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.senns Department of Industry, SOIL AND SITE EVALUATION REPORT Page __j of -4-
f*nd Human Relations
ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Cod
g'L~ 4
Croix
t.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must incl
,
F) 1-
not limited to vertical and horizontal reference point (BM), direction and % of slope, sca gi Y) I.D. 0,
dimensioned, north arrow, and location and distance to nearest road. Y l f
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VI9j[BY a, D E
PROPERTY OWNER: PROPER TION r'
Richard Stoift. V- - GOVT. LOT r 1" AR 19 xf(or) W
PROPERTY OWNER':S MAILING ADDRESS ' L BLO D. NAME
1353 Awatukee Trl. 1 16 na ! C d
CITY STATE ZIP CODE PHONE NUMBER ❑VILLAGE NEAREST ROAD
Tower Rd.
Hudson, WI. 54016 (715 549-6731
Tim
[x] New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to ils b 'Iding
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, pd/ft • 8 trench, gpd/ft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) starting C 102.6 ft (as referred to site plan benchmark)
Additional design/ site considerations trenches spaced to code 3/5' below surface level. Alt. area=111.0'
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem as ❑ U :97 S ❑ U KI S ❑ U ®S ❑ U ® S ❑ U ❑ S 13 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
1 0-12 10yr3/4 none sl 2mgr mvfr gw 2f .5 .6
1
2 12-84 7.5yr4/4 none cos Osg ml na na .7 .8
Ground
elev.
106.1 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-8 10yr2/2 none loam fill na gw na np np
ti...2 ' 2 8-18 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
3 18-32 10yr4/4 none sicl lfsbk mfr gw if .2 .3
Ground
elev. 4 32-80 7.5ry4/6 none is Osg mvfr na na .7 ` .8
106.4 ft.
Depth to
limiting
factor
+80,
Remarks:
CST Name:-Please Print Phone:
Gary L. Steel 715-246-6200
Address: 1554 20 Ave. , New R'- hmond, WI. 54017
Date: CST Number:
Signature: - 6-12-96 cstm 02298
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page
~,ef
PARCEL I.D. # pendinca
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 0-10 10 r3 3 none sl 2msbk mfr 2f .5 .6
+C'{'•5 'i\4
2 10-19 7.5ry4/4 none is Osg mvfr gw if .7 .8
3 119-80 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
102.95 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0-11 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
r 4 2 11-29 10yr4/4 none sicl lfsbk mfr 9w if .2 .3
3 29-78 7.5yr4/4 none is Osg mvfr na na .7 .8
Ground
elev.
99.05 ft.
Depth to
limiting
factor
+78
Remarks:
Boring # 1 -5 10yr2/2 none losm ill na 9w na np np'
5 k 2 -14 10yr3/3 none 1 2msbk mfr 9w 2f .5 .6
3 4-23 10yr4/4 none sicl 2msbk mfr 9w if .4 .5
Ground
elev. 4 3-31 7.5yr4/4 none sl lcsbk mvfr 9w if .4 .5
99.7 ft.
5 1-80 7.5yr4/4 none is Osg mvfr na na .7 .8
Depth to
limiting
factor
+801,
Remarks:
Boring #
1 -14 10yr3/3 none 1 2msbk mfr 9w 2f .5 .6
6 2 4-24 10yr4/4 none sicl 2msbk mfr gw if .4 .5
3 4-30 7.5yr4/4 none sl lcsbk mvfr 9w if .4 .5
Ground
elev. 4 0-80 7.5yr4/6 none co s Osg mvfr na na .7 .8
114.0 ft.
Depth to
limiting
factor
+80"
Remarks:
SBD-8330(R.05/92)
Page 'i of _g._
PROPERTY-OWNER Richard STout SOIL DESCRIPTION REPORT
P#MEL I.D. # pendina lot #16 Country Wood
GPD/ft
Depth Dominant Color Mottles Structure Roots Bed
Texture Consistence BTrench
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
l 0-9 10yr2/2 none 1 2msbk mfr 2f .5 .6
na gw if np .2
7 2 9-20 10yr5/4 none sil M
3 20-3 7.5yr4/4 none 1 fs Osg mvfr gw na .5 .6
Ground
elev. 4 33-8 7.5yr4/6 none co s Osg ml na na .7 .8
114.7 ft.
