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HomeMy WebLinkAbout020-1306-70-000 (3) R STC - 104 r RECEIVED 1 AS BUILT SANITARY SYSTEM REPORT ST CROIX OWNER- j' 8 W N SC k w a PJZ ZONINGOFRCE ADDRESS CTUr~ O1Rc~ tti) IS ? 1 to 0riol ku"I son V'/1 S'~0! to SUBDIVISION / CSMf tt~ Dl (2-~ d1115 ~~ASP LOT_ SECTION D_T D~ N-R1_W Town of_ LOON ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6Note- MhW~ 6)~ ! S ~ over aa'I'lefi ~3A~~le 1306 5rj uS~p s►1~~;►NOeR Sl~~l s Sep}- 1p,~k 3xS0 1a~N c1.el T aye ,y, aa~1 '~Y9' 3y, ~1~ROOiti I ND l CUTE 14oRTH APRON Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank m<~nhole cover. 1 BENCHMARK: I VU• U ALTERNATE BM' SEPTIC TANK/ PUMP CHAMBER / HOLDING TANK INFORMATION 1 Manufacturer: We2F-S Liquid Capacity: D00 ~jpl Setback from: Well NOr•►u House - Other Pump: Manufacturer Model# Size - Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM - US►N5 Slb-? W►N~~S Width: -3 Length 50 Number of trenches J Distance & Direction to nearest prop. line: OV IZ 56 Setback from: well: Wa )PA House Other 3 T t+eP~ocz - 4?• 3~ 14 L ELEVATIONS Building Sewer ST Inlet. U off. I a ST outlet 10 1 . 7 8 PC inlet PC bottom _ Pump Off Header/Manifold Bottom of system_t-All Existing Grade SAS Final grade N ~0~ 43 0 rv\ L wo•y3 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3V0 INSPECTOR: &67FU~~ 21~7j 3/93:jt Wiscon§in Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT 5t-, GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Z-41 00 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: I vin a wy, S h Z uds&A CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: O` too Z O 2.0 - 30& • 0 TANK INFORMATION ELEVATION DATA 4677CV31 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -0, 12Da Bench ar L n. k 7 / Dosi ng Aeration Bldg. Sewer 1-60 10217 Holding dt%* Inlet /,$o /Or.-I? TANK SETBACK INFORMATION <5b I* Outlet D/, r3 TANKTO P/L WELL BLDG. Aiirrintake ROAD Dt Inlet Septic a r2 NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe 4lyf'is• y Holding Bot. System 4 7.t ?2- q17' y, PUMP/ SIPHON INFORMATION Final Grade y 3,70 /4&L7 Manufacturer Demand Model Number GPM TDH Li Fricti System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM Liquid Depth BED / ENCH Width r Length No. Of Trenches PIT No. Of Pits Inside *Number: DIME-N-K15 N 3 -T 3 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA G Manu SETBACK CHAMBER INFORMATION Typeo Mo Model System ,Xj .SOS 00 42. OR UNIT DISTRIBUTION SYSTEM ea / meRfTUtd- Distribution Pipe(s) W00 x Hole Size x Hole Spacing Vent To Air Intake ~ Aw $Oi Length Dia. Length ire. Spacing -2.0! W1 "dee SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over -nth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench s of ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 09teflace'Kcw(al(C4 Vs Io~a,~ +K ~~ox.-~ hard Lawl~ #LA^/A A^4 4P KcW 40 G x 8z r x ~'rvW~~ L2' I,~•q? j ~3 Plan revision required? ❑ Yes P4 No Use other side for additional information. (Z. Ito SBD-6710 (R.3/97) Date Inspector's Signature ert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 'Wiscormin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX .Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299004 City ❑ Vill ❑ Town of: State Plan ID No.: Permit Holder's Name: ODSON S HWARTZ, TIM & DAWN CST BM Elev.: Insp. BM Elev.: BM Descripti n: Parcel T x o r 026- 1'06-70-000 too IOU 1 o a 2' vt TANK INFORMATION EL VATION DATA A9700319 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic We e_ K I-Zoo Benchmark 3 a 'p?, I/o Dosing Aeration Bldg. Sewer {ap 102.37 Holding St/ Ht Inlet 0' 10211-) TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic St7 n to NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe U.S I- Z;-57 657 Holding Bot. System S,' G RZ, qig' '17 -Iqt PUMP/ SIPHON INFORMATION Final Grade /V0.27 Manufacturer Demand Model Number GPM TDH Lift Fric System Ft Forcemain Length Dia. Head I Dist. To Well SOIL ABSORPTION SYSTEM BED TREN H --Width Lengthy No.O,`Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 1~1_ DIMEN I N ` -A4anu a rer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/BYRE LEACHING INFORMATION TypeOf \1 r , CHAMBER a Number: System ✓ l ~!D 3Q Y) W.PNIT DISTRIBUTION SYSTEM g Header/Manifold Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake i Length Dia Length Dia. Spacing d SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: 6HUDSON 27.29.19,SE,SE 716 ORIOLE LANE LOyTt 52 f f9 'fr/ ut- at, , tf ra" 6o-4`Ir'!'"...p. I~Q/G'tit.-l.r-R 0 1 1 \ e3 l Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. t ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: Safety and Buildings Division vp`ri ; SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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. / • See reverse side for instructions for completing this application State Sanitary Permit mber a~;R 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 D Pro Owner Property Location e_1 /4 1/4, S T , N, R E (o C im 9f I 'e~~Ujap~ Z_ - Propert Own Mailing ddress Lot Number Block Number City, St a Zip Cod Phone Number Subdivision Name or SM Nurr) r ( ) II. TYPE F BUILDING: (check one) ❑ State Owned El !t Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 1111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) cQ 7 p~47 - /q- / S a 1 ❑ Apartment/Condo OAO, - / 306 _ 70 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [Seepage Trench 22 ❑ In-Ground Pressure 42E] 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. SynezElev. 7. Final Grade GQ h Require sa. ft.) Pro Vy- ft (Gals/d /sq. ft.) (M /inch) M 97; 0 EI`v?a V 1 .0 %A WO U Feet n g aTotal # of Prefab. Site Fiber- Exper. VII. TANK CapHExisti - 11 INFORMATION App g Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic - New strutted Tanks Septic Tank or Holding Tank ff I ~ Q V r N ❑ ❑ ❑ ❑ ❑ 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. Per's Name: .Lint) Plumber's Sign ture: (No Stam s) MP/MPRSW No.: Business Phone Number: Plumber's Address St et, City, State, Zip ode): IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing tent Signa a (NO St ps) Approved El j Surcharge Fee) Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety s Buildings Do-ion, Owner, Plumber t INSTRUCTIONS ` - - 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, F08-266-3815. 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. 11. 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 into 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 :urve; 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- l l i. I_.. ) ( I-' L U I A hl I ► L . I U 5 L `.7 I: L1.; � I I I IN A M ETm��Lj.w4 � fZ....__ N•A M y. E JZI► eou e N _ . LOCATION "f -" I— I C E N S E =//- . . __._.. •• I, .... E______ .t . ..._ P L 0 -I- 11./1 A P • 9e/ • .M Tp 7 Al i 4, . .,.. 