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HomeMy WebLinkAbout040-1188-90-004 (2)S T C - 10 4 AS BUILT SANITARY SYSTEM REPORT OwNER!'�V.At�� �d�/'�S ADDRESS 6oK � Si � l/t%day✓� u SUBDIVISION CSMf 6A 9 SOLE 14ctl c-5 LOT 9-6 LZ - SECTION. T N-R Wl Town of IR DY ST. CROIX COUNTY, WISCONSIN INDICATE NORTH AP -ROW LL 3_ j--jjj(,jt--jori an reverse of ti-lis form. Provide setback acid elevation -ni- (D Ili--ovlde 2 dmeiisimns to cetiter of sOptic_ tajj�,, maiihOle cover ly O BENCHMARK: I C S� Ia� _/ rL c ALTERNATE BM SEPTIC TALK / PUMP CHAMBER l HOLDING -TANK INFORMATION Manufacturer- �GLiquid Capacity:��� Setback from: Well 7Z� House Other iL X 040011 SOIL ABSORPTION SYSTEM Width: ( O Length Number of trenches /34-f7-0 Distance &Direction to nearest prop. line.--- `0 Ul r �.o Setback from: well. � � House Z � Other Pa2cN ELEQATIONS Building Sewer ?1((F / ST Inlet3 ST outlet Wf. 7/ ump Off Header/ManifolA npoqo&tt�om of system Existing Grade ��� Final grade d DATE OF INSTALLATION: -�I�'��� �- `,h - 9�i �;�'jl6yfGD �- Z �� l� PLUMBER ON JOB: �OCiL B ` /V � c`3O �U _ LICENSE NUMBER: p INSPECTOR: 3/9 3 : j t �✓Ur,/VuJ, Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACHTO PERMIT) GENERAL INFORMATION ` Villa Town of: Permit Holder's - Name: ❑ City ❑ e 9 -77-a6l CST BM Elev.: Insp. BM Elev.: BM Description: �` i ',r / r✓ �j� ��,� � .' ' "'gyp. TANK.. INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Se tic f Dosing Aeration Holding TANK SETBACK INFORMATION TAN K To P / L WELL B LDG. Vent to Air Intake ROAD Septic' !� A Dosi ng NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction S stem TDH Ft Loss Dead Forcemain Length Dia. Dist. To well County: .CIO-- 0 /, X Sanitary Permit No.: �ql�� State Plan ID No.: Parcel Tax No.: STATION BS HI FS ELEV. Benchmark Bldg. Sewer g , St / Ht Inlet St / Ht cutlet Dt Inlet Dt Bottom Header / Man., 7. Dist. Pipe, Bot. System Y , Final Grade, SOIL ABSORPTION SYSTEM TRENCH Width p Length No. Qf enches PIT gE° �� � DIMENSIONSDIMENSIONS No. Of Pits Inside Dia. Liquid Depth Manufacturer: TO P / L BLDG WELL LAKE / STREAM LEACHING SETBACKSYSTEM CHAMBER Model Number: INFORMATION Type Q 6U_"i ) , ' PIS System: (� OR UNIT - ,� _.__L DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hale Spacing Vent To air Intake Length _ Dia. Length Dia. Spacing SOIL COVER x Pressure Systems only xx Mound or At -Grade Systems only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed / Trench Edges Topsoil [] Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) qq tj rC 1✓ / fl f Plan revision required? ❑ Yes Q No 4 Use other Side for additional information. SBD 6710 (R 05/9 7 Date ,,,1 �' Inspector's Signature Cert No. LLMENMWINIn SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05, Wis. Adm. Code 7 0 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. F]Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION tl 1/4 S T I N9 R E (o r) W t A) W14 PROPERTY OWNER'S MAILING, ADDRESS LOT # BLOCK# CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER d?I "J 11. TYPE OF BUILDING: (Check one) LJ CITY NEAREST ROAD State Owned ED VILLAGE : I- (/> D 0 / 13,'T01=L - rc,- 7 0 