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HomeMy WebLinkAbout020-1280-40-000 ao p ° O Qr O m cc L Cl) a) N C) i -= o� i C a*--) N� w w C a) as o co O N >. c0 O 8. Z N N N C z oo mr 3 w- � m »- NC O I LL CO O N o 0) q w C o M Z in E O Z r 0 O Z d d M C ' , U) a m I o zv' U c a N d 2 V C N P . °) Co N C U N N O) O N co E N o 0 m • N `o = — ° cu C\l ►i c O u ° O w q _. N Z Z O Z o C Z 0 E N - �� _@ I q M V) > � a 'm Y ca � I�'c o a` E I U N > ° f f' _ ) O O O •►v m �aaa C. c N o 7 O fn N ° ° N N J U O W } _ 2 O � C N @ 22 M J O T3 as m °s d I w a d q} w m ° a ao O O N C p N C C = N V c� co C N r r p y C) a) N 'O W C O M M O M 2 } co O N Z x U) w # U a N 0 a 7 w ' � p, Oi N E C C 7 _ j A 0 a O in LO) N 'FILED C] 4a �� 5^ E JAN 2 8 1999 ► 3 AUG 3 I e s KpTHIEENH•WAISH ,• Aegislet of De 4, SL SURVEYOR'S RECORp C ER T I E I ED S UR V E Y MA P Located in the Southeast quarter of the Northwest quarter of Section 34, T29N, R 19W Town of Hudson, St. Croix County, Wisconsin, being Lot 7 of the plat of Cherry Hill. Pat Yuengst 536 Lemon St. North ���IINiI►j�� Hudson, Wi . 54016 , 0 0 IV �ee0" U N P_L_A_T_T_E_D LANDS North - South 1/4 section line. • i S00915'37 "W r z , '` IA RVE'1 G. '� i N00 °/5 37'E !974.96 S 00' 15' 37 "W JOHNSON 132.81' 3163.89' o S °Ifi99 N1/4 Cor. . S1/4 Corner HUM ON s + Sec. 34 Section 34- 29 -19% W18 r O s y �e q o su + �J� e ��o110t0 PLAT OF CHERRY HILL to � .0 ,0 m (L ®7T 20 `� I 6 6' i C t M 195109 sq.ft. (4.479 ac) S 00'0 /00' —� 3 20 E 210.00' ID C) w 171220 sq.ft. (3.931 ac) Z; excluding easement `- �'. I W i 1 9 0) -- -J: I W• Z 3 407 X 06 ,' 54 , L 9 // 0 4 4 Q Q} • O W I �I � m (LOT 21 CL I o \ i o 4J� I Z' N 8 sq.ft, (2.010 ac) o \-,n Z I eo f e• N (O ° L_ (NO0 \% N 00' 14' 28 "E 445.00' Q r 41 \ O — — N \ / PLAT OF CHERRY HILL \ h 33' 33' ` -- - - - - -- - - -- - - -- a \ I Q1 0 1 "X24" Iron pipe weighing 1.68 \ \�� I Legend 0 -� P P g g � \ z lbs /lin. foot set. O I • 1" Iron pipe found. 18 W Bearings reference to 2 • 2" Iron pipe found. earin d g - North- 6 6'' the plat of Cherry Hill., so. 0 p Previously recorded South 1/4 Section line assured 0 5'-� 3 information. S00 0 15'37 "W . s / 7 N / SCALE IN FEET 1"2100 O /00 200 300 tom' aii This instrument drafted by 4982596 fie_ Vol. 13 Page 3598 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of��afety a Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY C e Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 1 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P 02 I.D. # dimensioned, n orth arrow, and location and distance to nearest road. EY �` 4 � APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION RE IEwED BY ATE E PROPERTY OWNER: PROPERTY LOCATION p 1 - 9/4 - G>'E.v S 7 GOVT. LOT `S1' 1104X11 1/4,S34 7 T � ,N,R 7 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Set (Sm g3G G Fi`70� y , Z. b 1 14 &R12Y �JI.L ) 3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILDjGE CfOWN NEAREST RQAD �I.DS ®� lv . �/� /� ( g� .��G `3`1 f IL/ufls��^J • � ir; [.