HomeMy WebLinkAbout020-1161-70-000 (2)*-r r/=i
AS BUILT SAIIITARY SYSTEIII REPORT
Opt,e-l-TOWNSHIP
SECTTON
ADDRESS
?b ffin-n_Jw 1a4T
tfol q,c-/
cRoIx couNTY, wIScoNSrN
SUBDTVTSIO D(
\
2 *acP:9_LOT SIZ Ir
PI.AN VIEW
SHOW EVERYTHING WITHIN ].OO FEET OF SYSTEM
BENCHI{ARK: Elevation and description :-€* a1 z1{
Alternate
SEPTIC TAIIK: Manuf acturet z ' ,: ,.1 t-,---t Liquid Cap .1? a -o
Ringsused,.ZuunhoIecovere1ev:-F.ina1gradee1ev:-
Tank inlet elev.: Tank outlet elev.3_
No. of f eet f rom nearest road: Front , side -{, Rear-Fi-. 7/
From nearest prop. line: Front , Side 1-, Rear-Ft . 74'
No. of feet from: WeI , Building:z? 1 7,fl
(Inc1ude this information in the above plot plan)(2 reference dimensions to septlc tank)
SEE REVERSE SIDE
73'/{* s-L/7'
/da a
INDICATE NORTH ARROW
/h
//'>/-/
-\)
ar.
oul
PUIIP CIIAIIBER
Manufacturer :Jlqu1d Capaclty:-
Punp uodel:-PuDp,/siphon Manufact. :
-Purop
size-
Elevation of inlet :
-Botton
of tank elevatlo
Punp on elev. :
-Punp
off elev.::Gallons,/cycle:-
A1arm: Uan. :-Swltch Type:-Locatio
Distance f,ron nearest prop. Ilne: Front-, Side-, Rear-Ft.-
Distance fron: well-Buildlng-
SOIL ABSORPTIOT SYSTE{
Bed:Trench:X.--s"epage Pit:-
wiatn : ill enqtn:ZLrumber of l,lnes : -fu raa sultE-7fiA
Ex18t.GradeEIev.PropoaedFl'na1GradeEIev.-
FiII depth to top of pipe:
No. feet fron nearest prop. Iine:Front-, Slde:f , Aear-st.lz '
No. feet from veLL: i@1fio. feet fron bullding
HOT,DING TAI{K
[Ianuf acturer :
-apacity
:
No. of rlngs used:-Elevatlon of botton tank:-
Elevation of inl€t:
No. f eet froD neareat prop. Ilne: Front-, side-,
No. feet fron: wel.I-, building-, nearest
Rear_Ft._
Alarn Uanufacturer:
INSPECTOR:-
'DATE:73 PLWBER ON ,'OB:
LTCENSE NI'UBER:
6/90.cj
raEATJQUri",tHUpSgN*#,7 . z s . r s .' trtr uxtt B t wlgEr rs
? srp, "L BRADL
Lebor and lluman Relations
sdtety
"r,o
au,tJinsiDi,iiion INSPECTION REPORT ,1f
(ATTAcH ro ernrurl 1
I
GENERAL INFORMATION
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic /T)/d.rte*/ D Oo
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
PUMP / SIPHON INFORMATIO
SOIL ABSORPTION SYSTEM
A9 3000ETEVATION DATA -/J
'Permit ame e
HUDSON
/ 00.
B E
/o0.
nsp. BM E
eflNJ
pt
iJfi,,,.
