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HomeMy WebLinkAbout040-1215-10-000 (2)rn A J)tSjp�Tn PA Lew��i�ai��5E1� �A rt M-0*W1 JA�Y� 8 i3 4 ZG Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTAC H TO P E R M IT) GENERAL INFORMATION ❑ City E] Village [Town of: 3ermit Holder's Name- &nA0AJ<-_-1 I %12" M 17E & DENN T R 0" Y :ST­BM Elev--.' Insp. BM Elev.: BM Description'. ff 0 r A &I Laf 1&1r^rSAA Aorl^kl CUPWATIM] nA I /-%IMF% 11MI-WINIVIJ11 I I%Jlm TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TAN KTO P L WELL BLDG Vent to Air intake ROAD Septic--- NA Dosi ng NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss ad Forcemain Length Dia. Dist. To Well 1 C! I County: I Sanitary Permit No.: I State Plan ID No.: Parcel Tax No.: 0 A14 0_1 "'2I if- 5 10-000 A&I � _j V..0 %-A %./ / -.I L_ V STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/ Ht Inlet St / Ht Outlet /06 3V Dt Inlet Dt Bottom T_ Header / Man. q9- 3S Dist. Pipe Bot- System Final Grade SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No Of Trenches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS DIMENSION LEACHING Manufacturer - SETBACK SYSTEM TO P L BLDG WELL LAKE / STREAM CHAMBER Model Number: INFORMATION Type of OR UNIT -1—S y st e m. . - _./ -"? /' 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 Ej Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) A S "I IC &no 'I LJOCATIONee TROY _1,_6.28.19-1034,SE,N'0V', LOT '+-Lf .)OUTH PAC Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date inspector's Signature Cert No. 14% Nt S T C — 104 AS BUILT SANITARY SYSTEM REPORT OWNERT(D Y-n, 'S (Z r\ Q. v\� ADDRESS/ ,31() S 1?, SUBDIVISION CSM# LO T SECTION 16P T e:Ze5,0'_N-R�W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 49d 11 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: e ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION A Manufacturer: Liquid Capacity: '50 Setback from: Well �7,R House -Other Pump: Manufacturer A _A- Model# A) size Float separation rvIA Gallons/cycle: �r jLA I Alarm Location N A, SOIL ABSORPTION SYSTEM Width: Length (4, 7 of Number of trenches .3 Distance & Direct ion to nearest prop line : C23 S Other Setback from: well: House , ELEVATIONS 3 7`0 Building Sewer ST Inlet, ST outlet PC inlet PC bottom PUMP Off Header Manifold Bottom of system ExistingGrade Final grade DATE OF INSTALLATION,: 7 - --/'�- PLUMBER ON JOB's 01 0�1 ) \j I vl\ R� kj� T1,50 LICENSE NUMBER: 1 -5 (40 -3 INSPECTOR: 3 / 9 3 : jt SANITARY PERMIT APPLICATION FZZ In accord with ILHR 83.05, Wis. Adm. Code DILHR —Attach complete plans (to the county copy only) for the system, on paper not less than .8% x. 11 inches in size. —See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ow-, h CJL Y\ 511/4 NW '/42 S PROPERTY OWNER'S MAILING ADDRESS LOT # COUNTY Ir 45 � CV%-0I x STATE SANITARY PERMI # leg ' '!)p4 Ctec� �if re ion to D*re!'otus aoolication STATE PLAN I.D. NUMBER T c�kj N9 R �(or) W 13 / BLOCK # CAcs e r" P r- 411 1 A)IA CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER If t dk M fv 5 V% 0 C ITY NEAREST ROA n 5 'K 11. TYPE OF BIJILDING: (Check one El State Owned EJ VILLAGE a Coto 0l1 ❑ Public N 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(V III. BUILDING USE: (If building type is public, check all that apply) Uy� -� � � � -S - � d - d 60 1 El Apt/Condo 2 ❑Assembly Hall 6 ❑Medical Facility/Nursing Home 30 Campground 7 ❑Merchandise: Sales/Repairs 40 Church/School 8 ❑Mobile Home Park 5 ❑Hotel/Motel 9❑Office/Factory 10 ❑Outdoor Recreational Facility 11 0 Restaurant/Bar/Dining 120 Service Station/Car Wash 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [K New 2. 