Depth to
limiting
factor
+8 "
Remarks:
Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
gw if ,2 .3
g_ 2 10-20 10yr4/4 none sicl lfsbk mfr
3 20-30 7.5yr4/6 none sl lmsbk mfr gw if .5 .6
Ground mvfr gw na .7 .8
elev. 4 30-54 7.5yr4/4 none is Osg
• ml na na .7 .8
114.7 ft
5 54-84 10yr5/4 none cos Osg
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
lepth to
citing
`.or
Remarks:
330(R.05/92)
Wisconsin Department Industry,
Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of _
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
7PARCEL 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 dimens
ioned, 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 ❑TOWN NEAREST ROAD
[ J New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building
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
Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed Tre'tcft
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:
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SW1jSE4 S3-T28N-R19 W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
lot #16-Country Wood
N
1"=40'
BM.= top of 12" pvc pipe C el. 100' by Aspen tree alt BM.= nail in Aspen tree C 105.00'
t 20 7Z.r
o (f 4~_ 20 1
10 0
36
N t:-
Gary L. Steel
6-12-96
Wist, Wi o si DepatmentotIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
bor and an Relations
Division Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
l~
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but Cr
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or CEL I vL a
dimensioned, north arrow, and location and distance to nearest road. I)e
riding
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION EVI
ST r-ne'vv
PROPERTY OWNER: PROPERTY LOCATION COWY 11-4
Richard Stout T SW 1/4 SE / fir) W
PROPERTY OWNER':S MAKING ADDRESS LOT # LOCK # SUBD. N y C~M#•
1353 Awatukee Trl. C6.1' na Countr b$ f
CITY f dson, WI. 54016 ZIP CODE (7PHONE 15) N549-6731 Troy ❑VILLAGE SOWN NEARESTTower Rd.
fx] New Construction Use ()d Residential / Number of bedrooms 3 ( ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 . 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) area A=98.5, B=99.5 ft (as referred to site plan benchmark)
Additional design I site considerations na
Parent material stream terrace Flood plain elevation, if applicable na ft
rU=SUunisuitable table for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
fors stem i [as OU ® S ❑ U ® S ❑ U ®S ❑ U I ❑ S O U ❑ S o u
SOIL DESCRIPTION REPORT
Depth Dominant Color Mothes Structure I GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Coat Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed (Trench
}..`.i., 1 0-11 10yr3/3 none 1 2msbk mfr gw 2f . 5 .6
SEEN 2 11-27 7.5yr4/4 none scl 2mgr mvfr na na .4 .5
Ground 3 27-84 10yr5/4 none cos osg ml na na .7 .8
elev.