1 PYC Flev=)oo.0 64, _ _.____, . .,.., 0 op IN ul ef •... ... •abl•P,z i• . ( ,�, Q 6 , . • :. .. . 0, -* /(751). � • Nate: ACji A<04+ lots NN.>< \ uel)J Pik rtaxthoz 13i3ts) ISO, riz6m Sep))c ,f. J, • 3 IvcLf , NdtP; wt11 is Fptii'1,n tI.PN/aooskca C, Apa�fi 848 so �Ro� s�pfi}� � y ��, a - pa' . • - // y fp • • ti v- jG yv '� .r y 1 • I' • • .. N • • • . . . , FRESH Ain INLETS ANDOBSERVA`PION PIKE CROSS ~SCTION /- E 1•__. 1 Approved Vent Cap Minimum 12" Above Final Gr.dSie---` - L (O(). y3 hn /O ) - V3 • )-, I6)- y3 4 " Cast Iron Above Piped Vent Pipe To Final Grade! • Marsh clay Or Synthetic Covering Min . 2" Aygrcy i l o Over Pipe �� f Distribution q " _ _ Tee • Pipe u __......._ I .t __ • � , -. 9 c, 00 �_ ., 1,1 1 , 72, Ob Aggregate U _ Perforated Pipe Below • ll 4q Beneath Pipe e Coupling TerminatingT t� - ` 0. bU v Bottom of System ,v�1v Ai'EA- TES r D S--e- 0E.eget TE'S T— -F too /- S 1Y • Wisconsin Department of Industry, • ,Sp 4 ANQ SITE EVALUATION / -3 - Labor and Human Relations Page of Division of Safety and Buildings ' 9) in accordance With s. ILHR 83.09,Wis. II! �J County Attach complete site plan on paper not les t� 8 1/2 x���h�e�Tn size. Plan must G• a�. include,but not limited to: vertical and horixonfal referencepoint BM ST (, �,,tlirection and percent slope,scale or dimensions,north arrovy,and�(dc tion and dittarice to nearest road. ,�� Parcel I.D.# _. -"`. 02.0 - /366 - 70 APPLICANT INFORMATION- Fleis\y fin#.�4yfptrila#io►i. '` Reviewed by Date Personal information you provide may be used for sece dary�y&oses(Privacy LAW, (1)(m)). I ' Property Owner . " ,4 T e /1 i 1 Property Location a/q T `�Aw� �Z Govt.Lot SE 1/4 .SE 1/4,S -27 T d� ! ,N,R / q E(or)�l Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# I g 20 A S perm 1J R • tog Si — I/WI/3',1D 1/,.$ (A/ Yee:111 City State Zip Code Phone Number Nearest Road HuP.SoA) 1 /0/51 5110 169 I( -1 i5 )3(l •z9�y ❑ City µ cla L Town I d,f'/ELE Zti - 121'ew Construction Use: residential/Number of bedrooms 3-q Addition to existing building ❑ Replacement 7 5 ❑Public or commercial-Describe: ^///e - ,1 O 7- /fC -1�S 1 eAJ27 2 '1 D— /so Code derived daily flow 67D U gpd Recommended design loading rate/1/fe bed,gpd/ft2 • e _trench,gpd/ft2 Absorption area required /(///f bed,ft2 trench,ft2 Maximum design loading rate/'/ bed,gpd/ft2 ' 8 trench,gpd/ft2 Recommended infiltration surface elevation(s) 5-e-e- f 3 ft(as referred to site plan benchmark) Additional design/site considerations WSE- G 0 A16-- 7i.Pwsu..l S — !C' i2 .0.✓ 5/e 4,7 PAD/2 6.0, 15 Parent material Scs 66 I3 U R k k A4 le D I — /04A Flood plain elevation,if applicable /414-- ft c4lo 6U ,-ri;P ot M1+ 1qp-317.5 S = Suitable for system �Conventional Mou In-Ground Pressure Ade System in Fill Holding Tank / U = Unsuitable for system E"J S El U S ❑ U S ❑ U S ❑ U ❑s ,L-�-, U/ ❑ S EU . SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/fie Consistence Boundary Roots Bed ,Trench in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. • la / o-y /O/ 3/2- L zfsb� 07r/e �s ;N„ . s : • 2- ./7 /0 Y/ .3/ S-/L /fs%4 , f/P - es • / f . z. . . 3 Ground 3 07.3s /a yg 1//y LS /444 ye dS ( S — . "2 : ,f elev. /00-icf2 ft. 35.16, /Or/e rCe - - 'rr��. S. _ D ,5' _ 1.1° Depth to - , limiting ' factor - Remarks: Boring# . / e -i /0 ii/e 3/2_ L- 2-r 54A 4,1v/2 ,� 5 2,ti . s : G Pi Z. y IV/a ' e 3/,3_ S'L /y, -7,e es ,y .s 3 *3/ /6y, 3/ SiL /f'sk 411-74/• eS /7' . 