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HomeMy WebLinkAbout030-2093-20-000 Q c w ro O M ~ Q ~ O Q C C C O I 0 I N E2 (0 ^r A Cl) L O co O 0a E `O N Q co E 0 p O Z O U L (6 LL ~ c -Q E2 o Q F- Z co V N Z N m E0 Z d y N IM- Z d m C yi O ~ ~O Z d c et I'' O d 2 c cu z E '2 C0 'D 0) J~ N Co O N C • N O O ~ L C c Z F- Z OI U O ° - z o N Z V1 jy E N O t0 = N - w ce) I'' J C O c6 N L I, . G (L ui E U) N N = N H F F O > wU- O O O O Z ° a c o w (0 (o J U "0 OOi QOi O 2 Z M In ~J O N O N N O w E Lo C m d P- U) CD n CD o n ~l r m Q u~ m O M N N I N O 3 M H C ` d C U CL = 04 (D CO O 0 O N @ 0 'a 'a E O O O I O O O \ L N h t > N E E 'L7 N N V _O rn 0) C (n C a~ a~ 4 Lo _ 17 U) Lr) 7j:: C No 0 o c(0 oo n O O U co 0). • y' O N (n F N O N Z Z (n cO ~ V lC k G ! C) 'D 0. T 0 CL L) r~ E i C C .d+ j o U) 'r aboc.s~iDepartment ofIndustry, Labocai4 -Human Relations SOIL AND SITE EVALUATION REPORT Page 1 of 4 nivislorli of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code revised 2/25/94 (Sub, T & R) k.V; COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: JoAnn Persico PROPERTY LOCATION part NW-SW-29 plus GOVT. LOT NE 1/4 SW 1/4,S 29 T 30 AR 19 W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 700 Second St. 2 i-j hland Hills CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD Hudson, WI 54016 ~715) 386-8236_ 1 St. Joseph CTHW "E" JX] New Construction Use [X] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 45n gpd Recommended design loading rate -N&_bed, gpd/ft2 -45 trench, gpd/ft2 Absorption area required NA bed, ft2 1000 trench, ft2 Maximum design loading rate NA bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.8 ft (as referred to site plan benchmark) Additional design /site considerations Bed not recommended; install 2-5' x 100' trenches w/ 14-12" rock beneath laterals Parent material fluvial outwash over glacial drift NA Flood plain elevation, if applicable ft rU= itable for system ccQ~ WENTIONAL UND I(-GROUND PRESSURE A -GRADE SYSTEM IN FILL HOLDING ITANI, nsui table fors stem RS ❑ U E S ❑ U S❑ U 8 S ❑ U ❑ S Q U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Bax>daly Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 0-9 10YR 3/3 - sl 2 m sbk mvfr cs 2f/m .5 .6 1 2 9-25 7.5YR 4/4 _ - sl 1 c sbk mvfr gs if .4 .5 Ground 3 25-37 7.5YR 4/6 - is 0 sg ml gs if .7 .8 elev. 103.3ft. 4 37-96 7.5YR 5/4 - mfs 0 sg ml .8 Depth t0 w/ stratified occasional 10YR 4'4 medium s & common 1/4" 7.5YR 4,3/4 1 stratified: limiting bands - texture changes at dept indicate best performance from renches w/ ex ra rook factor to allow lat ral movement and a reduced oadin rate below that f clean sand > 96" L there is room or a 4 br trench s stem: Tintall 2 - 5' x 134' tre hes w/ 5-12" rock Remarks: Boring # 1 0-10 7.5YR 3/3 - sl 2 m sbk mvfr cs 1f/m .5 .6 2 2 10-15 7.5YR 3/4 - sl 1 c sbk mfr gs if .4 .5 3 15-39 7.5YR 4/6 - is 0 sg ml cs if .7 1 .8 Ground 119-111 R 38 elev. 4 39-60 7.5YR 4/4 - mfs 0 sg ml as - .7 ' .8 103.9ft. 5 60-65 7.5YR 5/4 - ruts,, 0 sg ml I s - .7 .8 Depth to w q ":"7772 1 limiting 6 65-85 7.5YR 4/4 - mfs g .7 .8 factor h 85" horizon 4-6 show stratified 1/4-4j, 7.5~R 'ls,b nis, esp 40-48=&: 0- h r y are n Remarks: typically 1" a art Oz © (V CST Name:-Please Print Henry F. Grote n 665 81 Address: PO Box 57, Knapp, WI 54749-0057 nm Signature: Date: Number: 30 65 PROPERTY OWNER JoAnn Persico SOIL DESCRIPTION REPORT Page 2 Of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in.. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `s 1 0-9 10YR 3/3 - sl 2 m sbk mvfr cs 2f/m .5 .6 3 2 9-27 7.5YR 4/4 - is 1 c sbk mvfr cs 1f .7 .8 Ground 3 27-45 7.5YR 4/6 f3d 7.5YR 4/6 is 0 sg ml as if .7 .8 7 -5. R 5, elev. 4 45-55 7.5YR 3/5 c2d sl 0 m - - - - - 9s .9 ft. Depth to limiting factor _ '2L- _ Remarks: Boring # 1 0-10 10YR 4/2 - sl 2 m sbk mvfr as if .5 .6 2 10-15 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 3 15-28 7.5YR 4/4 - sl 1 c sbk mvfr as if .4 .5 Ground elev. 4 28-45 7.5YR 4/6 - is 0 sg ml cs if .7 .8 1n5-a ft. 5 45-85 75YR 5/4 - mfs 0 sg ml - - .7 .8 Depth to limiting strat fied bands 7.5 3/4 sl&ls typically 1/2" 45, 51, 55, 61, & 69 factor Remarks: Boring # 1 0-14 10YR 3/2 - sl 2 m sbk mvfr as 2f/m .5 1.6 5 2 14-18 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 3 18-32 7.5YR 4/4 - sl 2 c sbk mfr as if .4 1.5 Ground elev. 4 32-39 7.5YR 4/4 - is 1 m sbk mvfr cw - 7 .8 106.6ft, 10YR 6/2 5 39-51 7.5YR 4/4 f1d sl 0 m - as - .3 i.4 7-5YR 4/8 Depth to limiting 6 51-59 10YR 5/4 2.5Y 613 scl 0 m - as - NP .2 factor 39" i some 2.5Y 613 cl inclusions; horizon is sistant to enetration Remarks: 1 Boring # 7 59-72 7.5YR 3/4 f1p 7.5YR 4/8 sl 0 m - ai - .3 1,.4 occasional 7.5Y 4/8 and 5/4 s inclusions probably mots horizon r sistant to pen tration 8 72-110 7.5YR 5/4 - mfs 0 sg ml - - .7 .8 Ground elev. clean mfs her but too deep to b of much help! ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PROPER,OWNER JoAnn Persico SOIL DESCRIPTION REPORT Page 3 of 4 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots Bed Trench in. - Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. h 1 0-10 10YR 3/2 sl 2 m sbk mvfr as 2f .5 .6 2 10-16 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 Ground 3 16-27 7.5YR 4/4 - sl 2 c-m sbk mfr gs if .5 .6 elev. w/ occa ional f gr ins-R ft. 4 27-40 7.5YR 4/4 - sl 1 c sbk mfr s - .4 .5 Depth to 5 40-64 7.5YR 4/3 - sl 0 m - as - .3 .4 limiting factor w/ f g 1~0! - 6 64-90 7.5YR 4/4 - mfs 0 sg ml - - L 7 ,g Remarks: w/ common 7.5YR 3/4 sl bands (0 m) 1/4-1/2" typically 1" apart w/ some stratified mfs & s Boring # 1 0-11 10YR 4/3 sl 2 m sbk mvfr cs if .5 .6 2 11-25 7.5YR 4/4 .6 - s l 2 m sbk mfr cs if .5 U 3 25-40 7.5YR 4/4 is 0 sg ml as if .7 .8 Ground elev. 4 40-46 7.5YR 313 - sl 0 m - cs - .3 i .4 5 46-64 7.5YR 4/4 - is 0 sg ml cs - .7 .8 Depth t0 w/ repetitive ands 7.5YR 4/6 sl limiting factor '?81 6 64-90 7.5YR 5/4 - mfs 0 sg ml - - ,7 ,g Remarks: w/ occasional 10YR 5/4 is bands; horizon 4 has occasional 7.5YR 4/4 is inclusions Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) i , J 1 i wr / J J. rv~X/~' .rr 1 V r o ~ n ; t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / ADDRESS /11z t4L'qxjL? / L =Z! J c j/ SUBDIVISION / CSM# /"-2~[-/ C,r G~ LOT # 2 SECTIONT p _N-R_!W, Town of 'j6 S4--P,4 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s 1r ,pLG l~o t3 1--- ' . Cry X73 A OW Provide setback and el vation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. sE D ° d /Zr~aJ >/~r~ LE► 4~2~J[aft Z Al BENCHMARK: 7 BM: Uej c r le f. 9 2 ALTERNATE SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMAT,IO,N Manufacturer: Liquid Capacity: lee e, Setback from: Well House other /L~Aa f ~1~ Pump: Manufacturer 6e)Crc n S Model# 4-- Size Float seperation Gallons/cycle: Alarm Location Ii lo"Lli4tt~~t~ SOIL ABSORPTION SYSTEM Width: Length (tom Number of trenches Distance & Direction to nearest prop. line: SC r Setback from: well: lt- House Other 124/4-O . ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade i DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: /Y/f CyZ/ INSPECTOR' 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hu n Relations INSPECTION REPORT ST. CROIX S a fety and Buildings Division (ATTACH TO PERMIT) anitary Permit No.: GENERAL INFORMATION 268605 31 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: THEIN, STEVE ST JOSEH CST BM E ev.: Insp. BM E ev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600303 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~by2- Dosing &50 e:j Aeration Bldg. Sewer 1 Holding ` ` St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom g 6)- 7 Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDHLift Friction System TDH Ft H Loss 3 'Forceit~ain Length Dia. Dist. To Well : $OILABSORPTION SYSTEM SEQ /tTRENCH Width, - Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I I N DIMENSIONS ~ Ma SETBACK SYSTEM TO P/ L BLDG WELL LAKE/-STREAM LEACHING u acturer: INFORMATION TypeO CHAMBER Moe Number: System OR UNIT I ' DISTRIBUTION-SYSTEM f` Header/Manifold Distribution Pipe(s) x hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing I ( I I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over J Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched BedJTrench Cent er Bed/ Trench Edges Topsoil ❑ Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST JOSEPH.29.30.19 N /SW, COUNTY RD E 1 A 5 Plan revision required? ❑ Yes ❑ No / Use other side for additional information. E~ ~3 4 FFTT SOD-6710(R 05/91) Date Inspector's Signature Cert. No. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hu Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 268605 Permit Holder's Name: ❑ City ❑ Village Jr] Town of: State Plan ID No.: THEIN, STEVE ST JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600303 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 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 i 11 Lift Lriction System TDH Ft TDH oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Model 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: ST JOSEPH.29.30.19W, NE, SW, COUNTY RD E Plan revision required? ❑ Yes ❑ No l3Use other side for additional information. 1// ! /h SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: E 77 91 DILH SANITARY PERMIT R TRANSFER/RENEWAL COUNTY UNIFORM PERMIT # (PLB 67-T) a 6 oS PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PROPqRTY LOCATION: 1.4 r/~!~a~_,( teas CITY: /iO ((J N,R E O 0- bION VILLAGE: S r TOWN OF: LOT NUMBER: BLOCK NUMBER: ~INAME: NEAREST,~AD, LAKE OR L DMARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): ' SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRE Y5,?5; -~`r7z 1, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUMB IGN URE: PREVIOUS BER' ME (IF CHANGED): P ER'S DDRESS: T _ PREVIOU MB R'S ADDRESS: PRSW NUMBER: PHONE NUMBER: _ MP/MPRSW NUMBER: PHONE NUMBER: SIGN T RE OF ISSUIN AGENT: DATE APPROVED: (/D DISTRIBUTION: Original -County 114 Copy - Bureau of Plumbing DILHR-SBD-63 ( . 5 ) Copy - Owner Copy -Plumber ^~wE^ Safety and Buildings Division ~~■~r.r. 