HomeMy WebLinkAbout040-1237-90-000
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT I
'eO \
Owner C o N S fi t~99
- ~ IZ~,, L ! N ) -+:Property Address ~u Y u b 1 s r CHU;x~
City/State ~b s o N 1r j s o ~viNGGOF1 OF
Legal Description: 4y ~
# ~,uv >a n v(Jb
Lot Block ~ Subdivision/CSM W
N '/4s U t/4, Sec. 3 , T l t N-R 11 W, Town of 2 t, PIN # 0 /p /,437'~?O - 66C)
-11, 1 a-oS
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer W R-w-~- ' Size ST/PC ) QUU / Setback from: House 13' Well-;;' 50P/L -?;k S'
Pump manufacturer - Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks:
Meter to
Al location
-le
SOIL ABSORPTION SYSTEM:
Type of system: ~ N °Y\- Width 3 Length 5 Number of Trenches a
Setback from: House Well ?Sy' P/L ?S 4d Vent to fresh air intake
ELEVATIONS:
Description of benchmark Pl fig Elevation
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet 5 ST Outlet y U PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover 0 U
Distribution Lines ( ) LS ? 5 ( ) 1 5 0 ( )
Bottom of System (N) y S U ( )
Final Grade ( ) ( ) y ( )
Date of installation B /3 Permit number ~k g 3 9 V State plan number
Plumber's signature License number LQo~9 ()y Date
Jv
Inspector t l
Complete plot plan a
J
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.
PLAN VIEW
3-A o
N d ►ti.p
Not'e' Mp1u) R ')1 Oft 04 1 { t
N
INDICATE NORTH ARROW
Wisconsin pepartment of Commerce 30 ro D 3 IEJ
Sefety and Buildings Division PRIVATE SEWAGE SYSTEM Co tyT . c oIx
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitnP8N9?8.:
Personal information you provice may be used for secondary purposes (Privacy L S.15.04 (1)(m)].
Permit Holder's Name: Village Town of: State Plan ID No.:
D.S. CONSTRUCTION & ASSOCIATES C+RBP
C BM Elev.: Insp. BM Elev.: BM Description: Parcel o.:
~ It O~ c ~-1237-90-000
TANK INFORMATION ELEVAT N DATA A9700205
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / pcS~ Be [~.61) /O bt7
Dosing kM
Aeration Bldg. Sewer G
Holding St Inlet
TANK SETBACK INFORMATION St Outlet G,~ ~J?
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
y(o
Dosing NA Header / Man. 7,7
Aerati NA Dist. Pipe ` S fl
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufa Dema
Mod I Number M
TDH Friction TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSO TION SYSTEM
BED /TRENCH- -Width S( Length 75- No. Of Trpnches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ DIMENSIONS
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING
INFORMATION Type912 'A ~ 'Y CHAMBER o e Num r:
Syst ~ /IVGN7i)+ -D 3 -OR UNIT
DISTRIBUTION SYSTEM ,
Header / Ma i old / Distribution Pi e(s) It x Hole Size x Hole Spacing V.
To Air Intake
Len th Dia.
g ~ Length Dia. 3q Spacing
a, rCaa
(Z Garr ~.C/S
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.)
LO 37ION: TROY 3.28.19,NE,SW 544 GILBERT ROAD LOT 68
AL e- M ' IS0 nvn4 U72 ~o t /,-avr lO/W.. 5' en ~
Plan revise re ld?l
qul d? ❑ Yes No
Use other side for additional information. -1c7
SBD-6710 (R.3/97) Date Inspector's S nature rt o.
ADDITIONAL COMMENTS AND SKETCH t
SANITARY PERMIT NUMBER:
I
l~\■,.. `min Safety o and Building Water Division
Systems
SANITARY PERMIT APPLICATION Bureau
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 r
than 8 112 x 11 inches in size. S K
• See reverse side for instructions for completing this application state Sanitar Permit Number
' ~ 9 39D
The information you provide maybe used by other government agency programs p 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
Pr erty Ow r Name 1 Property Location
Te `C1/4 _50 1/4, s 3 T , N, R Cr E (or W
Property O ner's ing dress
City Lot Number Block Number
"S
lyl, V
Subdi ion Name or CSM Number,
y Sta a Zip Code Phone N umber
( _
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) r~ o
1 ❑ Apartment / Condo
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. TjkNew 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 21171 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12WSeepage 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. y lev. 7. Final Grade
