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HomeMy WebLinkAbout042-1084-60-110 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER h ADDRESS 9 S 76 SUBDIVISION / CSM# U a P g LOT # SECTION .3d T Q~ N-R tk W, Town of ST. CROIX COUNTY, WISCONSIN i PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e S .'17 6 ~j INDICATE NO TH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,i LQ,4- Liquid Capacity: /&ro Setback from: Well nJ/~ House l~ Other Pump: Manufacturer ~N A` Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width' S Length -52 Number of trenches Distance & Direction to nearest prop. line: / 0 . Setback from: well: House of Other ELEVATIONS Building Sewer 9d.~ ST Inlet: 9oZ ST outlet: PC inlet PC bottom Pump Off Header/Manifold 96-41 Bottom of system Existing Grade Final grade I-S o/ ~ S'3D ' 9 7 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: IS INSPECTOR: 1 3/93:jt oI 030 d Lo~ Vol I ~ (A Z Z O N O < O A !Y• = p3j O tin O cOD 7 to N 0.4 C lC 11 N M O. fD H N ? CO 0 CL o ° o a t, ' c ` 1 o~ o m o m l -i °D ~ N 3 3 0 °o 0 3• ° O O A~ ~3 a to ~oo ~ t/! y ~ o a 3 O m tnZD c~ D W d 3 O Q (D ` 41 O\`, L O -i ° z ccoo CO CO n r cn o m 4 O ca -4 3 o o m < z 132 CA vi to a D (7 -co 0 .0 U _0 d eD - m cO < r~ Ol y N N 3 CC Q 3 G N Z r ° C Z O (D ° N =r _0 m ° m CO) X N O C N C CD W O. 7 Z i CD c6 -i ch rb: z m O p Z 0 N O O !WD A CL z o » cn 8 w Z O D CD CL I x o I m Dpi c N o a I y~ j I I I I H I 121, II II a Y A p m Al. Oo b9 O V+ O N ~ay O CL Al / 11fi9l g ~ FILED - - MAR1519960- 4566f$ g. JAMES O'CONNELL J ROOM of Deeds CERTIFIED SURVEY MAP WILLIAM CLAPP ,A W Fart of the Southwest 114 of the Southeast 114 of Section 30, Township 29 North; 1'hge 18 West, Town of Warren, St. Croix County, Wisconsin. ? N114 COR. SEC.30,T29N,R/8 W, OIndicates 1" x 24" iron pipe weighing 1.13 lbs.',i n.... ♦ /COUNTY SURVEYOR'S NON.1 ft. set. N Owner's Address: Route 2, Box 11142 N Owner's Address : Route 2, Box 113--~M. !x-, ♦ Roberts, WI 5402.?"` 2 /,P UNPLATTED LANDS y r N 90.00' 00 "E 1221,02' y . N 396.00' 264.00' 561.02' O 0 o z QI" )17'q r7t - 2.0 c M Q . 3Yc LOT / LOT 2 _ LOT 3 Ion O 3.000 ACRES 2.000 ACRES 4.250ACRES 1~ iy N C; /30, 670 S0. FT. 87; //3 SO, f T. /83, 122 SO. FT. ♦ eq NET = 2. 700 ACRES NET s I. 800ACRES I L NET + 3.823 ACRES',y 117,_603 SO. FT. 78,402 S0. FT. 4 /66,6/O SO. FT. N vI 1 y ZI= M~ 'D0 V10 q7 V- #90.00'00 /221.02' 'wE 0 O 396.00' C/ 264.00' 36/.02' h 396.00' _ 264.00' 36/.02' N90-00'00"W 2640.04' S INE SE 14 66' 70 TN AAVENUE S£ LCOR. SEC' 30, T 29N, RIO W l/NPLATTED LANDS S 114 COR. SEC. 30, T29N, R/8 W /COUNTY SURV£YORIs MO N.! S 0 /COUNTY SURVEYOR'S MON.) SCALE /"r 200' Z'0 0 30' /00' 130'200'230'300' 400' 300' 600' 700' Q Q 2Z$ = N Description : That certain parcel of lane located in the Southwest 1/4 of the South.