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HomeMy WebLinkAbout020-1326-20-000 Q O I N O I h 0 69 O h ~ O N I N ~ I tl ~ I ~ I y I 0 z N a Z c _ C U. O 3 w I Q I I 3 O v m I z z E = o v z CY) a to N U) O O Z c :3 w aoi Z 4 o Z ' c E 7 N Cl) Q N O. 2 t 0 s s C C Y 0 0 o 2 c Q z H p Z N y C CD 4) E 4) N '_O L t6 O d - Q) CO 1) d N C O c rG G O o m FO- LO 'r CO) U) U) :3 a ) 3 0 o I ~w X000 Z e IL CL CL a y p N n y v) J 0 2 rn rn v Co o y O co EO E 0 co m :3 =3 y a m -6 o d Q > cn c p o °O 0 to c E O g M O O o c, o CD co 0 o CD co ~ m C O N O co N~ 0 E c ~aNNI C M Cj O O N 'O O 00 l=y~'l *4 d N CO 2 Z' c 04 2 •OVA 0 2 2 N O Z c O ~ .w rA € a ~$t a `ate • a a~ 2 N c w E t c c 5 Laboonsi Due~patm ltofIndustry, SOIL AND SITE EVALUATION REPORT Page J_ of J r'and an Rations Divi&ign 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 1 CRe,, k 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 OV)(NER: PIROPERTY LOCATION ,j~/(L GOVT. LOT 1/4 1/4,S iZ T Z9 N,R 7 E (or) W PROPERTY OWNER':S MAILING ADDRESS Lf~ T iL BLOCK # SUBD. NAME OR CSM # p I 7Aj4 A-L&ti -Q 7Awit- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE R]TOWN NEAREST ROAD New Construction Use[ ] Residential / Number of bedrooms (J Addition to existing building j J Replacement ( ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerationsSntc. E VAt-oA&~jr' pig-, k)iopo"gL Parent material Flood plain elevation, if applicable ft FU = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK =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 Baxx GPD/ft iary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& >Q 0- ' i 16'A / L r`; •r C t, l I1-3-7 16ye 41-? S, L ! s r~~~ ~u trot Ground 37- !Y1 16-YW3 !h TTL #^14 S,C, ! ;b;r ~Lu elev. j4s~7ft. 83 9-83 / 3 /.S S6 Ph j Depth to limiting factor Remarks: !'tT*rC/NZ- 15:.1 Ifs WALC 43C' &JR14Z-1eP 7i5 Boring # le. g-zS l~`/'3 S~ I rat c~- rn Ctv G-S SCE s^~, w $ i 12-24-7 bye 4/4 Ground iale9 ft. ~3 - Z_ / ti/P 3 MS SCE - Depth to limiting factor > •7.O Remarks: CST Name: Please Print / A ^ Q~ SOPhone: Address: I 'Y Signature: Date: 7 CST Number ~G~ 1 -7 PROPERTY OWNER f(-Le- SOIL DESCRIPTION REPORT Page 4 Of "Ail PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barxfary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends r. 16 Yre 3 r L bK r- w i f -Z fa 5 ; L / M sbg A -w- Ground DZ 24-4 6 S~ sb~ htSr' w ele ~S SG n, I r~Lv im9 ft 83 416L M 414 Depth to -464 16Y 4/3 limiting factor SS .-7 Remarks: Boring # L Ground elev. 83 S, 4 rh S SG r.~ S /L3 .Z ft 1 Depth to 16YR !f'1S d''1 l -1 46 limiting factor Remarks: /,()?TLE 4 '56)L OIJLV /N NE Boring # O- /Qy+2 i L / yh sbK rr r c5 ~S•• 3 SuL % M si~t./~r crs $ Z~-sz /dM#4 CS Ground elev~ $ -I l ICS 4 3 rnS 5 r~ j i0;, ft. Depth to limiting Remarks: Boring # °aa~tda: ~i Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 4 ~ok V_ tt AS' i N~~TN A j 6CALE ~ = 3v yti~ j B-3 65~ O b~ ir b / i i 1,D~ r 4 ~ $F~acw M iaQ It - I %&N &N AT dcDcrr11Ed3Z L sr akt k a A%4imt Ecty= /b666'. IKt~►A~ b~:aM W ESQ" ,isconsin QeWunent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of j abor and Human Relations Givisiogn ofSafe,~( & Buildings in accord with ILHR 83.05, Wis. Adm. Code m A- COUNTY