�4 N� Af New Construction Use Al Residential/ Number of bedrooms U&)< ' [ j Addition to existing building Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading We ©. Z bed, gpd /ft trench, gpd/ft Absorption area required wed, ft trench, ft Maximum design loading rate O bed, gpd /ft gpd/ft Recommended infiltration surface elevations) ft (as referred to site�PIan benchmark) Additional design / site considerations I L � 'V �! �� U rl % rJ �t> nl �� CS i W P Pi2C� J [r Parent material Flood plain elevation, if applicable It S �2�nsuitable table for system CO V ENT� 0 L 0 ND IN•GROU RESSURE AT-GRAD SYSTEM 1 FILL HOLDING T k jNK U forsystem s L� U S ❑ U ❑ SU ❑ S ❑ S [(U C] S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BwxJ3y Roots. GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch [3 6 -7 Ground j qi S elev. �•� ft Depth to limiting factor ! t Remarks: Boring .# n c � Q `1 cs Ground elev... _ , ; n ft Depth to r', ^ �l vEU limiting fac to. ' _: 6 5 f qdo Remarks: CST Name:— Please Print Phone:' A ddress: 0 CaX �yc}� Signature: ��� Date: � � ?2 ^ p� CST Number: �� PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground $ 11�Z4 yi� 4 ...� . y ; L s elev. 1 g AX fL pcl� Z 7'h &STn Depth to _ limiting factor , Z • cV Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to _ limiting factor Remarks: SBD- 8330(R.06M2) V IN r r 1 I 1 K\ 4r ` L � � rt 2: r H c � f V � I i I O� I ' t t . I1 r 1 N � O rJ � 00 ri n Z Wisconsin Department of Industry SOIL AND SITE EVALUATION R E N U R T rage — ol Labor and Human Relations ft-jWor, 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- �' r vertical and horizontal reference point BM , direction and ° /u of slope, scale or PARCEL I.D. # not limited to Po ( ) - dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION to V4 Lciv c' GOVT. LOT SL 1/4 N vJ 1 /4,S 34. T �2.� ,N.R / 7 E (or) W PROPERTY OWNER':S MAILIN ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VIL GE OWN NEAREST R QAD ,S' -C--' &� -S o/ (`�(5� 3F6 -- ^ 1/ c� i 1Se L ir: L i4 tit New Construction Use fj Residential /Number of bedrooms Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd _- Recommended design loading rate Z bed, gpd /111 gpolft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /11 lL,Ltrench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/ site considerations Parent material Flood plain elevation, if applicable ft $ : Suitable for system C I VENT OT1AL 0 ND IN -GROU DD AT -GRAD SYSTEM IN FILL HOLDING ,T K U =Unsuitable tors stem [IS [N U S❑ U ❑ S [ I U El S U E] S (�I U ❑ S 6 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Baxxtary Roots. in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch ..0.77— oA l Ground S elev _ ft. Depth to ' limiting factor 3 : 7_ i Remarks: Boring # l I' C7 ` r t o G eW-1 Ground elev. It Depth to limiting r te... ., .' .�. fac to c �RptX Remarks: _ CST Name:— Please Print Phone: c-� / •� - '` e Signature:�� Date: � ?2 ^! CST Number: �4 PROPERTY OWNER SOIL DESCRIPTION REPORT cage of PARCEL LD. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baridiry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rRw& Ground elev. fL Depth to limiting factor Remarks: Boring # n ie- Ground elev. l �'rr S'1�5 r C ILI ft Depth to limiting factor � i Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor 7 Remarks: SB D- 8330(R.05A2) of t � F i r� o r 1 /h Ql C> I f 1 I J I ( 1 1 1 0 N N j 00 VIP o M � �C v � L i CROIX COUN'I'Y ZONING DEPAR'I'MEN 'l' AS I3UlUF SANI'T'ARY REPORT Owner 7. Address P- # City /State Legal Description: Lot Block Subdivision/CSM 11 '�� /f,, Sec. ,T,;Z N-R4r W Town of s ,,/' y _ , d PIN 11 D_ c? ..; 47,?a , - t� p• � �,�' SEPTIC 'TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer �`1'!