1-1 Replacement 3. ❑El Replacement of 4. ❑El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System B) E]A Sanitary Permit was previously issued. Permit — Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 Seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 ❑Mound 22 El In -Ground Pressure Experimental 30 ❑Specify Type Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy V 1. ABS ORPTION VI. ABSORPTION SYSTEM INFORMATION: 1 G 1 - GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE , I REQUIRED (sq. ft.) IO'do 106 C5 PROPOSED (sq. ft.) J (Gals/day/sq. ft.) (Min./inch) CN/ 1112 IVI 1 3 Feet ELEVATION Feet V VII T� II. TANK INFORMATION CAPACITY in gallons New rxisting Tanks I Tanks Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- structed Steel Fiber- glass Plastic Exper. App, Septic Tank or Holdina Tank I L-1 I Lj I LiftPump Tank/Siphon Chamber Lj F� I F-1 F71 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (P Plumber's Si atu (N Stamps) MPRSW No.: Business Phone Number: 5Z, Plumber's Address (Street, City, State, Zip Code): 37 IX. COUNTY/DEPARTMENT USE ONLY F-1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued issuing Agent Signature (No Stamps) Approved El Owner Given initial .1 Surcharge Fee) Adverse Determination I U X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 A sanitary permit is valid for two (2) years. 2. Yur %an it,6ry,. permit may be renewed before the expiration date, and at the time of renewrii ny new criteria in the Wisconsin Administrative Code will be applicable. 34 All revisions to this permit must be approved by the permit 'ISSUing Y 4. Changes in owner -ship or plumber require>s a Sanitary Perm; tJ subirpit-ted..to the county prior. to installatiqn. 5. Onsif� seWIge systems ITILISt be propel. WTai,Rt pumper whenever necessary, usually every 2 to 3 years. I ­ '�?J '4 1 r�tor c_� r he 6. f you hav6 ouestions concerning your onsite sewage system, contact your local codea fili 1'�M' State of Wisconsin, Safety & Buildings Di.visiom-,. 608-2,66-3815 To be complete land,,.49cu rate this sanitary .permit application. must include: I. Property, owner's name and mailing address. Provide the legal description and parcel tax Mlmber(s) of where the system, is', to*be-L,i n4AI I'e'd-- -nd complete or 2 Farri ly Dwelhng,- 11. Type of building being served. Check c" bedrooms III. Building use. If building type is Public, check all approprLiale boxes that apply, IV. Type of permit. Check only one in line A. Complete line B if permit isfror tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system f.ypE,.,. VI. Absorption system information. Provide all int n a 0 r; re"flues+r- VHr Tank. information. Fill in, We capacity of E�ver-�., ­�eov, .1 tanks and ma1lzI Vnufacture�' s narrie.indicate rCfqb or f. �St ;d aI n a i6 k septic, put ip'siphc n and hol,'Aling wti� G L ' prcduct approval frcm D I L H R'. 1,70 i_� Or viii. Resporisthility stat"ment. instaiiing plumber, IF, ■-i o f; s-Jv It Nip, etc.), address and phone number. Plumber n-&� u- gn a P,.., IX. Cdounty/Department Use Only. X_ CountylDepartment Use Only- _Iornriete rflans and sPec.,f;ca*ion­- not smaller, S A P! ,(),Ir p ? ! , ) r the finHowing, FJIJC e.a 'holoding tam —I X strearns and lakes- pua�r or a F) k,., 51 C7' A'� 9 2 t h andi the I ki c loca a u 1 d i C) complete specifications for pun­Ips and cont.rclls-, dose V 0" i. L 1 .1 IT) performancp,'cpiVe; pump model and pump manufacturer, D) cross er c t i o n of the sod absorption system if. , I.r.,equired by Me-colinty; E) WI t6st data on a.115,form; and F) a I 11;fb qg mformation.