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HomeMy WebLinkAbout030-1091-90-000%9 S1 T ZONING CROIX COUNJ Zoo '�y'` AS BUIUF SANTTAIZ� REP010' DEC Owner A00ALer pAr-r4if s oki C;?o U98 A C X Address -WE.,93 ne OUNTY jl`,,* C) City/State C)FFICF ,1 V� Legal Description: Lot -Block Subdivision]CSM Y 1/4 1/4 ,Sec. T N-R X, Town of Ja-s-,,�..-i PIN # SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/�6/ Setback from: Douse S 0 " Well //0 " P/L Pump manufacturer Model Alarm location 00� Setbacks.- Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYS'ITM: Type of system: Zee- 14 Width _4" Length Number of Trenches Setback from: House - "-26e' Well PIL Vent to fresh air intake 90 60 ELEVATIONS: Description of benchmark 4r 7/�_? Elevation 1490. 00 " Description of altemate benchmark N I'S t00e /.. Xe VC JL Elevation )o9. V ## i Building Sewer /0 ST/HT Inlet -/03.9'(P ' ST Outlet -_>03. PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover /0 IP Distribution Lines (4) loo,xt) 0' (h) — 45.. S � e - Bottom of System (A. 0 Final Grade (4) log,r�s 60 /00- 4F -S , Date of installation 4�//�/9&I'crmit number 3/-<�<,/�7 State plan numbcr Plumber's Signature m jr "1 11 / _#1 License nuber .004t- Inspector - """,5 f U q 5 2 D at c /o? // .51,/ 50 V ('()t,,plctc plot plan ar 4 3 0 NOTICE: Please provide the foi[owirI A plan view sketch showing everythin within 100 feet of g the system. • Two horizontal reference points to center of septic tank manhole ho to cover. • Show alternate benchmark, if applicable. PLAN VIEW AfD 100 ew� l•JE�,c AEp+ s.,ot.uc£ kr. A4'-,go0*4►?k t S �tt�aP 300, a• 1'!or ►�d %joy �s To �rV►��{ w w /ttc /1/?0cQnr .1,1,4j,6 Difse 030vI Aw,,-y � � w 12,�044;im ARK, -4g-soeprloAs Aev � -ro _ A &'e0u,00q ITT �� 4-41w,41) '7Pa d. 00 . oo \IC.Aj T -A-r EA10 D c. �t ff 1� a �c,t c �•Sr�� �4�TioJ �. �C INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safeiy and Buildings Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. PT�96�NIa 96BERECity 1 Villa en Town of T & BARBARA ST, JOSPPH CST BM Elev-:- Insp- BM Elev.-. BM 0 16 �0 rAikiv 11k1CnD1kAAT1nK1 ELEVATION -rlr%Kl DATA I 11'a1 %01'L1V11--% I IWIV TYPE MANUFACTURER CAPACITY Septic �� �(� (� Dosing Aeration Holding TANK SETBACK INFORMATION �„��_�T�6��.,, TAN KTO P / L WELL BLDG. nt to Air Intake ROAD Septic -3 o NA Dosi ng Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM M TDH Lift ri ctj on TDH Ft Lossead Forcemain Length Dia. Dist. To Well SOIL 4B-S-Q.RPTION SYSTEM County- ST, CROIX Sanitary Permit No.: 315942 State Plan ID No.: Parcel Tax No.: 030-1091-90-000 AqRnniii STATION BS HI FS ELEV. Benchma.� j f/, j t t-b �k(t,�r�- 2•Yq t0X. C, Bldg. Sewer Ipq,pj- St/Ht Inlet St / Ht Outlet g .(� ��Z.