St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. f'tan fritist include ,but-,/ not limited to vertical and horizontal reference point (BM), direction and `Yo bf.slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 4& Sam Miller GOVT. LOT 1/4 •_)1/4,S 1 Z T Z9 N,R 19 E(or)W PROPERTY OWNER':S MAILING ADDRESS LOJ4 BLOCK# SUBp:,tdAME OR CSM # Trout Brook Rd. S 2nd Addn to Tanne Ridge CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ,[:1(ILLAGE OWN NEAREST ROAD Hudson Wi. 54016 ( ) Hudson'' Tanne Lane [ ] New Construction Use (j Residential / Number of bedrooms [ ] Addition to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate D bed, gpd/ft2 O, trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate Q.l bed, gpd/ft2 O.1S trench, gpd/ft2 Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark) Additional design/ site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable It S = Suitable for system c0 VENTIONAL M UND IN-GROUND PRESSURE AT-GRADE s~YSTEM IN FILL HOLDING K U= Unsuitable fors stem l~7 S❑ U INS ❑ U S❑ U WS ❑ U (d] S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BotuxJary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends ` A 4 /byL 1 s+~ r I S o.s s , t / slok m~cr CS - o.z 03 Ground L6A4A s /dt r l'i't f' 7 elev. ft. Depth to limiting factor Remarks: Boring # 2 L 56 r 10A lolls -3 7 ~Y 4 S L m s bk A ~r w 6.Z 0.3 -7.syk 4/4 m swyl M r Lj .2 6.3 Ground 6 /-i31 >l~yt~4 elev. ft Depth to limiting > fact»o2 LIJ Remarks: CST Name:-Plea nnt Phone: 386-4080 arve G. Johnson Address: , O . Bo 91 Signatur Date: Oct. 96 CST Number: 3484 PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # 6S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 5Rooi s GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerx h 0-J 3 / - L ! n. s r D. .S' 13 vy Q414 S L p A ' Ground /O'/P,4 tJr S~ ~'t+ sb~ /h r' W 6. 0.' elev. 602-7 Depth to limiting factor IQ.S~ Remarks: Boring # gro. A -7 /o\/r 3 L 1 sbk ~f Cs 1 4 .S' CU 7-2-5 16\14 +/4 m slok m~r- w - O.a ' .5 Ground M-Fr elev. 1~ 2g /o,,/ 4l3 S rn 4. o Fs ft. Depth to limiting factor i /0.67 Remarks: Boring # A L ~ m sb~ mfr C 0 a .5 -z7 /n 4 4 - 5L 1 m s 1, m r 5 L 4 c`/ A J 7/~ :o Ground elev. ft. ~3 Z- /04 3 s p r rn CL') p.`l Depth to $d 7-13 1&-14 4L4 S (3 Ply limiting factor > Remarks: Boring # ~~iiv\4 Ground elev. ft. Depth to limiting factor Remarks: Con noon/D (14 /07 r i ZS I DENCUM a~12 K - I n= P ~ ~ EL-F-v = ►oo,m' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L_of Labor ar d;Human Relations Civision 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 Cool x 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. . 'V , - APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 0 NER: PROPERTY L CATION ~y I(LCR GOVT. LOT 1/4 1/4,S iZ T 29 N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LQT C BLOCK # SUED. NAME OR CSM # o t> -Y 4&(1 t CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD ( New Construction Use[ ] Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations'50lL L VALUA ~,t6;." QL?>U>; tie k ft'4 A6i0R6J4L- Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK ❑ S E 1U U = Unsuitable for s stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S C31 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft Boring # Horizon in. Munsell CQu. Sz. Cont Color Gr. Sz. Sh. Bed Trench :<z Qi o-11 l6*3 / L A, Sig ~ >ti; 'r r v % it k C W-3-7 16ye 41-? L) Ground 137- Sif 16,Y441-? 