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HomeMy WebLinkAbout020-1334-90-000 ~ 0 300 ~Y O k O 0 N O~ O C ~ ~ i I d O Z O C z C LL O 3 a i o z rn z o z ~ d d IL co N H UW) 0 O Z c - ai Z d 2 c ° N H lp N Z E ° ° O) M N O. N 7 N ~ N i O It •N L L O O a C O m N 0 C-4 O Z 2a E° ~ Z O O N Z E Y N N 10 a. _ IL m d C O O C An O v 01 O C O t0 d L O ~p N N N O (O V) U) U) M 00 {{SS.~ FSy CO N n. O > S \ gooo ~ •N 4i aaa Zoo a o N d r- co N fA J V y rn rn O . CD S O N 0 O O O E 0 14 o m y a v a~ a cn U) c 0 0 0 0 O) O E OI C 'O N N N V L f0 C R N M r C. O N o W .d. '70 CD 0) • ~ N n 7 O O O C O V o N S g N 0 Z_ d'd Cn c v d ~e € a #k a m a L • ee a d rr`1~~t +r E c c 0 ~1 A c°~az ONV l .f ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT s' Owner 5A Af Address At>X * f_1;-/ City/State N td 0-5 0 N tat 4/0 /4 s c NTY OUN 7 FICE CNING O Legal Description: Lot Z? Block Subdivision/CSM # ~fI DL fq 1~ d S r 112 1 k / %a 5F %4&/~, Sec. Z'7, T 2.1 N-R /f ~ Town of t-( L-1 ID cz~ N( PIN # 02-© -1331/ - 9O SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer h FI,5 f; 2, Size ST/PC ZIO/ Setback from: House ?S 'Well (-2 P/L`fN Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of-system: `TICS. Ne M Width + Length -7 S Number of Trenches Setback from: House SS' Well %7' P/L Vent to fresh air intake 7 t ELEVATIONS: Description of benchmark 1 f ► 0 E F I = 5% 8 is Elevation IO« 100 Description of alternate benchmark Ta P F B Iack Fog ey 0 A /v N ""c , 40 r Elevation (o l, 23 Building Sewer ST/HT Inlet ST Outlet 9? p PC Inlet - Oc3, $ $ PC Bottom Header/Manifold Top of ST/PC Manhole Cover,,, Distribution Lines (a) 9d g ` 96,,_7 (5) 9 t~ : T rk / 77 ( ) RN 97,93 4,qz 94,y4 l~ 3 S SA ~(5) /c.;~" 9 5, 35` ( ) Bottom of System W) Final Grade (P J 4• , y so' % 3 ( ) Date of installation /?'/I Permit number Z9cf 14 ZI State plan number Plumber's si nature G_/.4 ~ I License numberkj0qf,0?TOO Date 4 l2jl9 Inspector ° w Complete plot plan r NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PL VIEW r OVA W E L X00- Sc (b r, g I pN! f r Y V. ~ IGO.p ~ i l I -7 S - ALT ~s 4 j 1 INDICATE NORTH ARROW Wisconsin 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 299144 Permit Holder's Name: ❑ City ❑ Village jjl Town o : State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: Op DCa O~ V1 1 020-1334-90-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar u 7.27 I v 1.ZL ► o v Dosing f. SAA ~-Ij /dy// Aeration Bldg. Sewer Holding St/14f Inlet cj7-4V TANK SETBACK INFORMATION St/ VrOutlet 101.7- TANK TO P/ L WELL BLDG. q;~lntake ROAD Dt Inlet wJ Ih Septic d j~p~ j 5 l,~S NA Dt Bottom Dosing NA Header / Man. p. NA Dist. Pie 10 -r-5- Aeration P 47 G,S3 1 Bot. System .'75 '3 Holding PUMP / SIPHON INFORMATION Final Grade 7!0 99 Manufacturer emand t •92~ Model k1ou"M GPM TDH Lift Frictio ystem TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth _7 5, DIMENSIONS J aQ DIMENSIONS LEACHING Ma cturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER a Number. OR UNIT System: CCM" DISTRIBUTION SYSTEM Header/Manifold r Distribution Pipe(s) r N x Hole Size 4 x Hole Spacing Vent To Air Intake Z3 Dia. 4 Spacing !7 A' m, c~ QT 21 Length Dia length 7 fro SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r 11 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges _ 8 No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19,SE,NW 736 WILFRED RD-BADLANDS PRAIRIE LOT 29 h 14. ViOA - 1 z V o~ 66c k 6w4 k 4TM Plan IeOMJ~uired? ❑ Yes g No ^Use other side for additional information. "d il, J SBD-6710 (R 05/91) Date Inspector's Signature < ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division 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. 