�'�U/e� Tcs, y Size ST/PC/, Setback from: House / S Well 4/0 P/L SG - 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: ��,,� clo,. -bWidth 3 Length _7S Number of Trenches .2 Setback from: Housew7.j Well ti0 P/L - /,0' / Vent to fresh air intake ELEVATIONS Description of benchmark Elevation Description of alternate benchmark /' 42 r j ; e m ,, �7' ,rte Elevation e Building Sewer e�9- ST/HT Inlet 0 ,::E 3 7 '" ST Outlet -61 0 2--- �rPC Inlet PC Bottom Header/Manifold 9i­ Top of ST/PC Manhole Cover 9/ /Y-.1- Distribution Lines () Bottom of System( Final Grade ( Date of installation Permit number ,?X Ytl,jJ State plan number Plumber's signature License number Date Inspector _lf5 ('ivnplc(c pin( plan M I NOTICE: Please provide (lie following: i • 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. 0 ^J �' PLAN VIEW -- 5'K7S GXia t,+ 6ervs Ig I c� -r INDICATE NORTH ARROW Wiscon Department of Commerce PRIVATE SEWAGE SYSTEM Count y' Safetx and Buildings Division ST . CR01X • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarp�ri.: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. Permit Holder's Name: illage Town of: State Plan ID No.: � YUENGST, PATRICK as;34 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel b'2b'-:1280-40-000 ©C,) h TANK INFORMATION ELEVATION DATA A9800587 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benc ar q,�/L( 07. G vv Dosing Aeration = - -- - Bldg. Sewer pz�,Z ; 2 9e -03 Holding _�_ St /,OClnlet Z�c d TANK SETBACK INFORMATION St/ toutiet ZZ ° ISO TANK TO P/ L WELL BLDG. e I ROAD Dt Inlet Air intake Septic �" �- 6Z I S I NA Dt Bottom —� Dosing NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System 0 fZ•02, f•O►gj , G,Z L PUMP/ SIPHON INFORMATION Final Grade 5 •% t v 7v Manufacturer mand s'{ � 7 X 17, f Model Number GPM TDH Lift Friction S stem TDH Ft Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM B E M Width Width Lent _ — t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth r g ' DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING e an / ufa�we� : SETBACK CHAMBER f r INFORMATION Type O o e u er: Syste J 7,D N�a- '� OR UNIT DISTRIBUTION SYSTEM Header / Manifold !! r � Distribution Pipe(s) `` x Hole Size x Hole Spacing Vent To Air Intake Length 2L Dia. `� Length 7 Dia. = 7 ' . 7 Spacing ( 1 C4 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 34.29.19.1342,SE,NW 686 ERIE LN ERRY HILLS LOT 7 o I �>�t ( �,rllk.u!���avt,PcrL l 5 �a ,�� 3 d A i 6 wt 6Y S VK� lam" ton L��' P a� v re i � ❑ e �(� No Use other side for additional information. SBD -6710 (R.3/97) Date Inspe is Signature ert. No Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 B Washington Avenue 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 than 8112 x 11 inches in size. S ?CYDi cr • See reverse side for instructions for completing this application State Sanitary Permit NNuum���^ber Personal information you provide may be used for secondary purposes E] Check if rslon to�previous ap lication [Privacy Law, s. 15.04 (1) (m)). & 8& & M e g L C • State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Propert y Owner Name Property Location 7­ $1011 1 /4, S ,?! T j ? 4? , N, R /9 E (or)�o Property Owner'f Mailing 96dress Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number ( ).:7?4 Clu A6 d a� 11. TYPE BUILDING: (check one) ❑ State Owned ❑ it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Tow OF &Iklolso.v 111. BUILDING USE (If building type is pub check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 3y cQ 9. 1 9. 