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Home My WebLink About008-1095-10-000 (2)scoqsin Department of lndustry, ,-.pr and Human Relations Division of Safety & Buildings SOIL AND SITE EVALUATION REPORT in accord with ILHR 83.05, Wis. Adm. Code Page r of 4 COUNTY St. Croix PARCEL I.D. # REVIEWED BY DATE PROPERTY OWNER: Walter Fenstra PROPERTY LOCATION GOW. LOT NE 1/4 Ur 1t4,5 34 T ZA ,N,R id g&rtw PROPERTY OWNER':S MAILING ADDRESS 285 25th Ave. LOT #BLOCK #SUBD. NAME OR CSM # NA CITY, STATE ZIP CODE PHONE NUMBER(t:s) 6el-2e1iWoodville EcrTY EVTLLAGE EIOWN Eau Galle NEAREST ROAD 1Oth Ave. Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction andY" of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION.PLEASE PRINT ALL INFORMATION [x] New Construction [ | Replacement Residential/ Number of bedrooms Public or commercial describe Use 3 I ] Addition to existing building Code de ved daily f,ow 4^n gpd Recommended design loading rate I beO, gpd[t2_ .45 _fench, gprl,,ft2 Aboorplion area rEuired 1125 6gd, ftz 900 genfi, lP tvtaximum design loading rate .4 bed, gpdft2__gl _rench, gpdrt2 Recommended infiltration surlace elevation(sl a7 .2\/aa.75 ll (as refened h site plan benchmark) Additional design / site considerations install 2 - 5t x 100' trenches 151 apart CL to CL parent material till/fluvial outwash Flood plain elevation, if applicable NA ft S = Suitable for svstem U = Unsuitable foi system CONVENTIONALEs trU F tru MOUND S IN.GROUND PRESSUREFs !u AT.GRADEFs tru SYSTEM IN FILLDS QU HOLDING TANKDS EU SOIL DESCRIPTION REPORT Boring # Ground elev.8e.2 ft. Depth to limiting factor > 75tl Remarks: Horizon Depth in. Dominant Color Munsell Motfles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh Consistence Bo.ndary Roots G P D/ftz Bed Trcndr 1 o-12 10YR 3/2 sil 2mshk mvfr cs 1f /n 5 2 12-22 10YR 4/3 sil 2msbk mvfr CS 1f 5 5 3 22-75 10YR 4/4 sl 1 fsbk mvfr 4 5 w/ occasional p ockets 7.5YR 4/4 I:& commor rgr&cob;t re sl is of ten cs1 r ic is ge j nerally poorly sort ed Boring # Depth to limiting factor > Tgrl Ground 3 tt. elev. 92. 1 0-18 10YR 4/2 sl 2msbk mvfr CS 1f /n 5 6 boundary dips I occasional gr R218-36 7.5YR 4/5 sl lmsbk mvfr 5vw/ gt & occ co b A }I L \ 3 35-78 7.5YR 4/4 sl lcabk mvfr t -Rrt r\lLu 4\e common Is (0 s g mI) I occasional p ocket.s 7,5YR 4/5 s; I ils "t3 "'Ju\'l 25 it t3J hI I CRutt' ,cusr'' 5\ Name:-Please Print Phone: P0 Box 57 K i/llI Signature: 6/22/93 CST Number: 3055 Remarks: 1 I ( Tml:LrIfflilEB t{alter Fenstra PARCEL I.D. SOIL DESCRIPTION REPORT Paqe 2 . d,4 n Boring # Ground ele\r. As-7 lt oeph h limiting factu 6l!n Remarks:cy si coats & dk Bn c skins comon in horizon 2 Horizon Depth tn. Dominant Color Munsell [roUes Qr.r. Sz. Cmt Color Texfure Struchrre Gr. Sz. Sh. Consisbnce erday Roots G P D/ftz Bed ffrcffh 'I 0-14 10vR 1/2 siI 2msbk mvfr cs 1f 5 6 2 14-22 1oYR 4/3 siI 2msbk mfr ci 1f 5 6 1 22-32 7.5YR tr/4 SI lmsbk mfr cs 1f 4 5 E & occ cob 4 ,2-64 7 .5YR 4/4,4/6 sl&Is lmsbk mvfr cs 1f 4 PoorlY more ls than sl;Isis0 g ml but loa ,ing should be assir ned b€sed on: 64-70 10YR 4/4 nrp5\R4/6 scI 0m IP 2 Boring # Grcund elev. ts -t lL Deph b limiling tachr 78n 1 0- 15 2 15-29 3 29-34 1oYR ,/2 sil sl sl Ics 2msbk mvfr cs 1f 5 6 lovR 4/t lmsbk mfr cs 1f 5 6 1OYR tt/t!lmsbk mvfr cs 1f .lr 5 4 3A-74 1OYR 4/4,4/6 osg m1 7 w/gr&mcc Remarks: Boring # 1 0- 14 10YR t/2 siI 2msbk mvfr cs 1f 5 6 2 14-27 10YR 4/t si1 2msbk mvfr cs 1f 6 3 27-16 10YR 4/4 sI lmsbk mvfr cs 1f 4 5 4 36-44 1OYR 4/4,4/6 1cs osg mI 7 I w/ gr & cob Remarks Grcund elev 75.6 It Depft h limiting hchr 44" Boring # Grcund elet/.76.1 lt 1 0-10 lWR 1/2 sil 2msbk mvfr cs 2 10-25 10vR 4/'siI 2msbk mvfr AS t 25-t6 10YR 4/4 sl lmsbk mfr 4 -ao 1OYR 4/4,4/6 Ics osg ml f,/ gr & cob 1f 1f 1f 5 6 5 6 4 5 7 Deph b limiting fach( ao,l Remarks: sBD-833O(R.05r'92) PROPEBfY OWIEB X"It"" F"N't'" SOIL DESCRIPTION FEPOBT FlTtafrril Boring # GDund Page 3 ot4 $fs fr. Deph b limiting lachr ---L2::_ RemarlG: Horizon Depth in. Dominant Color Munsell Moses Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh.Conslstsnce BilIEy Roots GPDfiiz B6d lTrsdr Iimit:is cI M c2d fiEts @ 42 nall & (2 north naII umer hor ilar : pits Boring # Grcund Iimlti ng fact