-4, east 1/4 of Section 30, Tot'mship 29 North, Range ,18 West, Toun of Warren, o. St. Croix County, Wisconsin, more fully described as follows; Commencing at the South 1/4 corner of said Section 30, the POINT OF BEGINNING, of the parcel to `-e herein described; thence N 00°42'30"W i W (assumed bearing on the North/South 114 line of said Section 30) a e4Q distance of 330.001; °thence N 90000100"E 1221.02'; thence S 00°42'30"E v ~ h 330.001; thence N 9000'00"W 1221.02' on the South line of the Southeast 1/4 of said Section 30, to the POINT- OF BEGINNING, containing 9.249 acres, being subject tb easement over the Southerly 33.00' thereof for town road purposes and-also being subject to easements of record. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, William Clapp, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that this map and description are a true and correct representation thereof. DEPART~4ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS i N Ws-m.'s, DIVISION LABOR AND PERCOLATION TESTS (115) Tt ~ # 17V/ /0 P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) [-0 o? LOCATIO : SECTION: OWNSHIP/ OT NO.: L~~ NO.: SUBDIVI I N NAVE: Sw 1/SE 1/ -3a /T 2-T N/R TE I,W 111,0'eE11/ P,~I-r 40AC44f- ENor"JG- e's COUNTY: M A I LING ADDR SS: St, CR O K, K/M, C4-4 R + 113-e-' A ~o t.7 E P-TS 6UI S , S-40 Z (P ~ '~Z l~o,c USE DATES OBSERVATIONS MADE NO.BEDR : COMMERCIAL DS RI TION: q .4, 1 Residence Z it 3 N XNew ❑RePlace y ^ l yo T40 l Cl Jed RATING: S= Site suitable for system U= Site unsuitable for system dCS 7 B U R le ~4TzD T ONVENTIONAL: MOUND: IN-GROUND•PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ©s ou ©s ❑u as ❑u os ou os au I~C - -if Percolation Tests are NOT required DESIGN RATE: A If any portion of the tested area is in the 71 under s. ILHR 83.09(5)(b), indicate: CL~ss Floodplain, indicate Floodplain elevation: GIiNT R TeSr ~ND1Ti0•)S: ,zSUAW glp Y 3 PROFILE DESCRIPTIONS 1~} OST- BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 0 g3 ' DID' QN . SII 2. i' TrIAJ S1'l G, 0 ' T,IA,, vcjey S3 . V ' cS ~ G . B-z- o' 9/.sor err > 9,o' 1,s' q YY ileR CS R g S I / 3 0' / ~~,,~V 1. S' 'D,r, Q,a St, 1. S' L1, 24 Ell- B-3 ' T~tti vck e S . B.~ ' IV- 1,0' -D k. Ba. 51 ~ 6-R.~ T-A'j r I ~P S 9,a q3, ~o >~'.o e_e ~Ss 6- R- , B- S 9, 0' 5' r > d D K. f~a S 1 1,25' 711a. S 7 s 1'4X 67- 0- - B- , H PERCOLATION TESTS fN VE P y e- S GQ , S 1`il°~? T~ S TEST •1 DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI O PER INCH P- / 2 P-1 , D 2- P. - 4 3 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. - SYSTEM ELEVATION. b- Tif e.V 6& 0 Ti6F.vl - ~T Sd / T, N 1 I F'OMESITE SEPTIC PLUMBING CO. r L 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 657 # 2q 7 2- PLOT- MASTER PLUMBER LIC. NO. 3307 M.P.R.S. '141S, ",\!N, INSTALLER 3 DESIGNER LIC. NO. 00663 L o -f. A5 TQ£f- w~ $fkE . ~IEUnT~O~= /OO, O ~ _ C 40 o 5.41 : 1= 3 o X = P~RC S RTES 64 ^4 41 Q, H 5 2 135 ' G S r ~ i - - - y 3 . 