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HomeMy WebLinkAbout042-1045-90-120 (2)County Planning and Zoning Monday, August l], 1007 ar 10:49:1IAM.St. Cro*Lyc Page I of I Detail Sanitary Information - --------------- Com uter #: P 042-1045-90-120 Sub/Plat: NA Section: 17 Parcel #: 17.29.18.260B20 Lot: 2 TNIRNG: T29N R18W Municipality: Warren, Town of CSM: Vol. 08 Pg. 2303 114 114: SE 114 NE 114 Owner: Peabody, David 1081 96th Avenue Roberts, Wl 54023 State Permit: 193364 Issued: 03/10/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 05/14/1993 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes issuer/inspector As Built Jim Thompson Yes None i i =g No Maintenance Scheduled Pump Date PuM ped 5/ 14/ 1996 7/ 12/2006 7/ 12/2009 Plumber Other Re uirements Schumaker, William 1 st Notification 2nd Notification 3rd Notification 04/20/2006 Additional Notes Money Owed Appt. for 5/14/93 @ 8:30 but no information $0.00 recorded on report. Bill's as -built doesn't have any elevations recorded for the tank or system - 5' x 100 trench with 2 lines. Setbacks shown AS BUILT SANITARY SYSTEM REPORT OWNER. 410- TOWNSHIP 44e SECTION T N-R—W ADDRESS -ST. CROIX COUNTY, WISCONSIN —LOT SIZE SUBDIVISION LOT PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .4- 'Wo INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark /�10 65-'e"' SEPTIC TANK: Manufacturer: Liquid Cap. ZoOej Rings used: Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road :Front,Y., Side_, Rear Ft. From nearest prop. line:Front—, Side , Rear —Ft.-'Ap, No. of feet from: Well Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE k PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of -tank elevation Pump on elev.: Pump off elev.:-Gallons/cycle: Alarm: Man.: Switch Type:- Location Distance from nearest prop. line: Front, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width 5 Length a.- Number of Lines: Area Bui 1 Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop, 1 ine : Front , Side �-L'Rear_Ft , iJr10, No. feet from well: f`�� . feet from building 71od HOLDING TANK Manufacturer: Capacity:_ No. of rings used: _Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line -.Front , Side, Rear_Ft . - No. feet from: Well , building , nearest road Alarm Manufacturer: DATE: 6/94:cj INSPECTOR: PLUMBER ON JOB: LICENSE NUMBER: T T Tim T 96TH A -FRI 14"T PL;t 44W4 tkt r 0► Ti M Labor and Human Relations INSPECTION REPORT Safety ancLBuildings Division t (ATTACH TO PERMIT) GENER,AL INFORMATION TANK INFORMATION 2 ELEVATION DATA A93000 1"%4 TYPE MANUFACTURER CAPACITY STATION BS HI FS E LEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St / Ht Outlet TANK TOE P L WELL BLDG. vent to ROAD Air intake Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM Friction 5ystem TDH Lift Loss Head I TDH Ft - Forcemain I Length Dia. Dist- To Well SOIL ABSORPTION SYSTEM No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth BED/TRENCH Width Length SIO S DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P L BLDG WELL LAKE / STREAM CHAMBER Model Number: INFORMATION Type of OR UNIT L System: DISTRIBUTION SYSTEM vent To Air intake x Hole Size x Hole Spacing Header / Manitold Distribution ripe_{s} 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.) xx Mulched 0 Yes E] No 'rOT 2 96TH AVE. I oge I jr-JOCAT--LONes WARREN 17.29.18.2060B20,SE,NE, L I th4ff � -7 Plan revision required? Ej Yes No Use other side for additional information. inspector's Signature Cert No SBD-6710(R 05/91) Date - I SANITARY PERMIT APPLICATION �'LH�COUNTY In accord with ILHR 83.05, Wis. Adm. Code eo? Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITXA I Y PERMIf # 1:1 4to 81/2x 11 inches in size. ChIgr vision pr vious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION N R Ir E & TA"71r 9 I (or&-2 PROPERTY OWNER'S MAILING Af5DRESS LOT # * BLOCK # t" r/ F-4 4; � I-d- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER knhe. �,,4LE A),e 11. TYPE OF BUILDING: (Check one ED CITY State Owned VILLAGE : AJoo NEAREST AD TOWN QF: El Public &1 or 2 Fam. Dwelling—# of bedrooms PA CEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) ;Z e7 1 ApVCondo 2 El Assembly Hall 6 1:1 Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 1:1 Campground 7 0 Merchandise: Sales/Repairs 11 EJ RestauranVBar/Dining 40 Church/School 8 1:1 Mobile Horne Park 12 El Service Station/Car Wash 5 0 Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. R&I New 2. OReplacement 3. DReplacernent of System System Tank Only B El A Sanitary Permit was previously issued. Permit # V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 R. Seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 ElMound 22 El In -Ground Pressure 4. ❑Reconnection of Existing System Date Issued Experimental 30 0 Specify Type 5. [:] Repair of an Existing System Other 41 ❑Holding Tank 420 Pit Privy 43 ❑Vault Privy V1. ABSORPTION SYSTEM INFORMATION: 7. 'GALLONS PER 77y]2. ABSORP. AREA REQUIRED (sq. ft.) 3. ABSORP. AREA PROPOSED (sq. ft.) 4. LOADING RATE (Gals/day/sq. ft.) 5. PERC. RATE (Min./inch) 6. SYSTEM ELEV. /161 roir 7. FINAL GRADE ELEE?T�ON , I 071.C) s I T - ?114_ i00010 Feet - 2,,C/- Feet Vill. TANK CAPACITY in gallons Total # of Manufacturer's Name Prefab. site Con- Steel Fiber- Plastic Exper. App. INFORMATION New rxisting Gallons Tanks Concrete structed glass Tanks I Tanks I - I Septic Tank or Holding Tank ty I Vo 470 1 f Li _L L_j Lift Purn Tank/Siphon Chamberl ini I I i i I Ll F� I Lj I El I Vill. 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) /MPRSW No.. Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 77- T COUNTY/DEPARTMENT USE ONLY F7D!sapproved Sa itary Permit Fee (includes Groundwater �Date Issued, Issuing ent Signature Starn Approved Ej owner Given initial Surcharge Fee) Adverse Determination, 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 4, r 7 1. _A •ean itar . permit is valid for two ears. , Y P: t i years. `� Y&tip scinitery� permit may be renewed before the expiration date and at the e 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. 6nsite sewage systems must be properly maintained. The septic tank(s) must be b a licensed pumped Y 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: f. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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. VI 1. 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 8% 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 fakes; 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 farm; 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 #or monitoring groundwater, ground- water contamination investigations and establishment of standards. sBD-6898 (R.11/88) 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), tl�en 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 Location of property_���Ll/4 N � 1/4, Section T Township Mailingaddress `0 �Aj Address of site Subdivision -::? 