101.7ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-9 10yr2/2 none 1 2msbk mfr gw 2f .5.6
;2
2 9-20 10yr5/4 none sil m na gw if n n
iiii:S:•:~;•:x
3 20-33 7.5 r4/4 none os mvfr Crw na .5.6
Ground
elev. 4 33-80 7.5yr4/6 none cos osg ml na na .7..8
q. I
Depth to
limiting
factor
+80"
Remarks:
CST Name:-Please Print Phone:
Gary L. Steel- 715-246-6200
Address: 1554 200th Ave., New Richmond, Wi.54017 10-26-95 cstM02298
Signature: Date: CST Number:
.JPERTYOWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL IA A -Bending rt^ y
Depth IDoif~it~antColor Mottles I Structure I GPD/ft
Boring # Horizon ih. MOnsell Gu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed !Trench
2msbk mfr gW f .5'..6
3 <; 1 0-8 10r3/3 none 1
2 8-15 10 r4/4 none scl 2msbk mfr Cfw 1f .41.5
Ground. 3 - 15-34 7.5 r4 4 none is os mvfr na .7 1 .8
101ev5
4- 34-84 10 r5 4 none cos os ml na na -.7:.8
Depth to
iimiting
factor
+84"
Remarks:
Boring #
1 10-8 10yr3/3 none 1 2msbk mfr gw 2f .5::.6
4 2 8-16 10yr4/4 none scl lfsbk mfr gw if .2.3
3 16-33 7.5yr4/4 none scl osg mvfr gw if .4::.5
Ground
103!3ft 4 33-82 10yr5/4 none cos osg ml na na .7'.8
Depth to
limiting
fapp2
Remarks:
Boring #
1 10-10 10yr3/3 none 1 2msbk mfr gw 2f .5; .6
:
5 2 10-20 10yr4/4 none sicl lfsbk mfr gw if .2:.3
3 20-30 7.5yr4/6 none sl lmsbk mfr gw if .4.5
Ground
10~1et ft. 4 130-54 7.5yr4/4 none is osg mvfr gw na .7! .8
5 54-84 10yr5/4 none cos osg ml na na .7.8
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev.
ft. j
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
r
Y
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SW4SE4 S3-T28N-R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
lot #57-Country Wood
t
N
1"=40'
BM.= top of 1" steel pipe C el. 100'
Alt. BM.= top of wooden corner post C el. 104.00'
t
~V
01
~.Z
~o
o" A di
~►,,,..,1 / -*'4v
Gary L. Steel
11-26-95
STC - 104
AS BUILT SANITARY SYSTEM REPORT
0WNERIf~cty /f ~ts~.fc i A
ADDRESS
3~YB/6
SUBDIVISION / CSM# Ceu,rr ~~a OL LOT # ~6
SECTION T aF- N-R /r W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
s,
3
s eio71'C
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
C
BENCHMARK:
,St M G 5' J / s
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: _n~ Liquid Capacity: ~••,g B
i
Setback from: well SjG House p'S' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: ~y~~
INSPECTOR:_ ~7'7-
3/93:jt
Witconsion Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor avid Human Relations INSPECTION REPORT
Safety and Buildings Division ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
262372
Permit Holder's Name: ❑ City ❑ Village (X Town of: State Plan ID No.:
LUDGATIS MARK TROY
CST BM El V.: Insp. BM Elev.:
..IT BIM Description: Parcel Tax No.:
C,tSMG A9600183
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 19,1-ol
l- Benchmark
Dosing Oxa fA 3 , W 7,3
Aeration Bldg. Sewer
Holding St/ Inlet
TANk SETBACK INFORMATION St/ I Outlet 3 03,
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
rl
Septic -_25 NA Dt Bottom
Dosing NA Header/Man. J
Aeration NA Dist. Pipe C
Holding. Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Man cturer Demand
. 06
Model Number GPM s
TDH Friction Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width , Lengt r No. Oflrenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS SS
CHING acturer:
SYSTEM TO P / L BLDG WELL LAKE / STREAM fijk
SETBACK
INFORMATION Type O Rt,tu-' ckv: - I CHA
NIT
System: t/cc,
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hol Air Intake
Length Dia- Length ~ ' Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At- ade ems Only
Depth Over u d Depth Over xx Depth Of xx Seeded / Sodded xx ulched
Bed /Trench Centeri V _3 Bed /Trench Edges - Y Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)-*,/~, _ e.E4c ~F
LOCAT ON: TROY.3.28.19 , Svc, SE, ;LOT 10, TOWER ROAD
Plan revision required? ❑ Yes 2-60-
Use other side for additional information. J 5
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
ti`
SANITARY PERMIT APPLICATION BureaSafetyuandBuildings Divisi
of Building Water System!
