HomeMy WebLinkAbout040-1034-20-000
t
8 v
0
RECEIVED
STC - 104 R
AS BUILT SANITARY SYSTEM
REP - i r 1 ? 1997
OWNER ST CROIX
01 COLItm
ZONING PRCE
ADDRESS
SECTION LOT #
_W, Town of
ST. CROIX COUNTY,
WISCONSIN 610
PLAN SHOW EVERYTHING WITHIN IEOWO ~ a g. I ~ ` I I I
FEET OF SYSTEM
• £~~s 1.11 k.)e
P("T ~C c g fy~7n 4,/C N
~I
I
II
t~
SC)
N
INDICATE NORTH ARROW
Provide setback and elevation information
Provide on reverse of this form.
2 dimensions to center of septic tank manhole cover.
~ i
BENCHMARK: ,~P t ~~c✓i~ / a~
ALTERNATE BM:
~ZeC$'nr SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: /~JiP y Liquid Capacity: /,,TV
Setback from: Well House(,,,' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 3 Length 116 Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: (~5 House "Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: -~7 J
✓ /
PLUMBER ON JOB:
LICENSE NUMBER: F1Y ,j2V
INSPECTOR:
3/93:jt
.Wis ns~ department of Commerce PRIVATE SEWAGE SYSTEM County
Saf4jyandBuildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarlm ft:
Personal information you provice may be used for secondary purposes [Privacy LXw, s.15.04 (1)(m)).
SMIA is N i gIE$ Village Town o : State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TY46=1034-20-000
,
OD . .2. Ct.t,J
TANK INFORMATION ELEVATION DATA A9700295
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic emu- Benchmark, vC~
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet /0.0
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header/Man. i ,So•=
Aeration NA Dist. Pipe
Holding Bot. System /o.sv- yb, w
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand tai S • qq, x
Model Number GPM
TDH Lift Lrictio System TDH Ft
Head
Forcemain ngth Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth
DIMENSION Z DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Mode Number:
System: o? ' '-17 ' g p 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 8.28.19. 111B,NE,NE 490 COUNTY ROAD FF
/
Plan revision required? ❑ Yes [3-No
Use other side for additional information.
SBD-6710 (R.3/97) Date nsp ctof s Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH {
SANITARY PERMIT NUMBER:
~ Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce 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. 1"s,/
• See reverse side for instructions for completing this application State Sanitary Permit Number
a 81 4170
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 INF RMATI N
Property Owner Name Propert Location
A to n_ 1 E 1/4 Z' 1/4, S T , N, R /q k(or)
Property Owner's Mailing Address Lot Number , Block Number
4/i0 C'=fdk) c/c
City,Stat Zip Code Phone Number Subdivision Narrje r CSM Number
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 3 []Village
T/I G Iw
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo rv !U`
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. ;g Replacement 3. ❑ Replacement of 4_ ❑ Reconnection ofi 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 RSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 [3 Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
15~6i~ 3 571b vd. D Feet 9Y,1 Feet
VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
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-
Plum is Name: (Print) Plumber's Signature: (No St mps) MP/MPRSW No.: Business Phone Number:
71 4 ° 77V - /Y
Plumber A( dress (Street, City, State, Zip Code): 1
IX. COUNTY / DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
[Approved ❑ Owner Given Initial Surcharge Fee) G
Adverse Determination h-7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
~z - -
1 "
SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, 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, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line 6 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.