1 Lot no. vision name Other homes on property? -- yes_• No Previous owner of property ,\j Nj Total size of parcel Date parcel was created �C10\k Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes \11,,No Volume *land Page Number -4i�4 as recorded with the Register of Deeds. ------------ ------------------------------------------------------------- I INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 deed recorded in the office, of the County Register of Deeds asDocument No. 9Cand that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of sa-d system, and the same has been duly recorded in the office of County Register of deeds as Document NO. (q4 90 Signature of applicant Co�-applicant I - '�) - � � - Date of Signature �3_-8-91 Date of Signature ry f r i, A n. w' •s ..y ,.. .. i a� E r r D4CUMENTNO .!. ,. -._ a ., TATC=t>>RUFWiS-)N51h1`GFt%42-198 ... ..... - r .. • '. ,• - ca t i,F,rzJ.t; c..�,14l'n++,.••, ,are W.. E WARRANTY DEED7- RE • -_._.. Kef- Te t- h J • 7 k-r l nk a rA Pafr*_-t t a F ♦ He ) ink - p� - - ttSbaf an-d--w+ i fP-- c3tr b� �= i+ Va)~bh : f?� k� i f I >N $ OCT2 3 1992 . _ pt 10:40 4 co �eyS and warrants to R Das;id � P'" body and Jani'-:Q p'ea�y i as surv..,cir5hip frunrito1 prover-ty; i WE Reg:,�a,s of J,a�.� I TLJHN TO v� " the follow ig described real estate In-sa-Int— Croix County .1,_-- State of Wisconsin. Tax Parcel No 26CIB20 Dart of the SEa of the NEA of Section 17, T29N, R18W, Tcv;n of Warren, Described as Lot 2 of a Certified Survey Map recorded In Vol. 8, page 2303, and subir�ct to Covenants recorded in Vol. 895, page 10. *As Document Nc . 465054. TOGETHER WITH and SUbJE r TO the 66 foot private roac- way easement as shown on said Certified Survey :dap and TOGETHER 14ITH Outlot "l" (Private Roadway Easement) as shown on the Certified Survey Map recorded in Volume "8" of Certified Survey Maps on Page 2304 as Document No. 465055, all being a part of the Southeast 1/4 of the Northeast 1/4 of Section 17, Township 29 North, Range 18 West. This L not __—homestead property. (IS) (Is not) Exception to Warranties: Dated This __ 2th — — `day n1 ---- ——_-- — -- —.----(SEAL) David 1R. -Peaky--- — - (SEAL) Ja n i r7P R • Pea hod z OIL: t4 _ — _ �_ ..-- • _ -- t 9 _ r � --,SEAL) nnetaT -- —� _-(SEAL) Pamela F. Herink AUTHENTICATION ACKNOWLEDGMENT Signature(s)_ STATE OF 1NISCONSIN I ss �I 5 G I }f :,ounty 4 a�Ithenticated this____ -_-day of 19 Persolallr 'ame before me this day of /17 A I H 19.1-/ - the above named TITLE ME} •BER STATE BHR OF INISCONJIN (If_ - - rson the authorized by § 706 06, Wis Slats 1 foregoing ng nstro rnen' anceackno �� wSarne./ec/;ed THIS INSTRUMENT WAS DPAFTED BY Kenneth _J, Tier ink — Notary Public _:rri . C oe 11C -• ounCY*�`js f (Signatures may be authenticated or acknowledges Both My Commission 1s Dermanent y�• Tl, >�Ite WA' a n are not necessary IJ �, y " date '••••''� ) 'N::mes a1 , .: ara, 'r sr,:,ul T oe ivoej or nr,-•e(j ee ).. rle , s,gralur'os S82 NTF 0021 WARRANTY (TEED STATE BAR OF WISCONSIN %*w-c ,ax Forms PO Box 102M,Green Bay. WI54307 0208 G I' N, 2 — Ii82 1 DEC -111990' Si, 06y, GD,' W1 46 0%.51 C i CERTIFIED SURVEY MAP UOATE© I THE SE !