Public Ej 1 or 2 Fam. Dwelling-# of bedrooms -PARCEL TAX NUMBER(S) 111111. BUILDING USE: (If building type is public, check all that apply) ell 1 0 Apt/Condo 2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 F-1 Campground 7 El Merchandise: Sales/Repairs • 11 D Restaurant/Bar/Dining 4 D Church/School 8 El Mobile Home Park 12 D Service Station/Car Wash 5 El Hotel/Motel 9 El Off ice/Factory 13 El Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. ORep lacement 3. ORep lacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System 13) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 El'SeepageBed 21 ElMound 30 ElSpecify Type 41 ElHolding Tank 121:1 Seepage Trench 22 0 In -Ground 42 ElPit Privy 13 0 Seepage Pit Pressure 43 0 Vault Privy 14 El System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE C. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 1 0 ABS ORPTION N1G A YFeet ;'Feet VII CAPACITY Site VII. TANK in gallons Total # of Manufacturer's Name Prefab. Fiber- Plastic Exper. Con- Steel INFORMATION New Existing Gallons Tanks Concrete structed glass App- Tanks Tanks Septic Tank or Holding Tank ik F Lift Pume Tarp k/Siphon-Chamber-t- - __ _1 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps M P IM PJ18W No.: Business Phone Number: 7> k7 Plumber's Addriess, (Street, City, State, ZiV Code): mom 44 IX. COUNTY/DEPARTMENT USE 'ONLY F-] Disapproved Sanitary Permit Fee (includes Groundwater Date lssue7� issuing Agent Signature (No Stamps) ❑ Approved ❑ Owner Given Initial Surcharge Fee) I Adverse Determination I 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. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Cnsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 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, ground- water contamination investigations and establishment of standards. 5B❑-6398 (R.11/88) Wh;or-sin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations D44sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COU NTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S T CTZU b4- OU NTY PARCEL 71.D. # not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 3 q 0 9 0 APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION [REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT ��IAJ 1/4 t\�[A_)1/41S I �� T _2�8 N,R I c? E (ofL.� L k%T� �8QI L"T V-1 E PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSMI # Q' t11*'N Yt- IR-1 b CamP� C R-e y )s L) )4. CITY, STATE ZIP CODE PHONE NUMBER [:]CITY E]VILLAGE []TOWN NEAREST ROAD _� IWI 5V01:Z_ 1-f I New Construction Use J Residential / Number of bedrooms AdditiQn to existing building Replacement Public or commercial describe Code derived daily flow q o gpd Recommended design loading rate o bed, gpd/ft2 a, S trench, gpd/ft2 Absorplion area required � � Z 'S bed, ft2 �N3 _ trench, ft2 Maximum design loading rate QN - q bed, gpd/ft2 3. S tench, 9pd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft EE Suitable for system CONVENTIONAL Ers El U MOUND IN -GROUND PRESSURE AT SYSTEM IN FILL Ef S El U 0S El U U lZU CaSUnsuitable HOLDING TANK El S El U forsystem �Els SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motes