�j`j Dt Inlet Dt Bottom Header/Man. °r °x //fry ��D, S Dist. Pipe Bot. System /Z.00 12. /�- 2 5--47 ci -7. Final Grade Ir,> Z - 3 7. BED E Width Length No. Of T 7:5� Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME ONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer - SETBACK INFORMATION A CHAMBER Typyot�f Model Number: I S e m4w I yst _ORUN IT DISTRIBUTION SYSTEM Header/Manifold rr Distribution Pipe(s) rr x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length q 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.) LOCATION*. ST, JOSEPH 31*30o19.335A,SW 1200 MCKINLEY DRIVE Plan revision required? ❑Yes No Use other side for additional information. IZ 2,1- Olt SBD-6710 (R-3/97) Date Inspector Signature Cert. No No--- Safety and Buildings Division A201 W. Washington Avenue SANITARY PERMIT APPLICATION P 0 Box 7302isconsin In accord with ILH R 83.05, Wis. Adm. Code Madison, W1 53707-7302 Department of Commerce k 7 0 Attach complete plans (to the county copy only) for the system, on paper not I ess County N than 8 112 x 11 inches in size. cro f • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purpose 0 Check it re an Pr2 ation e7 Dr. [Privacy Law, s- 15.04 (1) (m)]. 00 /WC Xj State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr Owner Name Property Location 0 6s, SE.>e gLj 1/4, S T '30 IN, R 1 V(or) W 01 q c%l 4., &r r c.- c-r-S o -A s Lot Number Block Number Property Own is Mail Address -1353 K A �Lxo Sate Zip Code City, S I Phone Number Subdivision Name or CSM Number - -t St WO. nn 150_� 113 - 1 1:1 Cit Nearest Road 11. TYPE OF BU DING: (check one) Ej State Owned 0 VII(age J Town Ojse Eli Y\ I n Icy [] Public 1 or 2 Family�_Dwelling - No. of bedrooms [V F Ill. BUIL USE: (If building type is public, check all that apply) Parcel Tax Number(s) 99 7 1 ❑ Apartment/Condo /1,, 2 Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales Repairs 11 ❑ Restaurant / Bar / Dining 4 F1 Church /School 8 ❑ Mobile Home Park 12 E] Service Station / Car Wash 5 E] Hotel /Motel 9 ❑ Office 1 Factory 13 [-] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) ew 2. E] Replacement I E] Replacement of 4. E] Reconnection of 5. E] Repair of an A) 1. 'Ov, Existing System Existing System ------System -,.,------System ------------- Tank Only ------- ------------------- ---------------- ----- B) E] A Sanitary Permit was previously issued. Permit Number Date Issued EMEEEEEEMNWW� V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 E] Seepage Bed 21 El Mound 30 [-] Specify Type 41 [:]Holding Tank 12 eepage Trench 22 [-] In -Ground Pressure 3 , Ef 42 ❑ Pit Privy 13 Ej Seepage Pit 43 Vault Privy 14 [] System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp- Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate , 6. System Elev. 7. Final Grade Required sq. ft.) Proposed ft.) (Gals/day/sq. ft.) (Min./inch) 1 1001(00 Elevation o C) LID Feet, tul-I-S Feet Capacity k 00 .9 1, VII. TANK in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION I Gallons Tanks Manufacturer's Name Concrete Con- Steel Mass App- New Existin structed Tanksl Tanks tic Tank D El El D 1:1 �-a T �an k� I I - Lift Pump Tank /Siphon Chamber El I El 4 El 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 Si nature: (No Stamps) MP/MPRSW No.: Business Phone Number: ^zjZ - I Plumber'Address (Street, city, State, Zip Code): L 2L, MAL a2wm VENI :;0 IX. COUNTY/ DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 6sulng Ag Signature re (No Stamps} E,?'