L Z w S i i i F O' I I d a A N 1/1 U Z W Z W _ W i W Q m F F- Q Ln 2 1 Q:r-a a yr NORTH LINE OF THE SE1 /4 OF THE NW1 /4 188.90 157.00' �` 155.00' / n � N 259.66', N A c 0 LA w.L. = 9 1 10.' . ' N -- N 89'59'06 W ! Y S m �,. 33 3 34 a 582 � s -: .r S 3.94 ACRES 3 32.2 *>.� 1 83J SQ. FT. s, 2.05 O 89,192 I % \s_�•� y! 83, js 6 5 87' 33'US" I H.W.L. - 909.0 U 5� : F � 1 ,� • �, 35 M : VNI.11UM CUIILING ELE ATOM' f �I FCR LOT.. 35 -- °---310 0 .. .. . -•1 4.95 ACRES 215,413 SQ. FT. V O D °'1111.,, .. .i•': •= +.....:y: .. s:r.. �-� �"+� i -.., -._ , ..�.s.-- r,.+.....�- : 1111 ... . _,,.,,,,��•�< O� K • i MATCH LI E SEE SHEET 2 o wy / a4 S88 3 a .... �. - c 26 ' { I 28 27 O N 87 E 8.62' 1 JI 17 2.13 ACRES 5 65. , 92,795 SQ. FT. �Ogs�S t 575 27 . 4 5 ., i 9 / S79 - 02'3 5g t; °E 5j f Z 96 .78 a o a � 3 ri ui v �2 .. I I 10 W 4 o S o `T9�0 2.52 ACRES 3 Z �J�109,745 SQ. FT. '-Wisconsin Department of Commerce SOIL AND SITE EVALUATION 3 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 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference poi (BM), direction and -S � - C (� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 9 1 APPLICANT INFORMATION - Please i Dana i' Reviewed by Data Personal information you provide maybe used for pu . s. � 1) (m)). i Property Owner Location q jq98 - Lot S i�_ 1/4106#1/4,3 7T q ,N,R Z < 7 (nor) W Property Owners Mailing Address SAN Block# Subd. Name or CSM# F - !) 3 la n d City State Zip Code Ciiy [] Village N Town Nearest Road 14uct s o n c-</ L Syo/ Z� G n of ma -2 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement /� El Public or commercial - Describe: Code derived daily flow 7 r s � y gpd Recommended design loading rate bed, gp� tr�l� � g Absorption area required 6"V 3 bed, it 2 _� tt tr rench. ft Maximum design loading rate bed, gpol�� gWt Recommended infiltration surface elevation 7 s) Z, U O It (as referred to site plan benchmark) Additional designtsite considerations Parent material ZT !GG/ �X f' y wc t 5, Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound Ground Pressure AT -Grade System in Fill Holding Tank ❑ U = Unsuitable for system Cgs u 6a S El r U ❑ U I O S ❑ U I ❑ s lR u ❑ S R U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mollies Texture Structure Consistence Boundary Roots GPDtft2 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 !o r y e I 1 Mab k M-Q- cS 1 1 � m Ground elev. 4KZ ft. Depth to limiting ; factor Remarks: Boring # 2 - /0 r S SO MCI 12k fn i C • 3 - r l M s m .7 Ground elev. ?4 U1 Depth to limiting factor Z-121 Remarks: CST Name (Please Print) Signature Telephone No. a v✓� -c ?l �� y7- y0o Address Date CST Number q mar r� Sa w r 3' Y6zs__ PROPERTY OWNER /� SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. Oft. Depth to limiting factor tin. Remarks: Boring # l o i z /0 r — S /ma 6 m r l f (o /a /- / S i b& i — Sr /A M S OSCA m i Ground elev. 9 7.cb ft. 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. Bed , Trench Boring # ?! /D r S hta C ,S [ C Ground elev. Depth to limiting factor /V in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) i A 3 of 3 -e r d o-f to O -V w 7 9 ORI 1 & 3 1 3cvva/ *0 P u /Oz-YO . N, .Sy Sit Z. 00 tool REA 13M L I y S 1' +c I wet 7S jet s i3n� I Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar8"Ve.