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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM#> v T.c LOT #
SECTION ~,?_T c;? N-R ~;'L) W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK: a ~5 j
ALTERNATE BM•
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: h2,,&es•7`e---.rJ Liquid Capacity:
Setback from: Well l~ ~ House 30 Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 5 Length 7 Number of trenches ,:7
Distance & Direction to nearest prop. line: `r-
Setback from: well: 3 C~ t HouseC -t 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:
PLUMBER ON JOB:
LICENSE NUMBER: ~'.2
INSPECTOR: 7
3/93:jt
-Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ village ❑ Town of: State PI
D,?ORNSTAD, JOHN & ORIN X
CM Elev.: sp. BM Elev.: D escription: Parcel Tax No.:
In
TANK INFORMATION ELEVATION DATA 930
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark oT (0~ / CCU
Dosipg-
Aeration Bldg. Sewer
Holding St/ Inlet 3S 9s,
a ` r
K SETBACK INFORMATION St/ Outlets 9 S
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > Sp' 07 1t NA Dt Bottom - a
Dosirrg-- NA Headed
Aeration NA Dist. Pipe
v.
Holdi Bot. System 9/7a
1 1
PUMP/ SIPHON INFORMATION Final Grade
Ma urer Demand
Model Number
fiA
TDH Lift Loss Ion System TDH Ft
Head
Forceinain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width, / Length ' No. Of Trenches No. Of Pits In' la. id Depth
DIMENSIONS v~ DIMEN I
SYSTEM TO P/ L BLDG WELL LAKE/STREAM L G Manufacturer:
SETBACK C MBE
INFORMATION Type O r er:
System: -drtr $ >20 s Pr R UNIT
DISTRIBUTION SYSTEM
Header / manifold „ Distribution Pipe(s)/ / x Hole Size x Hole Spacing Vent To Air Intake
Length j~ Dia- Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys
Depth Over n Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center .36 -1// Bed /Trench Edges"Y T ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: DSO 12,29,20W, RE, S~ BRANDON DRIVE > w,
j (1, 6 lo"
,.P.i'F Z- r
99,iS
Plan revision required? ❑ Yes o
Use other side for additional information.> -
SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
s
Safety and Buildings Division
SANITARY PERMIT APPLICATION BureauofBuilding Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, Wl 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. -
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]- State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
r Ja s 1/4.r^ 1/4, S/,j T ,2,7 , N, R,2p E (or)
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
41 e" 5 ( ) ti City &e- Y II. TYPE F BUILDING: (check one) Z State Owned Village Nearest Road
❑
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
kz-
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
Qp4'
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. E' New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an
System ________System_____________TankOnly Exlsting System ExistingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground Pressure 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) r gr El yyatio~a
r _ p d Feeti ?-TO >E• Feet
VII. TANK Capacity Site
in gallons Total # of Prefab. - Fiber- Plastic Exper.
INFORMATION Gallons Tanks manufacturer's Name Concrete Con- Steel glass App.
New Existing structed
Tanks Tanks J J
Septic Tank or Holding Tank M r dA1_e_ ~ 13- 1:1 11 1:1 1:1 El
Lift Pump Tank /Siphon Chamber ❑ F-1 ❑ ❑ 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: o Stamps) P MPRSW No:: Business Phone Number:
r
Plumber's Address (Street, City, State, Z Code).
5
IX. COUNTY/DE ARTEN U ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Signatu a (No Sta ps)
Approved ❑ Owner Given Initial ~ Surcharge fee)
T/Q
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) 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, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. 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 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.
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION _
LaF~or 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 81/2 x 11 Inches in size. Plan must County'
Include, but not limited to: vertical and horizontal reference point (BM), direction and`.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD. _ e n
iv/N7E,0 TEST 6A-w17/ON S . su~.~ y, l1 s vow ~ov~ ; ..~a' ,7
v. ~ 4.
v
APPLICANT INFORMATION -Please print all Information. y 750,asT. Reviewed - Dat , y
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). >y ST (,;;0,,X
'
Property Owner ~erV.viS .OTOAFV.ST-fD A-P Property Location _ ~C~,aafd~.