#Approved 1 0 Owner Given Initial surcharge Fee} -7 112 M / A Adverse Determination / X. CONDITIONS OF APPROVAL REASONS FOR DISAPPROVAL: DISTRIBUTION: Original to County, one copy To: Safety & Buildings Division, Owner, Plumber SBD- 6398 (R. 11/97) • L7 r 6 r �p 0�, ajQ-( S e_+ bc.c ks �ec� Ca/vim C3 3 V, ...tee a 'PLOT & CROSS SECTION PIJ1Ni L1PPA BROW. EXCJIYATMP&UmMNe UNIT INC .. PROTECT . . 9. b�cc. �¢�QfSon to � ec 31 Ok,��n) W►eSe2 qPic s.haQyo Sep��'c ` 131dq Sew ea � �E` � 31104 CDR 35 9— - 5X 75 "� ag g3 Trcr►ch e s >1 . � 0 OF 4fi S%a �rac�e �n . AI�uLn.�Sf �fieM a�eG £ • G rac � S ' too SCALE FRESH AIR INLET,AND OBSERVATION PIPE �X��-P} hofr-� APPROVED VENT CAP MAXIMUM 120 ABOVE FINAL -GRADE � 11►IA�ii!►+MJM OF 42" ABOVE PIPE TO FINAL' ARAM 4 Now MAAEM MAV OR 8 VWHETID DDV E RING MII�M& As M 2' AGi G REGATE OVER PIPE 018TaA10"ON POPE i ELEVATION BED lKmom PER $QIL TEa . Is �- PT. 0 a ■ 0' AOSREAATE � le • 6EI�rATH PIPE 4' IQA T IRON VENT PIPE TEE .soaTEsTM BY:—T . 14ni 1 ifec 0- ry, rx <, ISO r� PERFORATED PIPE BELOW COUPLING TEiitiNNATINO AT BOTTOM OFSYSTEM Wisco ,nsin Department of Commerce Division of Safety and Buildings SOIL AND SITE EVALUATION Page Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and r, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). PrODerty Owner Property Location J Govt. Lot Property Owner's Mailing Adare_ss_ Lot # Block#- 7— _.de . - I-%, Uu, 2,10 Parcel I.D. ff / A ) -. L> L,"-3 0';_ 0 Reviewed by Date M] 1/4Lj 1/4,S S 4 T 0 N,R It (or) W Subd. Name or CSM# CityA State ZipQode Phone Number Nearest Road r, 1:1 C i ty Village Town . ;_>5 � I " ry New Construction Use: )AJ Residential / Number of bedrooms Addition to existing building � Replacement . El Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/fe - trench, 9 pd/ft2 Absorption area required it bed, ft2 1115 trench, ft 2 7 IV, Maximum design loading rate bed, gpd/ft2 - -00 trench, gpd/ft2 _T) 97�o4lc;�CI7,0)1 %.tl " 'V Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations A A Parent material (NA ---,A Flood plain elevation, if applicable ft rill i1c J:16 S Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U Unsuitable for system , I I S 0 u 4S El U S 17-1 U U 0S U Es U L7X Boring # ... ... . ...... . ... ...... "!AX Ground elev. ft Depth to limiting factor Boring # .................. ............... ............ Ground elev. V7V"1V_ Depth to limiting factor SOIL DESCRIPTION REPORT Horizon Depth in. ,j Dominant Color Munsell 0 Ye 4�z. Mottles Qu. Sz. Cont. Color Texture 51 1 Structure Gr. Sz. Sh. �ns6k Consistence rn�'r Boundary Roots G P D/ft2 Bed Trench L 2-3 Z3 0 41r Al 7 Remarks: / 9� 4/2f!) Y9 tp- m r 6K ILVI -7t e F L 7 J �in- Remarks: SST Name (Please Print) Signature Telephone No. 02 Addres Date CST Number q j job, s I Ilk-vj Ric � 0 D u) I --' � - �_�i � - �/" 9 .A. SOIL DESCRIPTION REPORT ' PROPERTY OWNER Page of PARCEL I.D.# F Baring # Horizon Depth in. Dominant Color Munsell Mottles Chu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Bed Trench s6k . .. ....... ............ .. ...... .......... .... 