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. f' • 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 E] Check`ff /eJFsidri cowl k7pplication [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name *opert Lo ation /G:114 1/4, SZ4F T , N, R E (o® Propert Owner's Mailing ddress Lot Number Block Numbe 3~ 6~fi•4x1.r~ C-u~ 1Z_ /Z,~ ~ City State Zip Code P pne Number ubdwisio Name or CSM Number 1100L /0' 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ~ dowwn of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ® !tea 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 12E] 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. Q 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 XSeepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] 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) Elevati n Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks manufacturer's Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank /Wt -O<)G ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - 11121- y ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s age system shown on the attached plans. Plu ber's Name: (Print) Plumb sSign ure: (N Stamps) FWNPRSW No.: Business Phone Number: 2S Plum ePs Address (Street, City, S fate, Zip Code (F~ C t.l Cif Z IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) E] Approved E] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: G s INSTRUCTIONS i 1. A sanitary permit is valid for two (2) years. I i 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. i 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. If. 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. Safety and Buildings Division ~•;~~ri ; 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. F t • 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 7eW10n'to ~revious,application [Privacy Law, s. 15.04 (t) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1i4 e 1i4, S T j, N, R E (or) W ; ck Property' Owner's ailing Address P Lot Number 6 o Number , 1 t City State Zip Code Phone Number Subdivision, Name or CSM Number 11. TYPE BUILDING: (check one) ❑ State Owned ❑ Cit~r Nearest Road VII age Public 1 or2 Family Dwelling - No. of bedrooms own OF '`f III. BUILDIN USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo ' 2 ❑ Assembly Hal[ 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. pr New 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 130 Seepage Pit 43 ❑ Vault Privy 14E] SysterKdn-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/s . ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity g allo Total # of Prefab. Site Fiber Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ lrft Pump Tank /Siphon Chamber -7 , ' ❑ ❑ 11 El 11 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: (No Stamps) MP/, PRSW No.: Business Phone Number: I e A Plum er's ddress (Street, City' S te, Zip Code). Z:2 Z= L711 _14li-I 7 a-, 49 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) ❑ Approved ❑ Owner Given Initial surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, 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. 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. VIIL 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; frictionjoss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system i 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. lz y N ~ i ° N G~ LA SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE & !LEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK & 6" MIN. WARNING LABEL ABOVE GRADE -4" MIN. 18" IN. 6" MAX. INLET ~WATER TIGHT SEALS L GAS- _ TIGHTi , 1 4" BAFFLE A SEAL 1 FA PROVED CI PIPE ALM INTS GJ/ CI 3' ONTO B i PE 3' ONTO SOLID ON 117 LID SOIL C SOIL PUMP OFF ELEV . FT. OFF RISER EXIT D RMITTED ONLY TANK NUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: r ~57~c~ ~BER DOSES PER DAY : TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER:? -mina CAPACITIES: A = a/,S'_INCHES = ~loS~~rGAL. MODEL NUMBER: ~Qr SWITCH TYPE: B = 2 INCHES = Z y GAL. PUMP MANUFACTURER: C = INCHES = /3 ( GAL. MODEL NUMBER:/ SWITCH TYPE: "Apt &."a D = INCHES = 97 GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 2.5 FEET + FEET FORCEMAIN X ,Y50 FT/100 FT. FRICTION FACTOR .5~ FEET TOTAL DYNAMIC HEAD FEET r ~ INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH .~3 DIAMETER LIQUID DEPTH .38/L SIGNED LICENSE NUMBER: In,17 2/9 DATE: /r q 1/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT -~St. Croix County OWNER/BUYER J 1 6-uc / L t"', MAILING ADDRESS PROPERTY ADDRESS 7 3 a 14 - j Sw W , 3 C ::S~ i ! Fa (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION U 1/4, 1/4, Section c/ T ~ N-R l W TOWN OF ( .l,aC'pd ST. CROIX COUNTY, WI SUBDIVISION t ~ ~ tJ y t w LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE 1, 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. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: I St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This'application form is to be completed in full and signed 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 ITZ? -7'~-j.e )-J/I/\ Location of property_J_-1/4 Sc--j 1/4, Section c,T ~o N-R j W Township ~ To L-i~ Mailing address X35 14'e-4 Ut II.; Address of situ {~jG!<LA NQ_ _ IELU Subdivision name Lot no. a2 _ Other homes on property? Yes -7 No Previous owner of property. CT 8cg fe o Total size of property Q.~ Total size of parcel Date parcel was created , Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume S~ and Page Number 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. g yp yjF'A- , 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. 1 97, ;Si natu e of Applicant Co-Applicant Date of Signature Date of Signature 540455 'AItK 1A l l I>t I ll ^7 ii. "I!aIld Hi L 1 , ;rtn i n~i tin_ of rlr"-sisrER'SOFFICE To~ n,1 rte r~; co, R<`_ E~r ?ucl In `;nc -truce P, t _ - S`. CRC=.X :TY., WI t<ph,.n Pr:n MAR 5 1496 • ~~:nu ~.M r ~t Dc6C3 crGiN gNS F E IR Lot plat of Hi hland Hills in the Io,-P, o' !o eph, t. roix M111tI, i~isco-rsin. is not Kux E.~;,t,nt.,uat ttr, Fasements, restrictions !ind r1 h= -~c8V Or record, l any. February 96 is D ~j P,Itcd of ' Hi ~;nland Hills, partnership ' ~r ✓ ->tG~t t'v JoAnn Persico Ro_rr RuelLn ;truce Peterson - - AUTHENTICATION ACKNO~% LEDGMEN C 5+ate A Nvisconsin, t i roix rE1?ruar ' - - - _ 1., fib. _ T-_r~ ~TTS, a partners J`oAriz -c rsi-Co; 'R oer-i:ui=Tin arc: Illlf '.1[ 1(3hR ~1.\It B:;RuI' \`.!~C~"L^; - _ - - - - - Ai.0 -\11 :3 cr M• N• H Lo :j 0 IV W. b fv Al to m 0 0 CERTIFIED SURVEY - 1n m to :to C* 0 N H. 0 m MAP IN VOL. 7, su M r aQ,a a PG. 2081 a C m m 0 Ia. ra 0 Q m n n tomn0< H.~ LOT 4 ;a :31 to 0 ms=mom-n •e m o m J a. rA CD O o v, UNPLA_T_T_E_D LAN O N O W 'N m S2 ° 2 / ~O - o/, 6 S9 " o t 4 p 1,y CFN S02° 58133 E /29 FR ~ C 3 22 o/G 3g IV `VC •pE.Sgc ~ - , 00, S /QS O ^ Sq. ss a. 22 oz, ROos" N IV r0 0Co m cn \ Ty~ ~O F N O 3 \ ♦ / C> ~ W to 3 w \ cr 1 O m -n OP r O o D CD -I C" Nlp°o z m a) m r o 0 o cmnQ W N , m 1 N N -n z A 2 f r p 0) 0 0) OD 0) W °m oa tD W i w w ° O cn co O O O W n XI` 0 O N C) oa N m m cn co o N N O • 0 SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Building Systems g Water 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. • Cl C40 I • See reverse side for instructions for completing this application State Sanitary Permit Number a{ 6S'Go5-- The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)J. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location E1/4 1/4, S 01, T 30 , N, R 1,9 E (oro Property Owner's Maiaktw~ dress Lot Number Block Number t City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ~t~ Nearest Road ❑ VII age ❑ Public 1 or 2 Family Dwelling - No. of bedrooms _3-- Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a a - 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. IV New 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43E] 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 Y17 Q Q , $ Feet /0 V Feet - 1 1606 VII. TANK Caallo in gacltns Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 000 C ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility foF installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu a 's Signature: (No Stam s M PRSW No.: Business Phone Number: 3 715--5737-46415-1 Plumber's Address (Street, City, State, Zip Code): r IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Ag nt Si re N tam ; Approved ❑ Owner Given Initial j fy~GlD Surcharge ree) e~ Adverse Determination O D X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRO-6398 (R. 05/94) DISTRIBUTION: Original to Cnanty, One cnpy To: Sofety &Bnildings Division, Owner, Plumwr r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. VI11_ Responsibility statement. Installing plumber isto 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 scal-e 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 carr - - - effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. "5c//,Yo AUC, U~ivro/~snE~" G/r d 361' 36" /4/~jPdU~Q CO(J~/~ CAR, D°o N d . o )P. 16/1, YS 7&7 -7 EL 99 LfJl1 La%19 017 ~yd 1 ALT 1 _ ~ _ ~ t p g~ 8 9 pl?a/9osCo ®gAPO _ _ 6 90 . ► JD00 4AL. S• T JC /DO TIPE~srC,tEs ~ 13/1 = ToP or- Pax P/P~ EG./oO,o 5C Lor CoRNer2 /Or l ~R~cv~~ ~oR 9 z o -9~ D,PA,,~~v6- 13 y ~(36 hIGW, 4-1vd 01,5rw S 86 #Mo5ow S6PTeRSeTl Vii` vF'Ya,~b~ /W Jrw ~3 2 0 S- Vtriscsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 4 Acabor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY revised 2/25/94 (Sub, T & R)~~~ St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION part NW-SW-29 plus JoAnn Persico GOVT. LOT NE 1/4 SW 1/4,S 29 T 30 N,R 19 W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 700 Second St. 2 Highland Hills CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hudson, WI 54016 (715) 386-8236 St. Joseph CTHW "E" JX] New Construction Use [X] Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 45n gpd Recommended design loading rate NA bed, gpd/ft2 .45 trench, gpd/ft2 Absorption area required NA bed, ft2 1000 trench, ft2 Maximum design loading rate NA bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.8 It (as referred to site plan benchmark) Additional design/ site considerations Bed not recommended; install 2-5' x 100' trenches w/ 14-12" rock beneath laterals Parent material fluvial outwash over glacial drift Flood plain elevation, if applicable NA It S = Suitable for system cQNVENTIONAL OUND I -GROUND PRESSURE M GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [~`S ❑ U S❑ U S❑ U S❑ U ❑ S Q U ❑ S Q U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-9 10YR 3/3 - sl 2 m sbk mvfr cs 2f/m .5 .6 1 2 9-25 7.5YR 4/4 - sl 1 c sbk mvfr gs if .4 .5 Ground 3 25-37 7.5YR 4/6 - is 0 sg ml gs if .7 .8 elev. 103.3ft, 4 37-96 7.5YR 5/4 - mfs 0 sg ml - - .7 .8 Depth to w/ stratifie occasional 10YR 4'4 medium s & common 1/4" 7.5YR 4,3/4 1 stra ified limiting bands - texture changes at dept indicate best perfo mance from trenches w/ extra rodk factor to allow lateral movement and a reduced Loading rate below that of clean sand p,9611 there is room or a 4 br trench system: install 2 - 5' x 134' tre hes w/ 5-12" rock Remarks: Boring # 1 0-10 7.5YR 3/3 - sl 2 m sbk mvfr cs 1f/m .5 .6 2 2 10-15 7.5YR 3/4 - sl 1 c sbk mfr gs if .4 .5 3 15-39 7.5YR 4/6 - is 0 sg ml cs if .7 .8 Ground - - elev. 4 39-60 7.5YR 4/4 - mfs 0 sg ml as - .7 .8 103.9 ft. 5 60-65 7.5YR 5/4 - - mfs 0 sg ml .8 Depth to -,7 .8 limiting 6 65-85 7.5YR 4/4 mfs 0 sg factor ? 