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 8112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sani~taryrmit Nurrb rr p
The information you provide may be used by other government agency programs ❑ Chec icr f I. vision to revi ~pplicatio
[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 Gd 114 1/4, S T )T , N, R E (or) W
Property Owner's Mailin ddress Lot Number Block Number
4a-v - T
City, State Zip Code Phone Number Subdivision Name or CSM Number
2 j
tom' . ~
2 ( o ^ d 4
II. TYPE F BUILDING: (check one) ❑ State Owned ° City Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ° Towan OF p ve v
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/Condo 1;2 3;;1
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 System Tank OnlyExisting 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 210 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 E v. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation
L1 ,S~a ,eiac.-- 91Y ,6 , Feet za2~ Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex er.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic Appstructed
Tanks Tanks
Septic Tank or Holding Tank ❑ El El ❑ 1:1 -
Lift Pump Tank /Siphon Chamber ❑ ~ ~ 1:1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature No Stamps) //MMPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code
a r
/lie Z,1 -
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee (includes Groundwater j Issui Agent Signa a (No Stamps)
VApproved I ❑ Owner Given Initial Surcharge fee)
Adverse Det
ermination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05194) 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 ne~,v 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 `.Mate 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 Dweil,ng.
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-
V! 1. 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.
s ~ s l' yGc~
Poe-lo
1
"Ilk
~r 16'04as'ti
Laoorwa human mewsons y
Pi' ision of. Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 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. pending
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT SW 1/4 SE 1/0 3 T 28 N,R 19 3M(or) W
Richard Stout PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
1353 Awatukee Trl. 16 na country Wood
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 (719 549-6731 Tro Tower Rd.
[x] New Construction Use [ 39 Residential / Number of bedrooms 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate_. 7 bed, gpolft2 •8 trench, gpdjft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd$ .8 trench, gpolfl2
Recommended infiltration surface elevation(s) starting C 102.6 ft (as referred to site plan benchmark)
Additional design/ site considerations trenches spaced to code 3/5' below surface level. Alt. area--111.0'
Parent material outwash Flood plain elevation, H applicable na ft
S : Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U - Unsuitable fors stem skS ❑ U X)S ED KIS ❑ U ®S ❑ U ®S ❑ U ❑ S EAU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tlendt
1 1 0-12 10yr3/4 none sl 2mgr mvfr gw 2f .5 .6
2 12-84 7.5yr4/4 none Co s Osg mi na na .7 .8
Ground
elev.
106.1 fc.
Depth to
Imiting
factor
+84"
Remarks:
Boring #
1 10-8 10yr2/2 none loam ill na gw na np np
2 2 8-18 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
3 18-32 10yr4/4 none sicl lfsbk mfr gw if .2 `.3
Ground
elev. 4 32-80 7.5ry4/6 none is Osg mvfr na na .7 ' .8
106.4 ft.
Depth to
limiting
factor
+80"
Remarks:
T Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 20 Ave., New R' hmond, WI. 54017
Signature: Date: CST Number:
6-12-96 cstm 02298
eMPERT OWNER Richard Stout SOIL DESCRIPTION REPORT Page of
PARCEL I.D. t pending
Depth Dominant Color Mottles Texture Structure Consistenoe Boundary Roots GPD/ft
Tiendt
ed
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. B
1 0-10 10yr3/3 none sl 2msbk mfr 2f .5 .6
3 2 10-19 7.5ry4/4 none is Osg mvfr gw if .7 .8
Ground 3 19-80 7.5yr4/6 none co s Osg ml na na .7 .8
elev.
.02.95 ft.
Depth to
limiting
faclor
+80"
Remarks:
Boring # 1 0-11 10yr3/3 none 1 2msbk mfr 9w 2f .5 1.6
4. 2 11-29 10yr4/4 none sicl lfsbk mfr gw If .2 1:.3
3 29-78 7.5yr4/4 none is Osg mvfr na na .7 '.8
Ground
elev.