County
sT. cRolx
Sanitary Permit No.:
186553
State Plan lD No
Parcel Tar No.:
o20-L161-70-000
TANK TO PIL WELL BLDG Ventto
Air lntake ROAD
Septic /2 L/67'/7, s Y//.5 NA
Dosing NA
Aeration NA
Holding
Manufacturer
Model Number
Demand
GPM
TDH Lift on Svstem
Head TDH Ft
Forcemain Lengt Dia Drit. To Well
ITIIIIIIIII
STATION BS HI t5 ELEV
Benchmark t, 61 /o). tU /D0,
Bldg. Sewer 1,tv 4q zc
5t / Ht lnlet at4,tu
5t/ Ht Outlet ),8 )cl ,1,o I
Dt lnlet
Dt Bottom
qv L>Header / Man *,)7
Dist. Pipe x,qa q ),q
Bot. System q,q q
S .,14
Final Grade 5,8 4e,uU
-1,t S q7,7'tSi'ta *r. ^t I )o,, l,,L ( t^t<,)
IIIIIII
IIIIIIIIIII
BED / TRENC}'
DIMENSIONS
width5'.*nina No. Ol Trenahet PIT
DIMENSIONS
No. O{ Pits lnside Dia Liquid Depth
SETBACK
INFORMATION
SYSTEM TO Ptt BLDG WELL LAKE / sTREAM LEACHING
CHAMBER
OR UNIT
Manuladurer
rygeoI f UJ-u-)
System: /&,O l)'a>t \ rou Mod€lNumber
DISTRIBUTION SYSTEM
Header/Manilold
Length _ Dia
Distribution Pipe(l)
reneth f!Dia _q,'Spa.ing L
x Hole Siz€x Hole Spacing vent To Air lntake
SOILCOVER x Pressure Systems Only rx Mound Or At-Grade Syjtems Only
Depth Over
8ed / Trench CenterlF,,{ 12
Depth Over
Bed /Tren.h Edges
xx Depth Ol
Toproil
xx Seed€d / Sodded
EYe3 DNo
xx Mul.hed
EYes ENo
COMMENTS: (lnclude code discrepancies, persons present, etc.)
soN 23.29.19.924,NW,SE, LOr 25, WrLL BRADLEY DR.LOCATION:-
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4 ,7r
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Plan revision required? E Yes
Use other side for additional info
s8D-6710 (R 05Ar)Date
4 6 2 L
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billD
rnQtioh.
7
lnspector's S ignature Cert No
\
DILHFI SANITARY PERMIT APPLICATION
ln accord with ILHR 83.05, Wis. Adm. Gode
-Attach bomplete plans (to the county copy onty) for the system, on paper not less than
ElLx 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICANT INFORTIATION - PLEASE PRIilT ALL INFORTIATION.
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:d;U/rud.rup&soi<.
\in4er-v*rn U.tl
/x-**
\
sTnTe SAUTANY PERMIT FU
Z "K,,0,, #SJ*s app r icati on
STATE PLAN I.D. NUMBER
/erU 7a ,:rl/e u
PROPERry OWNER PROPERTY LOCATION;;;i;lii,s ts r rq,N, R /? eo,vO
PROPERW OWNER'S MAILING ADDRESS
7- e Za-s ht',a€- /l- €
LOr#
^7<
BLOCK #
b,,'+CITY, STATE
C, tfo*t
ZIP CODE PHONE NUMBERVtt t457Frq
SUBDIVISION NAME OR CSM NUMBER
Ft v /a/te r
1 E AoUCondo
2 Z Assemblv Hall
3 E campground
4 U Church/School
s E Hotet/Motet
State Owned
u6-//0/10
6
7
8
I
truTtr trtr
lll. BUILDIilG USE: (lf building type is public, check allthat apply)
ll. TYPE OF BUILDING: (Check one)
Other: Specity
10
11
12
13
Medical Facility/Nursing Home
Merchandise: Sales/Repairs
Mobile Home Park
Off ice/Factory
I prOll. E t or 2Fam.Dwellinffi of bedroo ^s 3
Outdoor Recreational Faci I ity
RestauranUBar/Dining
Service Station/Car Wash
lV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
B) E n Sanitary Permit was previously issued. Permit f
B 4.5.A)1
Date lssued
Repair of an
Existing System
Reconnection of
Existing System
New 2.
System
Replacement 3.