554• 61101 • See reverse side for instructions for completing this application State Sanitary PPerrmit/JNummbeerr The information you provide may be used by other government agency programs E] Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 73 ~ A/; l&-e _1 Rd. State Plan I.D. Number 1. APPLICATION INFORMATION (-yPLEVASE PRINT C/A~LLINFORMATION Property Owner Name Property Location 5A M IM ILL L A.- F_3 /4 tt)1/4, S Z 7 T 2,01 , N, R/ E (o(fr Property Ow er's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number L) IDSG~c t.U! yl~~~ (3%0)27 ~,Dl~AND aA►RIE ll. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road El Public 1 or 2 Family Dwelling - No. of bedrooms LTV i' OF v SOM LL fi2~Q R,D. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~a7• R 9.'q - 17& p 1 ❑ Apartment/ Condo 07-0-1 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. RNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ]]]]]System System Tank Only ExlstingSystem 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 12gSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 []Seepage Pit 43 ❑ V.auIt Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation tf' _510: ^I 4;' Co '7 r_0 'i~, 9 Feet X00.10 Feet TANK Capacity VII. in gallons Total # of Prefab. Site Fiber- Exper. NFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic ApP New Exist in strutted Tanks Tanks Septic Tank or Holding Tank ~G)Ca I WE I S E lL_ ❑ El E] n Lift Pump Tank /Siphon Chamber ❑ 1 E] ❑ ❑ 11 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: / I kE ibl 0A~ 6 Z, 4- el A 1016 a -l>3 do - Z Plumber's Address (Street, City, State, Zip Code): 1()-7o E(v h1' f /L_ R_ (U l'Ltr4 Lx tQ,S+ t f S / IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved ~$nitary Permit Fee (IndudesGroundwater Date Issue Issuing Agent Signature (No Stamps) [Approved ❑ Owner Given Initial ~o o' Surcharge fee) 1 p~.~ Adverse Determination 'l X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to County. One copy To: Safety & Ruildings Divi.ion, owner, Plumber 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, 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. 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, nuwiber of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, purnp/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. SCAIS SysTa~, 1 y5.94 7 p.S-o35oa 7340 U✓/L~FR£~ r~aAn -yf{ k ~ b2G~-/ 33`~'yU D2~VF U-jA ~AdR6E f ~4~ A 30 7B, IV fd,P o r ~p0 DO La, J O f1t M gRSE o F E IEe. Box E l~ 9~, yon 21 ell LAM f) -.1., 21 Lol IS y ~ -s - ► 3C -5 5 10 f g Z r ZI, gY i3y m I z T1 Cl I y r~ I o U I t~ I o r It r d r ~ R o I i O m l Z w ~I N o c (A#) I~ ' ~(A) ~ i goo H- 4 I Fti xo ~ 7, 0 00 0 rn LA c Wsconsin.DepartMent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code R COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference , yiirec and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and ' ` he:. -Aearest, oa_ 020-1334-90 ~ . ~ RE EWED BY DATE APPLICANT INFORMATION-PLEA ~R NT A*L ORM~„ N 1 PROPERTY OWNER: V.." PROPERTY LOCATION Richard Stout GOVT. LOT SE 1/4 NW 1/4,S 27T 29 N,R 19 fc(or)W PROPERTY OWNERS MAILING ADDRES~._k