99.05 fL
Depth to
limiting
factor
+78"
Remarks:
Boring # 1 ~-5 10yr2/2 none losm ill na gw na np np
5 2 -14 10yr3/3 none 1 2msbk mfr 9w 2f .5 1.6
3 4-23 10yr4/4 none sici 2msbk mfr 9w If .4 .5
Ground
elev. 4 3-31 7.5yr4/4 none sl lcsbk mvfr 9w If .4 .5
99.7 ft,
5 1-80 7.5yr4/4 none is Osg mvfr na na .7 1.8
Depth to
limiting
factor
Remarks:
Boring #
1 -14 10yr3/3 none 1 2msbk mfr 2f .5 .6
6 2 4-24 10yr4/4 none sici 2msbk mfr gw If .4-1.1 .5
3 4-30 7.5yr4/4 none sl Icsbk mvfr 9w If .4 .5
elm 4 0-80 7.5yr4/6 none co s Osg mvfr na na .7 .8
114.0 It
Depth to
limiting
factor
+80"
Remarks:
PARCELLD. pending lot #16 Country Wood
Boring # Horizon Depth Dominant Color Mom Texture Structure Roots GPD/ftin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mach
1 0-9 10yr2/2 none 1 2msbk mfr 2f .5 .6
13 2 9-20 10yr5/4 none sil M na
gw if np .2
Ground 3 20-3 7.5yr4/4 none 1 fs Osg mvfr gw na .5 .6
114.7 ft 4 33-8 7.5yr4/6 none co s Osg mi na na .7 .8
Depth to
uniting
factor
+8Q
Remarks:
Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
8 2 10-20 10yr4/4 none sicl lfsbk mfr gw if .2 .3
3 20-30 7.5yr4/6 none sl lfsbk mfr 9w if .5 .6
Ground
elev. 4 30-54 7.5yr4/4 none is Osg mvfr 9w na .7 .8
114 _ ft
5 54-84 10yr5/4 none cos Osg ml na na .7 .8
Depth to
limiting
factor
+84"
Remarks:
Boring #
E3
Ground
elev.
ft
Depth 10
limiting
factor
Remarks:
Boring
Ground
elev.
tt.
Depth tD
limiting
factor
Remarks:
SBD-8330(R.05/92)
r.
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 S4SE~ S3-T28N-R19 W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
lot #16-Country Wood
N
1"=40'
EK.= top of 1k" pvc pipe el. 100, by Aspen tree alt BI.= nail in Aspen tree @ 105.00'
f
! ~zp -72-
'0
1
14 FI
$ 9-F o!' lk fil
P
~l
Gary L. Steel
6-12-96
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
owNER/BuYER 1M ,A,^, Lug 9o & Ls
• MAILING ADDRESS Elk w' '6.5,6 1-
PROPERTY ADDRESS _,6_v 9 T
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE _ . 4 /l 1^
PROPERTY LOCATION :S_ 1/4, ~S_L:_ 1/4, Section 3 , T 2. N-RW
'OWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER J
CERTIFIED SURVEYMAP~~~/~VOLUMX PAGE "/W, LOTNUMBERZl~
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
acid 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 te.
SIGNED: y
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
i
S T C - loo
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 MAy.,kC 4i /~i4
Location of property '%F- 1/4 6L_1/4, Section 3 T ea _N-R_Z~ _W
Township -T~-A y Mailing address 13ea,r 4-o i L
D+ ~T. t6 r. iZ,. V aRJ2~1
Address of site dse,,C-J
Subdivision name S' A,„~,~,,,, Ut~esr{ Lot no.
other homes on property? -Yes L,/ No
Previous owner of property `aki
Total size of property , Le Aar.
Total size of parcel
Date parcel was created
Are all corners and lot Yes No
lines identifiable?
Is this property being developed for (spec house) ? Yes L-'~ No
Volume _IZ2 and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION TILE 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. , 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.