7~O/f/f'S /U/ EL SEti Govt. Lot /VE 1 /4 SC 1SY T 2f ,j.7,~f E (or)(0
Property Owner's Mailing Address Lot # Block# Subd. Name or C
67;z 7 /1/// RIP
City State Zip Code Phone Number 7j
f f UpfoA.) k)l. Jr_ El city ❑ visage own Nearest Road
Sal ~o (3~l > - yz79 ~BrP•4,v~oc,~ ~.c~
& '*New New Construction Use: t~ Residential / Number of bedrooms 3 - y Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
y150- N/,P Nod' 2E~on^t n~ 7 ~J
Code derived daily flow load gpd Recommended design loading rate bed, gpd/tiz ` trench, gpd/f12
Absorption area required bed, ft 2 i50 trench, ft 2 Maximum design loading rate- 7 bed, gpd/tt2 • a trench, gpd/112
Recommended infiltration surface elevation(s) SR2 /uoT1-~ to LO ft (as referred to site plan benchmark)
Additional design/site consi tions
Parent material 5C y /VG - Sr1C y~ y ufl~~ST~'~% Flood plain elevaflon, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure ,AT~Grade System in Fill Holding Tank
U = Unsuitable for system [Rr- ❑ U H'S 1:1 U [ El U L~ s ❑ U 21, ❑ U ❑ S [m]'6,
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz/. Sh. Consistence Boundary Roots Bed , Trench
CJf s
3 /a- /~'sd e nrfie C S .2
✓ / /o 4f Z,h, sd,~ n,~ f e S tJ~ s ' . G
Ground z 7. s YR Y16 sl,& f4
elev
I /•YLft. 7,S Vie 0 dg-
Depth to
limiting
factor
(In.
00 Remarks:
Boring #
1 o- o IoW 31-~- /-CA& 1U.-FA s 3 f ly .S
Z o -7 G / S /ivr T ~-t w -F • s G
,3 5FQ ,s D ,
(around
elev.
Depth to
limiting
factor
fa-In. Remarks:
CST Name (Please Print) Signature Telephone No.
R o[1 c R T- L
-24 c T Z G>,-> 71,5 = 3 M
- 8 SRS
Address Date CST Number
fate: C5r1tf Zy P2_
Private sewage consu tact s
655 O'Neil Rd.
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of
PARCEL I.D.ff I -o T 4'4 P- r- I
Boring # Horizon Depth Dominant Color Mottles Structure 2
g Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench fshe Cs Z f 1q:15
z - /b 3 / i< L *A-re C S / top: '3
Ground 3 - YA 2z
1 S/Ji~ /I.N~ Lc~ $ . ,
elev. 106
).57 0s,
Depth to
limiting
factor
0 it
Remarks:
Boring #
I /0 Y'e 31'fP s z s
-16 zo Ye 3 /,w sd& ter,,, f/2 c s (f ; -5
3 /G -3i o f Z.►►~ d e;w a s / , s
Ground 3.1.90 7, t . S. O GP~ ,
elev. S!g
go.so n.
Depth to
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
Boring # /o e 3/-1- /7~ Sd.~ M^-F12 S f • L4 . S
3 G-22~o 25~ M+~~ ~-S if s;
Ground a 7,5- P .S , O S 7
elev.
S~ fin.
Depth to t
limiting
factor
C74 in.
0-r- Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
In. Remarks:
SRnW-Anin IR_ nR/9.r,1
r
0
w
DUEST for 267 _o
0
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9 - ba R~ a
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w O
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rn H
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717 To (n
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6-If5 % L o T- G
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ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
Re: Soil Test Sites, and Siting Your Home.
To Owners/ Developers, Please be aware:
All of the systems for lots #4,5,6,7,8 in Hartland
Subdivision (tested under winter conditions March 11th &
12th, 1996) will require very large TRENCH TYPE conventional
systems because of soil permiability restrictions.Conditions
across other parts of each lot can/ and may require entirely
different on-site treatment systems.
Also, as required by state codes, an equally large
replacement area has to be left intact UNDISTURBED with
proper set-back distances to the well, other structures,
etc. as deemed by code. Less space is required if the owner
were to install a mound type system (i.e. no replacement area
is required for mound type systems).