Texture Structure consistence Boundary Roots — G P D/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITtrich Z S Ground l� 214 VVI S elev. q1. I ft. Depth to limiting factor Remarks: Boring # S 5_1 S )i Ground elev. 14 Jt Z_ I b'-' rz- V1 I/ 5 Zv ft. Depth to limiting factor v Remarks: CST Name: —Please Print Arthur L. Weqerer Phone: 715-4­25-0165�0� Vdress- eg6rer Soil Testing & Design Service-P.O. Box 74 River FallsWI 540.22 , Signature- Date- CST Number- C)3- 111 4:. C/ M00576 PROPERTYOWNER_ U l`{ _ VL _�- SOIL DESCRIPTION REPORT Pa9 e Z4 PARCEL I.D. # 014 lr-� -- !, 8 ia, 01 D- D 0 V Boring # Horizon Depth in. Dominant Color Munsell Mottles Texture Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence R G P Dlft oats "YA r Bed 0-S Trench 0-( Ion o s a , Ground `f lz 3 Q-5 �Vt YA u `{'-�, �S 1 041. V o . S elev. 0Ib. 3 ft. t4 LIM -3 U: 3 S Depth to limiting factor , Remarks: Boring # , Sti•4• :�. s ti .ti Z t I -q0 tkS` R- 3A. L Lt�` }S c�v-S� 3 /,� s l �� uh o _ . s Ground elev. 01Z 5�E-$ __ _ 1 n V AL V 1Y � lz y,, u.k-[ 1 v. s . Z ft. Depth to limiting factor Remarks: Boring # 1 ti dti l7L 3 8 1 D 3/� tisvti 1 ........v cc rV � � 3�6 n �S �� vu V Ground elev. 01 ft. SSE4 Z l� k rL _ S b Depth to limiting factor >� Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05192) cl 's ErL CIt 71 SE N-T Lef� TT S-f S%Mm Pir" PLOT PLAN SCALE 1 o QFL. t 13 0'. �a K7 ct a la QKJ it 1� OT7 cs f 8 4 q Page of L I-t 0 kJ z- ,(To a 6 It -Z�Elz P�T Rt-(:� tk�bvAj S L., PL L cwj m �.j cl"7 0 KJ LAJ I'M � L— �7 6—A s q'-Is l 7-15-- moo 5 76 CST # CST Signature Date Signed Telephone No, PLOT- PLAN r SCALE 1 " == -� Q f Q K7 +Q • Q r p,r,�J Q • � �-���T� �C Kok IA k Eob4 p4H�1�IEt� �! c 9,05 �'�, 17 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, W1 54016-7710 (715) 386-4680 April 26, 1994 Mr. Roger Nelson Nelson Plumbing 289 Sunset Lane Ellsworth, Wisconsin 54011 RE: Sanitary Permit Informatoin for Quality Built Homes Lot 64, Oak Ridge Acres, Town of Troy, St. Croix County, Wisconsin Dear Roger: Enclosed is the information which you gave to me on Friday, April 22, 1994 with regard to the above septic system. very sincerely, Mary 2jenkins Assistant Zoning Administrator Mz Enclosure OPY LQQ&W�UMpartT-Rr_rQRX IAAtyr ? 8 -19 • 817 PRIVATE SEWAGE SYSTEM Labor and Human Relations INSPECTION REPORT safety and Buildings Division {ATTACH TO PERMIT} GENERAL INFORMATION Permit Holder's Name: ❑City [IVillage R Town o ev_: Insp- ev BM Descripti TANK INFC]RMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TAN K TO P 1 L WELL B LDG _ vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM rF DH Lift Friction System TDH Ft L 5 Head orcema1n Length Dia. Dist- To Well County: - S CRQ T X Sanitary Permit No-: 1-99912 State Plan ID No.: Parcel Tax No.: SOIL ABSORPTION SYSTEM BED l TRENCHWidth Length No- Of Trenches PIT No- Of Pits Inside Dia. Liquid Depth . DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHAMBER Model Number: INFORMATION Type Of OR UNIT System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe4s} x Hole Size x Hole Spacing I' 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 Bed / Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 3 f . 