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a o y ~ o o I ~ C)o I 3: C5 ti ° O bs O ~ d 4 c 0 0 0.- CC- o Y E N h. C O 2 C N ; co d O +U' N N a fl. L -p U O N N •6 ' a) 0).2 L+ C co r- d O 7 O C ! CS O y c 0 i ro E E m o c y ro rn Y a~ 1 .LO+ O C O N > O O O) j -0 0 1-- 1 OI ro U (0 E N co 2 E aa~ U2!, O a) O h m C ~ CL ° (u aCp w 6 N ~ y ro~ co N O c0 m N co D. m N N CL EL cu y O c N O ! a) L ro 0 O Z rnA N z cam ro c,«_ Crn o -j-, y - LL an o p N w c N 0 in a) C Ea =N o z 5 c~ > 6 w?co Nca 9 E4 ! ~ aox0 E a .O L N N T L N C O O 7 CV a Q N m Q a o ! Q H= 0- co I I 3 m 3 m C>O W ICI z y z E N z ; O = O L E L L O L G Z r d d N~ ~w a m a m c I o c (7 0z (D Z d c o> E c z <n t- c o E '2 CY) N O c CZ cy a) j ro a) Q y a y Q a) 2 a) N ° C o c n. cn L - :3 O m o Q Q i o N Q 1 2 Z Z z co z o N z Lo co d ! Cl) a0i c R i o R E I R E N I N al c LO L d C d N +-O„ O a .4. .L. O C ~p c(L am ~coa` am °S Z r- V Fy- Iy- F -E' ! V H N H 7 v N 0 0 0 0 a m 0 0 0 0 d co z0 •rNV ; 0 a n. a 3 a a a N ~i a aci aci z 0 U) m J L) Qp1 Z Opt ~ ° a) Z LO L N N N O -;fit L O O "C E L Cl) O M O 0 d N 'O CD Q C3S N CON Q C a) c°O 'C Q z 42 !p N Q Z U3 ro ~j N O U N C 0 U N t ►~rl CO C C O O C O E Q 0 3 1', c c o 0 0 co a^o o w a) c c a o o N~ y E E N O O C 'a N N ,rOy "t ~2 'O J C a) a) J C 75 C T Mi?5 00 75 - C O O ~ CD -0 '00 O co N Z Z cy, (D _ in v 0 C'4 • Ci E O co N O O O co (n o o O y, O N W N O N Z Z N O N F- F- (0 CC r . ' E E E L E `w `m a a . C. d .V N a C ! y a d c ~w 0 _1 A vat 0 H 0 0 in ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must GAG include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. fp !*17- C/o O d Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lott 1/4 AIJ~ 1/4 S,,70 T Q N R E (o Property Own is Mailing Address Lot # Block # Subd. Name or CSM# O City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road Sri a © s- y his / _ _ 0„30 J'`~ ` New Construction Use: [9 Residential / Number of bedrooms Code derived design /f1o(e Kate GPD ❑ Replacement ❑ Public or co cial - De cribe: Parent material mme Flood Plain elevation i apohtable ft. General comments 1-1 C and recommendations: / ~/!7 ST rx . of ti Boring # Boring F/ I V9 Ground surface elev.# ~ ✓ Pit ! ft. Depth to limiting fa for Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r y A-G 1Zl z s Boring # ❑ Boring ~1• / Pit Ground surface elev. -16- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz.z. Sh. *Eff#1 *Eff#2 r 4 Al -4 X0 -7 G -Z * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST N (Please Print) Sig re CST Number Ad re Date Evaluation Conducted Telephone Number SBD-8330 (R07/00) L Property Owner.2t!~~e /T- dGsl" 'E- Parcel ID # Page of ❑ , Boring ~j Boring # . it Ground surface elev. T ft. Depth to limiting factor ? ZZ in. Soil Application Rate [i] . P Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color qGr. S~z. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r-T ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) i Y Soil Test Plot Plan Project Name Lawrence Moore Byron Bird Jr. Address 1460 230th st Emerald Wi. 54012 \ CSTV #220527 Lot2 Subdivision Date7/2612007 CountyST. CROIX SE 1/4NE 1/4S20 T 30 N/R16 W Township Emerald E]Boring Q Well PL Property Line# Alt. BM Ioh e4 ¢r :arc-e `BM or VRP Assume Elevation 10o ft top of white stake System Elv. 92.6 H.R.P. same as BM 470' PL 200' PL B #alt BM 45, B 1 lu~a o 10' 15'B3 45' B2 98' 15' 97' 96' APPROVED 5T, CROIX COUNTY 7 7 3 2 9 I APR 12 j Fllannino 7rnfrr, AmM Perks Committee VOL 17 I ru'rt UN 2 5 2003 K ATH~aPHGEWAE 4550 J ue------ 9 REGISTER OF DEEDS ST. CROIX CO., NI k If not recorded wiihin 30 days of RECEIVED FOR RECORD p = at pmvio data approval shall be 06/25/2003 03: 30PM M cn null end void Z 2 CERTIFIED SURVEY MAP C REC FEE: 13.00 No COPY FEE: 3.00 c PAGES: 2 c? m v) 00 z m~ m ^•O m) c: co z~mTO 000 I'm 0 0 Z g Dp T z -I z z z m BEARINGS ARE REFERENCED TO THE o m o C EAST-WEST 1/4 LINE OF SECTION 20, 88N co o m z m :10 v O G) O D -n M y m ASSUMED TO BEAR N87°44'52'W -0 -t g~ -n Omci Kr- m O* U) O O c r= cn Z > m =W -i~o~ C z Q =goo to KAY c/) 1 =0p m~ °zC C morn o No n Z >o ~oC) z~z n c~ C o°~ N m w~ z p F ~m0w~ m rv O m C~~C T ~m~ G $m Rf g WA cn1~ m N=l7 m<r -A q m w - r~r r~r D 0 W >j 0 1 m m m w 00 N0 mpz 0 0 m fDl1 vj G) O 0 z -v z 0 a G7 m n m V N00037'35"W 695.39' o m 348.00 847.39 0 -0 m O cn~D> 000- C7 0 -1-p I~ mm D w I~ ~om ~C/ I o i~ c~0 oO I 0 0 ~ m 0 of M r- I~ c: c: m 1n 0~ D n T G) m 0~ jam Zv m j P C104 m V 0) I (f~°~ z A IG A N yi L/~ =r0 U) j N A v ~co~o . i~ m0 c: -n c Cn I N O pnAiOc~ O m Q Ny ~zm I Q z N w D D F ~o u, 0 I m n n Lcn o w so m o C I Xtmi) U) i cL i O--IN m P m ~ZZ nOo n ' m< MO ZIn Ox ci 055 V -0 M I.. 0rx N 31 z 3J _ I O m S mD0-1 m Z D : I +--Dom-- < zz° mm0 wo 100'N Orn I~I~~0 O~Z I ~ZD I~i I~ Tc0 D z I C. 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I ICI cS m m SST£ 21M IT rM'IOA .Woo '901Apo JOI pJ00e uMOJ 9jDudo,lddo ay} pup 901;40 6uluoZ Z 40 1 }aayS Ajuno0 x1o.10 •}S ay} loo}uoo 'Iaojod Auo 6uldolanap ,o 6ulsoyo.lnd alopq (•o}a 'Iaoaod o} SSaooo 'azls ;ol wnwiulw 'spuol}am •9•1 ) suopoln6ai puo saln-i 'smol LIO-VS IM 'Puowy0l8 MaN dlysumoi puo !