rr Ls masslve cI ril mots below ,8rl Remarks: $f.i,tt DeNrb limiling hchr,8" Boring # Ilmltl ls massive w/ mots belon Bemarl..s: Gmund 95.9 ebv ft Dsph b limiling hcbl 40,, Boing # ffixftffiffiffi Gmund €lgt/._ tt. D€ptr b limitiitg hcb. On^ntun. sBD{330(R.05/92) \rJisconsin Deparll|gnt of lndusry, l-ebor ard Human Rolalions Divbion of Safoty & Buildngs SOIL AND SITE EVALUAT]ON REPORT in accord with ILHR 83.05, Wis. Adm. Code Page -aof ' Attach complele sits plan on paper not lsss lhan 8 1/2 x '11 inchos in size. Plan must include, but not limitsd to vodical and horizontal retorsnco point (BM), diroction and 70 ol slope, scale or dimonsionod, nodh arrow, and location and distanco to nearest road. APPTICAl{T INFORT'ATION-PLEASE PRINT ALL INFORIIATION SOIL DESCRIPTION REPORT Boring # Grcund elE/._ ft. Depth b limiting tachr Remarks: PROPERW OAINER: PROPERTY OWNER':S l\rAlLlNG ADDRESS CITY, STATE ZIP CODE PHONE NUMBER II t.D. # BEVI BY OATE PROPERIY LOCATION GOW. LoT 1t4 1/4,S T ,N,R E(or)W LOT #BLOCKT SUBD, NAME OR CSM* DCITY EVILLAGE EIO'iVN NEAREST ROAD I I New Construction [ | R@cement Use I I Residential/ Number of bedrmms [ ] Addition h exisling building Code derived daily flow_ Spd Recomrnended design loading rate beO, gM2_rench, gpdfi2 Absorption aroa rEuired _ bed, lt2 _ fend, ft2 i/hrdmum design loading raE bed, gpdft2_fench, gpdftz Recomrnended infiltration surface elevatbn(s) fr (as rehned h site plan bendm k) Additional design / site consideralions _ [ | Public ff commercialdes{ribe Parent naterial Flood phin elevation, it applicable It S = SuiEble loI svslem U = Unsuitable hi svstem COTWENTIOMI-trS trU MOUNDtrS trU IN.GFOUNDtrStr PRESSUf,E U AT.GRADEE]S trU SYSTEI IN FILLtrS trU I{O{-DING TANKtrS trU Horizon Depth rn Dominant Color Munsell Mofres Ou. Sz. Cont Color Texlure Structure Gr. Sz. Sh.Consisbnce Bqrday Roob GPD/'tZ BA Trren r Boring # Grcund ele\,. _ ft. Deph b limiting facbr Remarks ]ST Name:-PlEase Print Phone: Mdross: Signalure:Dat€:GST Number: t F.*\\^- P\-\ f\*.^(*n- rr,E -r4. tB -r,- *) )lt\tc ,- ,A'.-<- q t * -Q,- l.* *-\. L.- -*u^ r^S. ,Loa,-,..\ \,*L \ i3- , \.. 'ii* a_ g-a 9\ R-\ LJ* [-.,s' " .*L- q\ to.1( tq. u/ E] t1-1 . S.r.c' L- A\\o [' * I \ -J. t" = Sb' 5 t.vs'' J EI <L r $-rtr I Clg.+ f5- s \ ) z+r5/ $-t\ t E -L*:. T' \ q- ZSr, S' s{. r Y N*,A/ lo h It>N rr ,I,f,\'\,r\ \(* \ Qo.,c)L 3 \*. t..-(\ a . s, r. r u<), s"1 ..t- L.-.t ll^r., o^ --t-tar{';u\*: T*\ .t- L q,) srs..-\*.o --------: sgR. Tr t r.t((s?r +'t+\_ _ J i^ >,- G( ( ....-'*.. r -o!-1 ,\9,. t p*j:*" " ["t .^-, . ^-\( ul i s , .-d'i a g .Le ]< r.. L-,grl:.; b'Q./+^...,,e- &q [.-<_ ,'! L(^q,T--y3 < r oo.o) -ar-\- N., \1.rs af3lt 14r.n t"-.\.8 I rtpt ,,h Wiscon:in Department of lndustrv Labcr and Human Relations .Division of Safety & Buildings Page r of a Attach complete site. plan on paper not less than 8 1/2 x 11 inches in size. plan must include, butnot limited to vertical and horizontal reference point (BM), direction and"/ool slope, scale ordimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFOBMATION St. Croix COU PARCEL I.D. # REVIEWED BY DATE Wa1ter Fenstra PROPERTY OWNER:PROPERTY LOCATION GOW. LOT NE 1/4 pg 114,5 34 T ZA ,N,R 16 fuIl WPROPERTY OWN EH'.S MAILING ADDRESS 285 25th Ave. LOT #BLOCK #SUBD. NAME OR CSM # NACIW, STATE ZIP CODE PHONE NUMBER crTY f]V ILLAGE f,lIOWN NEAREST ROAD Recommended design loading rate ^ bed, gpOlft2__a5 _trench, gpd/n2 trench, ft2 Maximum design roading rate .4 bed, gpdlft2__:1_trench, gpdfip t I Addition to existing buitding Use 3 I fr parent material tiII/fluvial outwash Aqn gpd Absorption area required 1125 bed,12 e00 Becommended infiltration surface elevation(s)7.25/AA_7 ft (as refened to site plan benchmark)5t x 100' trenchesAdditional design / site considerations install 2 15' apart CL to CL icable NAFlood plain elevation, if appl I Residential/ Number of bedrooms I Public or commercial describe [x] New Construction [ ] Replacement Code derived daily ftow S U uitableS tem U uitabNS CONVtrs ENTIONAL DU trU MOUND S IN GROUND PRESSU REs nu AT GRADES trU trS U SYSTEM IN FILL trS U HOLDING TANK SOIL DESCRIPTION REPORT Boring # Ground elev.8e.2 ft. Depth to limiting factor> 76" Remarks. Horizon