Please understand, that in the process or procedure of
selecting the actual homesite, if the owner will be using the
soil test areas as provided and recorded by the seller/developer,
the following is very critical:.The installing plumber you
select, or a registered designer or engineer should meticulously
layout and plot the system as indicated from the soil report..
And an equally large replacement area should be plotted out.
Further information to be supplied by the owner is necessary
in order to determine the actual exact size of the system.
The final size of the system is dependent upon,the gals. of
wasteflow to be generated from the proposed size of the home.
The County Zoning Dept. must review the owners final house-
plans; only then can the installing plumber determine the
final size of the proposed system.
All of this has to be carefully addressed before a
builder and owner can safely choose one's precise homesite.
Often times the original soil test.area, provided for
subdivision approval by the seller as required by County ,
Zoning Dept. ordinances, is not in an area prefered by the
eventual buyer, or perhaps the size of the buyers home may
require a larger test area. New or additional testing may
be required, since a septic system by law has to be laid out
exactly within the recorded spot tested; it cannot be shifted
out of the area recorded with the zoning dept.
Finally, it is our recommendation (and of most
consciencous installers) that when soil permiability on
a site is very slow (.5GPD/ft2 or lower) to install a
presurized, dosed mound-type system. It is the consensus
of most officals that mound systems will generally outlast
in-ground conventional system (average life 10-15 years).
This is a very important option to cautiously consider.
Remember, the two most important systems you will be depending
upon for many many years to come is your well and the quality
of vniir =on* i n cv-*cm
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
/
OWNER/BUYER 4cSi79D~: Lfin ~s C~z/~'~Jet
MAILING ADDRESS 3ZG 5Wi4.
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE /re dS a n , 4, S qe 1 L-
PROPERTY LOCATION Nr 1/4, 5~ 1/4, Section 1Z , T 2--l' N-R 261 W
TOWN OF hl,,,ISonj , ST. CROIX COUNTY, WI
SUBDIVISION A' 2r 4.,~WO LOT NUMBER 2
CERTIFIEDSURVEY MAP , VOLUMES PAGE 26j , LOTNUMBER Z_
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.
l/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:
~1,,
. K
DATE:
St. Croix County "Zoning Office
Government Center
1101 Carmichael Road
Hudson, Wl 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property MA
,n ~lek°~vs »9
Location of property ,~V 1/4 _S:~' 1'4, Section 12 T Z 9 N-R 20 W
Township AWSo1, Mailing address _32_~
Address of site A Z i2y-
Subdivision name 11,4'eTL "-ftlh Lot no. Z
Other homes on property? Yes X No
Previous owner of property Z'47V l Z)2Veldao~
Total size of property X. Z-.r z'-er,-S
Total size of parcel to rc'-zs
Date parcel was created,
r-,
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes No
Volume 1196 and Page Number 259 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. 5,yli72S` , 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.
5-Y 1'7 ZA
Snatu of Applicant Co-Applicant
r
Date of Signature Date of Signature
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STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT NO. „
V0►.1170PAGE 2 g i `i'ER'S OFFICE
ST CROIX CTY., vv,.j
B & N Land Development, a Wisconsin Limited Redd forR3c;rd
is i i y Company
APR 8 1996
John B"ornstad and Orin Biornstad ri# 8:00 IVI
warrants to
I
conveys and
Register of D88d
.:J
THIS SPACE RESERVED FOR RECORDING DATA
n
NAME AND RETURN ADDRESS /O 0000
the following described real estate in t. Croix County, 1Y
State of Wisconsin: //0~10
I I
I
Lot 2, Plat of Hartland in the Town of Hudson,
St. Croix County, Wisconsin. PARCEL IDENTIFICATION NUMBER
I
i
TR s.~ R
FEE
This 1S not homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way of record, if any.
l
~I
1
-l~ March A.D., 19 96
~i Dated this ohs - day of
B & v opment,
(SEAL) (SEAL)
by (SEAL) (SEAL)
~i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
i
St. Croix County.