}uno0 'aIDIS o} }oafgns s1 dow sly} uo umoys lao-jod ayl :310N ;aa-4S pJ~~ }SO3 601 SZc xOe '0'd 61~:b-9-VZ (S1L) 'ON auoyd 3dld N081 „l JNUl3/ 8ns 0NVI 3 :9 b OZ NOL33S :Aq p9.l0da.ld i rn '83N2JOD ~1318vno iSV3 96096 eO / cn 4 I P 0 ~ 3„61,00.00 S 21V38 Ol 03WnSSV SI HOIHM }aa; OOl = 401 L 1333 NI 31VOS n tv 'M 9l 30NV8 ''N 0£ dIHSNM01 OZ NOLL03S JO Vt 3N TIVOS OIHdVND N 3H1 30 31411 1SV3 3H1 01 030N383J38 3aV SON18V39 r~ I + ~ (.I7F'SZ -g - ii SONdI 0 311`dldNfl ON 00+ 0 r*i I .B~'L~S M - «IAOZ.L8 N 77, I r 1 'n -30=iH91bA W►L / Hl ON I aq I84s JeAOJd43i + I rn ' A, oo 1 e~ep;eno.,dde ' O,(~~l11$ pub zz i I I pepiooa, }oust I~ 1 I I I m I o z se;}nuwoa s),ed H Io I I N IN : = pue 6uluoz ,bL -S n D Nuu2id OAlsuage,dwo Z U31HVZ co i° i I $ I 1° U) AIWOO X!0l~Z 'f Stll9(100 1 m M O ll~ N I I~ 0 z ens 0 rn 1 e 0 0 _ w I o' I m CDA0~8cl'j l 130V21d9 II3M I c IW Elm Iz I~ rn to saa3y 8L'L I T3 'bS L66`82F io :M-0-8 6uipnIox3 09-JV I~ N I rn ~OI1d3S ONIISIX3 so-jov 00.8 vh 1 v 1 T3 'bS 08s,`8b2 1 w ~ w + :Daay co 1107 I OI1d3S M3N.03SOd08d / 9~ I 80-1 S31OH:1S31 1105 0 / I / I O I I I (T W I I~ T X- X I ~ ~ 1 f I I ,OL'ZZS l l i X x x-x-- I i z6L'8 T'6 6*'l29 x -x I ' 3 «ZO,OZ.L8 S I 'V/1 3N 3H1 d0 •b/1 3S 3H1 d0 ]Nn H180N 30N3j 9NIlSIX3 W I NnNl 1N]NnNOW d`d OZ N01103S SONV7 0311VIdNn 1 1 0 '83N800 iSV3Hi80N 1 •100; .10auI N a6 o F a oi aad spuno 21.1 jo wnwlulw D' i.~~.. ~~71/11 f, 111 r1111 17 1 1 11 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1- of 3 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 81/2 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 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L Jew T- GE t)u~Lz- ()Off. •1:0T S~ 1/4 NE 1/4,S Z9 30 N,R J 6 E (00 W PROPERTY OWNER .S MAILING ADDRESS LOT BLOCK # SUB O CSM L IS I y,1 Z 7- 3 0 'M• s?', - - L J CITY, STATE ZIP CODE PHONE NUMBER CITY ❑V1LLAGE TOWN NEAREST ROAD F-"SE2Phk- w 1 s q o Lz h is) Z 6 s , X13 z.S li ► h ~-b Z ',-:s S~j ST • Pq New Construction Use IM Residential / Number of bedrooms 3 [ J Addiikn to existing building E J Replacement [ J Public or commercial describe Code derived daily flow uS~ gpd Recommended design loading rate r J-'1 bed, gp(W trench, gW Absorption area required S bed, O 3-'S trench, 0- Ma)amum design loading rate 13-S bed, gpd/ft2 0' trench, Recommended infiltration surface elevation(s) 98-D ' It (as referred to site plan benchmark) Additional design/ site considerations 'Inl )\S. w k y y n 11v . I r CF S PO 1Q F t LL. Parent material S L ~`M -ovM 6 L_ C-L'h L. 11 UL Rood plain elevation, if applicable ft I S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FL HOLDING TANK U = Unsuitable for stem ❑ S L~ U ERS ❑ U ❑ S &1 U ❑ S Lou 11 S 9JU ❑ S ($U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw-day Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench , --I vo-tvz 313 - si 1 Z'FSb vv~-~-~ 'S t Z -2 1.(3`ZR 31~ - 'Sl) ZM3bin min e-S Ground 3 U-3-5 1 S `1 R- 3! y - s ~s l~lz 1~ t v ~l^ S • .S q8 $ ft y 3 S-S -SCR s f; .S'1 R S /g \j is I ow, yn T - Depth to limiting factor 3S" Remarks: Boring # o ti0 It 313 - S L, 2~ S~l~ m`F a, S . S . o s yv1 1 cS .53 3 jLJj_Sj 10`-1 R 31 6 - S$s~, - Ground elev St-83 ~_S `2 Rl6 .S yR SIg V ~s o ~n Depth ID LA) c `T~~ 4> limiting l RrdvEf~ BSI N 'i i)f lilt An ..s l Remarks: ST rpax t CST Name.-Please Print Phone: 715-42 52C1tJiNGOF>xE Arthur L. We erer IWd eg rer Soil Testing & Design Service-P.O. Box 74 River Falls, Sign e: - 4 6-- ISO 3 Date: l ~3 -c1 M0657-6 PROPERTY OWNER u( is SOIL DESCRIPTION REPORT Page Z -"f PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o_ 6 1 O `'LCt 313 - S Z S b~ ~S , S z - f<. , U -ZS tiu `l R 311, s i ) Zr+~ S bk Yn T►- C -S S • L Ground 3 ZS-(4 S 3 `21Z- 31 - `F° ,b1z 'M vJH C - .S lev. 4~ • 8 ~i 4 • g ft. y y S o ~Q~I-c ►z Vi - S gLGt^ o s9 ~ ~ Depth to limiting factor Remarks: Boring # } ~b`1(Z 313 - s t'1 Z`C-s~k +ti►~~ ~S . S . y Z 6 ~Z~ lu~-~, 2 31(~ s i I Z w, s ~h m c s S ' Ground -Z-"7-4 • S `1 IZ 3 / - s d -S ~~2 `M v `Fh C S ~l -S elev. u1--1Z `l R-V/(~ °l 3. $ ft. Depth to limiting factor i Remarks: Boring # L S F 6u S t - `rt] "iA Ground l1U G ~j elev. ft. 1 S LR 0E- ~ V &J'--n 0)1 S Depth to ~L t u L W L S limiting E) r1j C-1 U rj U 1 ~V factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: PLOT PLAN Page 3 of 3 SCALE 1"= Lf Q' i 3 ~ c*Z., gy 8 ~CI. °188 1 B,~ B.