/�+ OF THE NE I/4 OF SECTION 17 T9N R18VJ r k ST. CROIX CO., WI. OWNED BY: KEN HERINK °1 ca R T . I In ti �- R0MIRTS, WI 54023 E, -� A 3 U AI - W NOTE: BEARINGS ARE REFERENCED aZ r TO THE EAST LINE OF THE NE 1/4 009 { BASED ON RECORDED BEARINGS?. N pZz W U 1L 4. V U N PL ATT.E D 730 Q.5`3. IJ . c V! 1010 CONTOUR F ze Lu 0323 �,�E 2a8.40 10. 99 ACRES co N ©, co N 83 c 4 78, 660 so, FT.) �. V 10. 16 AC, EXC. R'.O.W 0 W Ln (-1 ;n { 4 4 2, 549 SOFT) 0 S 74036'1 6"E 7 7. 28 LIMITS OF DRAINAGE LL. `_- ��.T4•��, EASEMENT. w ti o �~ 1`3'1?51 * •3�1��" i`s 66' WIDE PRIVATE ROADWAY '� 0 0 . w 4 EASEMENT cn W 3' Q.? r o Z �• M JLOT 2 4 • 4 2.90 ACRES "� '� •^� Q• - (126,353 SO.FT.) ~ o n W• 2.67 AC. Exe.R.O.W.3 w V- c { 1 16 , 13 O S 0. FT.) N N o► .. \>� U 1" pp Y} Lo-T � r tf � � OC + f J• �r� 3,67 ACRES ltw ��� a `11 N N; o i 1 59, 924 SO. FT.) m o 'ic 0 x z a'• y 3.46 AC. Exc. R.o.w V iM z p Z, i 1 50, 550 SO. FT.) " 4 °' a 2.82 ACRES ., 1 1.22,993 S4.FT.) '• z 5 A C. E xC . R.O,W ~' 21 ` { 1 02, 1 SO. FT. Q � av 1 S89.28' 28" E 3.7' 2.4' FENCE 1 3'3.0 *�gO7.08, 12 0. 04 ' 334.581 '-�` 363.00' N8902863 9,58 ' E- W OUARTER SECTION LINE Soo 3411211 W '1011111i1117.471 E lia CORNER SECTION 3s' 93' UNPLATTED LAND.5 17.(COUNTVMONUMENT .• # FOUND. SET NAIL. FROM � a, r„ 'r I E S) . JAMES M. WEBER 0 s SET 111X 24 " IRON P1PE WEIGHING 0' 1804 w 1.13 LBS. PER LINEAR FOOT. w SPRING VALLEY 0: 111 IRON PIPE FOUND.Wis. o4 ice � r '�. SUVk*4 ��� SCALE I" = 1 50' i�1�110�13���a SWEET I OF 3 JAME 5 M. WEBER S- 1 804 0 ' 75 1 50 300' DATED ►,,�v. t yg®. VOLUME B PAGE 2303 ri THIS INSTRUMENT DRAFTED BY ?+cam Ss cl;z� , Y r II ti S T C 105 SEPTIC TANK MAINTENANCE AGREEMENT i St. Croix County WNER BvYER �� t � � �.. � �� o / �AJ,_A ADDRESS "`' FIDE NUMBERC)CITY/STATE! - ...- --�a zIP_ PROPERTY LOCATION: �- 1/4, E 1/4, SECTION , T14---R W TOWN OF' ' `� .- Ai , St. Croix County, S U B D VISION LOT NUMBER -- 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 60% of the cast of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, sIgned by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying th-at (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. ulie,+,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 DNR. Certification stating that your septic has been maintained �riust be completed,and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expirati n--­,date . SIGNED: DATE: :St. Croix ,'co . Zoning Office '911 4th St. Hudson , WI 54016 ' I i DEPARTMENT OF ON SOIL (BORINGS AND SAFETY&BUILDINGS REPORT DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.090) & Chapter 145) LOCATION: SECTION: TOWNS UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sE 1/4 ��. 1/4� �/T �9 N/R 19 E (or �� ,��c.�r�.�� ? COUNTY: MAILING ADDRESS: lZ S7 )) b T}) 5T, USE EA I NESTS: DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R Residence -1 �V , p4N LNew ❑ Replace -) _ )) - 1�0 -� -- 1 -� _ 910 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN -GROUND -PRESSURE: SYSTEN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) F\-1A S El U ElS H U � S ElU ❑ S M-IE U ElS �U `-ems c,s s'x �p l �, Y If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the under s. I L H R 83.09(5)(b), indicate: , P\_ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS PERCOLATION TESTS PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. a 1©1, `� 7 - 2 G �• �1 ti'�'P, SIz S`"1�R-E SYSTEM ELEVATION CD 9 �• y �D T D1N '3T*r`RE w , r3�L C. —F S )-nE Lc1 S O, w, 1 Z S Cam_ S �A C 1-7 tN - l 1 Z. ILI vz.'z' ' s c-. f� L-C ) 't = s p 1 s 1 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, NAME (print) : AND n F -cav ADDRESS: TESTS WERE COMPLETED ON: CERTIFICATION NUMBER: PHONE NUMBER (optional): car 30Q� s-�� �tS L/ZS-01('3S CST SIGNATURE: RIVER FALLS; WI 54022 715-425-0165 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) OVER - SOIL DESCRIPTION FORM Attach Soil Prof Ilu Loca_lion Map On s_Suparate Sheet) CL ENT:=�' LINEAR LOADING RATE: PURPOSE:'5dL PS�� t1rJ-! SLOPE: f)CSCRIPTION 8Y• /� jZ`l`�' `.+���.- L e ASPECT: ' OATC.: ' 1 0 CURRENT LAND USE:�� COUNTY/STATE: S • L-�x�� LAJVEGETATIVE COVER: GROAN S-S LOT DESCRIPTION:' NT, r3lF� JI �/c ' f E1,T2-9/"j l ) '41 L J DRAINAGE CLASS: eu- LOCATION: j}�1 GALL NS PER Sp. FT. PER DAYS 0'�s PARENT I`SATERIAL 5 /DEPTIf; SOII. SERIES= P �. Q 9&� , --_. tbORI20N DEPTH 1iATRCX COLORS MOTTLES TEXTURE STRUCTURE C.OfJSISTENCE CLAYSKINS/ PORES ROOTS PH [BOUNDARY REMARKS _ :. ► ► Gr. Sx. 5ho. COATINGS OW rn s,b�z S 'Z ... m U� a_s 3 �3-�s �b�� 31� -- 1 l �b U-(2�- Z gsi 1 Z,nsvlz mf s o s m � OTHER SITE FEATURES/NOTES: � Signature Date CST LIMITING FACIORS/DEPTH: .2 tel rZAJ A --f r,p eAc,-00,, �✓ Cam__ ��l.-��� /yr o� � d`�— .�lin l � 3 r,p eAc,-00,, �✓ Cam__ ��l.-��� /yr o� � d`�— .�lin l � 3 T—� t ri i.? ' 7°i T� i -T M rtiTirl T Zl rtirM TwTm % 17l1iT T T/Y TN 'x !"1 .i i .O i `JV t3 i Ci i� l`r � 3' l �. V i 1L '�.1.� 1`� l Y� G t31�i i �v " t' l� J�- r_ .� I •-y r r T� r� T r� r"r! T--� T �, T T� r-s rw t"r! �' r.T T T T T T1 T-i m d" T-1 0 T % . i A 3 � L" A : 11-J o .r�E a .c� ►S � r i �v S r �. � JL w G cx S n� .i .� r vrc . eN TT�9 J. ACtiwit= �s: A9rn 1 /� Ty CJ�v1u-rrrJ l-J\ TiCr ti ie Address: WARREN1� . 29 .1� . 2��3t�2u , SE, ivE, LuT� 2 , 96TH AVE . Parcel : 042-1045-90-120 Occ z �;5e : Description: 19 3 3 0 q Appl icant : PEADDD Y , DAiV ID Phone Owner: PEADCDY , DAVID Phone Ci iuMACSriT" R W iijLIAR r C . Phone: � � 6 - 3 J- 21 -_-------------_,---_...---_.__.--...------_------_ -----_--_----------------.-_-----__---_- Inspection tZ'equest Information..... Reques for "RR : SCHUMACKEvii i. Phone Req Time 08:05- Comments: 9 �'3 i i.me Ex Items requested to be inspected ... action Comments� 00012 FINAL INSPECTION ---------___----_..-_-------._--__----...---__.---_--------_--..---------__-------_----_- Inspection History..... Item: 00012 FINAL I SPE%TIC3iv c( � /~ \ °� \ k \ �- ° �� . - .Z '� / /�� / / /, \! ' ' --~-- � \' ' � � � �� '/ � / ' / ` /77 / � / �~ �� <�_� ` / � /\ /~J L/ / // / / / / `�}/ / DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGSDIVISION INDUSTF�,' P.O. BOX 7969 LARqR AND PERCOLATION TESTS (115) MADISON, WI 53707 HU*AN RELATIONS (I LH R 83.09(11 & Chapter 145) LOCATION: SECTION: *TOWNSH UNICIPALITY: LOT NO.:IBLK. NO.: SUBDIVISION NAME: COUNTY: MAILING ADDRESS-. yz s--? ) ) � ") s-r. > EM- -I- S 11 V,)-> I LAJ ) -1 t4.0 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: T—R: '5FILE DESCRIPTIONS: PERCOLATION TESTS: LgResidence I _1 7N.) . N [RNeVV ❑Replace I I —) — ) ) - �o � — ) -) - c� c) 1 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL- MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL OLDI NG