Depth rn. Dominant Color Munsell Motfles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh Consistence BoJrda,y Roots G P D/ft Bed Trendl 1 o-12 10YR 3/2 si1 2msbk mvfr 1f /n 5 5212-22 10YR 4/3 sil 2msbk mvfr CS 1f 5 6 3 22-76 10YR 4/4 sl 1 fsbk mvfr 4 5 ckets 7.5yR 4/4 I & commor rgr&cob;t re sI is of Len csl r (is ge Inerally poorly sort ed Boring # Ground 3tt elev. 92. Depth to limiting factor > 79" Remarks I I 0-18 10YR 4/2 s1 2msbk mvfr CS 1f /n 5 i.6 boundary dips occasional gr 2 18-36 7.5YR 4/6 s1 lmsbk mvfr i.s w/ gr & occ cc D K $t 3 36-78 7.5YR 4/4 sl lcabk .cmvfr 11 4 common ls (0 5YR 4/6 s;is o,ften CS ")t'r\ Name:-Please Print Phone:n I rg ress Signature: P0 Box 57 Kn F !1JI 547 -005 t ockets 7 Date 5/22/93 CST Number 3065 SOIL AND SITE EVALUATION BEPORT in accord with lLl.lR 83.05, Wis. Adm. Code nq, w/ occasional p ,fr rd)>{ <a \- 3 mI) I occasional. 5 I p I,. -.1 PNOPEETY OWNER Walter Fenstra SOIL DESCRIPTIoN REPoBT PARCEL t.D. *_ Boring # Ground elev. 88.-Lft. Depth to limiling facht 6ltr Page 2 - ol.4 Horizon Depth tn. Oominant Color Munsell MoSes Ou. Sz. Cont Color Texturo Structure Gr. Sz. Sh.Consisbrice *TP Roots cPD/ttz Bed lTrcrdr 1 o- 14 10YR '/2 siI siI 2msbk Dvfr cs tf 5 6 2 1tt-22 10YR 4/'2msbk mfr ^. l mfr cs 1f 6 t 22-r2 7.5YR 4/tr sl lmsbk 'lf 4 1f 4 5 lr & occ cob 4 52-64 7 ,5vR 4/4,4/6 sl&ls lmsbk mvfr cs poorly sorted more ls than sl;is0 n, p 5YR 4/6 scl g ml but loa should be 5 64-70 10YR 4/4 0m IP 2 Boring # Bemarks si coats & dk Bn c skins common in horlzon 2 0-15 10YR '/2 sil 2msbk mvfr cs 1f 5 6 2 15-29 10yR 4/5 sl sl ,msbk mfr cs 1f 5 6 3 29-r8 3A-7a 1oYR 4/4 1ovR 4/4,4/6 lmsbk mvfr osg ml 1f 4 5cs 7 8 4 Ics rrl gr & occ c Remarks: Ground elev. 7\-7 ll. Deph h limiting hchr 7A" Grcund Boring # Depth b limiting hctor 84tr I 0- 14 14-27 10YR '/2 sll.2msbk mvfr mvfr cs 1f 1f 5 6 2 10yR 4/,sil 2msbk cs cs 5 6 ,27-16 10\R 4/4 sI lmsbk mvfr 1f 4 5 4 36-A4 10YR 4/4 tt/6 lcs osg nrI 7 8 r/ gr & cob Bemarks: elov. 75.6 ft Boring # 1 o-10 10YR 3/2 siI 2msbk mvfr cs 1 f 5 6 2 10-25 iova ut sll 2msbk mvfr ffi 1f .5 3 25-16 10YA 4/4 sl lmsbk mfr cs 1f 4 5 4 36-80 1OYR 4/4,4/6 lcs osg mI 7 8 u/gt& Grcund elev.7!'t-lt. Depth to limiting hctor Remarks: sBD-8330(R.05/92) 'RO'ERWOWNER Walter Fenstra PARCEL I.D. # Boring # Ground BEYs ft. Depth to limiting factor 4( SOIL DESCRIPTION REPORT Page I of 4 Remarks: Horizon Depth rn. Dominant Color Munsell MotUes Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh.Consistence Bqrrdary Roots GPDIIF Bed Trsrdl limiti ng factr :r is cI w/ c2d t-Gy mots @ 42 east wall & t 2 north wall ; upper hor rzons s1t rilar t o othe r pits Boring # Ground limiti ng fact rr i.s massive cl w,/ mots below JB" Remarks: elev.89.8 ft. Depth lo limiting factor 38" Boring # limiti ng factr )I 15 MASS].VC SC w/ mots below 40" Remarks Ground elev. e5.e ft. Boring # Ground elev. ft. Depth to limiting factor Remarks sBD-8330(R.05/92) Depth to limiting factor 40,, t \..-)\r..- P\-\ f\*-./(N€-blE -14. l.B -t,-*) , tLzt\9 t- ,4,.-<-q- t ^^ -0-.- (.* *-\. L., -fO^.* S. ,Le{,-r^A <L .|\ 7 $-rtl + I 1 Clg ) z.>rg/ l iiilt -1_*Q t O+tr-t 15- s \s-a r !ogr' t - ^t "B, *T \J. t". sb' B r q- Y S-tq\ I N,A/ lo 1,-\ lr rl h Q o..r )q\ B-\ l-*"t-t\ 2..s/x\u15,, L s.\ .-t- L *.., U^r., o^.{^. r \ ,f-\I(* I L 'aK{ '.u.LJ.. J .. [..rs' -(.-\ +- L *.) tr4+ \s qr.i.l* Ee. ut' L.^j f .1,r. .-\.--.o -----:\gR. Tr B1.r((a?r +,t +\ -<1-J i^ 1^. Gi a t1^1 Zn, A' s{. (^.* re-o-!-1 ,\s( t p*j:*" "["t.^,r. o.-\( L/(. ; tori'i ag qL"-]< a..L- e- &q t-*_ .'! L(^<{,r-tj Ct(, €..r)-..-\. b"&-/+* -.t$'l '' { sn- L L*.\.\-{., \'!.ts qr3x 14*n l.--\.8 ,l rtrt ll ,m \ I STC 10 { AS BUILT SANTTARY SYSTEM REPORT OWNER ADDRESS Qo a56 vr S*- ba.edwin SECTTON Zlf r7il,v(h "'e- ,Lo 5 v!..So,') i u,t,esot-n-q suBDrvrsroN / csn#LoT # 3 ,29 tiN-R tL.