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). M Pa l r�it d r' N e: [Afj c j� )] Wllage ❑ Town of: State Plan ID No.: CST B Insp. BM Elev.: BMDescription: Parcel r�fdi1335 -50 -000 TANK INFORM TION ELEVATION DATA A9800073 TYPE M UFACTURER CAPACITY STATION BS HI F ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATIO St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet it Intake Septic NA Dt B om Dosing NA ader /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer em d Model Number GP TDH Lift Friction System TDH Ft L oss H ead Forcemain Length Dia. ist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIM I N SETBACK SYSTEM TCI P/ L BLDG WELL LAKE / TREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER Mo Number: System: OR UNIT DISTRIBUTION SYST Header /Manifold Distribution Pipe(s) x Hol ize x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Gra Systems Only Depth Over Depth Over xx Depth Of xx eded / Sodded xx Mulched Bed/ Trench Center Bed/ Trench Edges Topsoil ❑ s ❑ No ❑ Yes ❑ No COMMENT (Include code discrepancies, persons present, etc.) LOCATION: UDSON 27.29.19,SE,NW 743 WILFRED ROAD Plan revision required? ❑ Yes ❑ No 7-1 Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Buildin water s 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 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. Q e See reverse side for instructions for completing this application State Sanitary Permit Numb r 3® & 0 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 INFORMATION Property Owner Name Property Location -.� t f 1 1/4, S2 T all , N, R 1 7 E (or Property Owner's Mailing Address Lot Number Block Number a P l City, State Zip Code Phone Number Subdivision Name or CSM Number Hd sQ S o!G (3�G) L �[ R C (✓ xs<—� 10 ►S� II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit u Nearest ad Public 1 or 2 Family Dwelling - N of bedrooms Tow OF I4Ua�'N �( . III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ® Zee- 13 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ New 2 ❑ Replacement 3 [] Replacement of 4 E] Reconnection of 5 E] Repair of an ___ystem -------- 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 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 In- Ground Pressure r r 42 E] Pit Privy 13 ❑ E] Seepage Pit C Z-� J x Coo 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 q , - , — D S43 b oo � --"` �G � v � Feet /00.'t S`Feet VII. TANK Capacity in allons Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name. Concrete Con steel glass Plastic App New Existin strutted Tanks Tanks e ticTank ing IanF we I s F-)Q ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ I ❑ VI11. 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 St mps) MP /MPRSW NO Business Phone Number: t t�� M�AQN�L� 7� rh� � Ma?Spo ?+��• �' Plumber's Address (Street, City, State, Zip Code): p 7.0 Ra&7 _A,E ,r 04 P 040 so Gv 1 S V o /C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) c Adverse Determination / Od �/� 313t �9 CS X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO -6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Divi ion, 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 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 and 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_ IL 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. VIII. Responsibility statement. Installing plumber into 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 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Q � 6 LlyND 5 A? A.a7 IA ' /c ' � W ItL REp l?0,4 T 8 x*s NoRTN