TANKIRECOMMENDED SYSTEM: (optional) UPS [] U S E UERI'SEluEjs RU EIS F`U z ee� s^ s'xI a - If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. I LH R 83.09(5) (b), indicate: I -, P\ - Floodplain, Indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION PTH TO GROUNDWATER -INCHES EST. HIGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) OBSERVED B B- L/ B- B- B- PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER IN HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. DROP INWATERLEVEL-]NICHES RATE MINUTES PER INCH PERIOD I PERIOD 2 PERI( P_ 7? P_ P_ L P_ P_ '1' $'� 1� t�LAJ -i Z LJ P_ 4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. bT 5 f t-r7ze SYSTEM ELEVATION 1--i M el-t FGlij 41-S PC 7- oki Ca- L WT P1 -z 0� 1-7 --D "vT LQ�'T jo Z X 6 slile S It 1, the undersigned, hereby certify that the soil tests reported on this form were made by me In accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. WFGERF R SOIL TFSTING NAME (print): AND [TESTS WERE COMPLETED ON: ADDRESS: GN CERTIFICATION NUMBER- PHONE NUMBER(optional): P.O. DOX Z4 491 N- MAIN IST, RWER FALLS 4* WI 54022 CST SIGNATURE: 715-425-0165 co= DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3 - 10") SS — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand > -- Greater Than 'sl — Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow sci -- Sandy Clay Loam R -- Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c -- Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL -- High water level, surface water ' Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 4% 5OT1- DESCRIPTION FORM Attach Soil Profile Location Map On a Soearate Shaej) LINEAR LOADING RATE: 0Z . 1z s PURPOSE: SLOPE fz JAJ CZ e) -e ASPECT: DESCRIPTION BY: L DATE: I CURRENT LAND USE: COUNTY/STATE: s-r 1 Y- Kjr-LAJ I VEGETATIVE COVER: LOT DESCRIPTION:- 7"T' OF )/V Se C # tZ its LA-) DRAINAGE CLASS: LOCATION: GALLONS - PER SQ. FT. PER DAY: PARENT KATERIAL(s)/DEPTli: SOIL SERIES. MPVPPC``� p iya QIL lr$S�IElCAT.IPY f K)R I ZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS Pi I - BOLJN DAR Y REMARKS I V�; C f I Gr. Sz. Shp. COATINGS n. is, Yn 's 10"'Z 'm Rlml1 NC, 9-11 y tb4yz- Y/V I, -z- I OLI N-z I'L CU Is Q Ls IWI Iz- C) S)Y\ LS - -7 L) JY' 1 tw-1 R I sib L -1 -3) ry� OR SITE SITE FEATURES/MOTES:r 0-004 F? -C/o C) CST # LIMITING FACTORS/DEPTH: Signature Date r x AEPIii MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS pil BOUNDARY REMARKS HORIZON Gr. Sz. ShP COATINGS in. moist OTHER SITE FEATURES/NOTES: Signature Date CST # LiHITING FAC10R5/DEPTH: DEPARTMENT OF REPORT ON SOIL BORINGS AND INDUSTfi•(, LA80R AND PERCOLATION TESTS (115) HUMAN RELATIONS (ILHR 83.0911) &Chapter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, W1 53707 J LOCATION=SECTION: TOWNS UNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: s� 1/4 1/4�� /T z9 H/R 12 E (or v� CZ � .� - �P CYsq2) �_1 COUNTY: MAILING ADDRESS: 1 —� T-7) ST, ST. 1`Z.s� l X ' - �`� � >J 1-C 1_ v `" .