01 ;-TL t,Jti S , C, f r"I ; ics 7 ft. $3 '/-If 3 / 3 - s S4 r, l Depth to limiting factor Remarks: AtT?LrNL 6tj IfW WALC OC' IRejRjn1L-LcP -16 !9"7W/«<-/16n,i0/ 9 "4im<K. Boring # g-ZS &V+2 3 S~ l ,M, c rat C~,~,► 4-7 i&e 4/4 IV-Si Ground elev. ~3 - ft. .Z 16\11p, 3 /►~S - io's9 Depth to limiting factor >-L&7 Remarks: CST Name:-Please Print Phone: Address: h► % s Signature: Date: .2 q -7 CST Number~44!94 Page PROPERTYOWNER4AI MI I f'LL61 SOIL DESCRIPTION REPORT of c PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bajidary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer _7-46 ; L % rh slag N-f~ Ground 9-2- /2 - S SG n, Ccti Mo ft 83 41- 6Z. 16 4114 Depth to $ -/64 'M 4 ~5 S~ ✓ limiting fact r Remarks: Boring # 4 S t- 1 r,7 sbK r Ground elev. 19-3 53 4 /f't S -56 S /03.Z It K-161 46 M:5 SG 1"1 Depth l to limiting factor Remarks: /D; L'v r tX 6 '58)L ©,JLV IN N E CbPLA) &A op '(1 AJ4. Boring # L / yh Slat{ N-;- C'S /`7 gl" S a- 27 6yP4 3 S14 / rr sbKr <.s . 5~ ~,,1 cs Ground elev Ad t2 4 3 fh S 56 gi;L ft Depth to limiting Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-8330(8.05/92) IRV ~D~T1.1 ~ I it ij $Z $ ~ ` 6cALE B-3 6s p ~ 2z' i i 4 f E&-JcW 4eK - 1rkdN AT nlc& WE*;r Lbr CoeKkn i A%wnc Erv= ib6~ td* > 3,z' f Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labo~.and i luman Relations Div{,in o4 fety & 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 CR61 Y. 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. n APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 0 NER: P PERTY LO ATION ILLE-Q LOT 1/4 1/4,S iZ T Z9 N,R /9 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT IL BLOCK # SUED. NA E OR CSM # 6S 2n,1~ k~uti -'O TIQAyA1E C CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE OTOWN NEAREST ROAD ( ) is as I +cNNa<"Y L14N,~ New Construction Use[ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations-58tt, kVAc.UAl -6,o,, QCtm1` Iya, RA AA0jjQdV4L. Parent material 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 ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bogy Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TMnCh d-' I i6 l L r7 'r l f in ~ /'n 51a t` ' l v I t F,A t k. H-3-7 /d IR 413' r"-- e- u I >tit Ground $-a 37-51 1 Y4 3 0) -,TL t,.1v S > C, f r>h ; k n r e, to elev. ias.7 ft. $3 S/-/ ✓ s s t, n~ l l3 .16440 Depth to limiting factor Remarks: A07?Lrn►1. 4tj NW 6JALC oC 196911,A- Lt o 70 19 N`Tn(i<:~C~ /~casTLy 9 ~/icK. Boring # mlic 3 Sz j c rr rat Ct v - .1 2 4-7 bye 4 14 Ground ITT J Z. /6/ 3 r'~S SCE f elev.9 ft ekj Depth to limiting factor >1 _67 Remarks: CST Name:-Please Print Phone: Address:, f'eJ; S'c f Signature: Date: CST Number~4'94 PROPERTY OWNER '~A 114 I4ICLK SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Baxrlary Roots GPDift -nch Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed n fdy,3 L / -Z b 5 ?L ( / i Slag It7 GroundZ ® SL >'t Sfs~ /~f~~ RILL) i64~ ft g3 I-62 /QY 9 - y'-S sG A I Citi - M5 s~ Depth to 4/3 limiting fact~~ Remarks: Boring # Q '0 0 +231 L l ~~r Cw j - S ►1_ n, ~bK r -q2 416 Ground $ r S SG rh 5 elev. /iniz48 