2 8 * 1. 9 . 817 = xx Mulched ❑ Yes] No Plan revision required? Q Yes ❑ No Use other side for additional information. SBD 5710 (R 05/91 Date Inspector's Signature Cert No } - SANITARY PERMIT APPLICATION (�t 'LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ( K 0 STATE SIT R PERMIT # —Attach complete plans(to the county copy only) for the system, on paper not less than 8% x 11 inches in size. s Chec if e i n;p PERMIT application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPEROWNER CPROPERTY LOCATION JY 't E 6­6 L S PROPER OWNER'S MAIL 14G ADDRESS LOT # BLOCK # Cl STATE ZIP WDE IJHUNL NUMUt:11 11. TYPE OF BUILDING: (Check one) ❑ State Owned O Public �Ll or 2 Fars. Dwelling—# of bedrooms..5 BUILDING USE: (if building type is public, check all that apply) 1 El Apt/Condo SUBDIVISION NAME OR CSM NUMBER 0 CITY NEAREST ROAD El VILLAGE : r 2 ❑Assembly Hall 6 ❑Medical Facility/Nursing Home 30 campground 7 ❑Merchandise: Sales/Repairs 4 ❑Church/School 8 ❑Mobile Home Park 5 ❑Hotel/Motel 9❑Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. EJ Replacement 3. El Replacement of System System Tank Only B) El A Sanitary Permit was previously issued. Permit# V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution 11 �eepage Bed 21 1:1Mound 12 ❑Seepage Trench 22 El In -Ground 13 ❑Seepage Pit Pressure 14 ❑System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA REQUIRED (sq. ft.) PROPOSED (sq. ft.) /* V11. TANK CAPACITY in g [Ions Total # Of INFORMATION New Existing Gallons Tanks Tanks Tanks 10 ❑Outdoor Recreational Facility 11 0 Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify 4. ❑Reconnection of Existing System Date Issued Experimental 30 ❑Specify Type 5. El Repair of an Existing System Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy 4, LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE (Gals/day/sq. ft.) (Min./inch) ELEVATION ........... Feet Feet t Prefab. Site Fi ber- F Plastic Exper. oncre Manufacturer's Name te Con- Steel glass App. structed I Septic Tank or Holding Tank _/e -67 Lift P1lWP:;a-1WGiVh0M ehalftCrr-f V111. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage. Plumb 's Name (Print): Plum er's Signature;41410 Stamps Plumber's Address (Street, City, State, Zip Code): '0000 ystem shown on the attached plans. 004HP&A-a-&- MP Business Phone Number: I v- IX. C NTYIDEPARTMENT USE ONLY gy .1 E] Disapproved Sanitary iPermit Fee (includes Groundwater Date lssueT�" Approved ❑ Owner Given Initial W.000 Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: Issuing gent Sigmpture (No Oamps SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber PLOT FLAN h SCALE lit= 3()? -Ti? L D iu G" 14.) e-,3,T` �9 . � kk7` L7L C? fit O'J `rO 1� 4 fi LTL � 1 +Av rL � { oZ 8` LrLcLZ., /Y x 6 yer0 IT N-T Left g. S Q- cl EEL CIO ego S. Afl/Lt"'��5 G vAG,Ev0, �fOSSc L) Fresh Air InIals And Observation Pipe Approved Vent Cap Mlnlmum 12" Above F rl Final Grade 20 - 42* Above Pipe 4" C a at Ir on To Final Grade Vent Pipe "Sh HOY Of Synthetic Covering Min 2'0 Aggregate Over Pipe Distribution F-0 Tee Pipe 0 0 0 0 6" Aggregate 0 Perforated Pipe Below Beneath Pipe 0 C00ing TorminctIng At Bottom Of Sy6lem F ID F, re,C1 k r OF 116C79 EGAIE tLEV. OF FEAT-► APPROVED S4WPETIC COVER OR, 9�1 OF S-rFtAA^1 00� Wvlsw >! 