A6
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Lab(;* and Human Relations Page of .3. 4
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 112 x 11 inches In size. Plan must county
Include, but not limited to: vertical and horizontal reference point (BM), direction and ST, C R d r
percent slope, scale br 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 lot secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Props Owner Td~-f i(/jE/SE.v Properly Location
N L,},llD DEUDp. (o
, ,25 gfoAPI 571,'4 7 Govt. Lot NE 114 " t/4,S~2 T q N,R Z~ E (o~
Property Owner's Mamng Address Lot # Block# Subd. Name or CSM#
lyo 9~7 w1//au& ,PAL E ,P/~ • Z HhRrLnN D
city State Zip Code Phone Number Nearest Road
11V ~S~'tJ GIJi s ya&o (7is )Mclo city O Village Lt' Town
L13 New Construction Use: Residentlal / Number of bedrooms + 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate 'zbed, gpdAt2_ ~ftrench, gpd*
Absorption area roqulred / bed, ft2 trench, h2 Maximum design loading rate ~ bed, gpd/tl2 • s trench, gpolft2
Recommended Infiltration surface elevation(s) - 3 ft (as referred to site plan benchmark)
Additional design/site co stations 1S~ Fti S 404,; "Y C v'~~~~ sloe W/ PAO P , t ~l
Par" t m terial SLS % 4M ale Y / Mood plain elevation, if applicable (t
i
3;Nglb
S = Suitable for system ~Conventional Mound , _ In-GGrrounn assure AT-Grade., System In Fill Holding Tank
U = Unsuitable for system L~ s o U ❑ S I'U 0'S Lam. U ❑ S 0'U ❑ S W ❑ S W-ul
,f/07"75 ilc SOIL DESCRIPTION REPORT E,rcFtS/v~' s/~~S
11 Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
In. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
o-/y Hoye yl,J- s l Z~w sh,~ f~ s f , s G
Ground 3 -6 7,S yje s
elev.
a so l0 /oy~' u S. O S o~~ a S -
Depth to 7, S yK % ~~Nv~D 5 ~S~r,~ Nt-r fi~Z rr G~; S
limiting % 4c) / 7%lel' vor
factor
Remarks:
Boring # 0- 7 O 'y/.;l-
2- 2.w► v~i~ ./,.,-f~ s -F S . ,
Z ^/00 /o sue/ / f sls,~ •rcrf,~° s z f . y; . s
3 1 /d y 2- 40 ,64~ ,~f cs , s • G
Ground - 74 elev.
o - -P& it 75- 51
Depth to
limiting
factor
;7 gin. Remarks:
CST Name (Please Print) Signature Telephone No.
9013eRT- ZtL13 RiC-kT- 7i - 3V6-818S
Address Date CST Number
Ulbricht & Assoclatse /O- - /c, C5T~1 a y~2_
S
PROPERTY OWNER SOIL DESCR! ION REPORT
Page Z of
PARCEL 1.0.0 Boring 4 Horizon Depth Dominant Color Mottles Structure p
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots
2 Gr. Sz. Sh. Bed , Trench
D-T /D
Ye5/ 1fslk -6e S 3f ,s G
l P .,S7
Ground Q `
elev. - /1!_ c~ yl j J!/ yilf l S/✓ity /N^T~ s . S (o
ior_2- it. 3f-10 75
Depth to
limiting
factor -
;
in.
Remarks: '
Boring 9
Ground -7,,5 ye
elev.
.7 S
17 X It
41
~o o So ry. ,
Depth to -
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Structure
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots D t
Boring M Gr. Sz. Sh.
Bed Trench
51
Ground y
elev.
/o!/ zo • 5 YR ~i/v~by l~rs 5~ S k nM-F~P . `l ' , S
Deplh to
limning S
factor S N
> 70 In.
Remarks:
Boring 0
Ground
elev.
rt. '
Depth to
limiting
factor
in. j
Remarks:
SBOW-8330 (R. 08195)
a o C~
m ,Q ~ M
Q~4
ti
02
av
. CQ o
A
QL ,vl
n
m
Sla
'ri
'a M
5
v
~ ~ O S
oG
~ O
In
V's
02
02
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