Depth to limiting factor Remarks: Aa7'TLEIJ 5011 L O::lLy IN N - ~ Oti' 'Qll~~i . Boring # L_. / 6e, rnr c'S A o - ~cay;e 9- 6YR41~ Ground eev~f - l i' IC) Q 4 3 /n S ski r~ j A t Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) N~~TI-1 Af i $ Z $ 1 B-3 6s i-V b / I \D) v j ~E,JGN ~M 1~ 1~ - I r i i2~N AT nl~rruE~C L.oT CO'QrJ~'~ ~ As66-m r- Euv- /b6,68'. /~'ivc► N ~~a M WEST V STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S M Ykj LL- F r ADDRESS $ 3 Co 6N00 AJ \2,-` F} 6'1 Ica W ! SUBDIVISION / CSM# 71 Al NF- K 10 (°L LOT SECTION ( T7--7 N-R 11 W Town of6 0"aN ST. CROIX COUNTY, WISCONSIN ~,►41 !"IP NE fcRAlta- eI fob, cc, PLAN VIEW , SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM `fe y" 12$ / 4 1~ 2g ~/dG E oosc t ' y QIffD ATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t ! BENCHMARK: TO 12 10 F I Z f Q X/X G.00 Nrfi.. r- /Z ALTERNATE BM: 76+ O F L toe-*-. r- e)vN4JAT10,kj r 3, 75 Z1SEPTIC TANK-/,,PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W1 I :r E rL_ Liquid Capacity: 04ZJ,:C~ SaAl- , Setback from: Well 7S House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle:. Alarm Location ` SOIL ABSORPTION SYSTEM Width: / Length 4^4n Number of trenches J Distance & Direction to nearest prop, line: /Z FAST 1o7"1;,,46 Setback from: well: House Other fil" (©2,g~ ELEVATIONS Building Sewer ST Inlet: 111- D = ST outlet: PC inlet PC bottom _ Pump Off F({ 11.13"7 . ~p0,'hl ~R1A I 1kZk; 1p0,10 Header/Manifold Bottom ~df system (2- 3p "7, p Existing Grade--? Final grade 7 = ©3, ~y DATE OF INSTALLATION: PLUMBER ON JOB: ~~4 LICENSE NUMBER: M 6L INSPECTOR: 3/93:jt Wisconsin D'~partmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) San299001t No.: City ❑ Vill ❑ Town o : State Plan ID No.: Permit Holder's Name: ODSON M LLER, SAM CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: f 11 020-1326-20-000 TANK INFORMATION ELEVATION DATA A9700316 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /Uo ' Dosing , 6 oil Aeration Bldg. Sewer j~I Holding St/Ht Inlet 1,67 O 2' TANK SETBACK INFORMATION St/ Ht Outlet r,,~o' ol.3Sl Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic NA Dt Bottom t, 02/ ioo. V 3 ~ Dosing NA Header / Man. i' ~y 3 Aeration NA Dist. Pipe A. 30 : oo- % 3, Holding Bot. System Ca 3 b~; F4.o5 , PUMP/ SIPHON INFORMATION Final Grade 03, ' Manufacturer Demand Model Number GPM TDH Lift Fri System TDH Ft Head Forcemain L ngth Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION Y J DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type 0 ,I CHAMBER Lr. Moe Number: System: l~/. k41 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges 3 a a/ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12.79.191$9,NW 836 140QN BEAN LOT 65 69- Otl, M 6) ''1 pp Plan revision required? ❑ Yes B No Use other side for additional information. 