System
Replacement of
Tank Only
Pressu rized Distri bution
21 E uouno
22 a ln-Ground
Pressure
Other
41 E Holdino Tank
42 Z Pit Priv-v
€ E vault Piiry
1 1 mtr12
Non-Pressu rized Distri bution Experimental
30 E Specity Type
V. TYPE OF SYSTEII: (Check only one)
13tr
14E
Seepage Bed
Seepage Trench
Seepage Pit
System-ln-Fill
2. ABSORP. AREA
REQUIRED (sc.ft.)"7s^d
I s. aesonP. AREA I t
I enoeosED (sq. ft.) |I zs-o lt:
LOADING RATE
(Gals/daylsq. ft.)
,C
5. PERC. RATE
(Min./inch)
6. SYSTEM ELEV
f2, -o,Qc,oeet
VI. ABSORPTION SYSTEM INFORMATION:
Feet
7. FINAL GRADE
ELEVATION
CAPACITY
in gallons Prefabvll. TAI{K
INFORTIATION New
Tanks T
Total
Gallons
#ot
Tanks
Site
Con-
structed
Steel Fiber-
glass Plastic Exper
App.
Septic Tank or Holdino Tank Y uaD /(ST
Lift Pump TanUSiphon Chamber
VIII. RESPONSIBILITY STATEiIENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print):
4)r'//,'a 2t -9 c ,/o *ro//cy
Plumber's Signature: (No Stamps)
6:f
No.Business Phone Number:
d Na-l-go t- c.., .' -{2 O 74 .--_ .o a
Plumb€r's Address (Street, City, State, Zip Code):
IX. COUNW/DEPARTMENT USE ONLY
ffir*,.o
Disapproved
Owner Given lnitial
Adverse Determination
EE
it Fee
Surcharge Fee)
r.II-Ir-fIIIIIII
(R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Own€r, Plumber
Manufacturer's Name
ft ft
1.
2.
3.
4.
5.
6.
[,rFniElftoTs
A Faf,itTyYrermit is valid lor two (2) years.
Your sdnltltf permit may b€ ren€wed belore the €xpiration dats, and at the time ot ren€wal any now
criteria in the Wisconsin Administrative Code will be applicable.
All revisions to this permit must b€ approvsd by tho permit issuing authority.
Changes in own€rship or plumber requires a Sanilary Permit Transter/Renewal Form (SBD 6399) to be
submitted to the county prior to inslallqligr. ,..,.
Onsite sewage systems must be propeily maintain€d. The septic tank(s) must be pumped by a licensed'
pumper whenever necessary, usually €very 2 to 3 y6aB.
ll you have questions concerning your onsits sAwag€ systsm, contact your local code administrator or thg
State ol Wisconsin, Salety & Buildings Division, 60&26e3815.
To De coTptele and accurate this sanitary pBrmit application must include:
Property owner's nam6 and mailing addrpss. Provido the l€gal description and parcel tax number(s) ol
where the system is to be instgtl€d. . !..
Type ol building being served. Check only ons and complete # ol bedrooms i, 1 or 2 Family Dwelling.
Building us€. l, building lype is Public, check all appropriate boxes that apply.
Type ol permit. Check only one in line A. Compl€te lins B if p€rmit is lor tank replacement, reconnection, or
repair.
Type ol system. Check appropriale box dep€nding on systeir type.
Absorption system inlormation. Provid€ all information requested in #1-7.
Tank inlormation. Fill in tho capacity of every new and/or existing tank, list the total gallons, numbsr ol
tanks and manulacturer's nams. lndicate prelab or site constructed and tank material. Complete lor arl
septic, pump/siphon and holding tanks lor this system. Check experimgntal approval only il tanks received
experimental product approval trom DILHB.
Responsibility statement. lnstalling plumber is to lill in name, licenso number with appropriate prelix (e.9.
MP, €tc.), address and phone number. Plumber must sign application torm.
County/D€partment Use Only.
County/Departm€nt Use Only.
t.