LO A-/NI /S7,00 ' v 40T 39 Lao nP f-ri.1ca a' coT 3 � a. drt 44Z �I. ; coT qo it t 1 • v Z � V- o to I SO w 0 V W ELL a w14Y � i�o l,Vo ScAL�� i �n w! z n. O w o co 0 11 0 a J M a Z i M v z I I V N + a I w a w to LU LLJ i I o I � I Dl Q M I ' i w Q Qq Q� I n t ' I �r t� a- I z VN t I Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page 1 of 3 Uiv�sion of Safety and Buildings 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 St. Croi.X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # . `/075 APPLICANT INFORMATION - Please pnnTff6i, Reviewed by Date Personal infonna ion 1 t you Provide may be used for seconds �'s- (PrYV�yq . (1) (m)). Property Owner J ^ , Ar erty Location Richard Stout Lot SE 1/4 NW 1/4,S 27 T 29 ,N,R1 fit(or) Property Owners Mailing Address L Block# I Subd. Name or CSM# 1353 Awatukee Trail _ - --1 ".'r 5 Badlands Prairie City State Zip Code ��.,�hone Nurage "" ity El Village [R Town Nearest Road 04" ' I Q Hudson WI 5401 6 1 5 )5 ee, `. udson State Hwy 12 1 ® New Construction Use: ® Residential / Nu r of � Air 3 — 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft — trench, gpd/f1 Absorption area required 8 5 8 bed, ft 7 5 0 trench, ft 2 Maximum design loading rate .7 bed, gpd/ft — 8 trench, gpd/ft Recommended infiltration surface elevation(s) 96 .65 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Glacier d ep osit Flood plain elevation, if applicable it S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [R s U I ERs ❑ U [X_1 S U US ❑ U ❑ S U U ❑ S IX U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 1 0-14 7.5 r2.5 1 none L 2mabk mfr cs 2f .5 '.6 2 14- 10yr3/4 none sil 2mabk mfi cs if .5 .6 Ground 3 50- 2 10yr4/ none ms osg ml cs -- .7 .8 elev. _ 101 .25 ft. S� z Depth to limiting factor — 9 2 in. Remarks: Boring # 1 0-16 7.5yr2.5 1 no L 2mabk mfr cs 2f .5 .6 2 2 16- 0 10yr3/4 none sil 2mabk mfi cs if .5 ,.6 3 50-96 10yr4/E none ms osg ml cs -- .7 .8 Ground elev. 101 Depth to limiting factor 9-&_in. Remarks: CST Name (Please Print) Signature Telephone No. Sc h a Address Date CST Number 1-'a SG a%7'_ 9 a� Q90 Richard Stout SOIL DESCRIPTION REPORT ?ROPERTY OWNER Page of PARCEL I.D.# 30ring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .Trench 3 1 0- 2 13 -50 10yr3/4 none sil 2mabk Mfi cs if .5 '.6 around 3 50 -91 10yr4/6 none ms osg M1 cs -- .7 ' . 8 flev. 101 .25 ft. >epth to imiting actor 9-1_in. Remarks: 3oring # 1 -16 7.5yr2.5/1 none L 2mabk mfr s 2f .5 ..6 4 2 6 -4 10yr3/4 none sil 2mabk fi s f .5 ..6 _ , 3 2 -8 10yr4/6 none ms osg : 1 s - .7 .8 around alev. 100. ft. Depth to imiting actor 8 9 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# 1 -15 7.5yr2.5/1 none L 2mabk fr cs 2 f .5 .6 5 2 5 -4 10yr3/4 none sil 2mabk Ufi CS if .5 ,.6 3 2 -8 10yr4/6 none ms DSg T11 CS - . 7 .8 Ground alev. 9 9 . 95_ — ft. Depth to limiting factor 89 in. Remarks: Boring # "round elev. tt. ' Depth to limiting factor in. Remarks: SBOW -8330 (R. 08/95) leg 3 a l y Ira �e73S 1 -0 N �3a �D 1w3 (� 'C '3 0 �y3 • i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S A M iM 1 LL C /L- Mailing Address Property Address J(3 GJ! GL FR F d Q -o A D �CQ (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Properly Location S - ' /4, � ' /4, Sec. 2 7 , T 7 `f N -R W, Town of subdivision X14 D LA 140 'S #� R Lot # . Certified Survey Map # � © ( G , Volume IP , Page # 9� Warranty Deed # _ S �1 3 5 , Volume 1 Page # 3? 