LOT # BLOCK # SUBD. NAME OR CSM # 1353 Awatukee Trl. 29 na Badlands Prarie CITY, STATE ZIP C Dlz~ y PHON ❑CITY ❑VILLAGE ,]TOWN NEAREST ROAD Hudson, WI. 54016 71`~l 549- Hudson Wilfred [x] New Construction Use Pc ] Residential l of~ ' ulnflb~ms 3 [ ] Addition to existing building ] Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Absorption area required 8 5 8 bed, ft2 7 5 0 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 -trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.90 ft (as referred to site plan benchmark) 5 Additional design / site considerations na ~v ? SZ2 Parent material outwash Flood plain elevation, if applicable na 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 :97 U aS ❑ U ❑ S U 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 Trench 1_ 1 0-12 10 r 3/2 none 1 lcsbk mfr c1w 2f .4 .5 2 112-35 10 r 5/4 none sil M mfr Cfw if n .2 Ground 3 135-45, 7.5 r 4/6 none is os mfr na .5 .6 elev. 100 . fit. 4 4 4/6 none fs os mvfr na na (l/ Depth to So limiting factor +88" Remarks: Boring # 1 0-25 10 r 3/2 none 1 2msbk mfr gw 2f .5 .6 - 2 2 25-33 10 r 5/4 none sil M na gw na np .2 Ground 3 33-40 10 r 5/4 c2d7.5 r 5/8 sicl M na ClW if n` .2 elev. 4 140-84 7.5yr 4/6 none sl osg mvfr na na .5 .6 101 .Ot. Depth to limiting factor +84" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. M New RichinorW, WI 54017 Signature: Date: 10-29-97 CST Number: m02298 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of s3 , PARCEL I.D. u 020-1334-90 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 'GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bd Trerxh 3 1 0-14 10 r 3/2 none 1 lcsbk mfr cfw 2f .4 .5 2 14-36 10yr 5/4 none sil M na gw if np .2 Ground 3 36-88 7.5yr 4/6 none fs os mvfr na na .5 .6 elev. 100. 1 ft. Depth to limiting factor +88" Remarks: Boring # 1 0-18 10 r 3/2 none 1 2msbk 2f .5 .6 Cfw 4 2 18-39 10 r 5/4 none sici M na 9w if np .2 Ground 3 39-47 10 r 5/4 2 7.5 r 5/8 sicl M na na n .2 elev. 4 47-84 7.5 r 4/6 none fs os mvfr 100. Qt na na .5 .6 . Depth to limiting factor +8411 Remarks: Boring # 1 0-19 10 r 3/2 none 1 lmsbk mfr 2f .4 .5 2 19-40 10 r 4 4 none sil lcsbk mfr 1f .2 .3 Ground 3 40-47 7.5 r 4/6 none fs 2csbk mfr na .5 .6 elev. 4 47-84 7.5 r 4/6 none fs os mvfr na na .5': .6 9 9.4ft. Depth to limiting factor +8411 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard Stout New Richmond, WI 54017 MPRSW 3254 SE 4Nw4 S27-T29N-R19w (715) 246-6200 town of Hudson lot #29-Badlands Prarie N 1"=40' BM.= top of mid lot survey stake C el. 100' Alt. BM.= base of elec. transformer C el. 94.40 fl gill IL too \ 2, V 1 2 Gary L. Steel 13~ 158.00' J Na h 32 3 31 N %p a: v 33 34 O ~ 2.05 ACRES o 2.00 ACRES Y 582'53'24"~4 89.182 SC. FT, 0 87•128 SO. FT. 32.5 s* , 3.94 ACRES ~c• v I ro 3~\J 171,8]) S0. FT. s~ 2.05 ACRES o ot. ~~~ry\ cP~ 89,192 SQ. FT. z CV e3.76 8 S 87'33b5" E it 716.30' J i I N jOp~S~• j i 'v, H.W.L. = 909.0 0 ` -101. RA 23 DEDICA TO THE PL al 35 ri MINIMUM CUILOING Ei,EVATON o o r H.W.L. = 925.64 j~9( 0 FOR LOT 35 - 310 o Y, 5 4.95 ACRES 'PA 215,413 SQ. FT, ~ 1'\ _ _ w T / 2 r~ _ o0 ' i Nays) r/ 1 y/ ; / \ ` ;4 a `19.75' 190 29 i5"~ J ~'S ss 80 200 ACRES P LINE 87,.136 SQ. FT. °o paw ~S88 3 "W 16 \ . o rn a h o° .12• 46.48') / \ z S Li 25 A' bK 207 = - - / / j\\ _ 89,965 14 is tiJ 7 26 , i ce' 11 \ by 48 \ 28 _j Ujk SC "an 7:7- N 87 49'5P E 168.62' II 4ps RED i DE01cA~o 17 I = - - - 2.13 ACRES z S65• I 92,795 