4. S% D157-RIRIJTIOM ME TO BE AT LEAST IUCHE:5 BELOW ORIGIUAL GRADE AJD AT LVINSTZO 110CHES BUT 00 MORE 7HA.,K1 H2Z MCVAE-S) M-LOW FiUAL G-RAIDF- MMIMUM DEP-rVi OF F.-Y%C-AVAT100 FK011 OKI&WAL&KADR WILL BE 3;�s�s MiNiMUM ()Ep OF EACAVATIOW f P\OtA 0�161WAL (3RApf. VIM- BE A4Sbftw:cm5 ley SIGUED -V L I C, F- U SE Q OtABE R DATE z tr I 6 Wisconsin Departnent of Indus", SOIL AND SITE EVALUATION REPORT Page of -71) -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 1/2 x 11 inches in size. Plan must include, but COUNTY not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # 0 dimensioned, north arrow, and location and distance to nearest road. 0q0 L[8$� -9-0 - 0 0 q APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION FREVIEWED BY DATE PROPERTY OWNER- PROPERTY LOCATION T GOVT. LOT K-\4-2- N, R I ') E (01Q) QU��vLmj � 1/4 N)kJ 1 /4,S I I:z� PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM# i3O Y, -7 �C-jz-s CITY, STATE ZIP CODE PHONE NUMBER E]CITY []VILLAGE GOWN NEAREST ROAD New Conshdon Use Residential / Number of bedrooms AddWQn to existing b0lding Replacement Public cx commercial desai be -N -q -bed, 9WP cl, S trench, gpdt' Code derived d* flow, qS 3 - gpd Recommended design loading rate I I - Absaption area required \,-Vz 5 - bed, ft2 '�Q*3 trwch,, ft2 Maxknum design loading rate QN - q bed, 9p(W trench, gpdtft2 Recommended infiltration surface elerabon(s) ft (as referred to site plan benchmark) AMbonall design 1 site oonsiderabonS Parent -material -Flood pUn elevation, if applicable ft S = Suitable for system U =Unsuitable for system CONVWON& as D U MOUND 0S ED N-GROUND PRESSURE 9S D U AT -GRADE [R S ED SYSTEM IN FILL 0 S LZU HOLDING TANK 0 S el U SOIL DESCRIPTION REPORT Boring # HorizonDepth in. Dominant Color Munsell Mottles Qu. SZ. Cont Color Texture Structure Gr. Sz. Sh. Con§sW)ce Bounclary Roots -2 GPD/ft2 Bed Tmndh �Q> S 0- Ground elev. tL 3/ 6 _ s 1 — s t� 'I 1 i s - . Depth to limiting tam Remarks: Boring # S S 1 -- � �= � z-�3 l©� t� ��� � � � � bar m.��. c� o. s �. S Ground ft Depth to limiting -Remarks: f7TName---Please Print Arthur L. Wegerer P hone: 7 15 -4 2 5 -016 5 V e'g: esserer Soil Testing & Design Service-P.O. Box 74 River Falls ,WI 540.22 Signature-. Date- CST Number: C)3- 1 [1 C/ M00576 PROPERTY OWNER. CZ>U'18Q SOIL DESCRIPTION REPORT PARCEL I.D. o - c)uq Page Z—of Boring # IGround elev. 016"1 ft. Depth to limiting factor It Ground elev. 0 � ft. Depth to limiting factor Lf ;! F-3 V Boring # ON, MV�011-111 Ground elev. CI I w 4 ft. Depth to limiting factor > 8 -1 Boring # Ground elev. ft. Depth to limiting factor Horizon Depth in. Dominant Color Munsell motfies Qu. Sz. Cont Color Texture Stru ctu re Gr. Sz. Sh. Consistence Boundary Roots G P D/ftz Bed Trerch mob SL vn `FhS C-S 0'. .1 3''ALA L Qi 1-t Tt 3 YA U S 14 (464 03 ts '-t v— Y ! g t- S 0, L Remarks: L ONE& % C— S 10, 3 S, Z.` b 't- h C S - U. 5, C] .