2-3 Ground V 3/39/a Y 9/V ------ , s-L /j„ � i 7'/ CS /Dlel ft. .c 3fii /oy,ey/� -- � 5 .,k _"_ . 2 Depth to - limiting rctor in. Remarks: . CST Name (Please Print) Signature Telephone No. Rof3e-T— 7ALf3eic�t- - 715 . 3 S6 • �3I,5 . Address Date CST Number �j' Ulbrioht Associates 5 Co cs�// 2 yg Private Sewage Consultants 655 O'Neil Rd. Hudson,Wis. 54016 ND7z 2 ,� 5 f, / •f,, OR\GL 4( s d . 5 - SOIL DESCRIPTION REPORT _ PROPERTY OWNER *‘14/gP Page z of PARCEL I.D.# - � /i5 Boring # Horizon Depth Dominant Color Mottles Structure G D/ft2 Texture Consistence Boundary Roots P in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench g / 0•3 /'W 3/,- — L i71:f4 /44 . y; .s L 3-4 i0 y/? 3/3 — SZ- 141 Y; .s Ground 3 7 •2Z /o y/� yA4/4, S"- /Mif4' 4r v�,e CS /f . Y: • 5 �- / 3 22 ft. V 22-yP/0yr�IN 7l - s o, s ale �s gQ Depth to 5 .9' /o//` /,CY D z lof 71 .O limiting factor fin. 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 It Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: SBDW-8330(R.08/95) P,5 3 0i- 3 Ulbricht&Ass eclonsultants Private Sewag 655 O't Rd•54016 Hudson,Wis. /'�-` 375- L. o T S \ t)/) or / '1 N \ I[ //U, =/Gb,Df ,± r ' i\o• 25Cc 0. /N / \ il0 '0a $CAGE : / 50 f34C/C4-e. TS 350 laz 8M d z r-X/S 7 i,v G— > -- 7 ; jA4'ri12&-_ To p of / -L " PO c N l t1710 cJs 1",vS129// •A' lv/// ` w /&-v,4 Tia vS — Cv,ev " 7/evl a/S /3 /d D. /S) ,�S N,P�/,�� Ca , /38 - /03. zcr) C o G VA SAc_ 2s7 9 7--3,,-- , , " ?y. s>,, �� tr svC� 6 sTrD ,s, s' , ..�.E _ _.y s T , , ..... 6P 7z,, c'‹ ' ,s- • 4--- , , -, 13 7 -5 iyr r N 11IM v- . � j f (,-,s e Lr toSCA/� g�0...„„ , / / '' = L 0 8N' /e \ \t 41- 2 / '( / Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division of Safety&Buildings in accord with ILHR 83.05,Wis. Adm. Code COUNTY ST. G/Cof'X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but PARCEL I.D.N not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or dimensioned,north arrow,and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: ilv y0/,P9 //i//$ /, i P 62246.L1• PROPERTY LOCATION 2),4//1-- �/}///O,tl - G%/1/7.,1/14Y GOVT.LOT ',ti 1/4 ',r 1/4,S 17 T 2- ,N,R /, E(or)W PROPERTY OWNER':S MAILING ADDRESS //yi8 /9/p vE-? a/5 l LOT I BLOCK I SUBD.NAME OR CSM# / 336 )110,i° 8 ITS ST ( IJ jj2-- �u i VD titNEAREST ROAD IIS CITY,STATE ZIP CODE PHONE NUMBER DCITY ['VILLAGE f I o�'i RE • LN ST, mu t, Al N. 55/o/ (G�) 2 22-5SS5 --Ftp.so,J �ew Construction Use [Ivy-Residential/Number of bedrooms /r`"'P 3 ( ] Addition to existing building ( ] Replacement [ ] Public or commercial describe ys0- Code derived daily flow 6,a0 gpd Recommended design loading rate ' 7 bed,gpd/ft2 ' r trench,gpd/ft2 Absorption area required bed,ft2 trench,ft2 Maximum design loading rate ' 7 bed,gpd/ft2 ' P trench,gpd/ft2 Recommended infiltration surface elevation(s) S-� P - 3 ft (as referred to site plan benchmark) Additional design I site considerations Parent material CS 6'l i$v.E'.eAA-A°O 7-- Flood plain elevation,if applicable %"4 ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system DS ❑U OS ❑U DS ❑U DS ❑U EJS ❑U ❑S O-U - SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Roots GPD/ft2 Boring# Horizon Consistence BoLr>�y Bed Trench in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. 4:;::::.1 ©_� /O j//e 3/2- ---. /S /i f/ ' ..., :.'