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HomeMy WebLinkAbout018-1006-30-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT r Co OWNER .7oli rl ~Q r~ /1 ADDRESS a s y z~ ` c~P'• ! J t a , y SUBDIVISION / CSM i ' ' Y SECTION T N-R W, Town of m M d ST. CROIX COUNTY,. WISCONSIN PLAN. VIEW . SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . G V ~ O 'A e INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. * l "BENCHMARK: ALTERNATE BM: :SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: /~i, doves ~rY~ Liquid Capacity: Setback from: Well 5-1 --T House C ~ Other Pump: Manufacturer ;Model# Size Float seperation` Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length ;~;S Number of trenches 2 Distance & Direction to nearest prop, line: ~o~s7L- Setback from: well: let-10 House -7a Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ~T PLUMBER ON JOB: LICENSE NUMBER! /~;v; 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Saft:~ty and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299112 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: DALTON, JOHN HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 9a,7 Gl, 77 r 018-1006-30-100 TANK INFORMATION ELEVATION DATA 0--x1 ~I TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q 7 -,2 00 t- Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 9a, g/ TANK SETBACK INFORMATION St/Ht Outlet ,i-7 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom go Dosing NA Header/ Man. '717 S' 9.21u, Aeration NA Dist. Pipe 9, A L/ I 893• q -oz, Holding Bot. System ~-7 PUMP/ SIPHON INFORMATION Final Grade Manufacturer -Dowancl Model Number GPM TDH Lift F ' on System TDH Ft COSS mead Force Length Dia. f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width a Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS '7 J_ DIMEN I N LEACHING Manufacturer: SYSTEM TO P/ L BLDG WELL LAKE /STREAM SETBACK INFORMATION Type O CHAMBER Moe Number: System: ~Ll~~ o~~' 7l Ur OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over L Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges g d Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. LOCATION: HAMMOND 3.29.17,SW,SWQ 1810 110TH AVENUE LOT 1 Plan revision required? ❑ Yes O~r/No Use other side for additional information. y 7uUi 6 SBD-6710(R 05/91) Date sp tt ignature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Y Ave sion SANITARY PERMIT APPLICATION 201eE.Washington and Buildings Vhconsin P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. ~'TG-tea r" • See reverse side for instructions for completing this application State Sanitary Permit Number a19110L, The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Pr ~Qerty Local ~4 S 3 T 2 , N, R17 E (orf~j ) N D Property Owner's ailing Address Lot Number Block Number 49 7~x pe City, State Zip Code Phone Number Subdivision Name or CSM Number Ae4- 'd 2339 111. E F BUILDING: (check one) ❑ State Owned o City Barest Road L Public 1 or 2 Family Dwellin - No. of bedrooms O ToVill wn OF e 7"X 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 211"). r? 1 ❑ Apartment/ Condo 0/S- lljGG'30 -140 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. jZ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of , 5. ❑ Repair of an ------System System Tank Only Existing System ExlstlngSystem B) (g A Sanitary Permit was previously issued. Permit Number Date Issued P-6--96 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12ja 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) gl -Z- Elevation A110- f1p, 12- Feet fy''Z' Feet VII. TANK Ca in gaccallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ,droi eo, y R ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: d y.. A* Plumber's A( dress (Street, City, State, Zip Code): _.3cccrl, A IX. COUNTY/ DEPARTMENT USE ONLY - A ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued issuing Agent Signature (No Stamps) Approved I ❑ Owner Given Initial ~ v~ Surcharge Fee) Adverse Determination c~ IA~4_9t X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y ~ x 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, 608-266-3151. 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 online 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. Fil 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 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 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 bcxes; 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. s a~ G G ~ . a3 G S f C ~ ~v e1~ ~Y`~O r 4 i Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of 3 Divisions Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code 1 t Attach complete site plan on paper nor*refe;qncQ*int x 11 inches in sire. Plan must County include, but not limited to: vertical and (BM)„ d'iiection and percent slope, scale or dimensions, ndistance tP nearest road. Parcel I.D. # APPLICANT INFORMATION - t.'41.fin ation. ed bDate Personal information you provide may be us mrPnvacy L.4, s. 1 .lM (1) (m)). Property Owner ~RltfvCIC Property Location Govt. Lot S ~j 114g6j 1/4,S % To? -~f N,R E (or~ L/7 Aj Property Owner's Mailing Address Z ` Lot # Block# Subd. Name or CSM# I1 f o eel 9m city State Zip Code Phone Number ❑ City ❑ Village K Town Nearest Road I r r /s S 7`26',1 /i Q2 ,U 6 !r r✓/ { A& 09 New Construction Use: ® Residential/ Number of bedrooms 92)~Py 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow X56 gpd Recommended design loading rate , -67 bed, gpd/ft2_A~ trench, gpd/ft2 Absorption area required y00 bed, ft2 trench, ft2 Maximum design loading rate 5 bed, gpd/ft2,_~trench, gpd/ft2 Recommended infiltration surface elevation(s) 0;2 -O e.6~1VI 2 57, 4. 2 ft (as referred to site plan benchmark) Additional design/site considerations Parent material S w~LaJa- 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 S0 U S❑ U ®S ❑ U 1)4S ❑ U ❑ S MU ❑ S K U 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 l 0 42 fed 11 t 2 4AaAA Aff)- 47 , S S G .2 of, .2 a-32 d S'% JlhSbll r cS r'~ Ground 5: XIA' a elev. Y!'I C r r t• Depth to limiting factor Remarks: Boring # -12- C Ground elev. Depth to limiting f ctor ~in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number ZD Sow ~1 ~ilF ~27~q 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color / Gr. Sz. Sh. Bed . Trench Ground 391Y 7$k-A S 3M E-~- . 5- elev. Depth to limiting facto ' in. Remarks: Boring # / 0 -rD ~ l adl( c ~ 2!~ ~ ~ ; Ground elev. ft. Depth to limiting factor 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 # 6,-12 /6 a Z 2jna6A ,S 12-3 y S I ! ~b AdCd c g Y :t 5-- 3 -q ~ S YlG ~ F S G ~ r, c s^~ Ground elev. Depth to limiting factor 710-in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Pel3 Of 3 T"a,J 7' r 1 z~euj 1,00,,J 00? T~~, p e E,C t 9l D ~o w s c s ,'rte r ~p ~ 3 , h rb3 v` ~j i j J I v I o~ ~r ~3' ~ Kati 711 e i , f U -564-503 CERTIFIED SURVEY MAP Located in part of the Southwest Quarter of the Southwest Quarter of Section 3, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: John Dalton 1794 110th Avenue Hammond, WI 54015 Drafted by. Kristi A. Eylandt 1 FILED 2 "012 7 1997 ► TOTAL AREA LOT KATHLEMH WAI, 3 49,970 SO. FT ftisterot deeds SIL 1.15 ACRES Cro&Co.,YN AREA EXCLUDING R.O. W.: 43,700 SO. FT. 1.00 ACRES UNPLATTED LANDS OF OWNER S 8859609" E 380.00' 100.00, i 190.00, 1 l i TOTAL ARC: a/ 2 z Z j WELL o f 49,970 SO. FT. y iz o o I 1.15 ACRES c I-o ~0 1> d o ; AREA EXCLUDp R O W: 10 jDr Io.ir-i* CA rv HOUSE 43,700 SO. FT. c~ l I Iv ; w = iv o o Iv w 1.00 ACRES CA I ow I I IZ m 0 . 0 p Im ID ~ 10 I' LOT 1 N I LOT 2 0Ni ► w w W i w CA o 0 0 1 R. 0. W. w W p 1 ° o 110th Ave 0 SOUTH 114 CORNER g SEC. 3-29-17 -N 190_00, 190_00' - (FND 1" P.) S 454 899 -E ,i ----S 88'59'09" E 380.00' cN - - - _ v 190.00- - - ~ ~ 190.00' 110th Ave c~"' 88-59-09- W 380.00' , S 8859 09M E 2646.0_8'---_--_--- G r SOUTHWEST CORNER 110 t_h A V E -N U E R. O. W 110th Ave / SEC. 3-29-17 SOUTH LINE OF THE SOUTHWEST 114 OF SECTION 3 (CONCRETE NAIL) UNPLATTED LANDS ~gG NS • RONALD F. JOHNSON S-1186 NOTE: The parcel(s) shown on this map is/are subject to State, County and A WES Y. Township laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. < Croix County Zoning Office and the appropriate Town Board for advice. 9,y S U R •~~~~~s~siw >e LEGEND Jb- County Section Corner Monument I S T C - 100 This application form is to be completed in full and signed by the only result in pdelays y felhede pet d iAny will development be intended for Should this house resale by owner/contractor, (Spec then a second form should be retained and completed when the property is sold and submitted to this office with appropriate deed recording the Owner of property e A r2 1 Location of property ~'c~ 1 4 ~ o / .1~ 1/4, Section _3, T o2,1 N-R Township ~'✓a,,,,rt -.~W Mailing address r7je 66 or 1111.1hill 95 1141 _0 a- S Address of site 0 7X n Subdivision name fie, 3`~ Lot no . / other homes on - property? Yes No - Previous owner of property Total size of property 'if Total size of parcel Date parcel was created Are all corners and lot lines identifiable? -X- Is this property being developed for (spec house) ? --2(-Yes No Volume and Page N umber _ of Deeds. 5 3 as recorded with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DO NUMBER AND THE SEAL OF THE REGISTER~OFT DEEDS R, VOLUME AND PAGE certified survey, if available, would be helpful so asdtol avoid In adf delays of the reviewin d references to a Certified Survey ss. If the deed description shall also be required. Maps the Certified Survey Map I PROPERTY OWNER CERTIFICATION (we) certify that all statements on this form are true to the best of my (our) knowledge that I property described in this (we) am (are) the owner(s) of the warrant information form, by virtue of a y deed recorded in the office of the County Register of Deeds as Document No. own the proposed site for the s ewage disposal tsystem) orresent ) obtained an easement, to run the above described pro, for I (we) construction of said system, and the same has been dulyrrecordedtin the office of the County Register of Deeds as Document No. Sof Applicant Co-Applicant Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER .~o~•~l'~?'o-c~` MAILING ADDRESS <7 Q jr- ldO n d e 4 • 41'e15 PROPERTY ADDRESS 1710 / l o T`i or , -e ms , z~ C 4J~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION -5a) 1/4, 1/4, Section--? T_~ _N-R_,L-2- _W TOWN OF~j,2 s-►z ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME /o , PAGE 33 3 $LOT NUMBER l Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ~ M ? ~ ~ ~ ~ ~ F DOCUMENT NO. VOL 348 P cE454 This Indenture, Made by Walter G. Knipfel and Janie Knipf el, his wife, and Whilma lrAI1_ 10 eaAtA grantor_ g of Hennepin County, W fir, here y conveys and warrants to John J. Dalton and Carolyn G. Dalton-, hus an and wi a as __~_int tenants _ _ grantee __6 of Washington County, wfaia*Mxtln for the sum of One_-..Do.llar-_.C$l..Q9_)__m-id___other__&ood and v l bl P_nonsiderat~hon the following tract of land in St. Croix _ County, State of Wisconsin; two-thirds (2/3) interest in the Southwest Quarter of Section Three (3); East one-half of the South-east Quarter of Section Four (4) all in Township 29 North, Range 17 West, subject to public highway and pole line easements. l - IN WITNESS WHEREOF9 the said grantor ~4ha whereunto set t1i_hand 8 and seal S this 26th day of Ate r i 1 , A. D., 19..~ . ~ SIGNED A SE 7.L, I ESENCE OF • (SEAL) Wal ter G fe - - -~i- - .(SEAL) Hugh F. Gavin Janie Knipfel (SEAL) Wilma H. Eskell ~I a ~r r ~s Wiscpnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor.jind Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268557 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: DALTON, JOHN HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 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 TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N LEACHING Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK INFORMATION TypeO CHAMBER Model Number: OR UNIT System: DISTRIBUTION SYSTEM [Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hammond.3.29.17W, S, SW, 110th Avenue 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 SANITARY PERMIT NUMBER: Safety and Buildings Division ~~■~i~R SANITARY PERMIT APPLICATION Bureau of Building Water System., 201 E. Washington Ave. In 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 ~11 than 8 112 x 11 inches in size. S / L711~"Ol • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check i revision previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Proper Owner Name Prop rty Location L 15 sW 1/4, S T , N, R 1 E (or) Property Owner's Mailing Address Lot Number Number City, State Zip Code Pone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms jilTown OF A /l CZ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ® ! ©O G ~3 0 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. WT 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 ❑ 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 S. Perc. Rate 6_ System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ~ 7l rF et gO - eAa, VII. TANK Ca in a city Total # of Prefab. Site Fiber Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks r Septic Tank or Holding Tank t (0®a ( {,(J ❑ ❑ ❑ ❑ ❑ 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. Plumber's Name: (Print) Plumber's Signature: ( Stamps) MP/MPRSW No.: Business Phone Number: r L Plumber's dress (Street, City, State, Zip Co IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanita~ Permit Fee (Includes Groundwater ate ssue u ng Agent Signature (No Stamps Approved F1 Owner Given Initial Surcharge fee) [/YJ/ A~yl dverse Determination 11 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 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 system=_ 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 ~:oncerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and 3uildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's