~ oo fvoT '2 1MPrt OR o►~ 1 Ct16 C4 ~ ~ 31q Z)IA 6`1 11 ~q3 zs _ J f g.2 3l' ~1.gs8 0 ~3nT, of @® ~*t q8.p I ~ v 1 i=L1ve~, Sov`nt Lj"t of 8O , - )rT LAST -Z-S' Fizopj W~l~ k 4 S or ~6-ISo-3 (715 ) 425-oi 65 1400576 CST Signature Date Signed-- - Telephone No. CST # Wisconsin a and Departinent of L 3 tabor Hum=an Relations SOIL AND SITE EVALUATION REPORT Page 1 Of Division of Safety & Buikings in accord with IL.HR 83.05, Wrs. Adm. Code COUNTY Attach complete site an on pi paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (Bluff , direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Ptw R laQ CE w - GB1-t9F S 1/4 NE .1/4,S Z3 T 3 O NR ) 6 E ( w PROPERTY OWNEFr:S MAILING ADDRESS LOT #t q*SUBD- NAME OR CSM # 1 L, 7 Z. z b o `T)) sT, - CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE 0FOWN ~NEAREST ROAD t't'l A-k-b W1 S`iotz htS)-2.6S-V3Z , 1 '1 ZPtL Ott ST. ~ , PQ New Construction Use Residential / Number of bedrooms 3 [ 1 Replacement [ ] Additi~rt b existing binikfing . Public or commercial describe Code derived d,* flow uS0 gpd Recommended design loading rate _I- gybed, gpEW j trench, gJX* Absorption area Wired 3D SS bed, ft2 '1_13finch, ft2 Mabmum design loaftrape o .S bed, gpW 0• L trends, gp * Recommended infiltration stuhace elevation(s) 0) B _'0 I It (as referred to site plan benchmark) Additional desist / slte ca>sidmaporis V"WJty;Z:~ w 8' k y g ep • Y"1 LA.. 1 ` OF S" >=t t-t_ Parent material 8 t v. T Y -ovM G t-Pye-L W L 'T1 LL Rood plaint elevation, lt applicable N -ft. i S = Suitable for system CONVENTIONAL MOUND IN-GROIAND PRESSURE AT-GRADE swrw IN FILL HOLDING TAW u= unsuitable for system 11 S ® U f~S O u ❑ S U O S Lou D S QU 0 S LUU SOIL DESCRIPTION REPORT { Boring # Horizon Depth Dominant Color Mottles' Structure in. Munsell Chu. Sz. ConL Color Texture Gr. Sz. Sh. Cow Bar ry Roots -Bed D/ft6 0=1 tio`LCZ 3t~ - s>'1 Z'Fsb~~ a-s . s . -13 Z Z~. 10 R 31 ~ ~ S t ~ Zrn S bk yvL'FI~ CS ~ S • ~ Ground 3 Zb-3S 1 • S `1 R- 3! y - s t ~s ~1z v 'fit- c S - ' y •S elev -$ft y 3S_S -SYR S!& 018 f~S`1RSIs V` s O3-r' m lr Depth b limiting i~tor S S Remarks: Boring # } 0_7 1o`1(Z 313 sL` Z,'FS~h m`FI~ a~S • S Z Z 7-qZ ~.S`t2 31 - SO Z-M 3 r4 CS . s. . ~ j Grotnd 3 tr(ZS ! o 'ltz 316 o S°f ►vt cS - € . elevR St-83 7-S `1 R V/9 -,.S `iR s>g V'Fs oti►.~ tin - , L C ~ - Depth ID LA-) fimitirg = facw N f Remarks: 1 ZS_ Nine-.-Please Print Phone: . Arthur L. We ever 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Siguorxe: Date: CST Number ` . M00576 " PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 . PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trw& j O-b Zb~tCZ 3L3 - s ' -L Sb 4'S •S • 6 " Mw". Z z s vt, i- 31 b - S t 1 -Lm sS l T rn '1't^ c -s - , S C - ' • S Ground 3 Z S-(4 S 1. 3't vz- 3/ - `FO ` 1 wl b1z M v 1y lev. 4 ft. Y y S-moo ' k tz V/ - S ~LGt~ OS-) ` Depth to limiting factor 7 7 0" i Remarks: Boring # _e 'I Z~-s~k ~-s - s ' . 0 tib`1~313 5t ky Z 6 -Z1 1,~~-~, tZ 31(~ - s i 1 Z, r~ s l~k v~ ~h cs s ~ b ~ Z~-4 ~ • S `2 fZ 3 / - s 1 c-S b~ r~ v'Fh C S - • ~ 's Ground l elev. U-8 ft. w C ' Depth to limiting factor Ll z, Remarks: Boring # Z ~LV Z fv0 S L L vim:,....... Ground &j'-no ~ S j elev. 1 S t'~ dl` - ft. W1 ' S ' X151 ~ t u ~ 1. Depth to limiting u v 1 L factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: PLOT PLAN Page 3 of 3 SCALE 1"= l f Q a 31 ,qy8 t. e,~ B.'~ ov 1voT '2[3rlPrM7- OR o*~ -W..wo.b" 1 DtSI'vR.,B 'Rf 1S P-tz,tsA . o" O tt-tGti j 1 31q, D!A ixV C e°~o 6`1 11 a~PlE/ try" . 601 B. 1 - zs • --J - F- s.z r 3l' ~Lgsa O .too, ~ m ~3oT, oF- Q2D Qg,O ~ j ~ U t l=tlve Sov`RF UAjt of g V` my j 2 t 1-0 l 8k2- PvT' C.ef~ST -?-S" Fizo ! ouwlJ , k 4 LL oC- -18 -g6 (715 ) 425-nl i;5 M00576 CST Signature Date Signed-- - Telephone No.-----_ = CST f c o y ° 2 3 °1 ° r1 eo n 3 4 cf) n O Z O N Z j Z O N 3 1 fTi N 0 "Y cu 3 N 0$ o v o o 3° `c• m w a m m w o co w Q N CD y C a z 0 N V CD m n en N Q y m N co 7 O V 07 N -4 ■S \1 C: CD C ' O O 3 CD CD :E C'a 0 -4 O O cn 0 f~l! IAN D. 7 dl CD 51 A A Si C A U) Z D a w D W a w j D C 4 a N N C c QQ N C W CL c O Q g 0 O CD =:p F3 V N C/) L N Z N C-0 z O 4 V G) CO :D N O C 000 N o 0 0 00 C7 ~ ~ ~ n < ~ z t~l v a (A t/l VJ , N co (A C D z . ~ S v o I o 00 ~ Wcr Svc o w o m j a C T 0 N 3 S o l w o 3 d CA D ; - w O z ° zca z D CD ° D D o N O Cl) s 2 7 m CO v W CD 0) 7 (D 0 to . CD C w a a S 3 Z CD CD C rn C N 'A 2 m a A z ° A W W m wo 0 CL C z o F c z m rn z y CD z CD w I w ~ , £ N C y O a Q jm3 a a ~Opp V m p.qC~ O yp c y 07 c ? N O C aB0'= z z ' c p =r a 0) a) CD a) -0 a N o C y N y 7 N O d d D o 7R mo a~ 3 ~o 7 3 - a C CU EL y~ 0~ A G -w < am(D CO o° Da,a 1a v u a o CD o~. CC m fi ~'9 =rc.'< N 0' C) CD N M. 0 m A CD o~DO o "o o o Q o ti [CD CD CO Q I b O CL G d y 25 ti ►1 Parcel 010-1047-40-175 08/24/2005 09:18 AM PAGE 1 OF 1 Alt. Parcel 20.30.16.28713-20 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JAMES & CLAUDIA THURMAN- DILTS O - DILTS, JAMES & CLAUDIA THURMAN- 1460 230TH ST GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1460 230TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 20.000 Plat: 1731-CSM 17-4550 010-03 SEC 20 T30N R16W PT SE NE CSM 17-4550 Block/Condo Bldg: LOT 01 LOT 1 (20 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-30N-16W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 07/22/2003 731511 2326/279 WD 06/25/2003 727329 17/4550 CSM 10/04/2001 658255 1732/035 AFF 10/04/2001 658254 1732/033 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/29/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 35,000 225,600 260,600 NO UNDEVELOPED G5 15.000 25,000 0 25,000 NO Totals for 2005: General Property 20.000 60,000 225,600 285,600 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 60,000 177,600 237,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 p APPROVED` ST. CROIX COUNTY 7 2 7 3 2 9 F Plannino enO Pgrks Committee AM 1 2 2M4 VOL 7 PAGE 4550 JUN 2 5 2003 KATHLEEN H. WALST ' REGISTER OF DEEDS ST. CROIX Co., VI if not recorded wnhin 30 days of RECEIVED FOR RECORD W = 400601 data Approval shall be 06/25/2003 03: 30PK U' null and void o 2 CERTIFIED SURVEY KAP N 4 N) ; REC FEE: 13.00 `O M CD COPY FEE: 3.00 o F. ° PAGES: 2 U) vv M ~ r . °M M X Oo z00mo 0o r 0 0 z cn o o T Z z z z m BEARINGS ARE REFERENCED TO THE N< o m z a) * -M v 0 v m y EAST WEST 114 LINE OF SECTION 20, °o m O,i K 0 m = K ASSUMED TO BEAR N87°44'52 W G) 1 Z Mm 0~v_~0 OC Z r~r z = m =W ~mv(n Cz O C~c) go 0 v U) K M:g 5; -0 MK (n G) C mom,,, x mD N OnT z>M r z- ~oZ 111 oz co O K0 ~ SrgT zrr Dm ~m~ C 0 F Opp C 5com a n~ N wM z ~m 111 co ~nw~i o mr~m CO) C"n MMT om v S mA ~00 M n - err m<Fn ~z 00 m -0 O~M> we " D ~czi o z 00 C M n m fr) o - ----D~ NOW37'354 W 695.39' v K m r- 348.00 347.39 o v M 0 cn MD OOpp I~ mmo~D c* 0 o I B O O M 0 o I~ p0= t I ~Cm Z c') I~ M M C7 ~cn0 m0~ M Z i 10Z m 71 CID i J m o rn j I~ >z A c') 44h g o y;~ -n N A N cn A OD m o C t o o 0 r\) 0 O m tv N y c)i Z m III z N C4 D D -1 P 50 cco NA nG)n~ M ~m m MA ❑O C4 O 0 D 0 4c I .a x U) U) v o ~1 v1 X ~p z ;i i 0 N z-4 M i~ N ~ ~ m I~° IN <cn -111--~v0-- COOw - m4 i m ~ 0Mm i Z=o zn 0X ..I.o 0 0 r-X c) ~Z5 1w ~C-) C *z I S m>z Om Drn LL--D0L7~- C.0 M MT v ; 100' I-gI0 O~Z 00 I z C I O NQ I I zz~ m-n Dz rnm to IQ w Wo. 66' -n z 0~ pi~ ..aa... ~co I onm 11 CJ I~;^u STC - 104 AS BUILT SANITARY SYSTEM REPORT'`x RICENE0 7 OWNER ~GC GJh[h C -C- ~~DD r t- Ay q 9,97 ADDRESS ST OFiOBX COLNTY Q/'Z 9 ZOININC~OPRC~ ct, 5 ~ SUBDIVISION / CSM# LOT # SECTION_T N-R_,W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM dt GcJ~■- - g INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM:y,~, SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~'LG 6Liquid Capacity: Setback from: Well House !ICa Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length ~S Number of trenches Distance & Direction to nearest prop. line: 2-~ S1- Setback from: well: y House Other ELEVATIONS Building Sewer /l7a• ST Inlet: ZO/ 31 ST outlet: PC inlet PC bottom Pump Off A Header/Manifold . K. 3/Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: 6 144~ LICENSE NUMBER:/ INSPECTOR: 3/93:jt Wisconsin Department of Industry., PRIVATE SEWAGE SYSTEM Etar~ ROIX Labpr and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name: EMI~ALD !age own of: o.: MOORE, LAWRENCE LE Insp. BM Elev.: c Parcel aX 11047-40-000 BM Desription: Elev CST BM ELEVATION DATA A9700096 TANK INFORMATION TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark Septic Dosing Aeration Bldg. Sewer St/Ht Inlet Holding TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/L WELL BLDG. Ventto ROAD Dt Inlet Airlntake ENNA Dt Bottom Septic Header / Man. Dosing Aeration Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Dist. To Well Forcemain Length Di a. H SOIL ABSORPTION SYSTEM BED / TRENCH No. Of Pits Inside Dia. Liquid Depth Width Length No. Of Trenches PIT DIMEN 1 N DIMEN I N Manu acturer: P / L BLDG WELL LAKE/STREAM LEACHING -Q 5- SETBACK SYSTEM TO CHAMBER Mo a Num er: INFORMATION Type O OR UNIT System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) I" 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 xx Depth Of xx Seeded/ Sodded xx Mulched [Depth Yes ❑ No d Bed /Trench Edges Topsoil E] Yes El No ❑ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 20.30.16.287,SE,NE 1460 230TH STREE Plan revision required? ❑ Yes ❑ No Use other side for additional information. = [=====l = cert. No. SBD-6710 (R 05/91) Date Inspector's Signature ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 5 Safety and Buildings Division r~~■~r■■,< SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. Ln accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number `,c< The information you provide may be used by other government agency programs ? ❑ Check it revision to previous application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Ow er Name Property Location Z, r ~/4 1/4, S X2e Tap , N, R~6 E (o Property Owner's Mailing Address Lot Number Block Number Cit State / Zip Code Phone Number Subdivision Name or CSM Number I~ ~e d5 O c7^L ( /3y)v , -7 zn rat < zd/j II. TYPE OF BUILDING: (check one) ❑ State Owned o City Nearest Road Village / L Public 1 or 2 Family Dwelling - No. of bedrooms Town of m zit«/ o J III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 24. + I ` 2'•] A dla ~ 1~5~7- 1 ❑ Apartment / Condo V& 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 2-10 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. 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 (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity in gallon, Total # Of Prefab. Site Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tanker mss. ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plr s Name: (Print). PlumbQr Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: PI ber's ddress (Street, City, State, Zip Code): -en spa/ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved san/t~r Permit Fee (~ncl haudesGroundwater fee) ate Issue QyC „/)ly rc pproved F1 Owner Given Initial ~~]j ( Issuing Ag t Signat a (No Sta Adverse Determination / ~(7J/ T X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Di--ion, Owner, Plumber INSTRUCTIONS - 4 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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. Onsite 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 and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 corriplete # 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 isto 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or vvith 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. GROUNDWA1rER 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 contamination investigations and establishment of standards. PLU I PLAN P.ROJECT ~e>1 ez , ADDRESS 114 p] 1141S~W ff,7e N/R/,( W TOWN ./c C UNTY -5 ~i>^oi x NIPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC~ CONVENTIONAI,~ IN-GR UND PRESSURE CONVENTIONAL LIFT_ MOUND- HO ING TANK SEPTIC TANK SIZE c-a-~ LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE ABED SIZE -22 1116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark ~'GJ H. Borehole Q Well Scale = Feet O Perc Hole System Elevation Uent 2" Grade TYPAR COVERING 2- 12" 3' 4 6' O 3l 6 Sewer Rock 12' a 751. ' / ~ a, t !c Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safiety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 3. APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location (3rGr.~f7 > L`I ® d^ Govt. Lot 1/4 ' 114,S T N,R E (o le_ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Ci State Zip Code Phone Number ❑ City ❑ Village X T wn Nearest Road ~7Q✓'it v' ~ 02 ~~d. New Construction Use: (Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow ~fJ 0 gpd Recommended design loading rate f✓ bed, gpd/ft2 ► trench, gpd/ft2 Absorption area required bed, ft2ZiD trench, ft2 Maximum design loading rate S bed, gpd/ft2-_trench, gpd/ft2 Recommended infiltration surface elevation(s) q ft (as referred to site plan benchmark) ► ~ "A Additional design/site considerations u~` o1cn Parent material /«1 ee_ ~'.r 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 system [~S ❑ U IRS ❑ U XS ❑ U J;zr S ❑ U ❑ S ~XU ❑ S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground' elev. Depth to limiting factgr S~ Remarks: Boring # f _ y d 'law Ile ~Z- oer 'V~ love 3111- L Ground elev /(V* 0 ft-. Dep` pth to limiting factor Remarks: t`''c9 dirt, CST Name lease Print) ature Telephone No. d Address = Date CST Number_ 7 c ~ ~ fir,- - , ~ PROPERTY OWNERSOIL DESCRIPTION REPORT Page of , PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots ~ Bed ,Trench Ground Depth to limiting factor AgLin. i Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor 'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Soil Test Plot Plan Project Name Byron Bird Jr. Address IY79 .gym er-®~ CS #3479 Lot = Subdivision Date/` 1 /4 1 /4SAT ~ N/RZ4L, W Township Boring 0 Well PL Property Line County ~f BM or VRP Assume Elevation 100 ft. System Elevation G~ 67 *HRP )roe- e- )2r Lt • r ~ YC •lot r 'J1 ,ice / ZP V i Scale 1/4" = 10 Ft. When Dimensions aren't stated 8 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 La oo rev`(-4-- b ' Y'VI O° rte-" Location of property~~l/461/4 , Section _)6_, T30 N-R__I(_W Township e►vl e.-ex. A Mailing address Jtl 7a Q 3d Address of sit Q .2L0 E' Subdivision name Lot no. Other homes on property? Yes No Previous owner of property ~q-vnE Total size of property ~Q Total size of parcel ZQ- Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume-s? 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 deed recorded in the office of the County Register of Deeds as Document No. C g , and 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 ~a construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Sig ature of Applic nt Co-Applicant a~ )q? 7 to of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L tLkl~CvlG'~ Moo r-e MAILING ADDRESS c;1 3 0 S f . PROPERTY ADDRESS w'i` S- (location of septic system) Please obtain from the Planning Dept. CITY/STATE O oZ 3 0 PROPERTY LOCATION J 1/4, { y 1/4, Section d T N-R_Z_6W TOWN OF L. yAw, t j ST. CROIX COUNTY, WI SUBDIVISION T M1 ER CERTIFIED SURVEY MAP , VOLUME2, PAGE ~rj 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 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 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 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 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three ye piration date. & SIGNED: , 0_&~ DATE: l St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • DOCUMENT NO t STATE BAR OR WISCONSIN FORM 2 FACE WARRAUTY DEPD J - VOL 599 31 NV THIS SPACE RESERVED FOR RICORDI.IG OlkTA Mary-- E : Moore a widow REGISTERS OFFK2 ST. '%.'RnIX CO., WtS, R86J. for Reoord conveys and warrants to .....Lawrence D, Moore and 1~Iania dpy of~,„}T,,_;t. A.D. 19 9 Moclrp,..hu.