..: 2- z /o s/ 2-f sde f/e ass z s ............... Ground 3 lil-y/ /dye .37 5/ 2-f f6.,r ,,,:fie p /1 f1 l0- ft. y/ 5 /o`f 3/6 — s,/ /ls6X- I / a 5 , y .- 5- Depth to 5-- 5i to, /ay/� 5/ `.. n S. Q, S3 - ,d--e_ . 7 1 ? limiting factor ,i } Remarks: Boring # 3f ,-� l _ P / 0-2 ,o.1,P3/2_ — /5 / fie 1 s ei 23 €::# 2- 5- 31 7syg / :>>;::>::>::><<:>:; 3 3V fz io vie 5/6 C. S . O, so-. d....le - ,P Ground elev. ' /oo,-5Z ft. Depth to limiting factor Remarks: A CST Name:—Please Print ?C�B E p T 74 L�p l' C k r' Phone: 7/5"_ 3 �/c� ^ e/6 •5- Address: (_cJ S cY AJ I L pk 0 - N u 17SoA) &)/s . 50/�o //,P'// TT / C'51 i- yc'Z Signature: E' Date: CST Number: Par10- ��'"`�' / This rest sitePpc� AAL for a conventiana! septic system. PROPERTY OWNER SOIL DESCRIPTION REPORT Page 1- of 3 PARCEL ID.. L6'f 52 /fU'ef /0Pv #"�- Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots T i in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. /� Bed Trends 3;::• / O-/2- /O 1/� J/2- /S /4vr, f, �� C S ,,,, , - • Q ,,�:::::,:;, z /1-.26 /o/ 3/9 i s/ 24,fie , 1:4 .es /7 , 5-- , 6 Ground 2‘-16 75Y�' v4 �_ /S /�, ye Gl� CS . 7 ,, elev. ///// r n , ,02,72-ft. y 71. -go roy, c/� — e.s, o, s�j , GQ�c. _ , _ .-) i .� Depth to V limiting factor it/ Remarks: Boring..77.s.1 k # �j- /1 D fcto /S �.� f �f 7 I.r �� -ls /o�,P 3// s/ )7e 5. 407e,e es . f , S' Ground... 25--ram 7 S fit' 414. J., D/ s5. .0 1'5 - 7 r .k- 9e�� ft. �� *jo /6 v,, . �•=%', e Sri d . 7 •P Depth to limiting factor - Remarks: Boring # .<:::::.:::.> a- 6 /6Y/P 3/i /s / fre "� SS 1— , 7 . 7 -,�i /. Ae3/y — 5/ ) 7"s,6,4- fie es /, , 5- - G. :: :::.:::... 3.1 fy /Ooe 3/ s/ //s X /P es" /7c , ' .s Ground elev. yy f, 7Sy,P 5/6, S ,S-• , of__lc — ,- - tf /o/, 06, ft. Depth to limiting factor 2 4,4 Remarks: Boring# 11 Ground elev. ft. Depth to limiting factor Remarks: con ehenln nClnn, 3 o-V 3 0 L., n r 5 Z. 1 E(EOki-1O►JS rat 9412- ) /3 3 /O Z. 7Z v /3 y 99 fq / SGALE : / " = 3O /3 /610 6 ( . = aAokAoF /3/75 Su �c��sTEl7 St/S'r£1 E1 o►J 4/seE /3 - 6Z— 8Y ) —a)t-.0 S — 1/I, 7 'e,t) 9G�� /0LJ -roe A.)c, O • g s!o chv \ LI'S 1 b 101/f 1. �✓` CO/ ' SA-C/ sy � j3iy = Top OF o 140 G . 29' / ,t — , co eA ° . ,rn' o • N °3010W 664.12' SY ?9~, S45'50'00"W 86.82' S44° 10' 00" E z 66.00' J I S76 2? q, E 463 ~I So S9 SI gap" J ~D / \ S89°30'15"W 942.42 r k Z S 'I' U 105 SE,PTIC'TANK MAINTE,NANCP, AGREE.NI NIT St. Croix County _l OWNF,R113UYrlt MAILING ADDRESS PROPERTY ADDRESS (location of septic systcm) Please obtain fiom the I'lanning Dept. CITY/STATE. , C-ra; CO%A!`1 V4 PROPE.RTY LOCATION S Q, 1/4, S 1~ 1/4, Sccfion T -N-1Z TOWN OF ~ %kd 50 r\ ST. CROIX COUNTY, \%,I SUBDIVISION LOT NUNIBEIR _-,Zxk CERTIFIED SURVEY MAI' , VOLUME; , PAC l; , L,U7' NUMI31iR S t~ - 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 lank 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 I, 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. *111c properly 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 systcm is in proper operating condition and (2) aflcr inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scull I/\\'e. 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 DNH Cell ificalloll stating that your septic has been maintained must he completed and returned to the St Croix County %.oning Officer within 10 days of the three year expiration dale tilt iNl :I) tit Clmx l ounly l.~,ninl; 1 )flirt. 1 iovcrnnrt.-nl I Biller 1 101 1'a11111r11a0 lload I I/'►! Ilud'.4,n. W1 '14010 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 I),roperty TY\ <Z~' w0.