n,=me and mailing address. Provide the legal description and parcel tax number(s) of where the system isto be instz 'ed. II. Type of building being served. Check only one and comalete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If bui ding type is public, check all appropriate boxes that apply. IV. Type of permit. Ch:ck only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Ch (:k appropriate box depending on system type. VI. Absorption system -,formation. Provide all information, requested for numbers 1 through -7. VII. Tank information. II in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's nar indicate prefab or site constructed and tank material. Complete for all s:: ptic, pump/siphon and holding tanks for 0 s system- Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility state rent. Installing plumber is to fill in name, license number with appropriate pre,-'ix (e.g. MP, etc.), address and phone )umber. Plumber must: sign application form. IX. County / Deparime Use Only. X. County/ Departme . Use Only. Co! crlete puns 3n: ~ifl(ations not smaller t ,an 8 1/2 x 11 inci.c-s n:r .t be submitted to-' ~ e + ~..!nty. The plans must n,~u_!e "he fc,!' w, s,) olot plan, dravA,, :gale or- with comf tF> d.~~er,sions io(;).IoW )f :-:ding tank(s), septic -sr P Idl` f el is , Wad . "52 J:. ~i. cS, pufnp or s'phon r;u..~~s. ...I 65,.o-ption > epIa.er J _as rl tf;e building served. _ 21 )u r , ,C; co e-trols; dose volume; n r•_ dancer el anc' C3) ; r t>s section ]t)sOYptlc :.~•il i' .-~u t i.' )unty; C, i _3C n 3 r" zing Information. C„ROUNDWATI:R SURCHARGE 1983 Wisconsin Act 410 i )cluded the creation. of surcharges (fees) for a number c _l_.iated pract it_, _ which can effect ctroundwater The monies collected thr )ugh these surcharges are used for monitoring groundwater contarninz tior, investigations and establishment of sta rdards. 44, 7- 1 3 ® Qe-X gy,~ 'ro des g~,g 30 HooK a '$y' ;L v ,9 78 ,3 i DA ro ¢ r~~ f y ° SY SW S &-1 rn10 yy ~ J9 • rA(.C - OF L,, r U S S c I l U ti• (reeh Air Inlay And Obeetv011on ripe r-"- Approved Vent Cap ~o 4" Coel Iron 4A 70 Vent Pipe Mar o Ilaf FMiOOleirlbullon - Pipe - Too 6 Pefloreled Pipe Below FleCoupling Termineling At Bottom Of STelem L it f_ I c J r. ~ 1 ~ j 'INN SOIL FILL DISTRIBUT1 F.1 PIrE . ArrROVEO SyIJTi`IETIC COVER, ~ MATERIAL- o" v" OF STRAW 21e0FRGG9r(,A7E alt MARSH HAy i 74,3 DISrr-.in1;TI :`AI 1trF TU. Ott-: Az' LEA 57 VJcWE5 B,Ct- OW O.RIG,NKA4L C~,RA.01E ~,VIU Aj LLASI"Zu Ik1c1.1,[:. F.S,I)T AI,Il /1 -7- lQn.iC JfiAW 47 kWC-J,IVi pt,LOW F,Il~IIIyL .~1~,OyD,E Y MAXM- tA Rkpr'Ij OF F-XcAv/ oo rxoM MI&WAL (39ADC WILL BE 4/00,~mcN.Es I1~.~1f!' lll"d ©,EFrt1 OIL EA VATI0N FPIOMM C~IGI.NAL (JR4,9, . WILL BC INCNEs SIGAIED: _ ~ I c E ►.I s c I, I u M Ft E I~ : _iG"i _ 6 V O ~1 ~J ~.Q-L~4 ~t DA-r r,,~y- 110 L 7 o 4 _ ? ? zs ? i 1 0 l ~ III Wis 4nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S4- Cro i 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 Jack ~1 t GOVT. LOT 5 I Z US 114,S 3T 9 N,R ( 7 X(or& PROPERTY OWNER':S MAILING ADDRESS LOT # LOCK # SUBD. NAME OR CSM If 9 d D Vrovt CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD V, o, d ✓ C o y s• 0/3-) L ~6 f~- r~w►h,. 