~baztd..alad._~rie.--.a---J.a xi _.1<enrits------ at the following described real estate in ...__$t . CroiX State of Wisconsin: ------•.......................County, Tax Hey No........... The South half of Northeast (SkNEk), Thirt - Section Twenty (20), Township' y (30), :Range Sixteen (16), St. Croix County, Wisconsin. SF s a:o~ EE3J This i-s homestead property. tli~lXQC 166 Exception to warranties: Subject to municipal and zoning ordinances and recorded easements and restrictions of record, if any. 711 Dated this 7-..----- a as ~ - - day of - - (SEAL) ,.~1--•- - ` - (SEAL) Mar E. Moore (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN Polk as. County. Per onal a before me, this 7th Augus day of , rIa ° E ' the above named MEMBER STATE BAR OF WISCONSIN ore-,...a w - doW (If not . autaorized by § 706.06, Wis. Stats.) 9r THIS INSTRUMENT WAS ORAFTEC BY j to me known to ;-tr ~'per=o who executed the Rnrt Tl 'oreseiTis~il~trlir,,., a,Z;_Y Wobor c Department of Industry, PRIVATE SEWAGE SYSTEM County: L@bgr andU-I uman Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 284238 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MOORE LAWRENCE EMERALD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 010-1047-40-000 TANK INFORMATION ELEVATION DATA A9700001 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration F-T NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift F riction System TDH Ft Loss Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMENSION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mo a Num er: System: OR UNIT DISTRIBUTION SYSTEM Header / Mani old 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 20.30.16.287 SE NE 230TH STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: + illi E ■ Safety o and Building Water Division, Systems r■■'~i SANITARY PERMIT APPLICATION Bureau 201 E-Wash IngtonAve. In accord with ILHR 83.05, Wis. Adm. Code P_•_ Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number a gj038' The information you provide may be used by other government agency programs ❑ Check it revision to previous application ]Privacy Law, s. 15.04 (1) (m)]. State Plan I.D_ Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S w 001 Pr perty Owner Name Property Location VJ Oa S F 1/4 N 1/4, S a,p T :S 6 , N, R E (or)~ Property Owner's Mailing Address Lot Number T lock Number O } City, State Zip Code Phone Number Subdivision Name or CSM Number rSY0I (7 IS > ahs- II. TYPE F BUILDING: (check one) E] State Owned El City Nearest Road E] VII age ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF wf, Ct 3d S III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 010- 1041 - C12 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. S New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 gl*ourld 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. 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 (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevatio 7 sO 3-Z S' /43-49 Feet oS,~ t` Feet TANK Cap cit VII- FORMATION in 9 llons Total # of Prefab. site Fiber- Exper. Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank AdO 1000 W ecY~s ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber Ica 01D We_cCs e_ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. mber's NLap-te: (Print) PIulTer'sSignature: ( Stamps) MNo.: Business Phone Number: Pludber's Addrg ss (Street, City, State, Zip Code): 00q CP &PA,4", ,Sn~_" /9 M P_r c cJ S-"/o0 IX. CO NTY / DEPARTMENT USE ONLY ❑ Disapproved Sagi~Part FeP (Includes Groundwater Date Issue Issuing Age Signat OS mps) Surcharge Fee) pproved ❑ Owner Given initial ,:R j;80 ~'7 Adverse Determination OvCJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divi-ion, Owner, Plumber INSTRUCTIONS ' J 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. Onsite 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 and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 contamination investigations and establishment of standards. J SAFETY & BUILDINGS DIVISION v State of Wisconsin Department of Industry, Labor and Human Relations January 9, 1997 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S97-40014 FEE RECEIVED: 180.00 MOORE, LAWRENCE SE,NE,20,0,16W TOWN OF EMERALD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, 10 04 p Gerard M. m RECEIVED Plan Reviewer ~~N 1 5 ~9~~ Section of Private Sewage (608) 785-9348 ST CFOX ti SHDA-799718. 10/841 009 .-o A. Page of 6 t MOUND SYSTEM RECE~~ED FOR 14 ~l 1997 A 3 BEDROOM RESIDENCE BOGS. DIV LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION ZO ,T30 N, R l~ W, TOWN OF 1=1'1 ~ N t_t) , S1 CtZplx COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR TS Sp,GE SYSTEM t ~l~ Z Z 3 o 'm S -r. n t g yS.R~B~Ns PREPARED BY WEGEF:ZEF~Z SQ I L TEST I NG e'~,s ~`!c'±C sI ~9 AND. DES = Ct~! SlE=tom`! I CE xis P.O. BOX 74 421 K. KAIK ST. E~ A;)THI it 47 c:.'cH } RIVER FfiM. VI 54022 ® .41 8 c-:av 715-425-0165 E Ls:-r rTH, °4°HHN° se~~`a S I G~ mmoo a~--0 6 JOB NO. PLOT PLAN Page -z-of 6 Scale 1"= L10 RECEIVED JAN - 8 1997 SAFETY & BLDGS. DIV. ~wT . w~u1"o aE t~T L~f1sT So' ~=,Zar~i w~o~~~ Z ~ 8.3 a~T•O~ ~ ~ ~ ' y~ 801 '0 a 69 CC q93 WP of 8"tti6tf~ i 31V %I R, Ave-Pi Pk y g'or-z" pv c 11 /r, I V! o t~oT -I P 6 eT OR 1S1tiRl~ Ott t s ~-~t~lq q-~ o 031 i Q ~oo`~ N 3.