I.
t.
tv.
vt.
v[.
vu.
tx.
x.
Complete plans and specitications not smaller than 8% x l1 inches must be submitted to the county. The
plans must include the follorying: A) plot plan, drawn to scale or with complsts dimensions, location ol
holding tank(s), septic tank(s) or other treatmont tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption syst€ms; replacement system
areas; and the location ol the building served; B) horizontal and vsrtical slevation reference points;
C) complete specilications lor pumps and controls; dose volume; elevation difierences; lriction loss; pump
pertormance curve; pump model and pump manulacturer; D) cross section of the soil absorption systom if
required by th€ county; E) soil tost data on a 115 rorm; and F) all sizlng inlormation.
1983 Wisconsin Act 410 included the creation of surcharges (lses) lor a numbor ol
regulated practices which can eltect grqlndwater.
The monies collected through thess surcharges are used tor monitoring groundwat€r, ground-
water contamination investigations and establishm€nt ol standards.
sBD{398 (8.r 1/88}
'This application form is to be .completed in fuII and signed byItl: - oh/ner (s ) of the propert,y
^
b.ing developed. Any inoo.iuuries
tf 11 -only rosult ln cleliy* bf the- permlt i.suancn. , should thlsdeveloprnent be intended for resale by o$rner/cohtractor,(specItouse ) , then I a second f orm shor-rld be retained and completed whenthe prgpgrty' is sold and submitted to this office with theappropriate deed recording.
STC 100
Owner of property ,\)
Location of ' property N wJ L/ 4 sE ty a , section 23 , T_21 N-nl-3_w
Townsh i p l/,ldro,
Mailing address 17 Tlor-,/u, 5
Address of site
Subdivision name
Other homes on property?X
Previous or.rner of property
0
/l
(
es
t-l"a on
o
t Do. a^i
M"
Total size of parcel { ocre<
Date parcel .was ereated L
Are arl corners and rot Llnes identifiabre?Yes
-No
rs this property peing devel"oped f or ( spec house ) ?_yes X Ho
v?r"rn" 99 0 and Page Number -t1l as recorded wlth the Registerof Deeds. - r
INCLUDE WITII THIS APPLICATION THE FOLLOWING:A WARRANTY DEED which includes a DoculIENT NUuBER, voLUHE AND pAGENUHBE| & TIIE SEAL Of THE REGISTBR OF DEBDS. ,In addition, acertified survey, if available, would be helpful' so as to avoidderays of the revi.e.w^1ng process. rf th; deed descriptionreferences to a certi fied survey Map, the certified survey FIapshall also be required.
PROPERTY OWNtrR CERTIFICATION
) certify that arr statements on thls foI(we
best
the
warr
De ed
own
obta
the
r eco
of my ( our ) knowled ge that I (we) am (are) the owner(s) ofproperty dbscribed t n thls lnformation form, by vLrtue of aanty deed record
rm are true to the
s as Document No
of the County Register of, and that I (we)presentlythe proposed si te for the sewa ge dlsposal system or I (we)ined an easement ,to run the above described property, forconstruction of said s ystem,and the same has been dul v
ed .in the office. qgqlSl
No.
rdqq ed
Ir{ I 5'ln the offlca o f County Reglster of deeds as Doeumen
L /**
Signature of applicant Co-appI icant
/- Ld- 7J i
\
Date of Signature Date of Signature
t
I
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(
?t ta 3rAC3 tSr3tvfo ,ol rcoFll D?r
OOCUMENT NO UARNAI|TY DGID
8TATE BAR OF WTEOONSIN TOBU T - TE
homcrtcrd prop€rty.
eaBenent E ,of record,
4941s1
= il Se,qlgl =
REGIST En',s Frc
sr. cn(D(oo.,ul
Rr'd for mcfi{
JAN 1 8 199U
:al
Frank LaPlante and No1rnan.9.... llqqfg.t
('onvev. errd wrrrant to .. .ttinnen--.[t foUmgf.t"rTP''"4n0"Qf'tgry-- f-cwner.. hus.band. and--xlfe ..----
st; 'crolx
d ll:00
R
o
ErICD-
At
d
-
t.hr folloring dcribrd lrl -t t ttt
Shtt of Wiroada:
County,
regtrlctlons and rlghts-of-way
lf any.