1/0t4 T New Construction Use [ ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 O trench, gpd/ft2 Absorption area required _ bed, 111:2 _ Z O trench, ft2 Maximum design loading rate bed, gpd/ft2 0,6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 30" dam, fivc -,A ~e, ft (as referred to site plan benchmark) Additional design / site considerations ~h n t - Parent material u c t c Flood plain elevation, if applicable /V 4 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE ~j GRADE SYSTEM IN FILL HOLDING ANK U=Unsuitable fors stem I~]S ❑U IES ❑U aS ❑U is ❑U ❑S ®U ❑S iU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& 1T 7:51 1~ s~In~ c7~~t G S c S f t- ~'7 Q 0 rId `711A3/Z M7','~„+ Ground .J y l s 2~ Rco nC rr I- ~ Sn "d ] ,ti, !S C S 0 7 a'~ elev. 6 ft. I d SYOZ 31z r ~t ~r Depth to tit 7, 1 till rfl~ LIZ limiting factor E r(- 67 7, Y9 i 5c'-1 w,C . 5 C S 7 '7 67-70 7.; YA H Y r~ Sq~~ f w,reb~ d 5 C S 0, 7 $ 7a -75 - y'YR S/3 r, J 4 Remarks: ~f 51~ a<(,l fe ii if H Boring ~ ::a: n•E diJVK . iY y 71 SyR,3/Z , Ground elev. -7. c ~P `b t b c~ C' 7 Q 8 71 _Q ft. Depth to limiting fatr3 I-- Remarks;Xh,); S'vwt roh ei+ v Y w~ ~Sfty, Phone: q Ogg CST Name:-Please Print B 611, Address: C . h5 ! Signature: A / Date: CST Number: ~h' CS - Ot d2- PROPERTY OWNER NFU Dalfoh SOIL DESCRIPTION REPORT r Page 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 I C, -2 lcu 30 15q L; -C, 61.,7 Ground 4343 to l fi i d 5-Yr; 312- 130.-r- 11a r~ C 7 L~ elev. 2 8 ft. 7 C~/R f Depth to limiting factor >7Z Remarks:6J. Boring # t-IC icC/R 3--- 5►) .~~ah~ 4ti'1 C G 5 2 IC I0"fY ~q~It rv, r s 2 0 T-10 6 Ground nd ~e ns 5 S t- Q, / elev. M~Jt-* i FGtiK $0-1 ft. tV+o reoks Y") : v Depth to limiting factor ~7 2- Remarks: Boring # s .5 7 0,3 Ground = n S 7 Lf elev. ft. Depth to limiting factor S"() (0, N"f-- Boring # -)Z iclg 3/3 I ~--zw i4 fg q/ ; I F~6t~ c s z d S c, .6 Fab Ground v C .S 0.7 ' d Y elev. 1, 5 YR -7 / y Q,% I" i~h y ft. - l~ I 611e PJ s. 7`~ Depth to a 7 limiting factor Remarks: SBD-8330(8.05/92) P 0 0 0 0 7nC'i ch II d~]0 (m7 4~; p p 0 P aX ° h; r) 0 < i in 3 D a r 7 , I 0 stP 1 3\ Q p :E QI II n _ n n O S o t p u nXWO n ~ON'<r0 ~c 3' I~ D c4- ;o l< I-- ro a - -4 0 ul p C4- p ~o n ~ 3 r O ri ~l I I ~ a ~ i 0 O) g~ oI III y nl w Plot Plan Soil Report for Jack Dalton. West Sight of two South 1/2 Southwest 104 sec3 T29N R17W Town of Hammond St,Croix County Bruce A Webster CSTM-5501902 ~oe< AV V . T-n4 g~s~ n„2-z ruto r ~'0 ~ UV ~ -s 0 n o ~ Er a 5 F o 2. t+ v p93~ s Q a o dP p a ax a ~ b ~ Q b Za o IMP a `0 OD ti n CD O C R) 110 O r ID 0 a td o0 co ~4 ~ 40 co a a ~ T k,D ~a FU Go (5- F-I -4 T- C711 ru w~ O Q STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St Croix County OWNER/BUYER j _o h ,~L To n MATIING ADDRESS 1 / O T U m a/ PROPERTY ADDRESS ~O /0 //e? ~h ~U C (location of septic system) Please obtain from the Planning Dept. CrI Y/STATE 14,2 ~ ^ o.4 d ' tt j i $ PROPERTY LOCATION S S W 1/4, Section -3 , T_2L~ N-R / 2 W TOWN OF ~t a- J t ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ----.,VOLUME PAGE , 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 conditioq and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. VWe, 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 year expiration date. SIGNED: DATE: -,/I" St. Croix County Zoning Office Government Centcr 1101 Carmichael Road Hudson, Wi 54016 11/93 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. in Owner of property JO X/I W7p Location of property_,~i~/' s ~cl 1/4, Section, T~N-R 7 W Township U,4-m / e4d mailing address Address of site subdivision name Lot no. Other homes on property? yes No _ Previous owner of property Total size of property O e'c4 Total size of parcel XIS Date parcel was created Are all corners and lot lines