1/0 / 1~7 C,D k. SBD-6710 (R 05/91) Date nsp nr's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t r f SANITARY PERMIT NUMBER: 7 Il~i~i~illrs Safety and Buildings Division 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 than 8 112 x 11 inches in size- SL Cro i • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other meni'a enc o rams ~~eo/ govern 9 Y 9 E] Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. $3& Ma©n ern w State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1q fl) In tLL+E2 SE. 1/4 W 1/4, S T 2 , N, R E (o W Property Owner's Mailing Address Lot Number Block Number BOX -.1► Z Z. f, City, State Zip Code Phone Number Subdivision Name or CSM Number v .So r4 CA-40 r r$eol uro )274TAovit-r e/D~~ 24d II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms 3 [SrTown OF cal o IUCAI 8E//11? RQ_ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) • ~A• 1❑ Apartment /Condo OZ - 3 2 G Z C 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. W New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank Onl Existing System y------------------- 9 - 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 M 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 Sd Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) , Elevation -7 5_0 9400 .40 Q~t3 Feet /03.7 Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex per- Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank )K Q q[} I UJE~ P ,Std & ® ❑ ❑ 1:1 E] 1:1 Lift Pump Tank /Siphon Chamber 1:1 El ❑ ❑ El ❑ 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: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I Issuing Ag t Sig ature (No S ps Approved ❑ Owner Given Initial 'If66 Surcharge Fee) Adverse Determination //U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Z 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 authoelty. 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, Safetyand 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. IL 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 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 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. 5 k/Y , d 4' l E 2 #Ile 1,o T .4 8 3 4, /YIN 1V~6~~~1 SYS7rt l 99 3' ScA4F Otl /o " Tpk7°r r20- / 7 ZG - 20 L3 • M 1 Rye ?v A/E <o~i1 f~L FIV= /00.enol y7, i N Alf r{ oe t! c 1 6•3 ja. I ! ~ ~s p1/' +1 a-y ~o t~ o j II ~s y('~a ~r t I F r i z' Q 4 4 / 7, r 4 ill 6 c Al e5l? m I o W 1 _ I o I E t K~." M ~ I rr) I y I -a I rn I ~ a ~ Y~ 1 , 7b ~ j r I I Lq I ~1 I w Z N 71 t , `v 1 t ti Z 1 L4 ul 1 m I -f O µ O i c~ o o ~ N` ~ ~ fn LA Wisconsin D"rtment e6f Industry, SOIL AND SITE EVALUATION REPORT Page % of 3 Labor and Human Relations Division:30Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY k Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 05-1 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 0 NER: PROPERTY LOCATION ~j 'S►_, ILL GOVT. LOT -St 1/4f44.a~ 1/4,S ;Z T 7q N,R 7 E (or) W PROPERTY 0 R':S MAILI DDRESS LfGT BLOCK # SUED. NAkiE OR CSM # Clg, STATE ZIP ODE/ PHONE NUMBER ❑CITY ❑VILLAGE RjfOWN NEAREST ROAD -Vo hl LS6NJ L-3, ]b ( ) Al, &s6 aJ NN~y L~aN Af New Construction UseResidential / Number of bedrooms U ~.l [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0 •`j bed, gpd/ft20_ 6 trench, gpd/ft2 • Absorption area required bed, ft2 trench, ft2 Maximum design loading rate tJ bed, gpd/ft26, ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/ site considerations c ~'yAc.C9 A' y t~ ,d~~vr i6a- A-At; A6iI0JQ6;'14L Parent material Flood plain elevation, if applicable ft ADE STEM IN FILL HOLDING TANK S =Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE 7R U= Unsuitable fors