__w, Town of €,( ST cLv 563AcRorx cot NTY, I^IISCONSTN Provide setback and elevation information on reverse of this form' Provide 2 dimensions to center of septic tank manhole cover' PI,AN VIEW SHOI^I EVERYTHING I^IITHTN 1OO FEET OF SYSTEM ):)M'+dlot \ 101\ fi'eta( trnL 1 { -' . t$w4'.f"v -:. J-L ,nn -rtf 0,/e L t^,s /'sr i'Prtc' TR 4\rjv I ,llu l:g'), 1OCO .bt bt ) .l 6$' .]r' Lrous€+ ))c[l lo/- fa qeotl€t ii.. <- of fo" rl zv' 1, l,r f;"c INDTCATE NORTH ARROW I J BENCHMARK:0 l- l,L.kt C,,r %, l8t-LI0,oh (lcl ALTERN TE B},1: SEPTIC TANK / PUIIP CIIAMBER / HOLDING TANK INFORMATION Manu facturer :drrr*,q Pwrc Liq"uid Capacity:I oco Setback from:r^rer, [b,- IdrI^2)t Otherouse Pump : Manufacturer N' lt Model #--_-_- S ize e: lttl*GaIlon s/ cycLFroat sepera "ron N! lF- Ararm r.ocation N' l* I,Iidth: Distance & Direction to nea lv,c,I v6 f Setback from: welI: rtvttllrrrn Building Sewer .. SOTL ABSORPTION SYSTEM lep tt?-,t", q6 Iength}"n^ r,"*-lt- Number of trenghes Iine. gc)ull\ Z tjOlrest pfop. House \')Other fr.,.* *\t"r tr 1*o,. h.,'l*) EIrE\IATIONS (Flr,, L,rr)CF/, n' Lir) ?C' il sr rnler , t'l g )sr ourrer ,7 6/ ekvaf t c"s at e PC inlet PC, Hp:id bottom lte " 7- Bottom of sys Pump Off rcr -rr. E ttti,l 89' .' 7 7 tem fiofiefi rllr/ctl ?7 - I zI"P 81.f z ,fie-Header/Mani f oId n.'nr 8t DATE OF INSTALI,ATION:,Sro 21 , lo ,1?7 J i) Existing Grade Final grade_ PLUMBER oN JoB . fin rr;- TE 7- LICENSE NUMBER: INSPECTOR: 3/93:.1t 6 [,1/p Lr,kr a_ LOCATION: EAU GALLE 34 .28. I.6. 5O5A wisconsin Department of lndustry, pRtvATE SEWAG E SYSTE M' Labor and Human Relations Safety and Burtdrnss Drvisron INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION TANK INFORMATION TAN K SETBACK INFORMATION PUMP / SIPHON INFORMATION SOIL ABSORPTION SYSTEM ELEVATION DATA 7 l Permit Holder's Name: rEwBoRG, REUBEN TJilv tr village E Town of EAU GALLE CST BM Elev.://)8,a,lnsp BM Elev. /(, ,'. / BM Description -4-".f ( Ics ()b7 P(+ CAPACITYTYPEMAN U FACTU RE R n ?al,Septic \) Dosin Aeration Holding TANK TO PIL WE LL BLDG Vent to Arr lntake ROAD Septic >/az (D dd t4 NA Dosing ---.-NA Aeration IA Holding 2 FS ELEVB5HISTATION //), Ll)Benchmark %,so3,7)'/',4a_ I)/ry, 5,7r'a.lFBldg. Sewer /6,O ?o,20'xtW lnlet c..pSt t frOuttet Dt lnlet Dt Bottom ,2tr Ya-Header / Man nffia-;#fr Dist. Pipe ryqru,frBot. System Final Grade y' 8a'?/ 3z'k*[i;-Gu* y',&'12*lUr(,Orc/ o/-/z^o S Cou nty ST. CROIX Sanrtary Pe rmit No 1998L1 State Plan lD No ParcelTax No.: 008-L095-L0-OOO Manufacturer Demand GPMMod6 Number TDH Lifr Friction m TDH F Forcemain Length Dia.Drst. To Well BED / TRENCH DIMENSIONS *'orYU Lenoth'5 No. Of Trenches PIT --...----.- DIMENSIO-N$- No. Of Prts lnside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO Ptt BLDG WELL LAKE / STREAM L CHAMBER OR UNlT Manu rer Type of fl eU (bld System: br"-Ck 7tA 47'o //* DISTRIBUTION SYSTEM Vent To Air lntakex Hole Spacing@ Lensth /{sp"r,ng/g-4 x Hole Size DraLensth /E:{Dra Header rA#aa++*l ]i ntuteneA fl Yes D No xx Seeded tsodcFJA fl Yes -{*o xx Depth Of Topsorl Depth Over BedlTrench Center Depth Over Bq*/ Trench Edges SOIL COVER x Pressure Systems Only xx Mound Or At'Grade S COMMENTS: (lnclude code discrepancies, persons present, etc.) L0CATION: EAp GALLE 34 .28..15 - 505A ,'i'?r i: - , t'2-db&cfl* /*rir^%-,.*"^Q"*t-;< Fj nl v d&2-, oy 1,//c\ (D Of 6- t: at-{? 1$cr''.l @ t-,e@rroAf C*tdn" 1.7 Plan revision required? fl Yes WG Use other side for additional information. sBD-6710 (R 05/91) /D c/lql (/I Date lnspector's Srgnature Cert No v \) -/ ff ?8' ) --. /, I ADDITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBER: -$ll Zr,,lu l$t"J vq)u tL" hqoy- of Wqln, Ft"sW0n trIILHFI SANITARY PERMIT APPLICATION ln accord with ILHR 83.05, Wis. Adm. Code -Aftach complete plans (to the county copy only) fsr the system, on paper not less than 81Ax 11 inches in size. -See reverse side for instructions for completing this application. !. APPLICANT INFORMATION - PLEASE PRINT ALL INFORTIATION. ST application STATE PLAN I.D. NUMBER PROPERWOWNER'KUU6;^ hlo,^t[o''PROPERTY LOCATION'ifii;il||,;3Y rl[,N,R 16 ypo* 'TiH"17i[eiuffi'a,'*l LOT#BLOCK #, i}''H]il . l\,\,n ok ZIP CODE ( ([1rl5l- 2$0 PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER r E Aoucondo z E Assemblv Hall g E Campground + ll Church/School s I Hotet/Motet NEAREST ?r,r4 00t'/09s-/O 6 7 8 I ,G 0 trtrtrtr Outdoor Recreational Facil ity10 11 RestauranUBar/Dining Service Station/Car Wash12 13 Other: Specify State of !ll. BUILDING USE: (lf building type is public, check all that apply) ILDING: (Check one) Public Medical Facility/Nursing