• fit] -S � � � Lt Q. 3 /to `` s �}c a •10.S Sal -aq *-t St 314 ef 0-3)�)Vx vv, U T-�- a. Remarks: o��vou��ma �e i�ii MME iii i��� Remarks: SBD-8330(R.05/92) PLOT PLAN page 3 of 3 SCALE III= �()I � CY-N-Z) -I?-- L � 6 E- � CZ- / U G- It,) e-,aT- ti 02- btX 0 OF - EL SUL w(ELL- -M tME kT LjaytiT ► Lkj 1-n F S '4 LI � 6 �b LIJ I tA Aj Tl� k.) L TP� Q1 L k�� 3 t4j 'S'YS77EM C-601i C-It 715 425 ' M00576 CST Signature Date Signed Telephone No. CST # 0,Uj,*T.TC TARK d'A 2 7 SEC* r2 j? 3(o ii C U it -'ION 1Q,0 6-e- A LOT NO T I-,- -iintenalicc! of yo�,r sopLic; P!'O')Cr U and to, SYSLem, cou"Icl rc%";uIt its failure to 11allcile wastes I-T 0 r M a i r i t c nca ri c e �-zsi cif u m 1) L. t I i e s c,. p t t a t1irce years 01: if needed, by a licenrccj septic Pumpor. what you in`o tl-"e sysLeT, 1 an fn C) -e eatncnt stage ill t1le WL154c disposal•a— Y Cr0i:-,'. County residentz; Tna,y 0e. eligib. I e o z- e c P, IV a [I (j l"­II t 0 11CIP . with thel cast of the re-Pla(zement of a fail ing systemwhich wus I r- t C 0 Ll n L Y a t c_3 r,1 3-11 Pricr to %'Tuly 1, 1973, 0 C 4-11.1s Program in August of 19oo, Wit -Al the requirement that Owners cif, all rl e w systems agree to keep their r, 1 P v, n, a 11 Itzi d properly The property owner agrees to SujDj,Qit to the St. Croix Coullty L 0 t' i 11 C: El Cel:tificaticn fo,,,--M, signed L)y the owner r, (I b y ( 0" I r P 1 U r1lb U U'riber jouriicy nan ra:censed Puloper Ver.41-f Ying that, thc On -,Site Wastewater dirsposal ""systeivxz m r s fn Prol-c- r opet-L-it cj c o:id3-tion zincl after tcr illspect �1 m P 1. n ec e s s a r,,., e sej-,, , ) , h twic; tank i-3 less than 1/3 full of t� I U (3 r.] ancl scum . A CL"t'f'Cat`011 f'"cam Will be Gent approximately 30 days PrI.Or to thA.CC. year expiration. IIWE, the uncler signed have read the I:ec,-fu, and agree to MC-lintalin the private sewacju clic-; P C-) s, a I systei --,-n accordaim.-o- witj,& the standards set forth, herein as set. by 9 - 1_1 41) C(_rtificat' I the Wiscn.11s) ID I, -1 c) 11 f 0 r 1T1 Irk' I S t c OMPICted arld r43turncU to 1-1-No s C A- 0 t1le ix County "Ljocj riinofficer wjLtjjj*-4 ,j 30 6.0 t .d Cal: d t S I G 11 L,11) D 2,%T E _7 Cr ol x County Z.onl'ng WI 54016 STC-100 This application roan is to b t1�e oc��t�er�s7 ©.E file z•a e ,COmpleted in full and signed b Will and. rasa p party bcing deVeloped�, An g y Y It in delays of t��e arm' Y inadequacies development be intended for re permit issuance. Should this House), then a second form r sale by owner/contractor,(s ec t}�e Should be retained and completed when a ra property ty is sold ,and submitted to n pp P late deed recording, this office with the `. - -w..r- - r. r w ww.r r-rwr wrr.rrrrwrw�r..r wwrrwr.�...wwwrwwwr�rrir. w rr -... r-r w r -- owner of Propertyr� Location of property 4 �,,� ____ /4. section 7 � C.� N R J C� Towns}yip � l W Flailing address n Address of sites; (� Ir - JV� Subdivision name Lot no .? other Domes on property? yes 0 Previous owner of property Total size of parcel Date parcel was created Are all cornors and lot lin es identifiable? Yes No I8 this property being developed for (SPgc house)? Yes Volume and pa0 ge 2Zumber .� try N of needs, aE recorded. with the Register ,+ ... ... irwr r'"'.rw�.r.rr.'r r'�r�. .r rrr.y wr. r.rrr ... ... �•r~��`w..r ,t '~.""ww+•rr....wr...wwrrrrrwrr..w.