1, ILO' C-� VL Ground � 05 elev. Ts ft. LLL Depth to limiting factor �in. Remarks: Boring # Ground elev. ft. Depth to limiting factor LL in. Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPDIft2 Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. -- Depth to limiting factor in. --- Remarks: SBD-8330 (R. 07f96) • R0be2�- 9L �.��6u�1 4t It2s,., SW Yi( S3i T20 4U2 1401 S+ :Toseph�(A)HsS��F to el 1 ba too � o o �6 Ll 67 cp a �hR.-4 � ^ a 0,ok 14 1 vn +0 b�GL j n S COS d v.cc. +.e. 0 � Mary jo 4oiij-54.-Ct., an �Gy zoo 1917 Bin 6a r, e L,.s e1.) 6� 1 rs i- Sol I +es+e2 are c. S C na�5a 2Z-7 3g,� 0 Wisconsin Departr-wint of Indu-.try, Labof and Human Relations Division of Safety & Buildings I AND S:TE EVALUATION REPORT in accord with ILHFI 83.05, Wis. Adm. Code Page - ) - of --3- TY Attach complete site plan on paper not less than 8 1.12 x 11 inches in size. Plan must include, but 0 not limited to vertical and horizontial reference point (BM), direction and % of slope, scalo or -'ANGEL I D dimer,isioned, north arrow, and location and drr'lance to nearest road -,CID APPLICANT 111`07ORMATION-PLEASE PRINT ALL INFORMATION .-Vi[WLD ICY DATE PROPERTY OWNER PROPERTY LOCATION -G-01alLca 1/ 4. S 31 T N. R "I R03e kr U C6A 0k PSTe9JNJ . _ _ --—•.--�-- _....__ _ Cam ' PROPERTY OWNER'S MAILING ADDRESS LOT N BLOCK # SSUBD NAME OR CSM 8 CITY, STATE ZIP CODE PHONE NIJIVBE R []CITY OV11AGE I OWN NEAREST ROAD qS-T,. P.A - U L M A 'S's- I I ((olZ) L1 � S - L4 19 .41sr. nsgpo---- AV," K I AJ AJ New Construction Use Residealal / Number of bedrooms Addition to existing building Replacement Public or oommercialdesvibe- -, rcode derived daily flow 7,50 -- gpd Recommended design bading rate._ OB"I bed, g pd/ft2_0&__ trench, 9pd,,�2 Abwption area required 2, bedA2 trench,ft2Maximum design loadiIng rate i, d, gpd/ ft _trench, 9PdF ' 2 Recommended Infiltration surface elevatlon(srrQ ,(A as referred to site plan benchmark) Additional design 1 site considerations Parent material Flood plain elevation, if applicable ft 'foNVENTiONAL M'Oi-1 N D IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL WOLCiNG TANK S = Sultal:-!e for system X S I] U ;5� S El U U E-S AU XS t 14 S D Els MU U = Unsu,table for syste6 100" 1 1 SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mott(,-,.s I exture Structure Conslstpn(x� Rxvxi-yy Roots G P D/f t2 in. Munn, II QLJ 'S7 C01 It COICV- Sz sh, BEd Ityxii 0-7 10 \if, 2 rrj y- -2-1C' j r 5 21- ';0 In 4 K 3/1V I ry%5b K 13 0 f�, -7 y '_ - _ __ . _ _ . _ -ram- _ - __ __g 5 q - 10D to IL�'t5)6 L) '-51 Flemarks: YK.."-Ij 2- 2- rVA �_.___ _ -1Z IQ / -6 -7_.� . _ _ _ ... IJ bX r 4 r-_ __ W __ . �__- r4c- (v ZS. q 10 y S. f -'z! --0 SAq 01 10 I I C.&I I flu -V 1 IVGKO9 1 if vMtP-t �ZG Address: A L L -S `ZZLr*'\ 4E, KNEK F gnat # I-- — 'ZZ-4j D,i CST NurnLw Z2 119<1 -7 1A 03' 07 ffiscon�;in Department of lndw�trj, LAbor and Human Relations So .,,ND SITE EVALUATION REPORT Page ol_-, Division -of Safety & BuildiNs accord with 83.05.. is. A . Code 9 COUNTY F " C) i X A,ttach cornplete site plan on paper not less than 8 inches in sl must inCkide, but 1_' c �, I ­ I PARCEL I D. # CEO-1 0 1 ?Do not limited to vertical and horizontal reference po' t di cti*and % o scale or dimensioned, north arrow, and location and dist ne.11 (0��0 03�) - 1091 - 90 VIEWED By APPLICANT INFO RMATION-PLEASE P I A INFORMATION RE D AT 10-02 P R 0 P E H TY OWNER: owwr _ __- _W____.