1342 A 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an ______ System________ System________ _____TankOnly__________ ^ ____Exi sting System_______ ExistiQgSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM (Check only one) • G % rl �j r ��� Non - Pressurized Distribution Pressurize�CA Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 IgSeepage Trench 22 ❑ In- Ground Pressure t 42 C] Pit Privy 13 []Seepage Pit �+ °� — S X 43 ❑ Vault Privy 14 E] System-In-Fill , e> j , X-4 , e_C CIA&M6 r7 VI. ABSOR PTION 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) Q Elevation Sd 74iY a t c QE 7 r d Feet D Feet cap acity VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks _l Septic Tank or f�QC% ❑ © ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber Signature: (N Stamps) JOMP PRSW No.: Business Phone Number: Plumber's � Address (Street, City, State, Zip Code): S �G IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwate te I ssued Issuing Age t Signature (No Stamps) Approved ❑ Owner Given Initial Kr Surcharge Fee) /5 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: *WwAc" 01 4644 SBD- 6398 (R.11/97) 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 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 - a Sanitary Permit Transfer/ Renewal Form (SBD- 6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be r — umped by a licensed pumper whenever necessary, usually every 2 to 3 yr !/ �✓ wi J/ 6. If you have questions concernir I ode administrator or the State of Wisconsin, Safety and Building To be complete and accurate thi l I. Property owner's name ar nd parcel tax number(s) of where the system is to be installed. II. Type of building being se is if 1 or 2 Family Dwelling. III. Building use. If building )ply. IV. Type of permit. Check c tank replacement, reconnection, or repair. V. Type of system. Check VI. Absorption system information. Proviae umbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tang, ..__ 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all 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. I I ;�',2'1` i�uE,daS7 SE��/r,�J/ Y Ta Q/�' /�� �0 7`�U G�ie �N ��✓•'s/ 7 �,� __ �� �'� C� � aJ ��' ,� /'�/ ` :10�"a is - c / /�� ° .. v �� �� v � �"� v S;k� -� b� � �. ca�wt 6tX�t,(S• � �l -� • , J �. �� � - 3 x ?S G1��. -►bevs �'� $' �� ° 9� S � °�� WisbonsinDepartmentofIndustry, SOIL AND SITE EVALU.ATIO.tL_RZ ORT Page of 3 Labor and Human Relations f Division of Safety S Buildings in accord With ILHR 83.05, VKs;: Ad�m,i Code ;. COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz . pta mus not limited to vertical and horizontal reference point (BM), direction and of ? lope, 6b et��' ' 4 PAR EL I.D. # . dimensioned, north arrow, and location and distance to nearest road. __ s b10 — ( L80 — L4 0 APPLICANT INFORMATION — PLEASE PRINT ALL IHFORMA � I N ,;' M� DAT _)'X ti- PRO RTY OWNER: — ROPERTICI KNN + a Q c5 E i eav+ Ft � 'tid;S T 7 N.R J E (or) W PROP RTY OWNE MAILING ADDRESS 0 #,` OCf(#� "S. D. ME OR qjW , Cl T TE ZIP CODE PHONE NUMBER [:]CITY OWN NEAREST ROA New Construction Use Residential / Number of bedrooms L [ j Addition to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow S -6• •gpd Recommended design loading rate d bed, gpd$ 6 trench, gpd/ft Absorption area required 76 _ bed, ft trench, ft2 Maximum design loading rate 5 bed, gpd/tt 0.6 trench, gpd/ft Recommended infiltration surface elevation 1p MAP-Y.