�.tiw...rr`rw�wrws 114CLUDE WITH THIS APPLICATION Tlf 11 I�1�ItItll,li'.�'Y I]ELU wh,ic}� includes E rOLLOWIt1G 1CU1iUi;IZ �a DOCUMENT NUIU3En, VOLU}SL R2iD PAGE ` III SBAL UZ' 7.'II I�GIS'1' % Certified survey, if available • t of b.�EUS, in addition c] e 1 ays c, r the reviewing ;Would be helpful so as tc� avoid reference , to a Corti g process . If the deed Shall also be required. gied survey Map, the cextiri description q Ired, ed survey Map PROPERTY 011RER, CERTIFICATION I (te) certify that all statements best ©f n on this form are true t y (our) knowledge that I (we) am are o the the property described in this info � (are) the owner(s) of Warranty deed recorded in the rmat'On form, by virtue o Deed" as _QLLice ©f the Count f a Document TIa. � y Register of oy:n the proposed site f , and t}zat I we obtained zn e iseme or lie sewage disposa]� s s� ) presently nt, to run the muavQ described tam Or' I (we) t110 construction of saki system property, for recorciecl in file office of Count ' and the same has been duly fro. 7 Y Register of deeds as Document Sxgna-tare of a 1 .�a _ p nt I C0 appl cant Date of Signature Data of Signature DOCUMENT NO Y THIS SPACE RESERVED FOR RECORDING DATA 50'7851 STATE BAR OF WISCONSIN FORM 2-1982 WARRANTY DEED VOL 1044PAGE 6� Rolling Hills Development, Inc., a Wisconsin corporation conveys and warrants to Eu ene 0. Larson, Don D . Kruger, and Lawrence M. Johnson Jr. d/b/a Quality Built Homes f the following described real estate in St. Croix County, t State of Wisconsin: Lots Sixty Two (62) and Sixty Four (64), Oak Ridge Acres to the Town of 'Mroy. REGISTER'S OFFICE ST. CROIX CO., WI Reed for Record CMG i 2 61993 O1 10:45 A. M W 0 °T ReOfster of Deods RETURN TO Tax Parcel No: The above --described property shall be used only for owner -occupied residential purposes. This is not homestead property. (is) (is not) Exception to Warranties: easements, restrictions, and rights -of --way of record. Dated this _ _day of October " 93 ROL ING H LS DEVEL -, INC. (SEAL) (SEAL) • Richard N. Fox, President (SEAL) (SEAL) • Frances J. Fox, Secretary__ AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN SS. PierC,e County. tA authenticated this day of , 19 Personall came before me this 0 day of October , 19 the above named Richard N. Fox and Frances J. Fox TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _t�'"'"`�''" Eo, me nown to be the person who ex cuted the authorized by § 7p6.r7fi, Wis. Stats.) ���� i instrument a ackn wi ge the sam THIS INSTRUMENT WAS DRAFTED BY 11,.• C. L. Ga lords Attorney'�: lar-en M. Enel River Falls, WI 54022 8 oNlIta'ry p- ublic Pierce County, Wis. (Signatures may be authenticated or acknowledge �•aot My,•' Commission is permanent. (If not, state expiration are not necessary.) ` ` .•.. ..d.efe: June 29 , 19 97 -r Names or persons signing in any capacity should be typed or printed below their a+pnaturea. SB2 NTF 0021 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208 Form No. 2 --- 1982 �� � �� ., � ' _..... _, S F 'r" aa� F T # �..-. 7...., �. 5 � � ��� �;:, �.� �,. �� .���'