- GROUNbWATER SUACHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a numr)---�r of regulated practices which can effect groundwater. wL.e t e e , _'.:�i charges are use..' njones col, ted fhrou& V wi-dler cc-)htaminalion invest�'gatl.'ions and establishner` of a d A- - 5BD-6398 (R.1 1/88) A APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Tom Schank & Melissa Anderson Location of property SE 1/4 NW 1/4, Section 16 , T 28 N-R 19 W Township Troy Mailing address Address of site Subdivision name Lot number 41 1310 Stassen Dr. W. St. Paul MN 55118 Glover Station Previous owner of propertyE-7e� L,4A"ct&, C6,tr '11S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes No Volume /0-0 ,7 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty d ed recorded in the Office of • the County Register of Deeds as Document No. � 77-6 2_! and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County gist of Deeds, as Document No. )• Signature of Owner Sign ure of C Owner (If Applicable) Date of Sigrfature Date -of Signature -:UMENT NO. STATE BAR OF WISCONSIN FORM 1 _ 1982 WARRANTY DEED 97769 VOL10"na-532 EZEKIEL LM ERAN CHURCH This Deed, made between ---- -- ---------- --------------------------------------- -----------OF - RIVER_ FALLS----------------------- i _ ____________ Grantor, and ------ THOMAS_ R. _ SCHANK_ and MELISSA J. ANDERSON _ __ __________ - -- ---- -AS S[TRVIVORSHIP MARITAL PROPERTY ----------- --------•--------------- --------------------------------------------- ------------------------------------------------------------------ ---------------------------------------•------•---_ -- - -----------------------------------------, rante e Witnesseth, That the said Grantor, for a valuable consideration______ ----------------- ----------------------------------------------------------------------- conveys to Grantee the following described real estate in _5t_. __CrOaX--------------- County, State of Wisconsin: Lot 41, Glover Station Second Addition, Town of 'Troy, St. Croix County, Wisconsin. RETURN TO Tax Parcel No: ........ -------------- ] S not This -- ----- ---- - - -- - - - homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And----EZeki_e_!_-Lutheran Church of_ Rlver__Falls ---------- ------------------------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except municipal and zoning ordinances, easements for public utilities, and building restrictions of record, and will warrant and defend the same. I)ated this rll---------------------------------- - ---- ��-- ------ day of-------------------- E�EKIEL LUTHE OF RIVER FALLS -'------------------ - (SEAL) ---------------- (SEAL) ---- -- ---------------- - - Randall P. Cudd ------ --P--resident-------------- - --------------------- -------------------- (SEAL) ----- - -- ---------------- --- ---------------------------- (SEAL) -- Lt'l --------- (SEAL) ...................... ---------------- -------------------- -- -- ----------------- - - - - -- --- Secretary (Luane Davis) AUTHENTICATION Signature(s) ------------------------------------------------ authenticated this -------- day of___________________________ 19-____- ------------------------------------------------------------------------------ TITLE : MEMBER STATE BAR OF WISCONSIN (If nat------------------------------- ----- - - - - --------- - - - - -- ---- ------------ authorized by § 706.06, Wis. Stats.) to me known to be the person _ _ _ _ _ �� �'� the foregoing instrument and acknowle�slll C THIS INSTRUMENT WAS DRAFTED BY � --- -------- -- - - --------------------- --------------------------------------------------- AttQrne __ at- St Croix ._--------- � --------------------------------------------- Notary Public - � ------------------------ County, ________ _____ Coun Wis. ( Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: _ --- _------------------ *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1 — 1982 Milwaukee, 'Wins. ACKNOWLEDGMENT STATE OF WISCONSIN ss. -St .