Home Merchandise: Sales/Repairs Mobile Home Park Otfice/Factory 1or 2 Fam. Dwellingrf !V. TYPE OF PERlllT: (Check only one in line A. Check line B if applicable) n) rXrlew 2. E Reptacement 3.' )system System B) E n Sanitary Permit was previously issued. Permit # 4 5. Date lssued Repair of an Existing System Reconnection ol Existing System Replacement of Tank Only 11 .E! Seepage Bed tzlfseepage Trench 13 lJ Seepage Pit 14 ll System-ln-Fill Other 41 42 43 V. TYPE OF SYSTEII: (Check only one) Experimental 30 E Specity Type Holding Tank Pit Privy Vault Privy 21 tr22fl Non-Pressurized Distribution Pressurized Distribution Mound ln-Ground Pressure 2. ABSoRP. AREA I s. eesonP. AREA I ".v,ffi(sqft) lr'ffi.33-,I 4. LOADING RATE (Gals/day/sq. ft.).4rT l e. sYsreM ELEV. l z. nxel cRADE la*f ,r;HTfrFifl':., VI. ABSORPTION SYSTEM INFORiIATION: 5. PERC. RATE (Min./inch) CAPACITY in gallons Prefab Plastic Exper. App. Site Con- structed Steel Fiber- glass VII. TAilK INFORTIATION New Tanks Existing Tanks Total Gallons #ol Tanks Manufacturer's Name A Seotic Tank or Holdino Tank x t0u)N t16 Lift Pumo TanUSiphon Chamber VII!. RESPONSIBILITY STATEiIENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. MP/MPRSW No,: frte 8 37 Business Phone Number: 0lrt57y-]08D Plumber's Name (Print): Br u ct lA-lL, t /tLsk- Plumber's Signature: (No Stamps), 8rr"-a/^ 4/W I u r, lx.ARTMENT USE ONLY I nt n ffi,ou"o Disapproved Owner Given lnitial Adverse Determination Etl it Fee Surcharge Fee) Groundwater a AL:x.coN 0 €4r-<r I-II-IB SBD-tr198 (formerly PIb€7) (R. 11/88) DISTRIBUTION: Original to County, One Gopy To: Salety & Buildings Division, Owner, Plumber / ifCheck to previous [. wPE tr tr trtrtr vut t9r glE ,rr*lC*rl tt ftrtfrtt*U o ry sTe-//os tN$rRtlcTrotrrs 't. 3 4. 5. 6. To be lt. t IV vti vlit rx x .J A sanitary permit is valid for two (2) years. Your sanitary permit may be rene'^,ed before the expiration date, and at the time o{ renewal any new criteria in the Wisconsin Administrative Code will t e 3.pplicable. All revisions to this permit filus! b() approvel !,,y the perrni!:lisuiilg authuriiy Chi.nges ir ownersh;p (,r plumber requires a Sar:itrlr,i zei'mrl i iilr,sl{-r /For('!!'"ii i-crrrr (SBai fi:1,19, io be subrnined to the io,.!nty pricr to jnr;tallation. O|l,d sewage syl':cn:ls rr r,..rbJ L'e i,,r'oper;y rzi.r:,r.:rtt,ec. iht : r,r'i:; tar,:is) rrr ii ,!,'e 1i;tr,1.,9; F., i'!!:r.:.i.,1 pumper whenever lrecessary, usually every 2 to 3 yearrj. lI ycu have questions cdncerning ),our onsite sewaoe syrtem, ccntart your loaai aoCe adrninistratcr ar lhe ' State of Wisconsin, Satety & Buildings Oivision, 608-266-3815. complete and accurate this sanitaly permil application must include: Property owner's name and mailing address. Provide the legal description and parcel tax nurnber{s) ol where the system is to be installed. Type of building being served. Check only one and complele # of bedlocnrs rl 1 or 2 Family Dwelling Building use. lf building type is Publ c, check all appropriate boxes that apply. Type ol permit. Check only one in line A. Complete line B iI perrnit is:ef tank replacemeni, reconnection, or repair. Type ol system. Check appropriate trox depending on system type. Absorpticn system inlcrmation. Prcvide a!l intcrmatic. iecuesl".J ,'r #1 7. Tank riiormaticn. F;il ;F rire irapai-ity o{ evel:, ir)w..'...,,r e\,:r .:,a.: rir:i.,:,r il,li!i.ri,:} i'rJff,l rri tanks an.l;':ai,,iac1'rrel's narle. lrrdrcatc pr,'ra,5 or fiilp...i,:s1, ucl-C -'''r ii,,i. rrrit,r:jil { o11:r..:::i. i,..: a/i sepr:.j, pliirp,isiohon irnd hcicllng 1ar'ks {o. l: ri:i,!'iter,. Check {::j,i ,,', '. ., :ir''r,.r,i:l {: r7:.',.!r1i,1,. i.njt::v.,?l e\perinientar !r i.i,-r1 i eppr.)val frcry. DlL.t,F Fespor'sibilily stirement iostalltr,'t f,lumher ,s i.) iiil ,^ r!3ir'9 r" 1,:iid i:' .!i)!., ,, .r :rr]o'Lrl'.r4.. ,,r.';'r ,., - I\tP. etc.), addres:.iat4 piion€ nunrb€:r. Plunrl-'tt clli.::,.qrr 3r'iti'crii,i).i'..ir1: Couniy/Department Use Only Cou nty/Depariment Use Oniy. Com[-rett] pi?ns and s!:Jearl;:atioi'tj rrlt smallei lh;,n 81; l1 ir:'-rl'g:,: m,r. 1 h!: , '.)i t: tt ?i:.. rh., .'.',l| ,ty The gia-!r'ts rxr,";ri,'Clt,dC tl!;. iCiiii!9!'rj ij pl()t t:ir1t, .r'.1rr,r, l,...ilr:, ",rl ._ .t'.,: ,:.', .'