Req 'r d,(`sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Ele
1 ✓d 7 S0 . t0 •0 Feet
~ V 45eet TANK Capacity
VII. FORMATION in galtoTotal # of Prefab. Site Fiber- Exper.
Gallons Tanks Manufacturer's Name concrete con- steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank r OVV i< ❑ ❑ ❑ ❑
Lift Pump Tank' /Siphon Chamber El ET El 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: rint) Plumber's Si nature: (No Stamps) MP/MPRSW o.: Business Phone Number:
7r~ 8 d o17~
JAA!g4 0, I 3,b,
Plumber's Addr ss,(Street, City, State, Zip Code): °
C) 10 IX. COUNTY / D ARTMENT USE ONLY
E] Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
IbIA roved Surcharge fee)
7'` pp ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6390 (R. 0S/94) DISTRIBUTION: original to county, One copy To: Safety & Ruilaings Divmion, 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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7-
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system- Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII- Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form-
IX. County/ Department Use Only.
X. County/ Department Use Only-
Complete plans and specifications not smaller than 8 112 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.
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av 3I`c Pip i,.,ftti, II ), N.
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. FRESH AIR INLETS AND OBSERVATION PIPE
CROSS SECTION .
1._T Approved Vent Cap
.. '•,,Minimum 12" Above N WUs
Final Grad? _-
•• ��� �`�' 4 " Cast Iron
Above Pipe Vent Pipe
To Final Grade
Marsh Hay Or Synthetic Covering
Min. 2" Aygr.cy',il _
• ' Over Pipe \V ''�
I1 _ Tee
Distribution �—
• Pipe - � _........_ r
„ �- .
`--) 9`l,SC Aggregate _ Perforated Pipe Below
• Beneath Pipe c Coupling Terminating P
(.. .H19y•OU __ �i Bottom of System
R.t16)•- TR.0.,tom_
•
Wisconsin Department of Industry, SOIL AND SITE EVALUATION /
• Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
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 C/�O/x
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.#
oyp • /237 ' y'd
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
•
Property Owner ',fop _m oe k. Property Location
s• CerA,s ripUGT4O,,, st'O cols,t, Govt. Lot NE 1/45V 1/4,S 3 T 2f ,N,R E(oe
Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# SS'r1 G3 3 VJoi 2yo P L 7
7a 3 57' etot-A s%• 'le • 68 / CO!/.'i y' t A 27 6S77f7-e'S
City State Zip Code Phone Number / Nearest Road j k /
//UPSO..1 IZ0/, I..s-vat I ( 7/S )3f�'/mil L� ❑ CityT�❑o Village Lvj Town Cs 1 = I'
Flew Construction Use: 111'Residential/Number of bedrooms 3 Addition to existing building
❑ Replacement �j 11]Public or commercial-Describe: /f///Q- No 7 /QI Fea t
Code derived daily flow y7(���''' gpd d
N/1 Recommended design loading rate /� bed,gpd/f12 trench,gpd/ft2
Absorption area required t bed,ft2 7� trench,ft2 Maximum design loading rate// bed,gpd/ft2 trench,gpd/ft2
Recommended infiltration surface elevation(s) -S'€4 t • 3 ft(as referred to site plan benchmark)
Additional design/site considerations Z Tit' S '11 7 S al(-
Parent material 54.,m7 t7U1`(,c)'T,,ssAA 7�I K AJ Flood plain elevation,if applicable /A ft
S = Suitable for system [TiConventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system S ❑ U ❑ S I�'U L3 S [1] ❑U s L"J U/ ❑ S o-lT ❑ S 0'e
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
I o.11- /p y1 2/2- eoM plere-17. 5.i L. /-74f/e An I f• GS
z za•33 /o ye 3/4. SG /-fyA d5 Cs /f, q ,• S
Ground 3 33'f9 , y 7`4 GS' /7 ,f UG • S' • CO
Cl y' Z7 ft. !
Depth to
limiting ,
factor
7f0 in.
Remarks:
Boring # - OR/ O•/3 /Dy�t �/ z .�s a��}� �U S/L I /Q 6".t 7Ci C S /71- ID .. ,up
2— /3 ' ' o 3/3 S7G /74:14e ./e CS /f . z ;
3 2l•f//ow y/6 G5- /f — . S : •6
Ground
elev 1:saft. V 1N AL
Depth to
limiting ,
factor
> rqg in. Remarks:
CST Name (Please Print) D �E T- 2`04 tl/�/�-Signature Telephone No.
/� /C vvl 7 i s 3 P6 cP/8 S
Address Date CST Number
Ulbricht&Associates 1-2."' ��— S
private.ceWapw r:nnsultants
655 O'Neil Rd. (6 9 /p
44.