---Croix -------------------County. Personally came before me this _____1.. ='...day of A ri 1 19 93 ___ the Bove named -- �+�-----------'�r�-- __i Y� _. t�� �_h e _Gt 0�-------- OWNER/BUYER STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County Tom Schank & Melissa Anderson ROUTE/BOX NUMBER 13 10 , -Stassen- Dr. FIRE NO. CITY/STATE W. St. Paul MN zip 55118 PROPERTY LOCATION: SE 1/4 NW Section 16 T 28 N, R 19 W1 Town of Troy St. Croix County, Subdivision Glover Station Lot No. 41 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 SEPTIC TANK PUMPER, What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 19801 with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ED _S7 DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, W1 54016 (715) 386-4680 Sign, Date, and Return to above address Y, Page ��of -- COUNTY 5 7L ` Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. - LEASE PRINT ALL INFORMATION REVIEWED BY DATE APPLICANT INFORMATION P PROPERTY OWNER: PROPERTY LOCATION C �/ -,�,�► / �/- - GOVT. LOT .S� 1 /4 Vet% 1/4,S /tom T 29 ,N,R �� E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # /3/L7 � SS � �/ &/p vZL� CITY, STATE ZIP CODE PHONE NUMBER QCITY []VILLAGE ®TOWN SORE ��C ROAD A). 57. � a l-t ,�,v, s-5 r/ X &/.� zISS--0 717 ��0 [Y] New Construction Use ] Residential 1 Number of bedrooms 3 -1v[ Addition to existing building I [Replacement 0 - [ J Public or commercial describe - Code derived daily flow Boa gpd Recommended design loading rate '¢ bed, gPft2 ' ~bench, 9P�f Absorption area required bed, ft2 trend, ft2 Maximum design loading rate 144+— bed, gpolft2 trench, gpolft2 Recommended infiltration surface elevation(s) 5fE ft (as referred to site plan benchmark) Additional design /site considerations 'USE Parent material �5 C 5 ,f5 13a1P&A1 P7' Flood plain elevation, if applicable _ ft CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK S = Suitable for system U= Unsuitable fors stem ED S El ElS 0 U ®S ❑ U ❑ S U El U ❑ S U Fxc � _Qnit nFSCRIPTION REPORT Boring # L:::_:-A Ground ` k elev. 41 ft. Depth to limiting facto x Boring # Ground elev. ft. Depth to limiting factor� 4 � F ✓W � r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Buildings in accord with 1LHR 83.05, Wis. Adm. Code Dominant Color Munsell Motfles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh.Bed Consistence BouncUy Roots eP©/ftFFDe Trer 31 �/ / �, ' l t 1C 7. 4 4- l 1 r r r 1-4.1 ,d . -,,,I%' ,I , ) 'i' j < Cd t ) -Ai i 1J.4 // ✓ B +?a/,Z /o --- / l-t1 / M/ -�>z ' / , r Remarks: ,," , ' - — - - - - F . , - - - Remarks: • � -�'v Af,r1/ r ''1S. MASTER PLUMBER LIC. NO.3307 M.P.R.S. i "1:r f ?At^TALLER & DESIGNER LIC. NO.00M3 W H I /12W S/aa ef- TiP���GS Zl St O 7/0 '44AXry �`id�l s.pew�// �'s�O�vS�'s�E..�f � ��1a1��p ���"�- Al7t/24044 7�` t (/�em �e .5/tee. �.� .e. y 6 -j- c 5 7`A-1 /,2- -& .Z O 90 ___ ' A ►. PROPERTY OWNER SOIL DESCRIPTION REPORT page of� PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 'GPj/ft 1 in.Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground eiet�. ft. Depth to limiting factor '• Remarks: Boring # , } s Ground elev. ft Depth to limiting factor Remarks: Boring # Y .. �•�YYY 4]T . : Ground : elev. ft. Depth to limiting factor Remarks: Boring # {�LX� S Ground elev. f#. Depth to limiting factor Remarks: eon 042+2nro ncrno�► i efat s ' o ' 3 7WCooe;4 �O HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERTT UtBR*Kr os rAl -mg 02 - AW MASTER PLUMBER LIC. NO.3307 M.P.R.S. YrNN. INSTALLER & DESIGNER LIC. NO.00663 av� TOP OF i � 5 �� � t_ p 13 : fi-PPP-6x. r 1Bj � r 40 V� 4L r N �? V IV 4'ICv-1TIaAlS �s -FoA A RiEA- z_ s u t �tE's T-C C) Ly s-rtM eft�-v-A-1'j*oAJS TleE"ctq_ '? 