-,-5I L J SV to Z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROMLE DESCRIPTIONS: MeRi'15EATIONTESTS: Residence —'s NV > PN, C`New ❑ Replace —) — ) N _ 1910 1 —) _) _)_ 910 RATING: S� Site Usuitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN -GROUND -PRESSURE: N-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑ nUI S ® S❑UISYSTEM-1 1:1 S U El �U N S rx ] Db I If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: _ Fioodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GR UNDWATER-INCHES EST. HI =HS= CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) OBSERVED B- -73 B- B- B- PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL -INCHES RATE MINUTES PER INCH PERIOD i P E R I Q D 2 PER P- 1 P- Z Z �i -zy 'I\-3 3� 13), �. `3Ji(. 8 %1//L lW)(. 3! 37 VC) P- � d 3 /1 L 5/ 11 l C P- P- _T __�4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. Q 1 C�1 rCl �T_,5), SYSTEM ELEVATION CD 9 g Y �Y) (�s ° N—z 2}E r E } BO vl i f ' r i'T 4 4 a O� W, Z S f 1 i• Q ., ..,... w I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, print]: AND DR ESS: TESTS WERE COMPLETED ON: -)-I_�-?d CERTIFICATION NUMBER: PHONE NUMBER (optional): CST— coo S-)(0 5_L/ zS_ 0/ � S CST SIGNATURE: RIVER FALLS' WI 54022 715-425-0165 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) OVER SOTI. DESCRIPTION FORM Attach Sol I Pro.fI lus LoCaliOn Map 0►1 a Soparate $r,aeti LINEAR LOADING RATE: ~z - ct ENT: PURPOSE:vA1..0 ��i- fib- SLOPE: V L • E G � ASPECT: ��`�. �— _ --- DESCRIPTION BY: 1 Q CURRENT LAID USE: iFl OATT::—' COUNTY/STATE: S--.1I\ VEGETATIVE COVER: GRh 5:s 1�T a e C l-), TZcT 1Z ) 6 LAt DRAINAGE CLASS: -� 1�) .l_ 1 l l A3 � LOT DE5CRIPTION: LOCATION: GALLQNS PER SO. FT. PER DAY: --- SOIL SERIES: M faCPPN� i'�'S PARENT FIATERTAL s /DEPTH: `rSOT P YS HORIZON QEI'TIE MATRIX COLORS MOTTLES TEXTURE STRUCTURE I U&SMEMT CONSISTENCE CLAYSKINS/ PORES RDOTS PII •BOUNQ/IRY REMARK moist Gr. Sx. ShpCOATINGS 3 Y) _ 2 CIL 23 $ 3o riiG 3- p- l 1 b �o-1 R 3A - s 3 y3 - Ls 1 b�Iz- 31 6 �b W 6 S Z �j- gib 1�`-IR 316 3 46- 66 log 2 316 64lo�t2 y/ 5 1. � � m 1r m U `�1•� C�L.S OTHER —SITE—FEATURES/NOTES: LIMITING FACTORS/DEPTH: Signature Date of Z CST N DEC A 1�900- 3 SL C�olx �' :6t-ww0 54 CERTI FlED SURVEY MAP LOCATED IN THE SE I/4 OF THE NE 1/4 OF SECTION 17, T29N, R18VI, c TOWN OF WARREN, ST. CROIX CO., WI. OWNED BY; KEN HERINK m R T. I ROBERTS, WI 54023 6a -w 2a 3 U� � w� NOTE: BEARINGS ARE REFERENCED �Z'E to TO THE EAST LINE OF THE NE1/4 o o}_ w� ( BASED ON RECORDED BEARINGS). ro � o oc ►- a ozz ....... - 00 f � .,; 27 a- • ' va� UNPLAT'TED 73005 't LAND S ' Z O Q ' E ^� . ° LOT I S A0 u Lu `�2810.99 ACRES N83°32 I (478, 660 SQ,FT.) C]• `r 10. 16 AC, EXC, R.O.W p La . ( 442 , 549 SO, FT) O ©' M Li S 74036') 6"E 7 7. 2 e ' �� —!' JIS W 66' WIDE PRIVATE ROADWAY �, 3a W 4' EASEMENT o � J NLOT La N 2 OD 2.90 ACRES '\ z 0. 3- (126,35 3 SO. FT.) r v o w; `� 2.67 AC. EXC.R.O.w N, Q / U. �•• ( 1 16 , 13 0 S O. FT,) : n N \ o► `� LETS co '� w 3.67 ACRES Ira z { 1 59, 924 SQ. FT,) o` 0 W Z t� r 3.46 AC. EXC. R.O. W • LOT 4 z Z \ ( 150, 550 SO. FT. ? o �• 2.82 ACRES �' 1 122,993 SOFT) 2.35AC.EXC.R.O.W. '' I IO2, 190 SO.FT.) 3� �f wl I; In 589.28' 28" E 3.7 .. 4g0T,OB' 120, d0 2.4' 334.581 FENCE 5' 38D.00, 33.0 f �"�►`7 N89026'28­ W 839,-56 ' I E - W OUARTER SECTION LINE Soo 34,12" w 17. 4 T' �UNPLATTEp LANDS E1/4 CORNER SECTION �3' 33' 01. • , 17. ( COUNTY MONVMENT .• 0. FOUND. SET NAIL FROM r I ES). ' ' .DAMES M. E aOR 0-- SET I "X 24"IRON PIPE WEIGHING +• 1.13 LSS. PER LINEAR FOOT. SPRING VALLEY 1 � WIS. � I " IRON PIPE FOUND. i. if; 1 fU sod,41 4�' SCALE ! 1 5 0 SHEET I OF 3 JAME S M. WEBER S- IS 0 754 150 300 b A TE o W22- , SOI yNo• VOLUME 8 PAGE 2303 r THIS INSTRUMENT DRAFTED BY co