Hudson,Wis. 54016
REC IVEO
to JI N 2 1997 z
ST CROIX •
,-oUNT`/ /
ZONINGc�w`c,E
0,
•
f . s' '-u-51 -CT/GSOIL DESCRIPTION REPORT Z • j
PROPERTY OWNER
� D// / �3 7 _ / Page of
4
PARCEL WI -1-62 4 �ZTo 9�
Boring# Horizon Depth Dominant Color Mottles
in. Munsell Qu.Sz.Cont.Color Texture r.StructureSz. Consistence Boundary Roots GPD/ft2
- Bed ,Trench
( 49•/V /O%2 2f 2-- $/ Lf shy 4+14,e c s l f .s ; . c
z J9.2e, ioyg 3/3 — SiL. /fske 44 fe es /of .2- ; .3
Ground 3 Zo•yd,, ioy/ Y/6 Gs /ffA d,e es - • s , . Co
elev.
F7. ft. 961.? / S// ' F-s /F fc A/4 _ -- ..s :. Ca
Depth to ;
limiting
factor
y
in.
Remarks:
Boring#
0-/7 /0V 2/2-- //fite7 ! .5i -H Z CC . 44, 7' Cs fi pp ,��
to 2- / %/%e 3/ sG /sk 40,�ie a S /of.`) ; • .�
Ground
( �D/CO 490 S`�Y f 5 / ��Q (/�T L -'' -- i S; .
Ssg•.js ft.
Depth to _ '
limiting
factor
'6(p_in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2
In. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Consistence Boundary Roots
Bed , Trench
Boring #
o// /c 2/2__ — Sit 24.5ke i* Cs i f- .s: . C.
�.. l z //'3z Age 3 /Y S' 2 5 Pg fs , • s; •
3 3116 /hy y/6 G-S /ffre 401 4
Ground
p elev. .
O sf ft.
Depth to
limiting
factor
>% in. Remarks:
Boring#
1
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBDW-8330(R.08/95)
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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 (r p fj. o s {s d .
Location o.f property -1/4 sw 1/4, Section W
Township a -Mailing address
Addr.essoCsite ~lr.tr• f- Rel- AvG~sbn ld
Subdivision name r0 Lot no.
Other homes on propert ? Yes No
Previous owner of property
Total size of property °J.,,/.4d
Total size of parcel
Date parcel was created
Are all corners and lot lines /identifiable? k_Yes No
Is this property being developed for (spec house) ? J~ Yes No
Volume and Page Number oa? as recorded with the Register
of Deed:.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRAIII'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
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I ~ certify that all statements on, this form are true to the
best of my Lpa-r) knowledge` that I Lwi5j am ( the owner ( 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 ~jG _3 and•that I UAwl presently
own the proposed site for the sewage disposal system or fI (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 o.f Deeds as Document No.
- 3 -S
gna ure of Applicant Co-Applicant
- A'xt'z -9 ~'7
0.0-t• cat i(rrurt-.iire. Dato c,t Signature.
S T C 1115
SEI TIC'T'ANK MAINTI,;NANCE. A(:ILEFINIENT
St. Croix 01111111.
O~'~'NI~,R/13111'I?It - S, G9ori ~ o ►1_ S cc,~
MALI.ING ADDRESS Sf L°yo t ,-~i~•ctvGlso~w1_SS~o/
(sj ~b
PROPERTY ADDRESS ,
(location of septic system) l'Ic, sc obtain (ions the I'lanning Dept.
CITY/STATE. _A AU10So r7
PROPF,R'TY LOCATION _V 1/4, - W 1/4, Section 1 N-It /
w-
TOWN OF _ ina 5e ST. CROIX COUN'T'Y, WI
SUBDIVISION Wgoo F; it k,&6 ic(7 L()'1' NUM131?It !i 8
CERTIFIEDSURVEY MAI' T , VOI,UMP; PAGEe , 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. Whal 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.
"Iltc properly owner agrees to submit to St. Croix Zoning a certification Colin, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
tine on-site wastewater disposal system is in proper operating condition and (2) alicr inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum
Me, the undersigned have react the above requirements and al,ree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the wisconsin DNR
Ceriilication staling that ix
you[- septic has been nutintaincd most he coinltlctcd and returned In the St (.ro
County /-mmi ; Officer within 10 days of the three year expiration date
DATE
tit t'rurs C't~unty l.i,ninl, t tllicc.
illvl'111111C11) ('tlllt'I
1101 t'alntu har) Road
1111(1-.4111. WI '0016
ti VOL 1240ParEP7
559633 STATE BAR OF WISCONSIN FORM 1 - 19$2
WARRANTY DEED
DOCUMENT NO.