___________._ . _ ST CROX P ITY LOCAT !ON C5qr&AeA COL*ITY 1/4,,S,31 T 30 N.R PROPFRTY OWNER S VAILING ADDRE( BLOCK# D. NAME OR CSM # CITY STATE ZWC0Drt_: P�10N_ -'F- L,�-57% JC17Y E]V I LLAG NT OW N NEAREST' ROAD hmsmmftwpq� �ST 1 SEP14 MeK I t�JAJ LL kj New C0jjr,,1ruct'on Use Resldenlk),l /Numbor of bedrooms Addition to existing build' -�-A �.. i ing Replaoement Public or commntdal describe Code derived daily flow. '7 Recommended design loading rc-Ife trench, 9pd.,ft2 gpd --------bed, gpd/ft2__._ Absorption area rN.ulred bed, ft2 trench, ft2 Maximum design loading rate bed, g pd /ft 2 tronch, qp�jj It2 Recommended infiltration surface elevation(SYTO 9� �rqs referred to site plan benchmark) Additional design site considerations Parent material 'f -pplicable __I ` �.__. -Flood olain elevation, I Mm S = Suitable for system CONVENTIONAL MC!-.;INC) IN GROUND PRESSURE AT -GRADE SYSTEM �N �-_ILL �Jr)'.`;NG3 TANX U = Unsu'table for u 10i LL,�k�� S Fj U J�_l S El U 14 S, El LJ El S K U 1:1 S011- DESCRIPTION REPORT 3oring # Ground elev. /a3. - �tt, Deplh to i,M!Iting factor Boring Ground e 1, ev. Depth lo limiting factor 9Z Horizon Depth Doi-ninant Color Mor in. M i_., n!; e I I Qu. SZ. C 071-7 ./C) K V .2 _y t 21- H 8 5 v L4/ 45 Remarks: Z _ j � —12--i 10 Yp3�y__ Z5- t42— 10 y g Ll Aa �____ 42-yu _ Ago� - 4y-9z_I ioY�s/ Remarks: e S ant. Color extureCorlsistence I Structure C,,-. F)z. Sh. BoLir" 7 ; Roots 2 ry\ q r- c's 0 L4 a, c.l< m4 r- far �5 C S -7 0 -NE I r"S10K `� nN4 r- r` 04 2 6 '77 a _ _ __ _ __ -5 0 C.ST Name -.—Please Print Phone-, y Address, FA L W L <1 VE- S C/O 12- 7-1) Sion Date C's f _cu _m­ -bo, f- D3 0_� -1 r I — L. HIPTION REPORT RC�PERTY OWNER SOIL L Page ,c 2 of # o n Depth Horizon Dominant Color Mottes - -j. i (c, ire Structure Consistences Co BojxJary Roots GPD/ftz "'I'mrch q in. Munsell Ch. Sz. Cont. C-obi Cr. Sz. Sh. B e d Od— -3 ovs route 7, S. 01q - -- Oki. "4 Dqth to 7 Y rn;t ing lac .5 01q Remarks- t�E N -loring # N- r '7 Gr ound 0 1 - 1! 156 t t. Depth to limiting 'ictor boring Ground elev. Depth tox limiting factor Boring 4, Ground It Depth to lirniting lactor 0 -1 ---- ,3b to Yk�- 3) ry-\ 4r E r a-5 _ C5 � ___.__ 0 0 S CS 2- Hem,'arks',--.. 7- Iq 2-) ry bK 0 Ll t-7 C) Remarks: Remarks: I D -a 3 InY 11 Ci. 5/f.) 2) • PLOT PLAN Page of Property Owner Legend L Legal Description_ BM g, fACE7 I Aj T 3D W.1 100.01 -:0 2- A-r �m vI Aj 0 F S-F. :1-CKS F-- P ter. e P,-O k x C�) \Aj��CZAI,--S) AJ \X cl soil boring w/backh('),- o cwfv\ = sWb&-' tio Te APPfZDXiMA 104) 0 4ti� I L PrZ-fORVTAIW3 TO Cie_ Lo��TE�* /6 f c#q- > Fr�6r&A WA-reK�c---re-U'cr---'- 2 5 Feo /-vx A 6 f-=LD UJ CA=,",D F:--O UIV OA T/ OAJ OUD E`OSTINC.7 032 - / �L VO-A7EK zMy2-VjC 2- R-OAA LX) E LL- 7 7g- g- S i g n e d C S T I\037b7 Date Page .. ) - ­ o f ­_ a� Wiscorfsln Departm(int of Indur;tri, Labor and Human Relations Divisionof safety & Buildings AVLach complete site plan on paper not lesslt� not limited to vertical and horizontal referen dimensioned, north arrow, and location and, I APPLICANT INFORMATION --PLEASE P cc A - R n o to no, GF1 L A PROPERTY OWNERi " - t�_A e6A KA F1-,-TePS(]PNJ PROPFRTYOWNFR SVIAILIN'GADDRESS 2- CITY, ,STATE Z I P C 0 1". E PHW_ NUVIK R ,!