.i',.-"- ,l t]c|,li.]r-j:aii,lsj.5er.ji.tar!,.1i.:!.1l)ltrlre"it...'.|,xili,,',l,l slrcd.r- ,,,.. 'dra( .i',r,,. .,r :,!'rn. , ij',Lr li(t',1t,ri,..,. a!.(!.r-s. a,,tj ih.: uCaii,ir, .Ji !1r i,u, ,rg Si, r rl . ,t' , c) cornoiet* specilica'ilors iJ( pJfi,p:i and Lroritrois, J{r.r-',i, .!r. r,,-:r;' ;. .:iieatrj,vij.-'ftic::nl ,ari:: 1,.Jri a. performance culye; pump model ancl pum0 man{faclhrI.r, D) c:'o:rs ieutr.in !,, ti,e sori abs.Jrfrirorr ':}st.ri il reqrlired by the iounty: E) Goil test d,rta on a J'15 forrn. and F) ali sizing. info.rnairoir. . GROUNDWATER S{'RCHAFbF 1983 Wisconsin Act 410 Included the cre.ttion cl rurcharqes {tces) fo: ij iir.!or j) -,r (,r regulate..: pr.;lctices which 4an effect gr,-)undwati.. '1 The nlonies coiiecteo lhrougrr these sr:rcltatgel. .!ri irsfic !tr it)rj',rirf water coni,rr,r;nation ilrvestigairons anr-{ eslahlisirr.-!(.r',- r '! ;ie:ri:-rri:. sBD-6398 (R.11/88) Pl,l oXr r) Sf Pnl 1,,s, 4, ' [\ruh, rh tuv w+lhutb"f ilE Yq ol- flF- U of S )q &16v bun 7 to% r\oP " r venrr''; lx,oo, yu,n.*, lYl,t,,t,,g l* *63o r2{/ Sf Co-r eru \rt r{ $ q' ,,:" rd $\ y') r."7 v \sc\'4$/o9?. E Cl \ oo f,r,rU [yg"cl. -r Vtcfrgoll'n d)**n" P*cnrt- Y" 'lvtq&,o J Y'T* ler.l elswru ?0,r1 l,97' ); el* VQp,r5 gt1t tr 7,7' 7'l\ )rV, * gsntel^ It- well *r d 3 [o)nuo* fio* " 3f q:re pr"t f t^ t\ \ xh( L Page i of ttHffg;*B3ffiffiJI:;I]*0,"O' SOIL AND SITE EVALUATION REPORT .*,on or saretv & Bu rdi rss fl W r r f ^rfr,ii,rlr:rrfir?)li;W:Z J"ff,.t Attach complete site plan on papet r{f{ess than 8 tfZ x 11 ihches in size. Plan must include, but' not limited to vertical and horizontal reference point (BM); directiorr andY,o of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION 6tL - q'l g$0 St. Croix PARCEL I.D. # REVIEWED BY DATE PROPERWOWNER: lllalter Fenstra w6-NA \t.- rarl b n !,,rk* PROPERW LOCATION GOW. LOT NE 1/4 rur 1t4,5 34 T ZA ,N,R 15 FfiB w PROPERTYOWNER':SMAIL|NGADDRESS *t ) n IUf't ttvv '-'" t 285 25th Ave. 5a gf pq,tl LOT #BLOCK#SUBD. NAME OR GSM# M CITY, STATE ZIP CODE trrloodville. t,lII 5tt1?8 PHONE NUMBER(zrs) 6sl-2s17 DcrTY EVTLLAGE ffiIOWN Eau Ga11e NEAREST ROAD 1Othr Ave. [xl New Consfiuction [ ] Replacement Code derived daily flow Use |Residential/Numberofbedroom5ft]Additjontoexistingbuilding I Public or commercialdescri hp asn gpd Absorption area requirsd 1125 5ed,12 900 [endt ,ftz Jr/aximum design loading rate .4 . bed, gN/ft2 .5 - " rench; Recommended infilBationsurfaceelevation(s) 87.zs/BB.7q ft (as refened to site plan bendmark) Additional design /siteCOnsiderations install 2 - 5' x 100' trenches 15' apart CL to CL Recommended design loading rate a bed, gpdfit2 '45 _trench,gpdift2 parent material tilllfluvial outwash Flood plain elevation, if applicable NA ft s= U- Suitable for svstem Unsuitable foi system QONVENIIONALtrS trU Fs tru MOUND IN.GROUNO PRESSUBEFs nu AT-GRADEtrs tru SYSTEM IN FILLtrs Qu HOLDING TAl.lK __qs Fu SOIL DESCRIPTION REPORT Boring # Ground elev.8e.2 ft. Depth to limiting factor> 76" Remarks Horizon Depth in. Dominant Color Munsell Mofies Qu. Sz. ConL Color Texture Structure Gr. Sz. Sh Consistence Bq.ruhry Roots G P D/ftz Bed Trendl 1 o-12 10YR 3/2 si'l ?mqhk mvfr es 1f /n 5 6 ?12-22 10YR 4/3 sil 2msbk mvfr CS 1f 5 6 3 22-76 10YR 4/4 s1 1 fsbk mvfr 4 5 w/ occasional p ockets 7.5YR 4/4 l:& commor rgr&cob;t re sl is of :en csl ,risge ne I a1 I I poorly sort ed Boring # Depth to limiting factor > TBtt Ground elev. 92.311. sI 2msbk mvfr CS10-18 10YR 4/2 1f/n 5 5 boundary dips occasional gr, mvfr21B-36 7.sYR 4/6 s1 lmsbk mt 5xibA+)-,w/ gr & occ cc L \ lcabk mvfr N / - Rrt335-78 7.5YR 4/4 t\\ltu 4\*\ g m1) I occasional p ockets 7.5YR 4/5 s; I ; isoffi " Jutl 25 tteommon ]s (0 s ItsJ L | <^r o Phone:Name:-Please Print I Kn F.G P0 Box 57 l^ll 547 Hen CST Number: 3065 Signature Date: t Remarks: K Dt.. sI \rC.F, 6/22/93 PROPERTYOWNER Walter Fenstra PArcF.t t.D.