This Deed, made between_ Richard O. Stout
lu'JIIA KWAOQ
MAY, 2 0 B9•i `
Grano`
. and D. S. Construction & Assoc.. Inc. ~dt 11 :45' : A M ,F
~fw 1J.1+fI. Witnesseth, That the said Grantor, for a valuable consideratiot~ y ra
conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA a
County. Stale of Wisconsin: NAME AND RETURN ADDRESS
Lot 68, Plat of Country Wood First Addition, cry: ~;~l.J~; Title, Inc.
Town of Troy, St. Croix County, Wisconsin. P.O.'Box 149! 206 2nd St.
4 Hudson, Wf 84016
ti PARQEL IDENTIFICATION NUMBER
~ f
-
h
r 4
This is not homestead property.
(is) (is not)
Together with al' and singular the hereditament and appurtenances thereunto belonging;
And Richard O. Stout
5.: warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
ea semen t:s, :reetrictions,.. rights-of -waand oovenants of record, if '8ny,
and will warrant and defend the same. -
tl I
f Dated this 19th. day of May- 19 97,
Y
~.eQc9,
(SEAL) (SEAL) ;
Richard O. Scout -
(SEAL) a (SEAL
t' AUTHENTICATION ACKNOWLEDGMENT'''
j Signature(s) State of'Wl cousin,
St. Croix.
' County.
authenticated this day of 19_ Personally came before the this 19th - day of
' Ma
6 y " - 19 97
;the above named
c Richard 0. Stout
i TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
a4 authorized by §706.06, Wis. Stats) Brenda ppulin:
to pf~ mr to be the peroo who execuyed tltrforegoing r_.
- r%..t.r:..
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
t Labor MA Human Relations ?
0h4lon of safety and Buildings in accordance with s. ILHR 83.09, Wis. Page / of J
Attach co"Vet0 8110 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 C/QD/'x
percgnt slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D. I
-0 1;'0' 3 7 • ;•O
APPLICANT INFORMATION - Please print all Information.
Personal Inforrallon Reviewed by Date
you Provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Y
Property Owner flllV/ Sit/lL'. Property Location
17. S. cpvSrpvcT~ov Govt. Lot ~e 1 /4 Ski 1/4,S 3 T N,R E (o~)
Frope Owner's Matting Address Lot I Blockll Subd. Name or CSMN
•723 5Y 4o/•x ST
68 ~ea,~Te/i lvoo~ :5s7s
City state Zip Code one Number
Nearest Road !~-~/c~
ffapSO.✓ ZJ/, Syo~G (715 ) 3j /I-2,f ❑ City ❑ Village WITO 4 RIL
4ew Construction Use: (17esidential /Number of bedrooms
Replacement Addition toe `isting building
El Public or commercial - Describe: ,I/a l
Code derived daily flow gpd Recommended design loading rate bed, gpd/tfz trench /ftz
Absorption area required ~/~bed, ft 2 trench, N 2 '
S-GC . 3 Maximum design loading ratW~/ bed, ;pd/N:: trench, gpd/ft2
Recommended Infiltration surface elevation(s)
It (as referred to site plan benchmark)
Additional design/site considerations Z- 7 s C 7 5 ' w
Parent material -Ir-
- Flood plain elevation, it applicable 11
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ~ U ❑ s Fai i p ❑ U ❑ S [ ❑ S 9v- ❑ S [3-H'
SOIL DESCRIPTION REPORT
Boring N Horizon Depth Dominant Color Mottles Structure
" In. Munsell flu. Sz. Cont. Color Texture Consistence Boundary Roofs G
Gr. Sz. Sh. Bed , ,Tren Trench
/ D.i1- /Q71~ ;t/ 2 QOM°r:TE77
-LOA r_
z Z • 33 jo S/ l fie Ht -fl ' cS /f N
P
~
Ground
elev. 3 ,
Depth to -
limiting
factor
7'e:-' $ In.
Remarks:
Boring # 11010 Z erjarZ7 s/L l~ .~r c f',' c S /7- A.)
L 3 3/3 S/G fs _.e 5 /V f
Ground •
elev.
Depth to
limiting
factor
fF__M• Remarks:
CST Name (Please Print) p~R &rR r Signature
Telephone No.
Address
5. 3P6 •c'/4S
Ulbricht $ Associates Date CST Number
is Z 2 - f i!'sJ-i~t ~-~E~
655 O'Neil Rd.
PROPERTY OWNE" / `~-SOIL DESCRIPTION REPORT y
Z
PARCEL I.D.# l0'~ fo~ Q / Z3 7 - Page of
Boring # Horizon Depth Dominant Color Monies
In. MunseO Qu. Sz. Cont. Color Texture G►n Sz uSh. Consistence Boundary Roots J
3 t9-/ ?-/2 S/L L F sf~ nti, Be`~~ c s
Ground 2 t ~ i Cs /V f . elev. F7. g-5-ft-
Depth to
omiling
factor
~ QQ_In. ,
~O Remarks:
Boring #
9- 414 fi C5 /74-
Z /O 3 3 N
Ground
f! elev.