9 Spec house [ yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Imptsaper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards.. set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the three year expiration date. 3 /3'<�/ 9� SIGNATURE APPLICANT DATE ",. -i,) NER 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 e5cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. I A OF APPLICANT CANT 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 t /U av VOL T3���ACE'3�9 5'74345 STATE BAR OF WISCONSIN FORM 2 – 1982 WARRANTY DEED DOCUMENT NO. REGIr ICE ST. CR !X CO, WI fat ^tN RICHARD O STOUT RK'i MAR 0 S 1998 conveys and warrants to SAM E MILLER a sing3,e_ rsax 8:00 A M of THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St Croix R 5 M M I u State of Wisconsin: Bo x �* f $ Lots 19, 20, 35, and 36, Plat of Badlands Ht✓OS" W( SYo /�b Prairie, Town of Hudson, St. Croix County, Wisconsin. PARCEL IDENTIFICATION NUMBER a ��N FER FEE This is not homestead property. (is) (is not) Exceptiontowarranties: easements, restrictions, rights -of -way and covenants of record, if any. Dated this 4th day of March A.D.,1998 (SEAL) (SEAL) • Richard O Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) ss. St. Croix County authenticated this _ day of ' 19— Personally came before me this 4th _ day of _ March , 19�$_, the above named - Richard O Stout TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stars.) �:' .�fi roe ia><�.zt to be the person who executed the foregoing `k0TARY i$a 3ndacknowledge hesa te. _. ; =' ` . THIS INSTRUMENT WAS DRAFTED BY � � QI AALGt Janet P. Stout "A PL ' \G }fit 0 ! Virginia R. Gartman n • • r Cr t. Croix J Qiunt Wis. Hudso Wi. 540 _ — I Nc— �ic )' (Signatures may be authenticated or acknowledged. Both are not She 7+cirtt�slon is permanent. (If not, state expiration date January 30, 2000 " IV _ ) necessary) Names of persons signing in any capacity should by typed o! primed be!o% !he!r >i ;, a(ures. STATE BAR OF W!fCO*,St•+ WARRANTY DEED Form No 2 — 1`_62 ivu � t : ut��nir i ru �.. 05.89' Z M N PARCEL "B" PREVIOUS PLATTED LINE N89'59'06 'W 4.35' o- N 114.80' 171.'6' N N ti 39 34 �9 -� O J � 35 0 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER M " ■■ 1101 Carmichael Road Hudson, WI 54016 -7710 _ - (715) 386 -4680 July 21, 1998 First Federal Attn: Tammy Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 743 Wilfred Road, Lot 35 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin Dear Tammy: A septic inspection of the above referenced property was conducted on July 7, 1998. This property is located in the SEY4 of the NWY4 of Section 27, T29N -R19W, Lot 35 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 3864680. in ely, mes K. Thompson Zoning Specialist /sm ST. CROIX COUNTY ZONING DEPARTME$r- AS BUILT SANITARY REPORT 1� ; ECEI VEO s Owner d V' i �8 `'e s "r CR:)ix Property Ad s r, �� - �Ji.1N y City /State ► D rV,y:F Legal Description: f Lot Block Subdi ision/CSM # 1 ' t /4 ZL ' /4, Sea �Z , Ta N -I W Town of D PIN # del�IIZ2 70 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer N Sizc(�P7C ODU/ Setback from: House Well P/L 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 r Type of system: Width 3 Length 5�� c 2 S J Number of Trenches CV Setback from: House >lC&y Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark P/ f p e Elevation Description of alternate benchmark S j LkK ee Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System a Final Grade Q) Date of installatio / Permit number �Q� / State plan number _ Plumber's si g nature License numberpdz�Z2 Date 1 / Inspecto ✓r1 Complete plot plan �+ k ' 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 A 5 ��ke �'o At UJ. 6 Yn >oo,o dike 3 v` Alt # Ru.h 1)4 Iv y ° �1 �C. d S �5�� v►7 INDICATE NORTH ARROW 0. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Coun +x INSPECTION REPORT 3ST GENERAL INFORMATION -(ATTACH TO PERMIT) Spnit1AW40 P information you provice may be used for secondary purposes (Privacy w, s.15.04 (1)(m)j. Permit Holder's Name: D-Cit ❑Village Town of: State Plan ID No.: PORTER, SPENCER /RUELIN, ROGER TROY CST BM Elev. Insp. BM Elev.: BM Description: Parcel 6021192-10-000 TANK INFORMATION ELEVATION DATA A9800462 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Veri TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet c Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction I System TDH Ft Forcemain Length Dia. Ff Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER model Number: System: 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 24.28.20.857,SE,SW 227 PLAINVIEW DRIVE Plan revision required? ❑ Yes ❑ No Use other side for additional information. FT 1 11 11 1 ITI SBD -6710 (R.3/97) Date Inspector's Signature Cert. No r Safety and Buildings Division 201 W. Washington Avenue Vi scons i n SANITARY PERMIT APPLICATION P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI '53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County jI than 8 1 x 1 1 inches in size. �T • Coro T • See reverse side for instructions for completing this application State San P� mi b Personal information you provide may be used for secondary purposes El Check if revis t prewouslapplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name roperty Location 5 C '6I' h s 1 /4 1 /4, S T ,ae' . N, RE (o W Property O s7ailtryg dd�ess In p � Lot Number e Block Nu State Zip D; � ( 'u b Subdivision N�m or umber c CL IA I I1. TYPE OF BUILDING: (check one) ❑ State Owned !ta Ne st Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF /^D � < r U• 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 9 / 1 E] Apartment/ Condo I) �� > /" 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. Replacement 3, E] Replacement of 4. E] Reconnection of 5_ E] Repair of an ------ System System Tank Only 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 t 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12M Seepage Trench a — 3 X X6.0 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit n �, I 43 E] Vault Privy E] 14 System -In -Fill �( l l VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Da 2. Absor . Area 3. Absor . Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Y P p 9 Y y Requlr q. ft.) Pro q. ft.) (Gals/da /sq. ft.) (Min /i h) 93 Q Ele�a G • .�• 1, Feet ©• �' Feet VII. TANK Capacity in gallons Total # of s Site INFORMATION Gallons Tanks Manufacturer's Name C oncrete Con- Steel Fibe Plastic Appr. New Existing t in strutted Tanks Tanks e ticTa OW ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ ❑ 1 ❑ Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewa shown on the attached plans. PI e s Name: (Print) Plu r' ignature: (No S m s) Business Phone umber: umbe sAddres (Street, City, t ?ZrCde): v�,r of � l� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) nApproved ❑ Owner Given Initial Surcharge Fee) ' ?