Lf~S
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UOCUMErJI fJU. STA''1; BAR o[ VIt,iCS1NSUI FORM II -Los- V Yt„ 1J2
LAND CONTRACT
1 fIt1N9 wIIF It 1: UVP:II r
'tU lit', U1010 Foot ALL TRA1,19A
r T } }2G•000 IS FINAN(I U AND IN (t l 111'It NUN-t,UNtiUA1 F:It { • t ~.rt
AtT'11tAN9AC11UN-D
RICH~FD 0. -STOUT 1~~6
C011tract, by and between App 7
- („Vendor", 1f IL`0:30J a.
>
whether one or morn) ?Y PI S.•
and
husband- wifef...••.•.._
whether one or more).
("Purchaser",
Vendor sells and agrees to convey to Purchaser, upon the promiltnd full
viliPere
forntnnce of this contract by Purcl:nser, the following property, together
lurtenant interests (nil called tho "Property"), the -
rents, proRts,,('Utlur6ro xother rapt
•
JG l: County State of Wisconsin: „e.°n" TO
i'r!t f C' '
Lot 16, Plat of Country Wood in the Town of Troy, Not yet assigned -
St. Croix County, Wisconsin.
TOGETHER WITH and SUBJECT TO any recorded easements,
coven,nts, reservations and restrictions.
is NOT
This . homestead prole-rty• 1353 Awatukee Tr, Hudson WI 54016
.
(i°) (is or as Vendor directs in writing
Purchaser n •rees to purchase the Property and to pay to Vendor at .............7`-1S"00---....... ,
351 00 ;0Q In the following ttmnner: (a) - ether wit. ;...crest front date
the sutra of ~
-.--,tog
at the execution of this Contract; and (b) the balance of per cent per annum
S
hereof on the balance outstanding froze time to little tit the raLo of.. nine--(6%'... .
until paid In full, as follows:
Monthly payments of not less than $231.09 on or before each monthly anniversary ate mon
is earlier after the date of this Contract
thetmo(or nthtof this Contractaas settforthlaboverthe parties'
commencing the month after er
signatures, with the entire balance payable in full one year after the date of this
Contract. Purchaser shall have the option, on thirtan(i00) days wrate ritttwonoticento( )
Vendor, to extend this Contract for one (1) year at ear anniversary
over the pprime rate at First National Bank of Minneapolis on Ze one-
of the °date lof et isl1eContr atc tgt,tw with .tai ectpa ntlent Itamoun tt lamor Li fed at 29 vears.
one•yearideu, .-jt~tp..yf<dzS..if tPurch~~er el:ctc to extend) after date of this Contract.
Following ally dehtult in payllient, hntcrest 3111111 nccrua rat the rule of ....9.....% per nununl on the entire amount
In default (which shall include, without limitation, delinquent interest :lttd, upon occcleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees. to pay monthly to Vendor atttuunls sufficient to pay reasonably en+tici-
prated annual foxes, special IlS3e99111e11t9, fire and required insurance prcmiunna when duc.'1'o the extent received by
Vendor agrees to aPPIY Payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payment; shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
13
amount may be prepaid without premium or fee upon principal at tiny tituc )MI1111 ill: 111:111 11(:111~ 11: 111:)(11E, f
n ,n ment, this contract Shall not be treated as in default with respect to payment so long
bavelantncce e of any 1 prittcre{ipynl, and interest (and in such case accruing interest from month to month shall be treated
as event
as the I
of credit of any proceeds
u meats been nthly as unpaid principal) is less than the unlount that raid Itscshall be continued been Ic the
made as first specified above; provided that monthly p ymen lit the vent
of insurance or condemnation, the condemned premises being thereafter excluded herefrom. fied with the title
to rurchase Purchaser states thntVendloreshall1°remain current°on byLandtho L r
for examination except:
Singergerhouse use and Bernie H. Singerhouse to Vendor, dated June 2, 1995, recorded June 5.
1995, in Vol. 1124, Page 496, D( c. No. 529718, and shall obtain a WarrantytDeedthe.
thereunder to the above described Property on or before Purchaser's paa y payments
r,alance due hereunder. If Vendor fails to_do`so^1Purnhrelease of ptl he Property .1