# Boring # Ground elev. gg-7_ft. Deph to limiting factor Gy si coats & dk 2 Horizon Depth in. Dominant Color Munsell MoUes Qu.'Sz. Cont Color Texture Structure Gr. Sz. Sh.Consistence BorrJary Roots GPE -Bed I-'-llrerf,fi 1 0- 14 10YR 3/2 sil 2msbk mvfr CS 1f 5 6 2 14-22 10YR 4/3 sil 2msbk mfr c1 1f 5 6 3 22-32 7.SYR 4/4 sI lmsbk mfr CS 1f 4 5 w/ 4 32-64 7.5YR 4/4,4/6 sI&Is lmsbk nlvfr CS 1f 4 5 poorly sorted mnro 'l imi{.in lsis0s nh. g m1 but loa Jing should be assir ped ba sed on: 64-70 10YR 4/4 0m 2 Boring # Ground elev. 7q.7 ft. Deph to limiting factor 7B'l Boring # Remarks Remarks: Ground elev. 75.5 tt. Depth to limiting factor g4,r 1 0-15 10YR 1/2 sil 2msbk mvfr CS 1f 5 6 2 15-29 10YR 4/3 mfr CS 1f .4CS29-38 10YR 4/4 s1 lmsbk mvfr .5 E 4 38-78 1OYR 4/414/6 ml-I .BIw/gr&occc :b II:il ffi ffi I I I 1 o-14 10YR 3/2 s11 2msbk mvfr L5 1f .5 i.6 2 14-27 10YR 4/3 sil 2msbk mvfr CS 1f E:1..) : oO 3 27-35 10YR 4/4 sI lmsbk mvfr .4:5 4 36-84 1OYR 4/4,4/6 lcs osg mI 7 8 w/ gr & cob Boring # Ground elev.75.7 ft. Depth to limiting factor 80tt 1 0-10 10YR 3/2 sil 2msbk \mvfr CS 1f 5 6 2 10-25 10YR 4/3 sil 2msbk mvfr AS 1f 5 5 1 25-16 10YR 4/4 sI lmsbk mfr CS 1f 4 5 4 35-80 1OYR 4/4,4/6 Ics osg mI 7 t I B w/ gr & cob I SOIL DESCRIPTION REPORT, rt ;r & occ cob ; more ls than sI; 5 mfpsYR4/6 scl NP s1 fmsbk .6 3 1es osg .7 CS 1f \.*i\tA- P\-\ f\*.^ q- i I I t-- I I I I i I i I I : I I iI I l - -- I - r' - [' ( *",-".r -'o.f I ff*-^r 1,2 o 'aK{' i^ 1.- G( a.S'y\u<5'tL*&* rf, K:"t ,Efft Il-*. L-t\ o"{. .-"* L *+ tl^\ o^-r-,r- r t A r!,A^rL l-.^-\ t \$*.^ L'*^.[. I16*\* q( t;? sq. ut' s+.! I 1 \t9_o j:,p$j:*" -;<-(T: -\j 't.'L- q_ J<q t -.- .'t +t(, *..>)\- v"{/ t"t.-l ; ^-\( ul( s , i*l'i atl *'-.N., \T.r.s a Blt 1Cn t *.\.8 ,9,1.; l' ,l t3pt I t- --l-' i'- i --- I !r; 4.NE b!\;1 ?-!, \ltpl r\or !'I_ I ?r ! -'- | _ -' - ' '12- ;(A \-q Z-r.rh5' 1^ S-tnlb t' - i-- r- r !-. | '- ;-*i - r' t !- t 1i"; i I 11- r I , '- .J ,8, ;'l- I :'i- f*--\i).r I.. ;i t aa -Q,- l.* *-t. L.. -Fu^.*S. ,I-.-.*^i a- t --I I ;s i-' t f- : t' I I I 1- t' I : I r I I ! : l I t .rao r& - I' !l l,lr It lt i rSir i es.o !l I I ! I I : t i I i I I I I I f,- a, II --- I I l- I i I i I.ll .i. v I ST ] !l 4\.-. ) ti ,i Qo.,c\q\ B-\ .l I r 1.L{ I > ; I ! I a, I I I : i I l^ I : I I -- -' I I i I i i : I i I I \ L 6 t"= fr' -,h S' a6.-\'t;I- t) : I '. ! s rr. J rr-iO---_--!'S&R.1( i (+,L t ?.Sr3 ?\ 4,F \&T GC 1r, --1-6 h -q 6s \Jo(.^ +t-.F c/ \ _\ (^, :r< \11 O -2 9Q 1C --tOQL h ol, c99 go ool g€z QOS o09 ooL I Q0, j Qoot IrJgQ o ao9 o oJ *\ o a C)Q/. ?4 S T C 105 SEPTIC TANK MAINTENANCE AGREEI.{ENTSt. Croix County atLoowNER/BUY E ADDRESS cITY/STAT PROPERTY U LOCATIO L/4,L/4 , SECTION ZTPa IRE NUMB , TOWN O L,*,ME(hli. jT_*Kn-o-l{ n SUBDI VI S ION , Sts. Crolx County, , LOT NUMBER_ . Improper use and maintenance of your septic system couldresult in its premature failure to handle wastei. propermaintenance consists of pumping out the septic tank every thieeyears or =]o.:.t , i f needed by a licensed sept,ic tank pr*p"f . What,you puE into the system can affect the function of th; =lipii" tankas a treatment stage in the waste disposar system. lSt. Croix County residents may be eligiUfe to receive a grantfor a maximum of 5ot of the cost of repfacement of a faiii;gsystem, which was in. operation prior to .fufy 1 , 19ZB . St. Croixcounly accepted this program in August of 1980, with therequirement that owners of aII new =yJtems agree to keep theirsystem properly maintained. . . T!. pfoperty owner agrees to submit, to st. croix zoni.g acert'i f ication 'f orm, s igned . by the owner and by a mater plumber ,journeyman plumber, restricted plurnber or a f icenlld'-f,r*perverifying that ( 1 ). the on-site wastewaLer disposal system ^ is' inproper operating condition and (2) after inspection and'pr*ping (ifnecessary), the septic tank is less than i/l fuII of'sfiate andSCUM. r /lle, the undersigned have read the above requirements andagree to maintain the p rivate sewage disposal- sys tem in accordancewith the standards se t forth, herein, as set by the Wisconsin DNR.Certi f icat ion statin g that your septic has be en maintained must becompleted and return ed to the St. Crolx Co. Zonin30 days of the three year explratl S IGNED St. Croix co. Zoning Office911 4th St. Hudson, t.ll 540I5 DATE: g offLcer within a date. ) F\\)\ s T c - L00 'This application f,orm is to be .completecl in furl and signed byItht owner (s ) of the property ^ ngin! 