$ Adverse Determination a `�� q Lg X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBA 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber s 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 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed II. 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. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11, inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with c6rhplete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Too I� tin dull u'�n unbf lbb� c) ors s fike Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P of Labor and Human Relations — Division of Safety rl< Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY . r Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste' C_� not limited to vertical and horizontal reference point (BM), dir and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distancenearest toad: v O— oLZ — ' t APPLICANT INFORMATION— PLEASE PRI1��T``lltt INF ! RMATIO,N REV D BY DATE PROPERTY OWNER: i , f 1 � P ERTY LOCATION Sp�AlCe1Z �0 \ZT S1� 1/4 Std 1 /4,S Z- T V6 ,N,R ZZ E (or) PROPERTY OWNER' :S MAILING ADDRESS LOOT # BLOCK # SUBD. NAME OR CSM # Z Z'? P�_ f10 t-,) Zj s — C�I.f O� C� LX�ID6E CITY STATE ZIP CODE' PHONE N y []VILLAGE [7�fOWN NEAREST ROAD S2�U�Z FM�g, LJI S�IDZZ, - {CIS); r `Rzo`-f Q� -PnNVt ��z_ (J New Construction Use (x] Residential / NilrrlbeT of tnedroolri [ j AddW..gn to existing building P4 Replacement [ ] Public or commerciali Code derived daily flow \ASo gpd Recommended design loading rate — bed, gpd/ft trench, gpd/ t Absorption area required -- bed, ft 5 b 1, trench, ft Maximum design loading rate bed, gpd$ , t trench, gpd/ft Recommended infiltration surface elevation(s) ,t 3.0 — ° 4 •O ft (as referred to site plan benchmark) Additional design / site considerations S NEQ tioYQ - 1% Diti N 4 Parent material — %I o U eiL Flood plain elevation, if applicable "N ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 0S O U [Is ®U [Is ®U W S O U O S RU O S up SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo Roots GPD /ft Xg in. Munsell tau. Sz. Cont Color Gr. Sz. Sh. Bed Tmrrh 'ytivV!iiCti i.Sriti 1 o � lb�t z Z 1 z Rt^ S ,L % knum Z 6 - tt-y1z 3J(, .q . S Ground 3 o-uS il�`1R 3)b S _ -S elev. Depth to limiting factor >ll� I Remarks: Boring # < O—b t l>`1 2 L t Z s i l Z+91� g • S, b s 3 - ���rrZ 316 _ St's Z�sbt,� m es , C , Ground elev. � f Sy -9 8 7- S V �Z- 31Y — S 0 S5 wI 1 �� •� Depth to limiting factor 2qV Remarks: CST Name: — Please Print Phone. Arthur L. We erer 715 - 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022' Signature: Date: CST Number: C i� � z .� q -' M00576 PROPERTY OWNER �iPO1L SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. tf opt 0 - � I of 2. l0 , ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench t Z- z Li s i Z sb rw �v S Z 6 v� C Sb1z cQvs 12 -a •`/ •S Ground 3 S3 -ay s `!2 31 y — s g- wi — ,� •$ elev. 4 D8. • ft. Depth to limiting factor w > t� Remarks: Boring # f 13 1 0�� vc Z — z'W1P� D�S� ° L5 ►�Q Z Id eu ij '� , � 3 zZ -q-, -)•s Lj tz yl( s ) SVk m 'Fr a w I I y S Ground elev. to `-tQ ft. Depth to fU�T� S V 1T w DUG 1/V — S limiting �,j (-:7 L • D _ SU factor �j \ u s Remarks: Boring # , 0 EX(-& G �U �b ClZ-t ��UUL - v) U IYv CEO s Ground x.) U u S 1F) 1Z elev. S �t 11U S 1�1Z ft. Depth to 1 &J ® j t7aJ li ' F1 fW U E 0 �` Tl/✓G dJ ` 1S factor Z MMN - Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD- 8330(8.05/92) PLOT PLAN Pa 3 of , qQ' _ SCALE 1 "= 40 ' P � 3 a.z 3 - - - •- .