stem ®'S O U RfS ❑ U S❑ U ❑ U El O U ❑ S I KU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -77 L9 //-3.7 16ye 4 , L l s r~- Cw lam, z 6.3 Ground {5'~ 97-S Y±~0 l~: TTY re.l + C2r~ 5, C. f rh ; bft y' e- LA> 6.'Z 3 63 s s c, iiv. 7 ft.3 /-lf 3 IOW4 Depth to limiting 4c tor H ~I Remarks: ACT?Lrra~ 4"J If1~ WALC ®V` ~~>e1nl - Lc 7r i9 7r~/r,~- /~O'~ i Ly +~Iic1C. Boring # ,w o-% % yob, f M 6 6A &S 9-z 2,247 6 SC, r~, w O, G Ground fps ~ ft. 413 <1>61 Depth to limiting factor Remarks: CST Name:-Please Print Phone:, ~A Qf,IN~c~~ Address: Signature. Date: CST Number.~4~,q PROPERTY OWNER S461 SOIL DESCRIPTION REPORT Rage►-Z of PARCEL I.D. It R' " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mr& -i L bK rb, > - i o-4 .18-26 16"yp, -31§ J> L st^K A-f~ C w 2© 3 Ground gZ f' ® SL n, b , H w 04 d>5 i( ft. 83 1-66 166 4 - S Spa A j C- L".) Depth to LaYi; 4 3 /5 S~ i r limiting factor y ss.& Remarks: Boring # 1G`ye3 i L ! bK (°w ! rs 0.4 d.% Ground 6Z [42--S3 p 1S c.Z 5; L 1 Yr, S bkr- elev. 8~ 53 4 t'rt S 56 C'.7 O,$ /C3.7 ft. 46 Depth to limiting ~ facg t T Remarks: iN Boring # Y p - iC~/+P3 i - L 1 r~ sb+~ rrr c5 l d .q.S G-27 OW4 SbK /Y;Fr, cs h• tar Ground O-SZ /6Y e4 4 C S S elev $ - t l ~b r2 4 3 /n S Spa 1 O 0 iC~, ft. Depth to limiting Remarks: Boring # , I< MR. }t.M1 TZ oflU, i cattts car t)TTU e-, -It L." Ground - oQ j kY P Avq ° K,AS:6PJA Z c)SiCa►\JS S,C T L^V4►C elev. ft. SKL6 " k&-MS SYS`i ~!'n ~i i ►1~ Ajgi e 14 Ate: r we Kl Depth to `JAI C. 5 43 i C16LJ !bJ t A JZ, L n i r TUC 'SOUAO~C 3 Q 4L limiting factor Sc°~Z)v t, S % 4 5 fZ~ S~, i 6 a' Remarks: S BD-8330(8.05/92) L ~O~TN Af ! is i $Z $-I ! 6CALE i h E~CtAT~ oN ,%~-Peo E6 E Lt, p, 6s i -T--- 76' ~J A%4-ML ELrY= lb6~ 66' /WISTALLFLII S/STINS 5)3&6L~, dS F44 i 1 ,coca-rN Ar4t, EAST -4s Pc:5t $L C. ovkk-S, z r Tv T44C $Ut1'1 1. PA (,C ? oV 3 SECOND ADDITION TO TANNEY RIDGE SPIECIAL ADDITION LOCATED IN PART OF THE SWI/4 OF THE NWI14, PART OF THE SEI/4 OF THE NWI/4, FART OF THE NEI/4 OF THE SWI/4, AND PART OF THE NWI/4 OF THE SWI/4, ALL IN SECTION 12, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN; INCLUDING ALL OF LOT 40 OF THE FIRST ADD. TO TANNEY RIDGE SPECIAL ADD. rls~"\'I~NCa1A V'!PiTEC S48°35 bQ"lN. 1\ SN9°29'02"W x,1253.90 39 ~ cy ~ t. zu. \Ka LOT 67 LO 64, LOT 63 LOT 62 la- LOT 65 a 4- ` LO 66 u K, r m R ^ h LOT 44 y , _ -BEAM -THE - -P b [ WES7 _ or. I. LOT 45.. LOT 59 LOT 60 p'- h L LOT 61' 35 LOT 46-- Y / " s a ) :o r. ~\i ~ • xc. z,c sa n. ~i S89'24b2"W 74.00' 00 3~ PLOT 47 LOT 58 ).o w~; a~.> t 1 v LOT O 1t II „z.uu ~ , Y'-i' ~ I t~+'~ .,~•},u, iii m fw4 (I LOT 57 LEGEND I)` ao a" w LOT 49 Y4y~ LOT 56 LOT 50 L07 55 % LOT 51 LOT 54 LOT 52 ~I LOT 53 nin I' a, ..N "I I r . ,ur a I SHEET I OF 3 SHEETS I I i I x " S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), 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 _5-A /n dL /LL. Location of property.~iE 1/4_.&z4/ 1/4, Section / Z ,T Z-7 N-R f W Township PU_pS,6 *4 Mailing address 2p 2 P Z.