3 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and"8uildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 289324 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: PETERSON, THOMAS/DUNN, TAMMI WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 042-1084-60-110 TANK INFORMATION ELEVATION DATA A9700140 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I 53 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: 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: WARREN 30.29.18.474A-10,SW,SE 954 70TH AVENUE LOT 1 ell- rv_ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 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. S-~ , Q b • See reverse side for instructions for completing this application State Sanitary Permit Num er t1 ? ! P The information you provide may be used by other government agency programs 0 Check if revision top vious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert caner Name Property Location 45[h C1 'r, A n SkJ/4 165 1/4, S 3C> T N, R L K$IC) W Propert wner's ailing Addres Lot Number Block Number ry\ c t (_4s Cit tate Zip Code Phone Number Subdivision Name or CSM Number 11 t IS40 ( %195)749 C1 44=- UO 11 II. TYPE F BUILDING: (check one) ❑ State Owned E] city Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms : Towan OF k&2CY_14%%^-4y-p III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) - 1 E] Apartment/ Condo 0,4 a - 1 0~ uc - 110 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 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 121<Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13.❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6_ System Elev. 7. Final Grade ~cFt) Elevation Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq,.ft.) (Mn 5 Q (off $ nr814ket 1 Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper- INFORMATION Gallons Tanks Concrete glass App New Existin strutted Tanks Tanks Septic Tank or Holding Tank loco W" es ee-El 1:1 Lift Pump Tank /Siphon Chamber ❑ NLtn I El I- El n VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Namerint) Plumber's Sign a (No Stamps) MP/MPRSW No.: Business Phone Number: t'o", 1503 Its -a ~'I43S Plumber's Address (Street, City, State, Zip Code): A, W C_ 19 Ile-ula 4~F Jxmn iJ I W1 _5 SLO 17 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) 1 Surcharge fee) [yApproved ❑ Owner Given Initial ~n Adverse Determination C/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHO-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi ton, Owner, Plumber INSTRUCTIONS f 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, 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. >E I - I I I I ~ 1~- I I ~ ~~U f -r- l - CiRO \Ix al - I ! 1. r I I , I f I I ~ I I I I I 13 I f ; err DOT- -10, I I ' I , I I I f , i , , I f I I I I ~ I ' I ~ + I I I I I'~~~ I~~e' I -t t I 1- ( I ~ I I I I I I I I 1 I f I I I I I I I I f I I I i i i I I~ I ' , ~j l o _ 1 I I I r i I 1 I I f f , I I F I I 1 ~ f ( --I ~ i j i I I ~ II I ~ I I I 1 I i i r I I I I ~ l I l I 1 ~ I I , I i f I I I I f I --r-- -a , I- 1---- r a I i I i . l , I ~ I I , 1 3 10 - I I I . I I 1 i I j i I I I i I t i 1 I I i , I : , I I I 1 I f ~ ~ I ~ i I I ~ I I~ I I I ! ~ I i i I i ! f i I I ~ 1 I ~ I I I I , i 1 I I I I I ~ ' I 1 I I I I I I i I 1. 