Lot 25 t
Hudson,
PIatst.
Tu Prrcol No
ofFoxValleyFlrgtAddltlonlntheTownof
Crolx CountY, Ul eongln.
bijil
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rhb ... .ln..noL(L) (lt -.i'
Erccptioa to lerrurtlr:
Drted thlg
Erank laP'Lante-
autElrtroallotf
Strnrlun(r)
rut$attcrtrd tblr .-..-.-.drY of
a
/*^-e7h'a*
' .-Norman C. ' Mea.re
, rg.93
ACENOtrLEDOIIlfT
trfi-,w
dey of
(sEAL)
(SEAL)
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aa
(sEAL)
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pr,rronrlly crmo bcforc ,Tri3
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TffLE: XEIBEB STATE BAB oF wIscoNsIN
(It Dtitilforird Dy I ?0G0G Wir. Stru.)
THta rxsrtuxSl{T wAa DiATr:D tY
Krlstlna OgJ.and"" "ffitit'i'ii6'y" et"Ieir" "'
(8L!.tu- anf br eutbatleerd or rclnorl.dgd. Bothrn d Hast)
to
fo
knorn to bc tlto >2. ...-- rho ccutrd trhe
inrtr trndr e#fr,ptt
, Stale of
Notary Publlc County, Wir
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eh el ro 5- ll ry rrr.l hL L trrel oc rrlrtd ld" tt& 'l|!fhtr
srArB t^l ot sllcotlirNrOlI ll} t- ltet
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s T c 105
SEPTIC TANK MAINTENANCE AGREEI{ENTSt. Croix County
o1^lN ER/BUY
ADDRESS ?ilu IRE NUMBER-
CITY/STAT 7rI 4at
PRopERTY LocATr oN: NnJ L/4 , SE t/4 ,sEcTrotr Z? , T Zl N-RJj_w
TOWN OF dso n,st. CroLx County,
LOT NU}TBER 2{ .
n
rr)
SUBDI VI S ION
Improper use and maintenance of your septic system couldresult in its premature failure to handle wastes. proper
maintenance consists of pumping out the septic tank every threeyears or sooner, if needed by a licensed septic tank pumper. Whatyou put into ttie system can af f ect the f unction of the slptic tankas a treatment stage in the waste disposal system. 'St. croix County residents may be eligible to receive a grantfor a maximum of 60t of the cost of replacement of a failingsystem, which was in operation prior to ,JuIy 1, 1978 . St. CroiiCounty accepted this program in August of 1980, with therequirement that owners of all new systems agree to keep theirsystem properly maintained.
The Ploperty owner agrees to submit to SC. Croix Zoning acerti f icat.ion 'f orm, signed by the owner and by a mater plumbLr,jou!neyman plumber, restrict.ed plurnber or a licensed pumperverifying that ( 1 ). the on-site wastewater disposal system - is- inproper operating condition and (2) after inspection and pumping (if
necessarY ) , the septic tank is less than L/3 full of sludge and
scum.
T /we, the undersigned have reacl the above requirements andagree to maintain the private sewage disposal system in accordancewith the standards set forth, herein, as set by the Wisconsin DNR.certification stating that your septic has been maintained must becompleted and returned to the St. CroLx Co. Zoning officer within30 days of the three year explratLon date. .
SIGNED:,J-- 6.T,-
St. Croix co. Zoning Office91r 4th St.
Hudson, t.rI 54016
DATE:- /- ZS" f 3
-t
,
Dcscriplion Lots 23, 24
Hudson, St.