-) Y1 S,LJX Jac l - 2-Local ion of property S~--_i/4 S 'P- 1/4, Section T A01 N-R~_W Township ~ L&~ Sow Mailing address fY1r1 S s i 1 q Address of site b dYi ~C, L Ny\e- ',n -rkg- knbi.6~ 9-115 t `~e(o c Subdivision name H kA y\ ; {f~ Lot no. ~d Other homes on property? Yes'Z~e\ _No Previous owner of property Qd-\Jk~ Q5A,)jQY\ Total size of property &~O% Aoe-S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? O( Yes No Is this property being developed for (spec house) ? Yes O _No Volume .//&.3 and Page Number 336 as recorded with the Register of Deed:. INCLUDE WITH THIS APPLICATION THE FOLLOWINGS A WARRA141'Y 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 refer(ices 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(si) of the property described in this information form, by virtue of a warranty deed recorded i the office of the County Register of Deeds as Document No. -''OAnd-that I (we) presently own the proposed site for the sewage disposal system or'.PC (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 ot.. Deeds as Document No. Signature of Applicant Co-App n't I~.~t • c,1 ~~~>>:~turc~ I)at~ c,f Rign,~ture ~v --r 'tea. DOCUMENT NO., STATE BAR OF WISCONSIN FORM I -1982 '-"1" 2FAC91 R!alRV[O FOR RIECORDINO DATA WARRANTY DEED •F , REGISTER'S OFFI -vo+..1162pnr336._ ST. CROIX CTY., This Deed made between Reed for Record Humbi•rc~--Land_'t rpora.tion,.,a..Mi_nnesota Corporation • F E B 2 7 1996 Grantor, and.. Timothy S , Schwartz- and Dawn M. ...Schwa.rtz,- Husband - at 9:30 and Wife, - ..et~tr~CBp,N. e Grantee, RegitCfDN~ 1, 1`1it)lesseth, That the said Grantor, for a valuable consideration...... . . RlTURN TO conveys to Grantee the following described real estate in St....Gr0.1A.... County, State of Wisconsin: Lot 52, Humbird Hills Third Addition, - Town of Hudson, St. Croix County, Wisconsin Tax Parcel No . T (~FER This i 5 not-..-..--• homestead property. (k) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrant% that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, restrictions and rights-of-way of record, if any and will warrant and defend the same. Dated this . _ ...9th . day Of February....__ 19-96.... (SEAL) HUMBIRD LAND CORPORATION (SEAL) • • bY?..o' . . Austin J. at on, Its President _ ..(SEAL) -..-....-.-..............-(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signataro(s) STATE OFXWXK%(RNX)X Mi nnes to se. amse-Y .........County. authenticated this -.----..day of 19-.-..- Personally came before me this -9th day of ..-For..nary 1996--, the above named Austin J.--.Baillon.,- President of • Humbird Land Corporation TITLE: MEMBER STATE BAR OF WISCONSIN (if not- F'4authorized by 700.08, Wis. Stnts') .,.to me known to be the person WhM AAAAAA foregoing Instrument and acknbwle4.- theatrp, ON THIS INSTRUMENT WAS DRAFTED "Y •'a::-i.i.,~: LINTY ...Humb.i rd.tand.-Corporaton--• PaullA.. Ba. .i.l.l.on. r.v7a:S.v«v..y-V" 11.2000 - Washing-.... ton vwv. Notary Public -.....:.-COuntydVtK. MN (Signatures may be authenticated or acknowledged. Both My Comnllsaion is permanent. (lf not, state expiration nre lint neressnry,) dale: Janua.ry.,,,... 31a-._ 1. . , II •N•my lit tenon. •IrnlnR in •nr e•r•<Itr nh..uld M lrrol m rrlntrd b.d,.w• ehrlr •IA n•ar•. 111 WARRANTY nP,RD ATATF. OAR OF R•19CONMN1. wb<nndn t".1 ai•nk Co- 1 - FDRM Nn. 1 Ht1! MRIe-•uk- wi..