1 ~ L ~ I I I I 1 I I I I I 1 T ~ L I I I { , I L - - 4-1 I I I I I I , ' i I I l I I I I I r I I I I : r I ' , t r I I i _ I ! j ~ f I I I , I I I 1 ' : l i I I I I , I I I i I I i I I J~- ~ I l I I i I 1 I I I ~ I i i I I I , ~ I ' I I I I I ` I : I _ - ~ I I I I i I ` t I I I I - I- ~ I - I I r t ~ I 1 - II li ~ ' I I : i t I I i r I I , I ~ 1 f - t ~-I--- ' L; i Y i I I I I I II ' I I I I I I, ~ I I i C I I I ~ ` I I I I I I I I , L r 1 t L I I i ~ ~ I I III , I, , I I : I ; tI . j I I , ' I I -I fi 1 I I i } I I i I I r , I i T ; : I I I F I I ' I I { : ~ r I I. I I I I I I ~ I Ar51 0/-- LD 7% o.v ft ve S~d 7G - a~P~ -P ~ drP % _ Wisconsin Department of Industry, SOIL AND SITE EVALUATION 044 $ l ~yl~ / 3 Labor and Human Relations GG Page of . Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. K/ p Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County Sr GdO/'K Include, but not limited to: vertical and horizontal reference point (BM), direction and ~C 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 i Property Location ?QN1 p,O= TJ~FP-S6A I'JAW/ ~ . 3bV, / Govt. Lot :!54Y 1/4 s~1/4,S 30 TZ? N,R A? E (or) W Property Owner's Mailing Address Lot # IBlock# Subd. Name or CSM# 2. Iq pe:9. 6o_ 14 2- Iq City State Zip Code Phone Number 7!~ ^ El Nearest Road City Vi a e ~J Town 70,704, 5T. R© Ltd 540 Z3 ( 71.4' 2 New Construction Use: residential / Number of bedrooms 3 - Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: V& _ 4/40 j- /f~~Q~yy c1F,Vf~~j~ Wd5 Code derived dally flow, &00 gpd j6 3 4V Recommended design loading rate abed, gpd/ft2 ' -7 trench, gpd* Absorption area required Al~ bed, ft2 75 D ` trench, ft 2 Maximum design loading rate bed, gpd/ft trench, gpd/ft2 Recommended Infiltration surface elevation(s) see- ~r_ 3 ft (as referred to site plan benchmark) Additional design/site considerations ~1 ~NVA &OX A1J7Z1.eU 72-0'1) Parent material Flood plain elevation, if applicable ft S = Suitable for system Conve onal Mound In-Ground Pressure AT-Gra System in Fill Holding Tank U= Unsuitable for system s❑ u CC3s~-❑ u E -s' ❑ u C~ ❑ U p s p u ❑ s, SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o-/ lope 3/ 1.7 bX e i fR s. .5- ols Ground j I© s S -s~C 5 elev. WAFY Depth to limiting factor 7 ~~in. Remarks: Boring # 1 (3 Io m 313 i llj'e S l y ;.s L /D Y SQL .2 f' 4-e S s'- ,yle o g- Ground elev. Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone No. 'RoGeT:r -Zt LB R i c k 71- 71.;' 396. 8105 Address Date CST Number 3-ai-T7 PROPERTY OWNER /l~.Gl SD 'J SOIL DESCRIPTION REPORT Page of 3 PARCEL 1.D.# ti . Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots Gep/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench IdJ112 3/3 /)C-' 2 -IL /D L A /*i a,S Ground 3 iZ o S s D, -7'' 8 elev. Depth to limiting factor In. Remarks: Boring # 10-7 /0 R 3/3 10-6e j ? 5' /7' -25 L Ti3 a 3 S/G s,~ s ~v~ y;s 4" -7rA 3 SL as . y; Ground elev. Depth to limiting factor 7 Remarks: Horizon Depth Dominant Color Mottles Structure p In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring # / 0-6 0Y2 38 D / S~ie .w•-f,~ S /f - Y ; • S S . S ' . /D Z - 116 q,,, ZX 117e-' Ground d S s 1 8 elev. Depth to limiting factor 7 In. Remarks: Boling # Ground elev. n. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) W C. ri _ r° y 1I n x* Hftl • CIS m o w • . t ,° (� / —., VVV V ; t U) ft ›,b c\ '' LrN b ,T1,/, 5 00 cn rn1 • lrl & C O 'e - - - - -M. i . N (77' / //`/ .� / /' / 1 / /-A/ I / • /ei /Dl / u3 'i /0/ / / o ,l / t /_ / • G, o -o 00 ' 00 's}S^ LOr L. ti s\-• N ---. 1 3'\ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INCitiJ 1R.' DIVISION LABOR AND PERCOLATION TESTS (115) . `->z P # 4/74/ ° P.O. BOX W 57969 HUMAN RELATIONS a (ILHR 83.09(1) & Chapter 145) LOB . oC//ol' LOCATION: SECTION: OWNSHIP/ LOT NO.:BLK.NO.: SUBDIVISION NAMC sw %/SE 1/4 30 /T2-1 N/R IFE (o'OGUAPPiii Prtei of 46, Aa,,&s- pEAJoi.06- CsM-r COUNTY: MAILING ADDRESS: I I O �t �T & IS 5' O2'2__, t;cRO(K Ai. Ct- P P ,Q , 2+. Z Bc) 3-- 5 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: 1Residence e R 3 N. r A - AI New ❑Replace �0� y ^ 1 p 7O J,4 0 . 1. - 1 q 50 /SCS 7 13ur&kL,,-lzor RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) V1SEU x1SUU ES �U nS K.0 I S14U CavaE.'roNRC -- 'If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: etA.s 31-- Floodplain, indicate Floodplain elevation: GU!%NTfg TEST COuD1TIoos: su.INY , 3 y" ' PROFILE DESCRIPTIONS 2'} t-ROSr BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) � r r , s,3 ' o/� 6„, . SI 2. L' T,,ti sil G, o ' r,i,t, VQQy j B / Iro 13.78 -- > 6-t, . 1 t B Z I.o !/•so r 0 vt,e y cS 6-12 • 1. De, (1,, SI 1• S ' LI, Qa . Si I S.$ - 'MA)B- 3 e. s 9/. 30 . �a ' ', s v yes . l i I o ` 1,0 ' 'De. ga, 51 3 6-a . ‘. 5 ' T�J Si/ 4,, S ' B 9, O 3, d > I T,t,,, UEe`/ CS 6, CrR • I,0 ` DK. (3a . SI ; I , 25 ' 74-,v. Si/, �, 75 ' B _ 9, o �z ,S rh6 > 9 D 1-4,./ I,�y c-S 3 6-e. . B- PERCOLATION TESTS (N (J6 R y C S 4 GR. STe111. S 11 'SMITE EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODI PERIOD 2 PERIOD 3 PER INCH P- / Vio ` 2. P-1 -7,O ' tf-- " 2 �3 P-3 3 .8 21-v- _ -� ,_. 4 y3 P- I _ 1- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan(.. Show the surface elevation at all borings and the direction and percent of land slope. e �I Tee-A)atUGlpl= zJ ✓ A4) TieE,0 _ cVT 50 , SYSTEM ELEVATION. i l I i i .. i , ��v ��-R s�D� _ TN 1 ii oven This test s•ite ste •• tt I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): HOMESITES@ [TESTS WERE COMPLETED N: I 655 O'NEIL RD.,HUDSON,WIS.54016 A u S - I al eto RO.BEAT ULBRIGHT.. - ADDRESS: ''CIS. MASTER PLUMBER LIC.NO.3307 M.P.R.S. CERTIFICATION NUMBER: PHONE NUMBER(optional): •'SIN.INSTALLER&DESIGNER LIC.NO 00663 Zy X Z 3 Ve —2/2 S CST SIGNATURE: `p-6& )4- -' DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. a -- _ - • - n - - - MG 655 4I'OMESITE'NEIL RD.,HUDSSEPTICCIPLUN,WIS.BIN 5401CO.6 ` ROBERT ULBRIGHT GST# 2t{S'2-- L D T' L�4 'CIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. 'N,INSTALLER&DESIGNER LIC.NO.00663 ki L o A I (A-Pr. Per P% _ F15 }} TR£E to/ S(ake- E I EU,TI.O,J /bO , Q / I ' I ISO 5cA-1 : I =3or I' . . 81 CKi6e- RoA 56-s x = PRc S ►T'ES : c�e • m , .q,-) .bo a, sts K .6G 0 1 ' ' B� X 4 1 id ct e, Nr 1... 1 / I S 2 'ES ' GS r w ' c y%a I- N /4-D Of i > r_ �3t Y 3 3 House- MUST Ltt > ZSi -F1e0 .4. . 