- �.. '� �L. alb � �V 1� W11+l - Lt-.IU0.0" ON Splh.L Su ftbo ul�- GROtAAD `►J S" l>t A , E 1 `I'S2" . Z _ el. a6. oN 3\P1h.IE� 36t PAOUIE 6RouM�) 1 fV f �PLPtSt. 112 . cl, 4 7Z� �� e � j Z� -Z ( 715 ) 4L-0169 M00576 7. ES -- T Signature Date Signed Telephone No. CST # I k" !) K/ (� S SEtowrJ �v Q1� -DUto� t�►�c 2 v ° fo SLap� ��, - Tt i �'t�v.�'A �� 2Ll' \ao►vw, vl� `t� -}-� �Tzb�Ct�s_ LN$TKIJ� Z TR�1JC1�k?S - 3�x 56•ZS' LWJG Lvl` - )j c.�p f'� - L'M sLLI�t�ItiDLR. L��y GL� 113�'S2.S_ S fD 1�101ZlZUiV )F:- svr� t3 e -eeQD pr R t}'1 G t1�ct, W iisco=DepartmentofIndustry SOIL AND SITE EVALUATION REPORT Page \ of Labor and Human Relations Division of safety a, Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Sr-, <!'Myx not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. u q �j 11 - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REII - WED BY ATE fir(( PROPERTY OWNER: PROPERTY LOCATION S p &j C.e12 S I�E 1/4 SIN 1/4,S Zy T 7 -1 ,N,R ZCA E (000 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM # Z Z'? Pl f'0N\ QKj byt 11 - T of C�11X CZlD6tr CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑1IILLAGE MOWN NEAREST ROAD l'�•�v�Z. �'mt_S ►'J S�t) (�ls) 3� �`S�10 `nZO�f P>��vit� v 'sz_ ] ] New Construction Use ]x] Residential / Number of bedrooms 3 [ j AdditiQrt to existing building P4 Replacement [ J Pudic or commercial describe Code derived dally flow \ASO gpd Recommended design loading rate — bed, gpdfft ' ° trench, gPW Absorption area required — bed, ft 5 b trench, ft Maximum design loading rate bed, gpd$ . 6 trer>ch, gpdtft Recommended infiltration surface elevation(s) a 3, o - °4 l . O ft (as referred to site plan benchmark) Additional design / site considerations s )!:'� "OYiZ C r" 1pftesr;- 1 4 Parent material %I o Ul;M S oy ot- H Flood plain elevation, if applicable T,3 Pi ft S = Suitable for system CONVENTIONAL MOUND W- GROUND PRESSURE 7 AT -GRADE SYSTEM W FlLL HOLDING TANK U = Unsuitable for s stem ®S ❑ U ❑ S IO U ❑ S ®t1 W S ❑ U ❑ S I�.0 ❑ S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench o � b td Z! z — s i 1 Z '' q a, - • S .L M Z 6 -3a Io-11i !L v s 1 Csbk AUS .s Ground 3 o-u S ► �`iR )A — s �) -'� M F}� c.S elev. fL y �s lt3 - s�tR 31 — g o s9 w► I - ,1 Depth to limiting factor Remarks: Boring # 0-b t u`ti CL Z[ Z s i 1 1`9 V t�'F► q, g • S Z . Ground elev. Sy ,9 8 7 - S Y rz. 3 — S U S3 r`1 1 • Depth to limiting factor - 7 9 $' Remarks: CST Name:- -WeasePrint Arthur L. We erer Phone 715 - 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: �� t'd j 9. 1 6 ` Z 5 Date: 2 : -) CST Numb D 0 5 7 6 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# Oq0- IotI -10 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 3 1 c" t.oti.VZ z- Li 31 R-s - , S , 1, z 6 -Sl . tvtiR - t/l, v�sl 1 c gUk c�\j es •`/ .S Ground elev. � • ft. Depth to limldng i factor > to Remarks: Boring # i 13 .3 P A 5 0- 1,js� a 1 0 -� It,- J�Z-3 Z S1� - Z.y`'t P� D\ 3� °LS ►.��' . Z 3 zz 147 ylb s 1 1 e.sblz m Ground Z P elev. y y7 lb (z- Y/u - s A p Sa m.v - ft Depth to NUTS S C' 1T Z v W DU (Z J hj S limiting factor ti.) LL L �{.S w 1 iJ p - 1 6 7 u A s Remarks: Boring # 13 3 o 6 '�M 1 D G s W2SL - 'D I U tyli CTe s Ground Ij U 0 �v Z elev. S lU S 1'riZ ft. Depth to ~' ® — g U 0 AJ i"i limiting factor — U S 0 kE T1 A/ G a1 l S Z r-t t; Remarks: Boring # Ground ' _ elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) : PLOT PLAN Pa 3 of SCALE 1 "= y0 ' - Z 3 L s iv� PRA'" 4 k B.