3, o /0 Co 7-lVeo a4 ST. co o " 76 4 ogl'ou& C444, S7Tee . &-P roe 30 3 .q Page of Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or I dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION .12 oy PROPERTY LOCATION PROPERTY OWNER: 2-P E (or) W -2 A 4.) GOVT. LOT - -re 'XI 5e-4 14-4'�< /'/�// -5�s -� e� 1/4 /VO1/4,S t(-p T N,R t PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # 1,?Ia 'd�' loe /71/ Ala 04,f CITY, STATE ZIP CODE PHONE NUMBER E]CITY OVILLAGE OTOWN NEAREST ROAD 1q,41- V-/2-) �--C71 7 Number of bedrooms New Construction Use Residential [ ] Addition to existing building Replacement Public or commercial describe PROPERTY 1 PROPERTY design loading rate bed, gpd/ft2 trench, gpd/ft2 Code derived daily flow gpd Absorption area required bed, ft2 trench, ft2 Maximum design loading rate _bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) P,,: 3 ____ft (as referred to site plan benchmark) A-) i- y 0 y 0 T Additional design / site cons erations 11-6/14 Parent materialeo �dl,4W5 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem El S El U [as El U 2S E1U (OS ou EIS EIU EIS OU SOIL DESCRIPTION REPORT Depth Dominant Color Motes Texture Structure Consistence MxxJay RootsGPD/ft2 Boring # Horizon in,. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 2 --------- 56/4t" 4,04 rX ........... Now 0 A". �lf /VIM Ground Ily - �p /0 Y'e elev. ft. Depth to limiting factor 13*vPj 0662�75 01,r Remarks- '`� Boring # 2 2 le /V 0 �� w � �� , �� _ y y ,� �,,� � �,� , III . 6 L9 Y/f Ground elev. ft. -70 141-2 2 Depth to — limiting factor > Remarks: Phone: CST Name: --Please Print -MVTVT--8I:fE SEfPT516 PLUM&N6 %-JO. Address: [Add r e CST E,55 O'NEIL RD., HUDSON, MIS. 54016 Signature R013LAI UL[31104. Date- CST Number: .41S. MASTER PLUMBER LIC. NO, 3307 m.P.R.S. .2-,17T2— rN!" ALLER 8 DESIGNER LIC. NO. 00663 I �T ct ORIGINAL lt�14 A-" PROPERTYOWNER SOIL DESCRIPTION REPORT PARCEL I.D. #_1-4 Page '-of Boring # Ground eleNf. ft. Depth to limiting factor /00 Boring # Ground elev. Depth to limiting factor Boring :XX Ground elev. Depth to limiting factor Remarks: �101e /09 - 7< e.91C 2� 2 16 f1le :2 y f � � �o y,� y f, ---.�-- oo 3161 -7 *4SSi r rM -1c 4- 4e OA14 V.V442 7A_ loo, Remark-q, 154 7-OA44 7-e_r,1> Remarks: Boring # -rk Ground 2-yx elev. X�) ft. I -f1 ,�� Depth to Yf - V A9 51 limiting v factor Remarks: C12M o13nnr© nc�nrn r'6-^--> e 77&4e C9 /e AO It rig 0'4 AC,*f 1;6 IN __..... __ �__.__ --_ __ Smut . �/��� /��`� Po< - 6 yS-rem A ee A vevrrc4z- RcF- PT, TOP Of P kOAJ iF L tz-- u^- ti C) 13 7p I-0, 93 �6, 2-P CAL C U AT I'd Q-S -U 5&-r- Zeicoo eA .5 7--eep-'ej -70 ------------ 4 6)0 ? x0i) 2(l; A 13M 30 pl'paw- 13 lo oi ilk 1� 7(p J3 -3 3(o 132- 40 (31 ,fit t 4eeAfi-=,U 7- "xF, 3 ftDUSC- MOST t-iE A-r- L-6-,t S 7�. �' � l��'Fy - HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUMIN, WI�� -#�-���-~- S. 54016 ROBERT ULBRIGHT MASTER PLUMBER LIC. NO. 3307 M.P.R.S. N. IMSTALLER & DESVGNER LIC, NO. 00663 rN :5-1'2- ; A-)6-- r-100 e-o(A 5 d-1 CA dt. 45" cab b(V 3CL 7/->5 cr N — �S Tt w. S4 pv.•..-l� 1 o n O Sig PAGE OF Sy5Ten1 Fresh Air Inlelc And ObWY(ltlon Pips Approved Vent Cap Minimum 12" Above Final Grad Fn 20 - 3 2" Above Pipe 4" C a at it on To Final Grade Vent Pipe "Sh Hay Or Synthetic Covering Min 2" Aggregate Over Pip* Distribution Tea Pipe +� a a a o 5" Aggregate Beneath Plpe a Perforated Pipe Below A CoQoing Terminating At Bottom Of Syttem US 1 � cL r^�. C14 � l 2" of g6GR EGAZE -� tLEV. OF C7 � 70 FEET.-.. * 1 ,APPR.�VEt) SjWT)4F-TIC LINER l �AaRsu VAA"J- 0,0 r. r/ p1-S-r'R.1R1JTI(3W MPE TC) 8E AT LEAST ►UCHE5 BELOW OR1GG1KJAL GRADE AQU AT LEAST ZQ IMCHES BUT K10 MORE THA Q H 2 IKICKES BELOW F'MAL GRADE MwcIMuM DkPrH of E.XCayATim►j FRom aKI&INqL 6KAnE. WILL BE 11JCNE5 MINIMUM 9'EPni of ExcAvnrION f P\OM �1611WAL GRaDE WILL. BE � INCNES G LiC E U SE UIJMBE R : to I to I DATE.