Boulevard
55125
and 25, PIat of Pirst Addition toCroix County, t{isconsin.
o
Fox VaIIey, Town of
a
John CurrelI
7 582 Curre1 1
Woodbury, MN
SAN LAND SURVEYING
HUDSON r W|SCONSIN 54Ot6
( 7t5) 586-2007
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CURVE DAIA
Curve
No.
Radius
Length
80.00 |
80.00 |
Chord
Length
106.71 |
65.83 r
Chord
Bearing
S25009 ' 13r'E
S40o5B r 26rl{
Curve
Length
116.821
67.841
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Slolc of Wisconcin
County of St. Croix ! sc.SCALE OF MAP - I INCH = 200 Fecr
t,Allen C. Nyha qen , regirlcrcd l{irconcin L ond survcyor, do hcroby ccrtif y thotonJauarv2919 g 0 r I rurvcycd lhc obovc dcacribcd ond moppad propcrty occording to
thc officiol rccords ond thot thc occomponying moP ir o corrcclly dimcnsionad reprcsenlolion to ecotc of lhc boundoriecrlhol
O IRON STAKES DRIVEN
O IRON STAKES FOUND
nd thol no Gncroochmcnlc by odjoining orncr! oppeoroll buildings ord improvcmcntr lic uholly
f rom so id survey.
Mop No.
Drown By
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Wisconsin Departrrnnt of lndustry,
Labor ard Human Relatiors
Division of Safety & Buildirps
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page / of s
AttachcornpletesiteplanonpapernotlessthanE l12xll inihesinsize.Planmustinclude,but
riotlimitedtovertical andhorizontal referencepoint(BM),direction and"/oof slope,scaleor
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
c 0 U
CEo
PARCEL I.D. #
REVIEWED BY DATE
PROPERTY OWNER:
/"ufii,N€(l&fl,-d PROPERTY LOCATION
GoW.LoT rrJW 1ru38 174,523 T'z?,N,R l? E (or)w
PROPERTY OWNER' :S MA LIIlC,qOD RESS-LOT #zs BLOCK #SUBD. NAME.,OR CSM #Bx Vaurv
CITY. STATE
Ccra4 {6Pol€ZIP CODE PHONE NUMBERln,,l (rz) Ast-9<sz DcrTY !.vrruoE flfrowr\ll/ulSo r,.t
NEAREST ROAD
['Jr..(g,{t.cY }2rv6
p( ruew Construction Use frf Residential/ Number of bedrooms 3
[ ] Replacement i t1 Public or commercial describe
I I Addition to existing building
Recommended design loading rate O'S bed, gpd/ft2-O'L [ench, gpdtttz
$ [4aximum design loading rate 6,f Ueo, gpOlrt2]3 .'L fench, gpdft2
ft (as relerred to site plan benchmak)
Code derived daily flow 4So gpd
Absorption aea requir eoQoO bed, ft2
Recommended infiltration surface elevation(s)g z,s-o?so trench,
Additional design / site onsiderauons
Parent material _Flood plain elevation, if applicable fr
S = Suitable for system
U = Unsuitable lo? system
CONVENTIONALEIS trU
MOUNOMs !u IN.GROUNO PRESSUREtss Du
AT.GRAOEEs tru
TEM IN FILLS trU
SYS
E'
HOLDING TA}.IKns su
SOIL DESCRIPTION REPORT
Boring #
Ground
{h,,,
Depth to
limiting
factor
Remarks:ul6 oF (L€P \pwca S*"rA /8= Lay&
GPD/ftzConsistenceBordaryRoots
Bed Trerd'tHorizonDepth
in.
Dominant Color
Munsell
MoUes
Ou. Sz. ConL Color
Texture Structure
Gr. Sz. Sh.
z o4 d</t)Y?Z/z L Oq)2l CIt)a
I o.4 d.5nv*13 SL
b
I .Cr lh,r{"I8,r/4
l1
I b
C I NP N}tnv/^+k a,2,d"l;lL Ctt l', al L*,r,r'/{;g I$z
I c.f io.tS
TII
n ?\rv1 I,4=s(/^v{+/ +
0
Boring #
Depth to
limiting
factor
Ground
elev.