'TE5T S /"TE- lvE// /fuS G/F 50 --fea/,, TEST S +srE PAGE OF CrUSS SZC~'IUt1 01' ~ ~C17 SyS~en-1 -Fb m -~Lfxly s i) -f 0-ax 7~ froth Alt Inla• And ODi,orvallon Plp• Approriod Vent Cop Mlnlmum 12 Above Final Grade 20- 42' Above Plpr -4' Cost Iron To final Goode Vent Pipe Marsh May Or Synthetic Covering 0 min 2' Aggregate - a .41 Pipe 01e111ertlon Pipe 0 0 0 Teo i b Aggregate Pipe Beneath Pipe e Perforated PIva below ° o -Co%Vlno Teronlnatlny At Balloon Of Syelem 9/ 9a~ P~p~o)eD ~l~e-~ ty~f.c~t SOIL FILL DISTRIBUTIO1.1 PIPE • APPROVED Sy)1fT1{ETIC COVER'- -e- OR 9rr OF STRAW 2°OFAGGREGAIE OR MARSM HAy • Ie0FJt-2t/z AGGREGATE ELEV. OF 9 FEET- DIS"rRI5'JTICUIJ PIPE TO BE AT LEAST c=V INCHES BELOW ORIGIIJAL GRADE AMU AT LEAST LO IAICHES BUT 1.10 MORE THA" 42 IMCHES BELOW FINAL GRADE MAXIMUM MrVi OF EXCAVAT100 FXOMi OWWAL 6i ADF- WILL BE INCHES nalmUM AEPTN OF EACA%IATION FP\0M Oilk'4I1JAL GRADE WILL br- INCHES SIG►..IEO: LICEMSE AIUMBER: 15 DATE: f w . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT 7~77-~ St. Croix County I~ OWNER/BUYER -//'YJ /yyi N /G M M i A. -DUN N MAELING ADDRESS a0 V Sb~- , W • M 4 `N 9-0,&X, 73- RIt c~, PROPERTY ADDRESS q5 4 -761' Ave i ()()64s UJ i Syoa3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION -5 W 1/4, 5 k 1/4, Section 30 , T W7 N-R_ W TOWN OF W Q f r E =)Q ST. CROIX COUNTY, WI SUBDIVISION W JN AAA- C (Q LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE .2 4 OT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance'consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) a4er 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: y ~y --7 St. Croix County Zoning Office Government Center 1101 Carmichael Road . Hudson, WI 54016 11/93 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 i ►1r a5 Pe f e rSaN -Tc r, m - ~ o vry Location of property k% 1/4,S t 1/4, Section .34 , T acf N-R_Lg_W Township Wo'cret'i Mailingaddress QMj& W. P, iN P0. 7d Addressof site c1Sy -70'x' Ave ?okzPls C-01 Sqg~a3 Subdivision name b'A Lot no. otter homes on property? Yes X No Previous owner of property Ke-N I G kders©►4 Total size of property 331) X 3 cop Total size of parcel Date parcel was created ►17~y /q I ? 9-o Are all corners and lot lines identifiable? Yes No Is this property being developed for ('spec house) ? Yes __A__No Volume poa and Page Number (ps as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY.:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. JA q tp 19 99 , 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. Signature of Applicant Co-Applicant 4-g7 A'~'j a Date of Signature a e of Signature FILED MAR 151990► 456664 JAMES O'CONNELL J 49 a 0880 CERTIFIED SURVEY MAP WILLIAM CLAPP -L1 c>r Fart of the Southwest 1/4 of the Southeast l/4 of Section 30, Township 29 Nor•tht mange 18 West, Town of Warren, St. Croix County, Wisconsin. W OIndicates 1" x 24" iron pipe weighing 1.13 Lrs. 2 N I11 COR. SEC. 30, r 29N, R /6 W, ft. Set. ' / CO(/NT Y SURVEYOR'S ,vON. / a Owner's, Address: Route 2., Box ll. h Roberts, WI 5402? N ° UNPLA TIED LANDS q y t moo-00100 f 1221.02' C 0 ti 396.00' 261.00' 36/. 