85" orizon 4-6 show strati ied 1/4-1/211.7.5YR 4/3 is bands. ospeci 0 48 & '65 t e Remarks: typically 1" apart CST Name:-Please Print Phon Henry F. Grote s► 71665-2 Address: PO Box 57, Knapp, WI 54749-0057 w Date: Signature: umber: 5/ 1 /93 3065 PROPERTYOWNER JoAnn Persico SOIL DESCRIPTION REPORT Page ~~f_44_ PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 3 1 0-9 10YR 3/3 - sl 2 m sbk mvfr cs 2f/m .5 .6 2 9-27 7.5YR 4/4 - is 1 c sbk mvfr cs if .7 .8 Ground 3 27-45 7.5YR 4/6 f3d7.5YR 4/6 is 0 sg ml as if .7 .8 elev. 4 45-55 7.5YR 3/5 c2d " sl 0 m 9$~2 ft. - - - - - Depth to limiting factor '77 ' Remarks: Boring # 0-10 10YR 4/2 - s l 2 m sbk mvfr as if .5 .6 4 € 2 10-15 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 is. 3 15-28 7.5YR 4/4 - sl 1 c sbk mvfr as if .4 .5 Ground elev. 4 28-45 7.5YR 4/6 - is 0 sg ml cs if .7 .8 1n5 . a ft. 5 45-85 7.5YR 5/4 - mfs 0 sg ml - - ,7 ,g Depth to limiting strat fied bands 7.5Y 3/4 sl&ls typically 1/2" 45, 51, 55, 61, & 69 factor ~ 's5! Remarks: Boring # 1 0-14 10YR 3/2 - sl 2 m sbk mvfr as 2f/m .5 .6 5 2 14-18 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 3 18-32 7.5YR 4/4 - sl 2 c sbk mfr as if .4 E.5 Ground elev. 4 32-39 7.5YR 4/4 - is 1 m sbk mvfr cw - .7 .8 106.6ft. 10YR 6/2 5 39-51 7.5YR 4/4 f1d sl 0 m - as - .3 .4 Depth to 7,5YR 4/8 limiting 6 51-59 10YR 5/4 2.5Y 613 scl 0 m - as - NP .2 factor 39" some 2.5Y 613 cl inclusions; horizon is sistant to enetration Remarks: Boring # 7 59-72 7.5YR 3/4 f1p 7.5YR 4/8 sl 0 m - ai - .3 .4 occasional 7.5Y 4/8 and 5/4 s inc usions probably mots horizon r sistant to pen trati6n 8 72-110 7.5YR 5/4 - mfs 0 sg ml ,7 ,8 Ground elev. clean mfs her but too deep to b of much help! ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PROPERTY OWNER JoAnn Persico SOIL DESCRIPTION REPORT Page 3 of 4 ` PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Thatch ..6 ? 1 0-10 10YR 3/2 - sl 2 m sbk mvfr as 2f .5 .6 2 10-16 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 Ground 3 16-27 7.5YR 4/4 - sl 2 c-m sbk mfr gs - if .5 .6 elev. w/ occa ional f gr 1n5_R ft. 4 27-40 7.5YR 4/4 - sl 1 c sbk mfr gs - .4 •..5 Depth to 5 40-64 7.5YR 4/3 - sl 0 m - as - .3 .4 limiting factor w/ f g h 2. CZ 1t0! 6 64-90 7.5YR 4/4 - mfs 0 sg ml - - .7 .8 Remarks: w/ common 7.5YR 3/4 sl bands (0 m) 1/4-1/2" typically 1" apart w/ some stratified mfs & s Boring # 1 0-11 10YR 4/3 - sl 2 m sbk mvfr cs if .5 .6 2 11-25 7.5YR 4/4 - sl 2 m sbk mfr cs if .5 .6 7 3 25-40 7.5YR 4/4 - is 0 sg ml as if .7 .8 Ground elev. 4 40-46 7.5YR 313 - sl 0 m - cs - .3 .4 4U2 .3ft• 5 46-64 7.5YR 4/4 - is 0 sg ml cs - .7 .8 Depth to w/ repetitive ands 7.5YR 4/6 sl limiting factor 6 64-90 7.5YR 5/4 - mfs 0 sg ml - - .7 .8 Remarks: w/ occasional 10YR 5/4 is bands; horizon 4 has occasional 7.5YR 4/4 is inclusions Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _'Sf Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S T N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ❑fOWN NEAREST ROAD [ ] New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: c~ ! i d d ~ , Cli d 43 o r~ ~ 9 ✓ ~n ~ y 1 a0 0 0 ~ N { o O r fi~ J ' I th 3 1 p 9D ♦+JC ,~~/1. aY~Y+t~fY•'~Z~, I ` yy}"yl^ .1.b., .~+•*"rS•G