0 S! S ~~f
Sa ',,~ft• ~ ' S, '
Depth to
limiting
factor
> lft/r-in. '
Remarks:
Horizon Depth Dominant Color Mottles Structure in. Munsell Texture Or. Sz. Sh. Consistence Boundary Rood
Qu. Sz. Cont. Color
Boring # S ;
~ • / /YA ~ 2___ Bed Trench
/G 2
CS
2- / /D jl SSG 2-~s die s / f . S .
Ground
Depth to
IlmiNng
factor
in. Remarks:
Boring #
Ground
elev.
tf.
Depth to
Ornning
factor
In.
Remarks: ,
SBbW-Haan in nnu+r.
14
" h
W
h o
- - -
M
g a
~ v, I 1
r I ~ ~ ~j (11
x l ~ oo ~ ~ v
i
I 1 Aj
I i ~ vl M
N
W~ w o
Qc r a l ~ ~ _
I`
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COWNITY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include/but St ` ix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale 07 e PAPICEL I D
dimensioned, north arrow, and location and distance to nearest road. I fend i ng-''
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY L- CANON y
Richard Stout GOVT. LOT nl'~\1/4 SW,A/,4,, 3 T 4 N,R 19 (or) W
PROPERTY OWNERS MAILING ADDRESS LOT # BLO~~ SVBt)'`N OfcCS
1353 Awatukee Trl 68 nva .f' d 7
? AREST ROAD
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 7MP
R°
Hudson WI. 54016 b15)549-6731 Troy Tower Rd.
tc] New Construction Use [ )q Residential /Number of bedrooms 3 [ ] Addition to existing building
[ ] Replacement [ ] 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 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 90.83 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted outwash plain 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 KI S ❑ U t7 S ❑ U CAS ❑ U ®S ❑ U ® S ❑ U ❑ S I NU
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&
t'.....:1:.. 1 0-19 10 r2/2 none 1 2msbk mfr cs if .5 .6
2 19-26 10yr4/4 none sicl 2msbk mfr C[W if .4 .5
Ground 3 126-40 10 r4/6 none sicl lfsbk mfr cfw if .2 .3
el
94 v5 ft. 4 0-86 10 r4 4 none 1 fs os mvfr na na .5' .6
Depth to
limiting
factor
+86"
Remarks:
Boring #
1 k-20 10 r2 2 none 1 2msbk mfr crw If .6
2 2 6 0-30 10 r4/4 none sicl 2msbk mfr crw if .4 .5
3 0-42 10yr4/6 none sicl lfsbk mfr CIW na .2 .3
Ground
elev. 4 2-84 10 r4 4 none os mfr na na .5 .6
94.33 ft.
Depth to
limiting
factor
+84"
Remarks:
CST Name:-Please Print Phone:
Gar L. Steel 715-246-6200
Address: 1554 200th Av . , New Richmond, WI. 54017 M02298
Signature: Date: CST Number:
4-18-96
PROPERTY OWNER Richard Stn,it SOIL DESCRIPTION REPORT Page 2 of-_
PARCEL I.D. It Pending
Lot #68
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Tmr&
1 0-19 10 r2/2 none 1 2msbk mfr If .5 .6
2 19-26 10 r4 4
n sicl 2msb
Ground 3 26-40 10yr4/ none qi C-1 6 lfsbk m
elev.
93.86 ft. 4 40-84 lfs
Depth to
limiting
+f8a4tor
11
Remarks:
Boring #
I 0-20 10 r2 2 none
h oa
4 2 20-37 10 r4/4 none sicl lfsbk m r
Ground 3 37-8 °
elev.
93.4 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 -20 10 r2 2 none 2msbk rnfr
4 5
2 0-43 10 r4/4 none sicl l fsbk mf
t
if -2i
Ground 3 143-84 10 r4 6 none
elev.
93.13 ft.
Depth to
limiting
factor
Remarks:
Boring #
4
ittv?.:~4~:..
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 NE4SW4 S3-T28N-R19W (715) 246-6200
town of Troy
lot #68-Country Wood
N
1"=40'
BM.= top of 1" steel pipe C el. 100'
~ ~GcJzr~~-t2-
C
Ifs`
Gary L. Steel
4-18-96