-S7, OAUL� I\AAJ Ems I I 16 12,1 Ll g 3 - 1-111 cl TION REPORT ,his. Adm. Code COUNTY t C PARCELID.# 0,EO-1019-2O SJ 1()ql - 90 R%EVIEWED Ey DATE PROPERTY L0(_*JAT'10N 444 1/ 4,,S T N. H LOT 4 BLOCK SURD. NAME OR GSVI ]CITY []VILLAGE NITOWN NEAREST ROAD 0011- L% I PMICKI wvbm-mhw� eO �2 I _AJ�J,L Y I ,ust include, but so 0, scale or Use Residential Addition to existing build* New Construction I Number of bedrooms Replacement Pijblicorcommorci.ildescrlbp.---,,------------- Code derived daily flow 7 a___ gpd Recommended design loading rate bed, gpd/ft2 '2 ----trench, g I pd. Absorption area rNuired bed, ft2 trench, ft2 Maximum design loading rate bed, 9pd,tft2 trench, gpd;'f,-12 Recomniended infiltration surface elpvallion(sM as referred t© Ian site p bchmen ,rk) I Additional design 1 site considerations Parent material ,NlD �57ON Flood plain elevation If applicable S = Suitable for sysle I GCNVEN'r1,0NAL M 0 �JN D iN GROIJIND PRESSURE AT-7ADE SYSTEM IN RLL N" ANK S S D U 14S F] U F] S U S U = Unsuitable for sys;4' S I Boring Ground elev lift De'p1lh lcj lim,'ting factor �.qo I I Boring # Ground F,,.! e v, I_W._14Zt Dopth to limiting iting factor SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure G P D /f 1_7 7 Horizon T e x t u re Ctonsistenw I Root,,; in_ Munwll Qu. Sz. Cont. Color Gr. Sz. Sh. Beo Trtyxj jo Ve 21 s t f now" 2 rn Qy- 17-21 (0 Yk rnsb H -7, a ry) C S 01-2 I -Milo Remarks-. � _ f n-'7 ' r o yr�L� j — s'� I � 2- t mar -fir �_ ah _- � O �S . O. G� —12- I a yrZ 3/(q - _ I_--�_2msbK m�I-��"__i °J''� __— d,s `4��i _ I_Z 0 _7 _ _. ------.C_I..._...�_ .I �sb�_ _nor __ .yJ_ 0j2 .�b�3 L_Jr� 6 ZS- 142— �O Y Ll r�_ A, D � 412 -L, q C] s 7 Remarks-. CS? Name�—Please Pr C . int MAIZY �aO HOLU Phonp- Address: K� En FA L 2 ?--ri SIOUItLif CST Numb0f _/� -7 M r) 3 '0 POPE OWNER R L SOIL L RIPTION REPORT -) RTY PARCEL I.D. 4 Page —,Z of :ring Horizon Depth in. Dominant Color Munsell z 0 ".'rourid1�- r)epth to 7, S Y > "7 3oring # Ground eiev. ft. Depth to limiting factor Boring # Ground Depth to limiting factor Boring ng # Ground 0 1 P, V. -- f It. Depth to limiting factor Motes Qu. Sz. Cont. Color Texture Structu re Gr. Sz. Sh Consistences Bounctvy Roots GPD"ft2 Bed iTmr& 009 �D- J4 !0--5 0,S(A tLJ7 0 2Ln 01LIVVV R e m a r k s: JAa K-;A\ VB E-��tq —L Remarks: 2- 4(e LI 7-ILI amp& IM R P rnq r k.o, - Romarks: P a 0 L PL()T PLAN P Pror-,,(-%rty Owner P&7�-�:R �z Legend: ) -- Legal Descriptio-, A -MCEL- Loej -# I BM AT YLJ T 3c) t� T &?eo u /Vo S u �z FiA A I �' - '-7 m C-Z) -T KS� -M 0 F ST-. :2�5 F-- P Cb u tj E w soil boring w/backhor, mo C-Wpv"\ 22S if,-t5-Tp--,)AcK WJ&TL OLD APPRDXIMA L-OCAT I OA) 0 40 11%00" 4�V>6 <ss L ArbfCWTAU3 TO Cie- L0(!J1V-TT--- � ,5'OP,-> F/ZDAk Pg�)f�'EMrV /6 1 OR- > FrU)m, A WATeK Sel?