r JOB ~-A !'LIP C ~0/~rG~QI~
TIMM EXCAVATING SHEET NO. / OF
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY lk410 Or' DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 ~ inc., Groton. Mass. 01471. To Order PHONE TOLL FREE I-8&225.M
' JOB SGL'L` +S V2Si NSW
TIMM EXCAVATING SHEET NO. OF Z
Route 1 Box 192 r- n
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-80D225-M
wisr,oDsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Fluman Relations Page 1 of 3
Division of Safety and Buildings j gpordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less i es in go. 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. #
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 Property Location
James Johnson Govt. Lot NE 1/4 NE 1/4,S 8 T 28 N,R 19 RXW) w
Property Owners Mllin aiM CTHW FF F Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number Troy Nearest Road
Hudson, WI 54016 (715 ) 386-6227 ❑ City ❑ Village )E] Town CTHW FF
❑ New Construction Use: lJ Residential / Number of bedrooms 3 Addition to existing building
)EI Replacement ❑ Public or commercial - Describe:
Code derived daily flow 450 gpd Recommended design loading rate ' 7 bed, gpd/ft2 •8 trench, gpd1ft2
Absorption area required 643 bed, ft2 562.5 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpdht2
Recommended infiltration surface elevation(s) 90.0 ft (as referred to site plan benchmark)
Additional design/site considerations install 2 - 3' x 961 turtle shell trenches
Parent material sandy/loamy outwash Flood plain elevation, if applicable NA ft
S = Suitable for system conventional Mound In-Ground Pressure AT-Grade System in Fill Holding tnTank
U = Unsuitable for system fn S❑ U D S El U ® s El u 10s ❑ U ❑ S 7 U ❑ s XY,~ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 1 0-13 10YR 2/1 - sl 2 f sbk mvfr cs 1f/m .5 .6
2 13-18 10YR 3/4 _
sl 2 m sbk mvfr cs 1m .5
Ground 3 18-34 10YR 316 - sl 2 m sbk mfr cs 1m .5 -.6
elev.
96.1 ft 4 34-41 10YR 4/4 - is 0 sg ml Cs 1m .7
5 1-63 10YR 4/6 - mcos 0 sg ml cs - .7
Depth to
limiting 6 1-11 10YR 5/4. - s 0 sg ml - ,7
cc8r in.
Remarks:
Boring #
1 -14 0YR 2/1 1
2 4-18 OYR 3/4 - 1 m sbk vfr cs 1m ,6
3 8-31 OYR 316 - 1 m sbk fr 10 M f 5 .6
Ground 4 1-35 .SYR 4/4 - s sg cs - 7 :8
~le>f 5 5-43 OYR 4/6 - sg 1 Cs 1m 7 ,8
ft.
6 3-68 OYR 4/6 - cos sg 1 Cs 7 ,8
Depth to 7 8-104 10YR 5/4 - sg 1 - 7 ; 8
limiting
factor
> 104 in. Remarks:
CST Name (Please Print) Sig u Telephone No.
Henry F. Grote 715-665-2681
Address PO Box 57, Knapp, WI 54749-0057 Date CST Number
12/9/96 3065
PROPERTY OWNER Games Johnson SOIL DESCRIPTION REPORT Page 2 7 of 3%
'
PARCEL I.D.#
Horizon De th Dominant Color Mottles Structure 2
Boring # P Texture Consistence Boundary Roots Geptft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3 1 0-14 10YR 2/1 - sl 2 f sbk mvfr cs 1f/m .5 ,.6
2 14-21 10YR 3/4 - sl 2 m sbk mvfr cs 1m .5 .6
Ground 3 21-30 10YR 316 - sl 2 m sbk mfr cs 1m .5 .6
elev. is 0 s ml cs if .7 , .8
95.7 n 4 30-44 7.5YR 4/4 - 9
5 44-63 10YR 4/6 - mcos 0 sg ml cs - .7 .8
Depth to 7 ,g
limiting 6 63-11 10YR 5/4 - s 0 sg ml .
f~ 8or in.
Remarks:
Boring #
Ground
elev.
n. ,
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
n.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
'n' Remarks:
SBDW-8330 (R. 08195)
• y Ck % .JL, O K So K 1 1 O l" .1 , ~lN N N G..g ~~1 W
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1
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I
have inspected the septic tank presently
serving the -TµizuS A-m residence located at:
~1/4, A). 1/4, Sec. T-2R N, R_ fLW, Town of
7-5
r~ Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced e)cl-
Did flow back occur from absorption system? Yes_No (if no, skip
next line)
Approximate volume or length of time: 6"-~° gallons minutes
Capacity:
Construction: Prefab Concrete steel Other
Manufacurer (if known) : A)le5~er
Age of Tank (if known):
(Sign tune) (Name) Ple se Print
(Title) (License Number)
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for_
inspection opening over outlet baffle).