02' O 1 QI„ M ~ Jiro LOT / LOT2 LOT3 W 4 ~I M O o 3.000 ACRES 2. 000 ACRES 1.250 ACRES p W - O 185,122 SO, fT. O O a / 30, 670 SO, fT. 67, / /3 SO. P T. ^ h 1~ 1' h NET & 2. 700 ACRES HET+ 1.600ACR£S . N£T + 3.623 ACRES' p~ N ' /66,61O SO.fT. N t 117, 603 SO, fT. 76, 102 SO. fT. - v 8 O O ~I ?I N 90' 00'00 " 1221.02' it. ,~j O O 396.00' _ 261.00' 361.02' Tf?Taf'~- 141S.02 396.00' _ 261.00' 361.02' #90-00'00"W 2640.04' S LINE S£ 114 66' 7o r H AVENUE SE COR. SEC. 30, r 29N, R/6W UNPLATTED LANDS S I14 COR. SEC. 30, T29N, R/6 W /COf/NTY Sl/RVEYOR' NON./ O / COUNT Y SURVEYOR'S NON./ 3 Z' SCALE 200' 0 SO' /00' /30'l00'290'd00' 100* 900' 600' 700' it 4: ' 4t W 9r, r.. Zhp Description: That certain parcel of lane located in the Southwest 1/4 of the South. east 1/4 of Section 30, Toimship 29 North, Range 18 West, Tou:m of Warren, Q a o St. Croi;c County, Wisconsin, more fully described as fo.llpws; b ° zt o Commencing at the South 1/4 corner of said Section 30, the PRINT OF : BEGINNING, of the parcel to '-e herein described; thence N 00 4213011W i W (assumed bearing on the North/South 1/4 line of said Section 32) a e distance of 330.001; thence N 90 0010011E 1221.021; thence S 00 4213011E • 330-001; thence N 90°00' 0011W 1221.02' on the South line of the Southeast 1/4 of. said Section 30, to the POINT.- OF BEGINNING, containing 9.299 acres, '-eing subject to eaFement over the Southerly 33.00' thereof for town road purposes ane-also being subject to easeme'!nts of record. State of Wisconsin) County of Pierce) • i t I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, William Clapp, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that this map and description are a true and correct representation thereof. 05/1297 MON 13:54 FAX 715 386 4687 REGISTER OF DEEDS. 001 VKx i oOcUMENT NO. WARRANTY OM TWO SPAat NCAMMm FOP wMc0001r:e DATA STATE BAIL OF WISCONSIN 702K 2 - use - 'Y 496889 S'LgrODfCO~W! Kent Michael ArAeraw and ......ttatihi^xri M...Z a le?r, a LI....t• ten aii£e-....^ APR 51996 `8:30 . w ooaveya and warrants to Tani A. DL4u1r a 50 1..... R~dDa0i1 - • - - - - - - ._....r_.-...-.... anus - - - - - - - ]?JAC a Oceslnty Beek a '1' m t 103 SO.2rnd at. Hoot 87 r the Mowing deaer%(A seal estrse In ...Ghana. . • state of Wiewusin: Tss Pared No:......._...~ Part of the SA of $4 of Section 30,r 9b ip 29 Nactt4 Range 13 rest, St. CsoU O=tyo Hisoooain described as follows: Lot 1 of Certified Survey Map f lIM !land 1S• 1990 in Vol. *SO# Page 2192, Doc. No. 4566"4. This hom4ste" property. (is) (is oat) EmaDtion to warranties: Dated this 31 d.y °t - 3 ILL. L) (SEAL) _ xsnt Hi*mwl Andwom ...........................................(SEAL).. ` ....................(SEAL) . AUTUJINTICATIO i A091IOWLSIDOURNT SiSoatat+(a) - - ................._..r..._ SCAMS OF W=WNSIV ML aatbmweded this --day ~ 1! Pammillf Hoerr bdow ms tbb ................day ad .........r....... 0 93 tba bow Hoard TrIM: NOWNR STATIF R" 0! W78CONMN - - rYi,.~ - / ~ ~ T to ~ f pl ,S ' ~ 1 ; " ~ . ~ ~ ~ 4 ~ 1 J ~ d ~v~ Z ~ _ ~