-Y) C� 25' Fed A f-70 LiAJ DA T/ OAJ 50 / Ok PsZo AA, Lp eLL- �E pT j c, TA-N � -TO g ,-,ATLD 5 _OM AA V VJA E]-3S- -7.5 Signed CST-� A\0 3-7 D 7 Date_ A -\I Z-2 771sr-ons:11 MopIrIMOM Of MUULA1y1 �WIL Afil) I L tVA.- iUN ht:rUN I r dyrj Labor arK1 Hunan Relatiorvi Division of -Safety & BuildmAjs in accu�k: ivith ILHR 83.u..'. VVIS. Ad(n. Code I COUNTY 3T. COw Couwy -- Attach complete site plan on paper not loss than 8 112 x 11 Inches In sizo. Plan must include, but not limited to vertical and horizontal reforenco point (W), direction and % of *lope, sale or PARCEL I.D. # 030 — 1019 — 30 dimensioned, north arrow, and location and distance to nearest road. 1. —1 030 — I Dq APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION 1T-1 V �IE � ED D Y DATE PROPERTY OWNER PROPERTY CWNER':S MAILING ADDnESS 935:5 a_�UITS CITY, STATE ZIP CODE PHONE NUMBER ,5-F PA tA L. IIA Al �51 1 __S PROPERTY LOCATION GE)Iv+ 1:14T -v*,5W 1/41S,3 I T 3 0 IN,R q Ec W LOT # BLOCK # SUBO. NA vIE OR GSM # OCITY []VILLAGE XTOWN NEAREST ROAD ,5T �5DSEM MC K%AJ&)L t4ew Construction Use p Residential / Number of bedrooms Addition to existing building Replacement Public or commercial describe gpcVt,2 t Lnch pd/ft2 Code derived daily flow --7,50-- gpd Recommended design loading rate _Q,:Z_b M, r 9 Absorpbon area requited _10 bed, ft2 trench, ft2 Maximum design loading rate V. -7 —bed, gpd/(12 0 4 g trench, gpdJjt2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material 5AA1�___e Flood plain elevation, it applicable AJ-Ar ft CONVENfIONAL MOUND R4.GROUND PRESSURE AT -GRADE SYSI E-M IN FILL HOLDING TANK S = Suitable for sysleal 0 S U = Unsuitable for systdQ S El U XS 11 U 5ds Cl u S [7-1 U 0 S RI SOIL DESCRIPTION REPORT Boring 4 Ground elev. .ft Depth to lirnibng factor W)" Ground ft. Depth to limiting factor CST N ar Address: Sign 34 Remarks, Remarks* —PUiase Print (7 Q5 420 - 1-7 -75- ("LUSTF—K 7 am._` A-0 e 5�t_wq�_ __ _ _?--�.• _ ___ _w_- ____._ Date-. CST Number- -370-7 ��y lqqo 7 Wisconsin Oepirtmonl of indu,Stq, Labor aryJ-Hunan Rtdatjoir; Divi*lori of Safety & Buildlnojs SOIL ANO �:''T*L EVii... a iON REPORT in accu;,.. vith ILHR 83-u, vVis. Adm. Cod(-) Attach completo site plan on paper riot less than 8 112 x 11 Inches In size. Plan must include, but not limited to vertical and horizontal referenoo paint (13M), direction and % of slope, scale or dimensioned, north arrow, and location and diStance to noarest road. APPLICANT INFORMATION --PLEASE PRINT ALL INFORMATION UUUN I T 3T, C cow C C) tknr y PARCEL I.D. # 030 —1019 30 030— 1 oq I — q0 RIVIEWED 13Y GATE PROPERTY OWNER PROPERTY LOCATION _. �� _ _�66Y4.1 I -iYt 5 W 1/ 40S31 T 30 N w R013ter PET_ �_____�_._ _ ___ _...__ _�___._ ___ PROPERTY OWNER''S MAILING ADDRESS LOT # BLOCK # D. NAME OR CSIVI # 35 3 j(Z4(2E 07 5u 17-e7 CITY, STATE Z I P C 0 D E E_N_U _M3_E_4[]CITY E]VILLAGE XTOVIN NEAREST ROAD 5-F PA LJL L, AAAJ IS %4511 __S (6124 LI? 3 — q 1,3 '5T. .3DS E PH I MCKIAWLG� New Construction Use Residential / NuniL)er of bedrooms Addition to existing building Replacement Public or commercial describe—, Code derived daily flow '750 gpd Recommended design loading rate __Qj b M,. ggl[12 y tfench, gpd/ft2 Absorption area required _10_jqbed, jt2 cl 3,W trench, ft2 Maximum design loading rate _.D. `7 _bed,gpdYft2 Ot,' trenCjj'gpd/jt2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations -5 AA)tx.'