~ x 6.2 LLL466 qS- 5 f i _ SouTvV L~N~ 80 h~ . Q e~L . NOTES: •l. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (_Y_ required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be 10oOIbsO gallon capacity manufactured by M i ~►~esT~~y PA-tkM-"r c~ow~t~~ti1 ~n0~ t~k 5. Bench Mark S oU 6. Divert surface water around system to. prevent-.ponding at the uphill side. RECEIVED Page of 6 JA N - 8 1997 SAFETY & BLDGS. DIV. Approved Synthetic Covering Distribution Pipe Frs--+1 C. 3; Medium Sand Topsoil F Elev. 1 O Z. O ` 3 E " b g % Slope Bed Of i„- 2 !2 (Force Main Plowed Aggregate From Pump Layer D \.O Ft. E Ft. Cross Section of A Mound System Using A Bed For The Absorption Area F 0~8_ Ft. G N. Z) Ft. A B Ft. H I- s Ft. Linear Loading Rate=q.S7 GPD/LN FT B y1 Ft. Design Loading Rate= o.y GPD/SQ FT j ~ 6 Ft. -7 Ft. K 1 1 Ft. L 6q Ft. -of W 3 I Ft. .F-ere-e- 1al-m- L Observation Pipe ~Jl PA 109 A -t ----------------------~I7F Force Main W 'T „ opPpst ®vb Distribution Bed Of 2 - 2 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area R'ECEI Page 10f QED JA A1 Perforated Pipe Detail `SAFETY 8 1997 B~ pis DIV. /0 End View Perforated End Cop PVC Pipe Install permanent'marker 1. \ el at end of each lateral vs Holes Located On Bottom, Are Equally Spaced Q S i PVC Force Main P PVC Manifold Pipe 4 Oistri ution Pipe Lost Hole Should Be Next To End Cop 1 End Cap /J P ZZ Ft. Distribution Pipe Layout $ 4 Ft. X LLb Inches Y LI8 Inches Hole Diameter 'fY Inch Lateral Inch(es) Manifold Z Inches Force Main Z- Inches # of holes/pipe b Invert Elevation of Laterals N01-SR. b~Xl.L1 =1.02 X~(_ Z~,U GPM Place 1st hole 7-yttfrom center of manifold with succeeding holes at 14e intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOMS ' PAGE 5 OF 6 + VEAJT CAP WEATHER PROOF ED JuLICTIOW box RF P Q 199 'i"C.I. VENT PIPE ~ APPROVED LOCKIRJG * 10' FROM DOOR. MIl1JHOLE COVER wIV .1 s D1v' •.JIUDOW OR FRESH 2 wA(tfJ11J''. L.P.gEL. $PF~r~ & g1.OG ~IUTAKE c amjDuir . ~ r' Mlu. ~t l0 I ~ crtA I - 1 ~ Ie'r+IU. IB•Mw. lh PROVIDE I NUL_ET _ AIRTIGHT SEAL I III I III *~iaF~~~S A ) I I APPROVED JOIIJT: APPROVED JOINT I 111 W/C.I. PIPE~ID' W/C.I. PIPEOR Tank construction I 11 ALARM shall comply with -I II ILHR 183.15 and 33.20 d I I I I Ow C I I 93 83 I CLCV. f L PUMP OFF r D COMCRETE 5LOCK r=L. Q3.oo ~3" APPRot RISER EXIT PERMITTED OIJLy IF TAWK MANUFACTURIi-K HAS SUCH APPROVAL. gEppING SPECIFICATIOIJS SEPTIC f DOSE S 1~Dw~S N t~T ST IJUMDER OF DOSES: PER DAy TAKIK MANUFACTURER: TANK SIZE: ZD~b ` 6 S GALLOWS DOSE VOLUME t S S`jSTIEMS INCLUDING OACKFLOW% GALLONS ALARM MAIJUFACTURC.R: MODEL DUMBER- ~A~ CAPACITIES: A= INCHES OR 30'6 GALLOIJS SWITCH TAPE: INCHES OR 3 ~ G~ LLOIJS PUMP !'IAMUFACTURER' G~ou~'ns X1 Ps' 1tiC. C= $ IUCHES OR 13 6 GALLONS MODEL EIUMBER: 38~ D- 10 INCHES OR V`l0 GALLONS MOTE: PUMP AMD ALAFLM ARE TO 5L b SWITCH TYPE: _ Z~•O~ INSTALLED ON SEPARATE CIRCUITS MIIJIMUM DISCHARGE RATE ~.-GPM VERTICAL DIFFERENCE DETWEEAJ PUMP OFF AUD_DISTRIBUTION PIPE.. S'6_1 FEET 2.5 o FEET t MIIJIMUM IJETWORK SUPPLY PRESSURE I`ts FEET OF FORCE mim x ~'b1 F~of,FKICTIOU FACTOR. O'~Z FEET TOTAL OtJIJAMIC HEAD = " 89 FEET Pump chamber DIAMETER 3 8" - INTERAIAL DIMEW6i01J f OF TAWK: LEkICvTN -,WIDTH 4LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = k-1 GAL/INCH P~Giz- (c) o~ b • Submersible MODEL: 3871 RED-EiVED SIZE. 3/4 SOLIDS Effluent Pum f l4N _ RPM:1550 t 8 1997 HP: 0.4 SAFETY & BLDGS. DIV. METERS FEET I 8 25 7 G 6 20 V i 5 15 a Z C 4- Il.6q _j 0 3 10 F- z$• o g 2 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY [QGOULDS PUNS. INC. sa IA FALS PEW YM ame - p Effective October. I= O 1988 Goulds Pumps, kr- SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRIMED IN U.SA. Wmcopsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety 8 Buildrgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but LK not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L, FEW f2 Q-K~ Cvi M p 0 TL GG%q. In 'S$ 1/4 N$ 1/4,SZO T N,R 16 E (o W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. R CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE 9FOWN EST ROAD mMfNVb k,j 5q',1Z n1-5 2-6S- it 3z8 qt_Q Z3O `1 ST. [ New Construction Use D4 Residential / Number of bedrooms 3 Addition to existing building l l Replacemen-- [ I Public or commercial describe Code derived dairy flow qSb gpd Recommended design loading rate o • bed, gp02 trench, gpolft2 Absorption area required 3-IS bed, ft2 ~1S trench, ft2 Maximum design loading rate o - S bed, gpolft2 0 • b trench, gpdMt2 Recommended infiltration surface elevation(s) 1 O 2. O ft (as referred to site plan benchmark) Additional design /sit- considerations t'lov~r.