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Wiscon$n Department of lndustry,
Labor :nd Human Relatiors
Divisidtof Safety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page I of 3
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 and'/o of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
Ceo
PARCEL I.D. #
REVIEWED BY DATE
PROPERWOWNER: / r A
/"*^ffii,N€( / t*#rrcs PROPERTY LOCATION
cow.Lor nlW 1t438 1/4,s23 r'z?,N,R l? E (or)w
PROPERW OWNER':S UA LIIIO AOD RES$LOT #2s BLOCK #SUBD. NAMLOR CSM #Bx Vat r rv
CIW. STATE
C,rrra4r(PoVg
ZIP CODE PHONE NUMBER
kzt 4ss -9<szlq,J
DCITY NVILI-AGE ffiOWT.I-r/u>s"i NEAREST ROAD
hlc" 8P.,{t t6 Y } P'vE
B( ruew Construction Use ftl' Besidential/ Number of bedrooms 3 I 1 Addition to existing building
I I Public or commercial describeI I Replacement
Code derived daily flow 45O gpd
Absorption area requir edQoA bed, ft2 ?SO
Recommended design loading rate O'S bed, gpd/ft2 O 6 trench, gpd/ft2
$ llaximum design loading rate 6,5 bed, gpdlft2]3 JL trench, gpd/ft2
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Addilional d6ign / siE considerations
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U = Unsuitable foi system
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.fiscons,g Department of lndustry,
Labor antl Human Relatiors
Divisiorr of Safety & Buildirgs
SOIL AND SITE EVALUATION BEPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page / of J
COU
CEo
PARCEL I.D. #
REVIEWED BY DATE
PROPEHTY OWNER:
/.*^ito ' N€*-lAfl,-d PROPERTY LOCATION
Gow.LoT rrlW 1t43E 174,523 1'27 ,N,R i? E(or)w
PROPERTY OWNER' :S U(lI-IruO EOD RESS-LOT #2s BLOCK #SUBD. NAME;OR CSM #Bx Vat I ev
CITY. STATE . ZIP CODE PHONE NUMBER^
Ca:r,q4 ( 6poV€ lq,J 6lZ) Ast -?(sz ECITY nViLLqcE ffiowru-rlu>soil NEAREST ROAD
bJr..8Pr{tq6Y }ArvE
Attach complete site plan on paper not less than 8 1l2x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and"/o of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
p( Hew Construction Use ftJ' Residential/ Number of bedrooms 3
[ ] Replacement t1 Public or commercial desqibe
I I Addition to existing building
Recommended design loading rate O'S bed, gpd/ft2-O'6-[ench, gpilftz
, ft2 Maximum design loading rate 6,5 bed, gpdlft2-13 . rL fiench, gpd/ft2
Code derived daily flow 456 gpd
Absorption area requir eoQol bed, ft2 4SO trench
Reco mmended infi ltrati on s urface el evation (s )(as referred to site plan benchmark)
Additional design / site considerations
Paent material Flood plain elevation, if applicable ft
= Suitable for
= Unsuitable
svstem
fo? system
S
U
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MOUNDMs tru
IN.GROUND PRESSUREEIS DU
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REPT].31 HUDSON ST. CROIX COUNTY ZONING PAGE 1
o5/O5/s3 oarL3 REQUESTS FOR INSPECTIoN WORK SHEETS FoR: 5/ 5/93 AREA: MJ
. . Aitivity: A93OOOo9 5/ 5/93 Type: colw93 status: PENDING constr:
Address: HUDSON 23.29.19.924,NW,SE, LOT 25, WILL BRADLEY DR.
Parcel: O2O-LL61-70-OOO Occ: Use:
Description: L86553Applicant: TowNER, VERN Prrone 3
Owner: TOWNER, VERN Phone:
contractor: scHLruAcHER WILLIAI.I C. Phone: 386-3121
Inspection Request Infornation. . . . .