- '7 ;.C1tJ " ' ft (as. referred to site plan benchmark) Additional design [site considerations Parent material () , > 4 `^' ^ C-) 1 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND 4GROUND PRESSURE" AT GRADE Sy TEM IN FILL HOLDING,WK U = Unsuitable fors stem S ❑ U FMS- ❑ U --"M S ❑ U ' —° ,E S . - ❑ U 1 ❑ U ❑ S MU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure I GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont Color Texture Gr: Sz. Sh. Consistence BoLrry Roots Bed' Trerrft .. .0 -6 z L_ r,.1 $; - 4 16 z a3 is Ground. 24 -<5 .. S Y il § lev. . d tt 8 �Y,2 4 4 5 .. S .... n� /. _ 5 0 Depth to limiting C � W D Remarks: Boring ,# / ... li3 I Ground 19 A 1 - 7.5 YA J ; r✓._ /h 9 b . �7 4�r 0. /c It. '',.� j� Q f S Q5-. 1 . .7 �Y. � Depth to �. limiting tr Remarks: - - CST Name - ' Pl se Pri t Phone: E ddress: Sgnat Date: CST Number: ,l 17/ � �-g4 PROPERTY OWNER PA 7 ' I A IEN6 SOIL DESCRIPTION REPORT T Page Z of PARCELIA.S Depth Dominant Color MoWes Structure GPD /ft Boring # Horizon - - Texture • - -•• Consistence' Barx�ary Roots in. Munsell 4u. Sz. CenC or Gr. Sz. Sh-. - Bed rrianch 3 10 - /1 Io �4 - - L. _ . I M C r - _ � r5 7 >� 1 ID 41 Ground { ea , SVR � 5 L ! lai rin �r- 0.4 p,S elev. i671 -n g 0-14 •7 4 Depth to limiting i IAi wS LAiv ' F7 Remarks: Boring # 6 -1 'IN L, / rti Cr' /h te GS Zm CIA :A ,sr CS $z .-I3° 7. s Y 4/4 _ s SC, �►► - (� .� o: C Ground elpv.. �•bft Depth to '� R, qtr Baas �� Ajc :��a . limiting fa t Remarks: Boring # '3. Ground In ft Depth to limiting fact Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: _ ... _. . S8D- 8330(R:05/92) • • .. , far � y ,.. _ CNt,e,e, �/(� � � T � � ` � 3 ` s O p{ G .� .__ . _ _ __ - - _ �i i� D .. � _ ..._ -- r i� ___• _ 1 �� 7 N . � _ w ' � o � � ` � ,� .� SLp � 1 ., � � �� x - 7 1 � 3 7� a � � o� L � JAI i .. ._ a o� 1 J � \ � _ - � � � � .. _ .. .__.. ... , rt .. __- - - wisconsin Department ofIndustry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2x 11 inches in size. Plan must include, but -5T 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 PRr RTY OWNER: PROPERTY LOCATION a Q � 3 cl, GOVT. LOT � 1/4 f4W1 /4,S� T ! ,N.R /g E (or) W PROP RTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR qW # CI T ZIP CODE PHONE NUMBER []CITY LAGE OWN NEAREST ROA U�St��J (,Ji (7J�, 3Ft .�� sr ❑ /�cs � ��/ �14AIC AT New Construction Use K . Residential /Number of bedrooms U N V, [ J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow - gpd Recommended design loading rate b bed, gpd/ft C9 • � trench, gpd/ft Absorption area required i- - bed, It trench, ft Maximum design loading rate a S bed, gpd/ft O. " ench, gpd/ft Recommended infiltration surface elevation(s) — ft (as: referred lo'site plan benchmark) Additional design /*site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND ' AT -GRADE Sy TEM IN FILL HOLDING�INK U= Unsuitable fors stem - S U - Err - ❑ U - v S U JZ S f�T S❑ U ❑ S au SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence UOtrtd3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz.. Sh. Bed ITmnch yy C� .- z. _. L- j /tit C rhr �1 zr'1 , 4 d .s t. $i - 6vR4- �i� t rj i7i� /1� r r� , 6,3 Ground. ZQ'SS .,S y 3 S , L M to n, r s S Q •� elev i a ft 8 /6'Y44 4 Depth to limiting f ct� or Remarks: _ Boring '# 13 l y 4 3 - _ <_ � /_. S ki n .