>O KJ 'x (4 j3 r- W j . 1 ~ i= S(1~U FF-c t_c. _ Parent material S L t_Yy 0 U G Lt~C,~ pfl, %T'uL L Rood plain elevation, if applicable 1y • A . It i S = Suitable for system COWRMONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑ S RIU atS ❑ U ❑ S ®U ❑ S ®U ❑ S [O U ❑ S Oil SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots Bed rer>ch r in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 ~ 0-9 3/~ s~ I i, sb mph ~s •s <a 2-Z.8 S `i 2 3f y _ S t W1 F(~ CS _ S Zm sbkt Ground 3 Z8 3$ -'s ~1 f l- s I S ~k ~ U'F~ C S ' y • S 01 t~iL 4 3$-'L 3t l see sus L © - Depth to eo►~ N o t= st°r.~~ - v v I limiting factor 38" Remarks: Boring # - • S .1, o-~ ~u`lR 312 - Std Z`FS~k Y~~►- a.S 13 " Ground 3 ~-6 b S `-t dZ 3L F l y fz S / L 01" N1 1J, elev. 92.5 ft Rl'y Depth to limiting factor ` ST CR X 1 Remarks: T Narne:-Please Print Phone: Arthur L. W e e r e r 715-4 2 5-` 6 dress: - egerer Soi Testing & Design Service-P.O. Box 74 River Falls WI Signature: Date: CST Number:_ 96-Vso L~-26 --i ao576 r PROPERTYOWNER '~"10~ -E3 SOIL DESCRIPTION REPORT Page= of 3 PARCEL I.D. # De th Dominant Color Mottles Structure Roots GPD/ft Boring # rHorizon p Texture Consistence Boundary in. MunselI Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench xw-t1 Z- 3/~J S Z'FSbk m~~- 0-5 - , S .6 8-3Z Lodz S Ground 3Z.-S3 S `ZR 31 ~•S `f R- S!3 v elev. pvr~ \Z 0 ft. Cc> >v S L ° 01- S Depth to limiting factor 3 ` Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # I L.Ground ' elev. ft. Depth to limiting factor Remarks: Boring # i .4.. i Ground elev. ft. Depth to limiting factor Remarks: r PLOT PLAN Page 3 of 3 SCALE 1"= 140 ' w~u1~ dF h~T ~~f1sT So' F►~.tir~ v~ovuD. o s & b9 LL q13 k~ ~v 8~) - L'i - lU0•~ O1v Toi- of 8"htl6o) bq~ r1 31V PnPF ~ ~n ~ w/ Lam. ~ h t)o K4r Cd1MPR(!T OR ,-x-- R-1' O a.i x ~,z `N1 L-L 4 6 6 q S_ tit. Q_) S ~i! t=~vc~ sow l,lni i o~ 8D Re. ~rt~ct~L 715 ) 4 23 - 01 6 S M00 5 7 6 CSTSignature Date Signed Telephone No. - CST # • LLaab~orandRp~anReiatO Industry, SOIL AND SITE EVALUATION REPORT PageI of 3 Division of Safety 3 Buuirip in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must indite, but not limited to vertical and horizontal reference point (134, direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L Nw R Q-K ~ `1`'100 R t?, AT. SE 1/41.1$ t/4,S7Z T 30 NR 16 E(OCW PROPERTY OWNER•:S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Zq_l Z Z3D Ti+. Sr. - - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®fOWN NEAREST ROAD M MNk-b w ] Sgo1Z t-i -2- 6S- LL 3Z8 - Z3o `Tw sr. P j New Construction Use bQ Residential / Number of bedrooms 3 [ ] A" to wdsfing building I 1 Replacement [ ] public or commercial describe Code derived daily flow qSb gpd Recommended design loading rate o ~bed, gpolft2 trench, gpd*2 Absorption area required 1-15 bed, tt2 3_1_3 trend,, ft2•' Ma)dmum design loading rate o - -S bed, gRW 0.6 trench, gpoltt2 Recommended infiltration surface elevation(s) 1 O Z . O ft (as referred to site plan benchrnark) Additional design / site considerations; t'1ovt.~0 w/$ u B r~ Nv . l ` G t= S'D Fct_~ Parent material S t U j 0 U k3_it Flood plain elevation, if applicable 1y • A . tt S = Suitable for system www"AL MOUND W-GROMID PRESSURE AT-GRADE SYSTEM W FLL HOLDING TANK U= Unsuitable for system ❑ s Il u 0S ❑ U ❑ S ®U ❑ s O U ❑ s MU ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft i Boring # Horizon Texture Consistence BDxd3y Roots Bed rErrtt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. o - 9 ] o `i Iz 3 i c~ -s i l Z s b ~ cS - • s - ~ a Z q-z.S s ~r 2 Sty s i 1 Z>ru sbk~ >n cS - • s • l~ Ground 3 Z$ 3$ -1-S `1 R- )IV s I 1 S '6k vr► \AF c S • 4 . S °t 6 ,fort y 38-5 ~ S `t IZ 3 l ~ l-~ S `-t s/8 L O~ I' - Depth to Z6_ja~_j n~ G 0 0 t= 3ty~\ - v g v ) limiting factor 3Pi" Remarks: Boring# o-~ 1p~-y 312 _ S~) Z`FS~k w1 ~F- a.s L Z Z 8-u2-S`lfZ31 1s,6►,. s3 -zMab - ~s s ~ Groud 3 14" S i v- L- F ` y II: S/6 elev. cii sa Depth ID limiting ~zy Remarks: TNnme:-Please Print Arthur L. We erer Phone: - -425-0165 715 egerer- _SoTesting & Design Service-P.O. Box 74 River Fa11s,WI 54022 Sgmmftxe Date: y -CST Number Lit C _VS -MO-0 5 1.6 PROPERTYOWNER 'f"1Ot,tQ SOIL DESCRIPTION REPORT • Page Z- of 3 PARCEL I.D. # " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence jElourxlary Roots Bed GPD/ft Treridt In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. <v - s ' z s bk m S Z 8-3Z LO`2IZ ~l6 - Ground 3 3z_53 S `Z R- 31 n•S kfZ S/e elev. ~ooft. C_pty ~vs L 16ti ° s Depth to limiting f factor 3 Remarks: Boring # mp• Ground elev. " ft. Depth to limiting factor ; Remarks: Boring # Ground t elev. ; ft. Depth to limiting factor L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: - • PLOT PLAN Page 3 of 3 SCALE 1"= top ' W ek- M)itF N-T L-" s T S(3' btu M y 1 ou>JD • S J J 0 e69 31(1 Pv~ PtP~ % % ~o )JOT CO)-PRCT OR ISI~►~Zp 1~} l s A-R~lq ~ q~ ° - O X B.Z 46 6 qs_ ~a~ s ~v I -rt I Fev_ c$ soffit l-iNE op e D h e. J IP eeL q&- IS() -2 715 ) 425-0165 140.9576 CST Signature Date Signed - Telephone No. CST #