SQ. FT. o° I - - _ - lpsp?S\•,, S7527 ng o ' • • . . ..l B \~9 p2.36 59.57 ZS F z p 'n 96.79' c m o ' o) cs d 16 N u, O c" N! w O 17 W 1 8 N I _ U O O A d 0 N Q J4 ~a 2.52 ACRES 3 o p0>1Jle109,745 SQ. FT. 2.00 ACRES A 1 z v- A? rn 87,146 SQ. FT !D 2 ~'d w E m ''1 h QI'. U lO H.W.L. ~ 917,5 cn y 2.01 ACRES m 89 87,404 SQ. FT. oq S ;'p R A f ham'' 26 Z61' N rp . ro• N 89'57'09" E 3160.96' 180.94' 70.44' 240.44' 176.40' E' 229.00' 54 EAST - WEST 1/4 LINE N 89'57'09" E% 3; UNPLATTED LANDS UTILITY EASEMENTS NO POLE OR BURIED CABLES ARE TO BF PLACED 1" = 100' DISTURB A`JY SURVEY STAKE, OR OBSTRUCT VISICt, THE DIS'rjR8ANCE OF A SURVEY STAKE BY ANYON OF WISCONSIN STATUTES. UTILITY EA5=MENTS AS h PUBLIC BODIES AND PRIVATE PUHUC I RU11ES HAV 100 77200 30~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S p M M I L. L MAILING ADDRESS B Q K 4tf / ' 1 PROPERTY ADDRESS 7 3 4 L jj ( L C rk C,0 D (location of septic system) Please obtain from the Planning Dept. CITY/STATE y 0 S a 0 W1 - VD 140 PROPERTY LOCATION J 1/4, W 1/4, Section Z °J T_R- W,, TOWN OF HL) ON ST. CROIX COUNTY, WI SUBDIVISION R A 0 I -A N Z) 3 A! R-1 6 LOT NUMBER CERTIFIED SURVEY MAP S(0 10 I(o , VOLUME to , PAGE g , LOT NUMBER 447 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 S T C - 100 This application form is to be completed in full and signed owner(s) of the property being developed. An inadequacies the only result in delays of the permit issuance. quacies will development be intended for should this house resale by owner/contractor, 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 S7 tP A-1 f L. t r Location of property_ sr= 1/4 Nw 1/4, Section Township c © ~ • T ~ q N-R Mailing address 5a wl 9D Address of site 7 w C F/ S40 Subdivision name 1- 0 ~ 1 Q 1 ~ Lot no . Other homes on 04 property? ___Yes---,? NO Previous owner of property I C. h a ✓c{ -T 10 Total size of property 7, o A e Total size of parcel 'a-, Date parcel was created p - lo _ 1 Are all corners and lot lines identifiable? _ Is this property being developed for (Spec house,Yes No Volume and Page Z " Number ~ 1 . ~'_Yes No as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUME NUMBER AND THE SEAL OF THE REGISTER OFT DEIEDS R, VOLUME AND PAGE certified survey, if available, would be helpful so asdtool av a delays of the reviewin oid references to g process. If the deed description a Certified Survey Map, the Certified Survey Map shall also t required. I PROPERTY OWNER CERTIFICATION (we) certify that all statements on this form are true to best of my (our) knowledge that I (we) am a pro ert the p Y described in this ( re) the owner(s) of the warranty deed recorded in the noffice lof he County virtue of a Deeds as Document No. er of own the S~ 4°R , and that I e epresently pro posed site for the sewage disposal system )orI(we) obtained an easement, to run the above described property, construction of said system the , and the same has been du e for the office of the County Register of Deeds as y recorded in Document No. S ature of Applicant Co-Applicant Date of Signature 56 (668 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL ',z 1 c~PA~[3~tJ PlCROOC GGS r~'R'S QF'FICEyy, Richard O Stout Co" Wl I I Z0,0 t r Rwrd I~ conveys and warrants to Sam E. Miller OCT 3 0 997 11:15 A M 8e ~ataa of w ~ THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS R the following described real estate in St. Croix County, jj State of Wisconsin: Lot 29, Plat of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin. r PARCEL IDENTIFICATION NUMBER (I I II 'I I it I TRANSFER i _ FEE I I i I ~I This is not homestead property. (is) (is not) II Exception to warranties: i easements, restrictions, rights-of-way and covenants of record, if any. Dated this 28th day of October A.D., 1997 i) (SEAL) (SEAL) I Richard O. Stout • j (SEAL) (SEAL) i w I I AUTHENTICATION ACKNOWLEDGMENT ~j Signature(s) State of Wisconsin, ii SS. St. Croix County. j authenticated this day of , 19 Personally came before me this ^ 28th day of Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page 1 of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ()a10 _ APPLICANT INFORMATION - Please print gJLh2tQrmation. Reviewed by Date Personal information you provide may be used for seconds y purposes (0qv y s. 15.04 (1) (m)). Property Owner Property Location Richard Stout Govt. Lot SE 1/4 NW 1/4,S 27 T 29 N,R 19 XE (or) W Property Owner's Mailing Address of # Block# Subd. Name or CSM# 1353 Awatukee Tra'{., Badlands Prairie City State Zip e-j oitie ❑ city ge ZI Town Nearest Hudson WI 54 16r, (71~~ 73'? Huson Village Farm rd t New Construction Use: Reside / N~r>ibQr ?f b 'f *ms 4 Addition to existing building Replacement Public or com'tnerei scribe: Code derived daily f1ow6 0 0 gpd Recommended design loading rate 7 bed, gpd/ft2 • 8 trench, gpd/ft2 Absorption area required 8 5 8 bed, ft 2 750 trench, it 2 Maximum design loading rate • 7 bed, gpd/ft2 • 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 9 4 . 7 5 it (as referred to site plan benchmark) Additional design/site considerations Parent material G 1 a r- i a 1 H an Sit Flood plain elevation, if applicable it S = Suitable for system Conventional Mound In-Ground Press AT-Grade System in Fill Holding Tank U = Unsuitable for system S ❑ U k] S El U E~ S ❑ Uure [J S ❑ U El g [ U ❑ S U SOIL DESCRIPTIOA REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Cu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 " 1 0-10 1 0yr3/2 none L 2mabk mfr cs 2f .5 :.6 2 10-44 10yr4/4 none is 1mgr mvfr cs if .7 .8 Ground 3 44-90 10yr4/6 none ms osg ml cs elev. - - 9 9 -5-0-ft- Depth to limiting factor min. Remarks: Boring # 1 0-6 10 r3 2 none ___L 2mabk mfr cs 2f -5 -6 2 6-36 10yr4/4 none is 1mgr mvfr cs if .7 .8 2 3 36-8 10yr4/6 none s sg 1 cs .7 .8 Ground elev. _ 99 -6-5--ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature / - Telephone No. ~rr~i cr S G w lys e I' L✓ i~- r rr"i ?L 5- ^ 3 ?-Z- 3 /'.2 9 Address Date CST Number O S4' o'77 Ive/ 't) j~ Y 6 v p? 9 4'!0 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT . Page 2 of 3 PARCEL I.D.# 3oring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0-6 10yr3/2 none 2mabk mfr cs 2f .5 ..6 2 6-42 10yr4/4 none s 1mgr vfr cs if .7 .8 around 3 42-91 1 0yr4/6 none s sg 1 cs .7 ; . 8 10 0-levf Depth to Imiting actor 9 2 in. Remarks: 3oring # 1 -14 10 r3/2 none mabk fr cs 2f -1; 4 2 14-4 10 r3/4 none it mabk fr CS if .5 -.6 3 4-9 10yr4/6 none s s 1 s - .7 .8 around alev. 9 9 -5-0-11- Depth to imiting actor min. 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 # 1 -8 10 r3/2 none mabk mfr s 2f .5 A 2 -40 10yr3/4 none it mabk mfr s if .5 .6 5' - 3 0-9 10yr4/6 none s sg 1 s .7 ,.8 Ground elev. 101 -.--eft. Depth to limiting factor _g 0 in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Az x67-- g Ids 3 d f 3 JCL- f 0 0 , !s- 04 p n 00 0 1 $ ~ ? sdp, a a