� 11 0 2 33 ?3 la►i W - LxL. LaG,O ON SpkvLe 30 FzJUE GwxAL3 pw� w Z _ . ab.q I of j INV PAOUIt GRoux- OW L X78 -Z,b 5 '� (715 ) 49 -01 65 M00576 CST Signature Date Signed Telephone No. CST # cR,o s-S S NjOj 0 s rev cmt Tz)(STLY ft. � 'ACCt.�q � �.rcv �. `� v P s �oPe �� w� � � - rte`: o utiv �..► sL.0 p � r�.� =� C'� SL{'OwN `CU Q1�. -ll ULOF; 1�11f�X . 2v° f o SI.�P� ►-yv ��>- S`-tS'T�'J Z. ' � ct _ V X 56.2 S' L W,)G I v t M G lA cPrp P�t�lti/ S\.L�E�IrvD�2. L�,N Cl`4r�r113�'R.s_ ��sY1o!r%1 Or ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 4 dt J/ This is to certify that I have inspected the septic tank presently serving the y ° U residence located at: S ; , SGT Section n T N, R � W, Town of Upon inspection, I certify that I have found the tanl and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes � No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete / Steel Other Manufacturer If know Age f Tank (If known) (Signature) (Name) Please print/ a X /) / 1 56 (Title) (License Number) 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 inspe i openin over outlet baffl (� Name Signature / MP /MPRS��! 9 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OOwner/Buyer S C e y' 1 Q I r r Mailing Address go � bt IA J/ y Property Address CPO � f l Q l U l 1 (Verification required from Planning Department for new construction > 0 �J ti / Identification Number 61 l �� City /State I � lU '�v" �� S ICJ 1 Parcel Identi LEGAL DESCRIPTION Property Location. , '/4, Sec. T ook N -R W, Town of Subdivision 1C /� , Lot # Certified Survey Map # , Volume . Page # Warranty Deed # , Volume / Page # Spec house ❑ yes 51 no Lot lines identifiable a 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 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. l * 6AA k-M &Dtlj SINAT 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. q /► Q MA -0 1 SIG ATURE 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 1:34 q c-.�l 670 S8 3f�1 ,TAPE BAR ()F Wl,( ON,[\ FORM 2 - WARRAN11 DEED DOCUMENT NO. _______Spen E. Porter-an" Shawn - _E _ Porter ST. CROIX CO., (onwvs mid warrant _____Rager_.M__ Rualin - AUG 19 1990 7n,5 SPA _E AE,;� ., � - _'R the lollowng desLni-x-d real estate in ____S_t_ -Croix- statc of WISCOTISIn. L 040-1192-10-000 Lot 11, Plat of Croixridge in the Town co` Troy, St. Croix County, Wisconsin. TRH "QF $ 0 FEE Easements, restrictions and rights-of-way of record, if any. August '98 Spencer E. Porter S-awn E. Porter A I I I l,N F I A I loN KNO\V I D(. \1 I NI Spencer E. Porter, Shawn E. Porter August 98 Kristina Od�iand Nttorney Kristina Ogland Hudson, WI 54016 Vl..0 UNPLATTED LANDS OWNED BY JOHN COLEMAN S 89 E 1770.68 500.00 453.00' ,W N � O 0 hh (0 0 do h 9 3 - 1.79 ACRESs,, -- - - - - -� -- _ ti� 2.15 ACRES - -- - 9 FR Dc CD ' 1 1 ko , 10 O o 4j N CD 0 , ti •to 1.60 ACRES 1 ,pti \41 a \ • \ 7 1.3c 34 R90 \°�� .yam 6 3 9 0 � /`9 6'0 2 � c ? O � y �o \O '� • \� o N q0 O� 9/ 6% �p .�. � 61 �\ � NQ o \0� � • 33 I2 17 1% 3 6 �o 45.. \ 770 18 ' 58 u` � 2.43 ACRES 1.33 ACRES "E 6 g9 6 o 3 °0 !` 22 O ff' 206 0 45'24 „ \ p, .3 � � ,� N630p 9 �� °2 .sue \�2 o 16 �' �' 1 61 ACRES 11 0 0 , 1.69 ACRES O �. 6 ' N T / ° S0' 4 6 „ 20 °4S'2q" 18 CD 2 ® 4u 1.30 ACRES `p� a 3/5 6 W ro ro in . a 153 °14'36„ ° M N i co N 84 44 E co 2 139 ° 45' 0" 21 339 .77' W W 1 220 ° 15'00" - _ i i N ° O N 15 -RFS 0 t; 0 N 1 4P A(•RFC