identifiable? K Yes No Is this property being developed for (spec house) ? Yes No Volume T 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 offic of the County Register of Deeds as Document No. ~ A LL/J~, , and that I (we) presently own the proposed site for the' ewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. mss- /VL S' natur of Applicant Co-Applicant CIP ,l . Date of Signature Date of/signature DOCUMENT NO. `2040 This Indenture, Made by Herbert M. Knipfel and Neste: Knipfel, husband and wife m rmeaot., grantors of Ramsey County, -T"K F , hereby conveys and warrants to John J. Dalton and Carolyn G. Dalton, husband and wife as joint tenar. grantees of Washington _ Coant Tc3Xs&i, Mir. for the sum of One Dollar X1.00 and osier goo- _ and va uab i-e consi erxa`ion - - - the following tract of land in St. Croix _ _County, State of Wisconsin; One-third (1/3) interest in the Southwest Quarter of Section Three (3); East one-half of the South- east Quarter of 'Section Four (4) all in Township 29 North, Range 17 West, subject to public highway and pole line easements. ll' R J IN WITNESS WHEREOF, the said grantor-S.-ha Vehereunto set __-_tbei~and S and seals _th's . day of April A. D., 19..-5-8. SIGNED AND SEALED IN PRESENCE OF (SEAL) Herb-pit bl. Kni f 1 _ (SEAL) mss. ~4 L P L LE Neste Knipfel n ~ i. --(SEAL) o o o co ~i Iw ~ ::r O M : O 'I co a, .t• o~3 cl, cl- z' 4 ~ o a O ~ ty t-e 14 z n. ~ rn O ~ ~:J G :3 oil C ct- Z o ~V w C7 Cn n o `D =3 V dl C ~ ~ c W o cn a c n Co l< a a e J n j DOCUMENT NO. 2W 4 ~i 1 707 348 A E454 This Indenture, Made by Walter G. Knipfel and Janie Knipfel, his wife, . and Whil.ma H. EskeI I _ ~giPA48sot o grantors of _ Hennes in Count 3, WDR=94 hereby conveys and warrants to_ John J. Dalton and Carolyn G. Dalton, hus and and wife as _ joint tenants _ __grantee sof Washington _ County, W4" thrir: for the sum of _ -_0iia.. D.o_llar _($1.001_and__other ~QQd__and valuable consideration the following tract of land in St. Croix _ -County, State of Wisconsin; two-thirds (213) interest in the Southwest Quarter of Section Three (3); East one-half of the South-east Quarter of Section Four (4) all in Township 29 North, Range 17 West, subject to public highway and pole line easements. r ~i a i IN WITNESS WHEREOF, the said grantor Sha Ve hereunto set their hand S and seal S this 26th day of April A. D., 19.58 . ESENCE OF (SEAL) SIGNED A SI bYal ter G Kni f e 1 .(SEAL) Hugh F. Gwin Janie Knipfel (SEAL) Whil.ma H. Eskell - - - L - ~co I! o rn ~ Ico O ►s o 't ~ 7d ~ Z ~I I'- ~ i o. ~ o ~ ~ i'•i tv III eD 1-4 1. z.3 M o I~ O c CA 110 a p z 'm ri ~ ~ C7 Z h1 a d~ C cn n 0 o co w °e m ~C ^ d i I. i it I! Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations ' Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 5'1- C'o 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 q ~otc f d h GOVT. LOT S X,_ &V 114,S3 T,Z / N,R' PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 179N 410-) #Vfhv t CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD ,Yn'YhOn) k`5 (715) o`~ 2- N1N+oh~ 1 11o t~ if ✓Y 1. J [X] New Construction Use Residential/ Number of bedrooms ~2- [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow. 300 gpd _ Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 s D0 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) S;°' ° r •'r /O4O~Mr r.{ Additional design/ site considerations 5%2ed $ r 3 6)v-7 a '70' i-'v hck't7 16 ?vr-,tirs 30 4~, d9AP Parent material L ° r s 5 e.5 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U as ❑U LAS ❑U ®S ❑U ❑S t~U ❑S ~U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-1 torR 3 s 1 2 F 0-5 a~ 2 13-62 torn 0. 