- H V l~.S NI t..l .6'. V0 /-6 Address of site $3 rn oe,V BEA M Subdivision name T,4XINE I/ &J04.4f Lot no. t Other homes on property? Yes---No Previous owner of property Pn N I~aLG It A/ A, AC Total size of property ? , C d IQ G Total size of parcel 2 , 00 14c Date parcel was created - cf3 Are all corners and lot lines identifiable? )e Yes No Is this property being developed for (spec house) ? aC Yes No Volume L~ 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. S`G VSS_5 , 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 construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. SoypS"S' ture o Applicant S' Co-Applicant !S" -Ilo-97 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER :5/4 M %yl 1 LL fg,_ MAILING ADDRESS ~ X ' 2 f 2. PROPERTY ADDRESS 3 ~o MOO/ FA A (location of septic system) Please obtain from the Planning Dept. CITY/STATE / V Z Z ®11l L-0 / .S'yQ lew PROPERTY LOCATIONS 1/4, /4 LQ 1/4, Section/ 1- T 2.'' N-R~ TOWN OF tfL-)1x50 N ST. CROIX COUNTY, WI SUBDIVISION TV NIF Y (V.~ (p lE LOT NUMBER S_ CERTIFIED SURVEY MAP T"1 /p3 VOLUME4o , PAGE 7s, 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 our 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: C~ Cf St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • ,f f 1t Z.. ~ ~ ~ ~ DOCUMENT NO. STATE BA F WISCONSI ORN 1-1913 trwct etsa"vso roe "teo"o,"o awrw ARRANTY DEED - 504855, 0L 1031ME 456 f r:.CISTc.'4'S OFr1C~ This Deed, made between i '.,"''X Co.. andall. W. Synan and. Patricia E. Synan, h ,ec'~ }br ReoM! %c usband. and wife , Granter, S EP T 1993 ' and ...Sa~!........:er.r...a...s•in9le.._Person it 10:4 A; M Wit~AlesSeth, 1 hat the said Grantor, f ra valuable consideration...... L~ - - - Randall W. Synan and Patr~cla E. Synan conveys to Grantee the following described real eststt in St . Croix ea*ue" To County, State of Wisconsin: t _ Tax Pared :ate:._«...» " The SE1/4 of NE1/4 of Section 11; the SWi/4 of NW1/4, the N1/2 Vt of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Y Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. FF~t cl AND ~ A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of :,eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence S00 28 03"E, 500.00 feet; thence N8Q 30100"E, ,M along the North line of Certified Survey Hap filed in Vol. "30, Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This 1.0...AQ.t homestead property. (k) (is not) Together with all and singular the hereditaments and appurtenances ti,ereunto belonging; And..... Ri;Asia.I1•_.If!.__. $ynar)__and•.Patr_ cia•.E..-.Synan.......................................................... warrants that the title is good, indefeasible in fee simple sad free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. s and will warrant and defend the same. i Dated this day of AU9.L18t...................................... , 1/..9.1. . . d~ ...(SEAL) ~ll?lrtF~C4!!! f. !~t.✓ ...........................(SEAL) Randall W. Synan Patricia )Synan • • .....................................................................(SEAL) (SEAL) i • AUTSSNTICATION AC=IfOWL=DOKNXT ' Signature(s) I STATE OF WISCONSIN SL 'I St. Croix . , conaey. l „ • ~ authenticated this ........day of 19. p~,o~,u ~ 1. AuguPerssnelly came before me dq of , 19........ the above named ...5»t.........._..... i~ Itanclall------- .nave;- X a............... TITLE: MEMBER STATE BAR OF WISCONSIN S nave . not . authorized by 4 person I07 LYOMdI'1 i T08.06, Wis. Stats.) . I ~ to me known to be the fi APAMIX ~F e I