Name i6e'Q,r p y Signature 16 1 MP MPR
5/88
r
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
v-- OWNER/BUYER G't vVl e-S ~ Theresa-L, Jo- hYIDSDn
MAILING ADDRESS q0 C f y FF 1-141ds I w-T
PROPERTY ADDRESS '7 q Q C f 4 rF AC UCISQ h t T ' ~O/ ~D
(location of septic system) Please obtain from the Planning Dept.
f
CITY/STATE flu d E or, W/ s c a- S `7 / `7 o ~tU
PROPERTY LOCATION I v E 1/4, A C 1/4, Section T Z$ N-R_zLW
TOWN OF I Lr 0 ~A ST. CROIX COUNTY, WI
SUBDIVISION 1V LOT NUMBER IV A
~
CERTIFIED SURVEY MAP ! U , VOLUME49M , PAGE 6 07 , LOT NUMBER 309(,'9_
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: ti L d
e
DATE: X62,&`2 7.3/- 1? Z
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This I 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 J10--m 6 s b -L Th e re,s c,- L, Tb ti r? S o h
Location of property _N 1/4 NL 1/4, Section , T Zk N-R l ~ W
Township fro y Mailing address LI-6/ Ff-
Address of site 4qo C ~nF-F
Subdivision name h Lot no. 31) q& 5-e
j other homes on property? Yes___X No
Previous owner of property J0111ice.,f S4 //N 5k0 a r 2
Total size of property AC, S
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? Yes Y No
Volume -q9 and Page Number (007 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
be 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. Z-//3 9 4q , 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.
S' nature,~9: Applicant do-Applicanf- 6,1
-7 3 (>~g'- -7- 3 / 9 7
Da~f Signature Date of Signature
OC~WdSFIT NO. B'PA'1'5t MI OF WISCONSIN "VA 1- an nos WAM assn wm rem exoeswit arna
w oe~ro
U* cw-na
ThU D"d, wade ._.x3.11 _~Ia._Slc~i~txn..aa~i A CflOIX CO. WK
arty. ►..Siu►u~t...bua a d..+ si_. Mc'd for %ooM fi* 30th
ff . _
_ . ibp a e0. i9 Pb
_
ari.-. AM&- JOhnsl~...and-MwxAaz..L.. Johnsen..-husband 2:55 P A
. . +In~i.M"41_.a -.3bint_.tanants
- firantes,
W'ft That the said Grantor, for a vaiushle consideration......
.
j esfeya to f3raates the lbliewiag descn'bed real estate is FAMM To
Ebanb, Blase of Wisconsin:
Part of the Northeast Quarter of the Northeast Quarter
Of Section 8, Township 28 North, Range 19 West, Town IF= Pared No:
of Troy, described as follows: Beginning at a point on
the South line of said Northeast Quarter of the Northeast Quarter 500 feet West
of the Bast line of said Section 8; thence West on said South line 200 feet; thence
North parallel to the East line of said Section, 435.6 feet; thence East parallel
to said South line 200 feet; thence South parallel to said East line 435.6 feet to
the POINT OF BEGINNING, subject to highways and easments of record.
j
MNSM
W,
F
This .....#s homestead property.
(n) (1,)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And---.-ggWtors_ William..J_-.Skaase--and--Sally--E_--Skaar-e---------------------------•----------------.-..-.---.--.
warrants that-the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants and restrictions of record, if anyanddxisting highways, utility
easements of record and the building set-back regulations specified in the deed to the
aV3 .ft°Z,d0"mA► the office of the Register of Deeds f r St lg~ix County, Wis.
in Vol. 482, Page 607 as document number 3b9j
Dated this .....-•----3Ot......•-•••----•----• day of ......June 18._$(s..