�, 0.3 �� 7.5yt2 Erna& lhr d. Ground t elev. 19 l � /t7 It. , yk — S If Dep 45. ! � ry SG j O l P c� X limiting. tr Remarks: CST Name* se Pri t 5C) Phone: - Ao A ddress: ' fk .. ... .._ Sgnat Date: 9 CST Number:34Z4 Ili PROPERTY OWNER P� � SOIL DESCRIPTION REPORT Page of PARCEL I.D. i Boring # Horizon Depth Dominant Color Mottles . _ Structure GPD /ft - - • — in. Munsell au. Sz. Coot C Texture Consistence' Bourrlery Roots olor -- (j Sz. Sh-- Bed Tmr& 3 4 - << Jb - Y►44 �' L. l m c r m►- c 5 7 -M 6 . r 5 >� 11-43 z 5, L Z rvr q u, M v�' cs Ground {� 7,S 5L ✓ elev. 101Lft -i9 7SYQ 414 Depth to limiting factor i Remarks: Boring # Ground �z I 7, S Y 4/4 S m el j� Depth to — - — - limiting fa to Remarks: Boring # A O g /�LJ L /� Cr ,m�� CS Z? 1 5 -9 24 0 Ye- 4/ z a.3 z lot . ,� � , MV J , c s S Ground _.. ' dev. Ac q S SG d.S O, t lift. , Depth to limiting — fact Remarks: Boring # 13 Ground elev. fL . Depth to — limiting factor Remarks: $8D- 8330(R:05/92) l a CN ,(� on ` a O p{ C N sL. I a � 1 ud o^ O � � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address A r 7 - z4fzllj�, Al (Verification required from Plaaning Dcpartmcat for new co=tructioa) .5.. C City/State _}la z Parcel Identification Number Q ,�, 1 — 4e 0 LEGAL DESCRIMON Property Location -_ %, -.i� /, Sec. 3 N R1 W, Town of 1 l761 Subdivision Lot #_ Certified Satvey Map # Volume . Page # Warranty Deed # �S J b Volume 13 page it Spcc horse l] yes d no Lot Bras ideaffAle yes ❑. no SYSTEM�ll�t�N�1NG� • . Iu�vpau9emd�y,��ooabda-scltmiEs p tohandlewastes.Proper _ Consists of paaping oat &c septic tm* cvaY ttn+ce yc= oc if nec&dby a Uc=scd What you put.into the system eaa affrocte f motion of the septic tanti as. :twat tt c m �e �rastedispo alsys . T p owner agoees to sabmif to St CrokZoniagDepartmena certiscafioa form, signed by the _ow= aad by a ma.awp •JOmmcYMnP rcstddodplumbaonuc sedpaapervc fyiag&it(1)&coa-citewastewat &q)OS tsystem is improper oPezaticag coaditim aadlor(2) after unpoction and pMq g.Cx aoocssary), &e septiotaalc is less fan W fA of smLdge. Y* Sac = dcrskood haroe mad the above reVk=cds and agovc to maiataia Me private sewage disposal system with the staada ids � �. .,as set by the Deparemied of o=m= gad do D of riatmxl Resoar es State of Wrsoomuxa Certmcatioa 6460 9thst YO= septic systdox has be= mainhined mast be Completed and retacned, to the St ewix.Cb%m t r Zoning Office within 30 /Uty -of the { SIGNATURE OF / / DATE OWNER• CER MCA.TION I (we) CC,,* that all rtatemeats on this form are tone to the best of my (our) lmowlcdge. I (wq,) am (lrt+s). the owncrK of the property desum'bod above, by virtue of a wuraaty deed reeor kd in RcgkW of Deeds Office. 7te' SIGNATURE OF CANT // / / 9/ DATE ssa «s« iaformati Any oa that is mis4Trescatedma result in the seal «« Y �Y permit � revoked by the Zoning Department. '« Indude with thk appticatton: a clamped warranty deed Srom the, Register of Deeds oC ice a Copy of the certified cuovcy map if reference is made in the warranty deed t4 Wow4ri F- Y. w I « # of 9 50.00' 7 �!! 3.573 AC. °al ` i 1:55.580 S. lr � La •.t °� m N 00 E a cu 445. M cu x� 2 � (� 6.469 AC. 1 282, 658 S.F. lj xi of WI M Z N 00`03'20' a 210.01 ` it i- : s` 2.026 AC.r��� 88.248 S.F_ P', I �C:o 4sn.ofl' is2.e1' 1974.96' 1 206,77' UNPLA'f7' €5 LAMq ,.. E wa wu a +t.5: :1 Ltw � f f � 1 ,� his • •irly �R. � n ��r � Y F � " "' � � � X � f 1 - �g hl �lw 1m W O.I. s, ` � `w• = 3 I..t1 IQ. �R me S.I. F r °fix c`� .` ,k r � $ �,�+' •�+����� v .x � f. .. 1- �. '�� . •2{r ,.! H .i' 3 Xa.4 sl y y J ". 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