. applicable` AJ Parent material Flood plain elevation f applica C () NV_C�T L10 N A L I00UND IN GROUND PRESSURE AT -GRADE SYSI EM IN FILL HOLDING TANK S Suitable for system [!IN I ble f S U 19S D U 5dS E3 U S Cl u El S RIU 11 S Zu U Unsu'ta or sysl�67 2. SOIL DESCRIPTION REPORT Horizon depth i n. Dominant Color Munsell mottos Cu. Sz. Cont. Color T o. xture Structure Gjr. Sz. Sh. C�orlsjstcrl08 [w-", Roots GPD/ft Be7dTruxfi I o 'Ir le(Aj AAA _ _-fir _ RIFY C) . __ ._ . A) eyve V #' _ --.-_ _ __w _ flevarksr' Remarks - Print C5T.Naru:—F!Aasa1 - - W-Y %:.c Address- 3CYONAO el FA Signal Date- CST Number: 370-7 Lkol lqqo M6 JUL-21-98 08:21 FROM :U OF M FOUNDATION ID:612 625 4305 ST CROEX COUNTY SEFUC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Y-s MP/ �:: 2— -Mailing Address G✓1 (4(oz Property Address /0 7S/ (Ve;riftcafiou required from Plamieg RC-Partwnt for new constructio]a I k l,,, tyt /L,/al o --lo �� —�O CityfState.� 1024,17 Q��S`"" cel Identification Number 0 L/ V LEGAL IDESCRIPTION S�J, 3 0 Property Location.. V+ , See- _3__/2T 'N.RZLW, Town of S"vm`on _FA Lot 9 Certified Survey Map N ....-Ilp V0,1ume 1.10 Page A PAGE 2/4 Warr=ty Deed #Z�Z10i Page# Volume t04, Spec house 0 yes no Lot fints identiriale yes 0 no SYSTEM MAMEKANCE Impwper = and of yow septic system crud result in its plc=ture fail= to hand C wustcs. Prop" mainteu=ce of out the septic wik eveTy three yeam or 9==, if Dm&6 bry a lke=d per. Wbat yoji put into the system eat affea the A� of Chi; =pt� for is a uvam=t stage I'A dae waste dispmai sy3teaL 113e -----y cvmer agrees to submit to St Croix Zocd g Dcpuftrnmt a on fonrx, sigmd by the ownez and by a mzwt phumber, jmnneymm pkwbar, resnictodphunber or a Ik=,edpumper n-rify4 that ( 1) the as -site w2stewaWdispO&A system is iti pt%er ope=ting c*nditton and/or (2) aflon fiLTec6on amd (if ntc�=W)o the septic tank is less than 15 full of sludp- ptmq? I/wr, the =dmigutd have read the above =ts and agree to an iabin the private swage dhqx=1 system widi the MududS se fray tk herein, as set by the Departmeat of Commmic and the Departmem of Nawml kcsouroes, State, of wiscons Mi. C=fi5ra&m stating the your sep& syMm W been mainftined nnist be completed and retumod to the St. Cro=i Conmty Zonir�rg Offic;c within 30 da of . 'Yeff explotion date.. "SIGNATURE OF APPLICANT DATE OWNER CEO IM!��410N I (we) certify that all staff ou this form am true to the best of my (mir) k_n4%V1edgc_ I (we) = (am) the owncr(s) of a vr4 by of a warran ded in Register of Deeds Office. xTA OF DATE Any infor=tion that is rnis-ccprcs�cd may msult in the sanituy pf,--.wXtb6ng revoked by the Zoning Dcpartrncat Indade wth this appUcatEoa: a stamped warranty dccd kom the Registff of Deeds office a con of the certified nwiv-y map if refe=cc is =de is the wanznty deed