Requestor: SCHUUAKER, WIt{. Phone:
neq fime: L0:05 conmentsz ,/a!CA- /O!.NItems requested to be Inspected... Action connents Tine Exp
OOO12 FINAL INSPECTION
Inspection History.....Iten: OOO12 FINAL IISPECTION
'rt'isconsirb€partm€nt o f lnd ustry,
Labor arrd Human Relatiors
Division of Safety & Buildirgs
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page / of s
COUNTY
CEo
PARCEL I D #
REVIEWED BY DATE
PROPERTY OWNER:
/"*"fii^,ue,Q-l&flM PROPERTY LOCATION
Gow.LoT r../W trqSE 174,523 r 'Z?
,ru,n /? E (or)w
PROPERTY OWNER':S I,lA LINE,qOD RESS-LOT #
2S
BLOCK #SUBD. NAME.,OR CSM #
\Zx Vau-pv
CITY. STATE
C..;=ra4 Li 6Pol€ZIP CODE
At"l
PHONE NUMBER(rz) 4sr -9<sz lcrrY DyrrucE Efiowtt
f/u>so rl
NEAREST ROAD
U,..(Pr{o.e Y }QrVE
Attach complete site plan on pap€r not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and'/o of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PBINT ALL INFORMATION
p( ruew Construction Use ftl'
[]Replacement 1 [1
Residentjal/ Number of bedrooms 3 I I Addition to existing building
Public or commercial descri M
Code derived daily flow 4So gpd Recommended design loading rate O'S bed, gpd/ft2 O 6 trench, gpd/ft2
,fiz l/aximum design loading rate 6 ,f ueo, gpolrt2! .rL trench, gpdft2Absorption aea requireo Qon bed, ft2 ?SO trench
Recommended infiltration s urface elevation(s)z (as referred to site plan benchmark)
S = Suitable for svstem
U = Unsuitable foi system
CONVENTIONALEIS trU
MOUNOMs Du
IN.GROUND PRESSUREEs !u TEM IN FILLS trU
AT.GRA
Es
SYS
E'
OE
U
HOLOING TAI'JK!s @u
SOIL DESCBIPTION REPORT
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{h,,,
Depth to
limiting
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rSss:lSCoruSr N
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L,o
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Wisconsin Department of lndustry,
l-a*r aN Human Ralations
DivisionDof Safety & Buildirgs
tt
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Page _ of _
a
Attach complete site plan on paper not lessthan 8 112x11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and"h of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
SOIL DES ro R ORT
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:6T'(ll€P S*"rA Lay&
Boring #
Ground
elev.
fr.
Depth to
limiting
lactor
C OUNTY
Cso
PARCEL I.D. #
REVIEWED BY DATE
PROPERry OWNER:
lnPrnvr{-
PROPERTY LOCATION
Gow.LoT n/W 1t43E 174,523 r 27 ,N,R l? E (or)w
PROPERTY OWNER':S MAILING ADDRESS LOT #25 BLOCK #SUBD. NAME^OR CSM #Bx Vau*v
CITY, STATE ZIP CODE PHONE NUMBER()EcrTY EyrLr-AGE ElrowN
JJttlSo xt
NEAREST ROAD
Flood plai
Code derived daily flow _ gpd Recommended design loading
Absorption area rEuired
-
bed, ft2 Uench, ft2 tUaximum design loading
n, if applicable
\-/
bh
ft
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Parent material
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Horizon Depth
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DateSignature:Cst-Nrhbk;,Z
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PROPERTY OWNER
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Boring #
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SOIL DESCRIPTION REPORT Page _ of _
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Remarks:
Horizon Oepth
in.
Dominant Color
Munsell
[ro$es
QrJ. Sz. Cont Color
TExture Structure
Gr. Sz. Sh.ConsisEnce BaJdary Boots GPD/ftz
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