04 Ground 2-95 r- l~ SYR 312. d C l 0 7 D. elev. ~ q 7 ~ ft. I ~,~rR V11 O. Depth to limiting factor > 9~ Remarks: /ff" r Boring # 0-17 01k 313 s i 2 F~ k t, d .5 0 ,6 2 _ 2 17-52 ion - - l F tok CS v, o- ~ 7 ~ 3 52-71 rolA 6 i [Fogs ;r~ f V, 6. 1 s cs 0,7 a,8 Ground tip / FIB AYR 10M OOT C ~1~ ~S O' l ~liV~ 11" 1 0 ft - Depth to , y limiting factor >7 Remarks: uvr-Ify-1 + it v-v c ti_ CST Name:-Please Print Phone- Y Wet rfi e~ q Iofo Address: UGH C lsb l %r~ 0011 Signature: Date: CST Number: v7 L l 99~ CSM S'p / 9o v W& PROPERTY OWNER A Irt- SOIL DESCRIPTION REPORT Page 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 to ? 2- SO a~ s f a S D-6 Iy-s7 ? sYR C- Ground 3 57-70 '7S Y K q& elev. G S ~ •g 04/ 9~ ft. I 70-KO ? SYR T4 Depth to limiting factor 7 gD Remarks: Boring # 7 +a BIZ s z~Gb 9,5-ye q1V Ground SY N os o tt dV 7N4~lI r. gift. 7- rR Y ,d S ►M [ S 0-7 G ~ ~ ~-7~ 7,S YR~t FIB tv">'RS y"a~~ .S 1 Depth to limiting factor Remarks: Boring # C, 5 [o-l IoYI~ ly I ~p~4 c I 0-7 o,S P-73 Lo YR 6 l qd ds c l o,7 Ground elev. 310 fGYR 616 u~ 017 ::A-? ILI L ft. Depth to limiting factor ~ sv Remarks: ± oevw rt-,, r ~ Uoc~ Boring # 0 h- 04 1,4 4 132 5- YR `l ~ ~r~r<s s e 5 l 01 7 C'f Ground rk S4 - v r^ 0 , 7 6 8. elev.-S~7 SY - 1 I 5 c S 61.~ KC -.3 ft. Depth to limiting Y S factor Remarks: SBD-8330(R.05/92) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 3 of S Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 5/' cvo)'I 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 LtC (n f y GOVT. LOTS YZ SP 541 1/4,S 3 T 9 N,R 7 (o W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # )110 Ve hV C CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®FOWN NEAREST ROAD f kw w-. rl JS Co ► s ! (715-) 7c(6 ;_6 9 2- q h 0/ 1 t<] New Construction Use ~jC] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily Howe c> gpd Recommended design loading rate bed, gpd/ft2 • 6 trench, gpd/ft2 Absorption area required • bed, ft2 SbU trench, ft2 Maximum design loading rate bed, gpd/ft2 ` 19trench, gpd/ft2 Recommended infiltration surface elevation(s)° o ft (as referred to site plan benchmark) Additional design/ site considerations s%-zed (--vr 3 ° jrj*, at- .5' (oar -,t-c- Parent material Lo c s f r s Flood plain elevation, if applicable El-IL ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends Ground joyR Y/ -A 'c----- L L ~c rrl rv U/ G v. r _ ele ga' ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Nam :-Please Print !Phone: s v J Address: Signature: n - Date: G/ T~ CSR1um -L PROPERTY OWNER SOIL DESCRIPTION REPORT _ Page of PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxfary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) L-iNct~ Q 0 0 0 0 7C" ~ c~- Z5' =O m p p 0 0 6 r- b 9 Q O C+ Y < P A ~I I~~ 3 Q } $ x Q Q- V) _ Q r- 0 I ~ ~ $ ~ to o n n o .o bd o 0 0 to nxWO+ o ~c3-3 I~ C- 7 ~ a-, -4 o L €O ~ S 3 r O fU A ~ I Ia h e Cl ? n I to X03' 0o IO ~X 0 a d~ a06TOSS - HiSO Jal-sgaM ualIV aDnja 'x!o,Ao'~-S jo A:~unoo PuOwWOH Jo um0i N6ai S t/ T MS J0 t7/T 3S 'p8AaA,4n5 aCl 01 a -A: jadojd uo om~- .jo --uiO!S 4.5apy 'uo::.I-oQ >1:),or- jo,4 q-.AodaZ~ l!oS pu-o u o-ld ::~olcl a c 2- cu -P C- C) 0 L o 0 d ~ m N cl~ cl O L L L _ ~oww -C C: I+a 1= L G d1 S2 41 t] i~ o~ a ar'' q q 0. IA u CL ~s F- 0i vi CDO P O 0 Ch o Li N C CD a► T~l u t4 ~aWw tm -a a } ou CL to eo°--OL