'J.ugloped . Any inadequacies 1r11 -only result ln aglty* br th;'permta i**urn.n. , should thlsdevelopnent be intended for resare by qwn er/coi-rtractor, (specItouse ) , then I a second form should be idtuined- lna completed whenthe prop?rty-' is sold and submLtted to this office with theappropriate deed recording, Owner of property Location Townshi p Maillng of' property /4 tlL ,r ,2T n-d L .4,2 L, d addre s s I 0t,eno ?u yt Address of site >ra r\Sl-re*70 Subdivl s ion name -----, Prevlous owner of, property V lun Fc^q t no. - o Total size of parcel 1B qvlf<-' Date parcel .was ereated U { Are all corners and rot lines identtfiable? _yes No Is this proper vorrrn" iilO andof Deeds. ty pelng developed for ( spec house ) ?_yes recorded wlth the o Page Number 2-6 a6 Register frecorded1nthe of fJ.c ter of deed B as DocumentNo. INCLUDE WITI{ THIS APPLICATION THE FOLLOWING:A WARRANTY DtrED which incrudes a DocuHENT NUHBER, voLUHE AND pAGENUHBER & TIIE SEAL OF THE REGTSTER OT' DEEDS. ,Irr AdditiON, Acertified _ survey, if available, would be helpfur 1o ;;-i; avoiddelays of the revi...1{t',q process. rf th; deed description ' references to a certifled survey Map, the certifled survey Mapshall also be required. I ( we ) certi fy th PROPERTY O}INER CERTIFICATION at aII statements on thls fo rm are true to thebest of my ( our )knowl ed ge that I (we ) am ( are ) the owner ( s ) ofthe propert,y abscrJ-bed I n thls J.nform atlon form, by vLrtu eofawarranty deed recorded t rh of f ice of the County Re gi ster ofDeeds as Document No., and that I ( we ) presentlyown the proposed site for the sewage dls posal sys tem or I (we)obtained an easement to run the above d e s crlbed property, forthe construction o sald system, and the Bame h aE been duly -?A gnature of applJ.cant Co-appl j.cant t Da te o S lgnature e of County Regls Date of Signature secti ""i { a {lane. STATE BAR OF WISCONSIN FOBN 1- 1988 WARRANTY DEED il.1020um ?LE rHra aPAct i:!fRYfo 701 iacoiolxo oArA OOCUMENT NO. This Deed. made betw".', ..!{a Ll.qf-..W.'.--E.gn . S andr a. .D... -. Eens.t r-o r...tru.s b.a.nd and...n if-e .s-t E.a---a.nd...... REGISTER'S OFFICE sT. cPolx co., wt Rec'd br Record JUL 6 leetr ;;;. . R; uh ;n . : L i o, A...N e " b-;-i [. . a.n d. .P e.L i.i. .q i. ? . . . Newb.o r g, ...h u.s,b.a.n d... a.n d. .lr i.f.e. ..a 9... 9.tlr v.iy ...rnar it al. pr oger-t Y...... Grauteer' WitngSSeth, That the said Grentor, for a vglulble coasidcrrtiou---.-- conveys to Grantee the following deacribed real estate in .----S-Lt----G-f-o-ut-..--... at H Bor 3$ Trr Percel No: -..------ ff.oej|uir eGrerorDcedr County, Statc of Y[isconsin: The Northeast Quart,er o Quarter (NEt of NEt) of(Sa), Township -Twenty E Range Sixteen (16) West 295- feet 2 lnches ln th t the NortheastSectiol ThirtY Four ight (28) North, , except a squaree Southeast corner' TRANSEEbg - ?.f4 EE Thir - -. .is-. -not.-. - - -- - - - homceteed propcrty.(is) (ie not) Toglether rith dl end ringul.er thc hereditsmenta end apprrtrurnecr thereunto bclonging; .rna...!{-a 1.t er...H-'..-.Eens-ir.a-..and.. S.andra--D..--- F-ens-tr a- werrents that thc titlc ic gpod, indefea.iblc in fee simple aud frcc and dear of easements, restrictions and rights of uay of record, and will warrant and defend the same. Dated this 3o day of -.----- encumbrancee ercept re.93.... errhru-/m ('EAL)(sEAL) (sEAL) a a-l E e.r.. F...-...8 e.ns l.r a. -----.-IIal-Ler--IL,-. s nrlre to mc (SEAL) * ,o .day or the abovc naned Wis. ration a . - $.ap.d.r.a...D-.-. -..8 e.n e.!.E a...... ACTNOWLBDO!dENTAUTEENTICATION Signature(s) a TITLE: MEMBER STATE BAB OF WISCONSIN (If not, authorized by ! 706.06, Wis. Stats.) STATE OF WTSCONSIN l - Sh--Cc..s'r.).f,,...coootv. I Pcrroually camc before mc t'hir ----- S *--la--.----....--.., rs...9.3. a tI,:=.... Notrrv hblic ------ii;-il; i":i" ;'' i;'' ; ;ffi ;;;; t:- ( t i datc: --. ---77.-../..t.:... .Nrocr of Dcnoot rltnlng la uy crpecity rhoutd bc tyocd or prlntcd bclor th:ir ilCEIt+ STATE BAE OF VISC-OIrSU! FORil Nc l-ltGt a. Wi-onslo lrcrl Blaol Co. Iac. Xilrrulcc. Wll. 1\ WARRANTY DEED a THItl INSTRUMENT u/AS DRAFTED BV . R i.v-er-.. Ea1]-s.r...WI..-.5 49.22. . -. (Signatures may ire authenticated or acknowledged. Both are not necessary.)