(SEAL)
01
(SEAL) _
W LLIAM SKAARE
(SEAL) (SEAL)
Y E. SKAARE
• i
AUTHENTICATION ACSNOWLEDOMBNT
ms(s) - STATE OF WISCONSIN
St. Croix ML
.County. 30th
authenticated this -------.day o1--------------------------- 19 Personal] came before me this .......day of
June 19--86.. the above named
•-----•---------i~ill#am a, SlEaare a Sally
i &.---Skaar-e-----•--•----------------•----•-•------•-
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by $ 706.06, Wis. State.) . :
to me known to be the person S---------- who
foregoing instrument and acknowledge th : e
r . ?
4_1,s-_,r,3In,Department of Industry, SOIL AND SITE EVALUATION Page 1 of 3
aoor and Human Relations
„xivisi(xt of Safety and Buildings ante with s. ILHR 8 3.09, Wis.
ORI
Attach complete site plan on paper not less than 81 x 1 n 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. #
0 4-0 - o S c~ -z-o
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 Property Location
James Johnson Govt. Lot NE 1/4 NE 1/4,S 8 T 28 N,R 19 Rar) W
Property Owners MM ail' CAdddress Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number roy Nearest Road
Hudson, WI 54016 (715 ) 386-6227 ❑ City Ef village Town CTHW FF
❑ New Construction y Use: u Residential / Number of bedrooms 3 Addition to existing building
)E] Replacement ❑ Public or commercial - Describe:
Code derived daily flow 450 gpd Recommended design loading rate ' 7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 562.5 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 90.0 ft (as referred to site plan benchmark)
Additional design/sits considerations install 2 - 3' x 961 turtle shell trenches
Parent material sandy/loamy 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 for system M S ❑ U [91 S El U ® S E] U Q S 1:1 U El S Z U ❑ S XQ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 1 0-13 10YR 2/1 - sl 2 f sbk mvfr Cs tf/m .5
2 13-18 10YR 3/4 - sl 2 m sbk mvfr cs 1m
Ground 3 18-34 10YR 316 - sl 2 m sbk mfr Cs 1m .5
elev.
96.1 fL 4 34-41 10YR 4/4 - is 0 sg ml Cs 1m .7
5 1-63 10YR 4/6 - mcos 0 sg ml cs - 7
Depth to
limiting E 6 1-11 10YR 5/4 • - s 0 sg ml - - .7
.11or in.
Remarks:
Boring #
1 -14 OYR 2/1
2 4-18 OYR 3/4 - 1 m sbk vfr Cs lm 5 ,6
ss 3 8-31 OYR 316 - 1 m sbk fr Cs if 5 .6
4 1-35 .5YR 4/4 - s sg 1 Cs - 7 .8
Ground
lem~, 5 5-43 OYR 4/6 - sg 1 Cs 1m 7 ;8
ft.
6 3-68 OYR 4/6 - cos sg 1 Cs 7 .8
Depth to 7 8-104 10YR 5/4 - sg 1 - 7 :8
limiting
factor
>1Q4 in. Remarks:
CST Name (Please Print) Sig ur Telephone No.
715-665-2681
Henry F. Grote
6 Date CST Number
Address PO Box 57, Knapp, WI 54749-0057
12/9/96 3065
James Johnson SOIL DESCRIPTION REPORT 2 4 "3
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
_ Bed Trench
3 1 0-14 10YR 2/1 - sl 2 f sbk mvfr cs 1f/m .5 .6
____wmwa 2 14-21 10YR 3/4 - sl 2 m sbk mvfr cs 1m .5 .6
Ground 3 21-30 10YR 316 - sl 2 m sbk mfr cs 1m .5 .6
95.7 tt 4 30-44 7.5YR 4/4 - is 0 sg ml cs if .7 ,.8
5 44-63 10YR 4/6 - mcos 0 sg ml cs - .7 -.8
Depth to
limiting 6 63-11 10YR 5/4 - s 0 sg ml - - .7 .8
ffer in.
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft. .
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
-fL
Depth to
limiting
factor
in' Remarks:
SBDW-8330 (R. 08/95)
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