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HomeMy WebLinkAbout040-1222-50-000 c v o 3 ° N c O C r c, U) o 0 U O a ~ w I O N v m 0 O in N ~ ~ C N d (6 O L y U N c O N Z o LPL c c N_ N B > N Q y O 3 ~ v ~ z U z O ~ v a Z ` w 00 co H m a m c O I o z d C d Z d O C O Z fA I- r I'. N c p o rn _v m c V I, N co N }V N 'J5 O a L c _ S c ~ Q a z°~-z d .o ~ z N o co ca 'a aci c 00 C . I O d - N - N ° W d (D Z5 m O .8 E > It o o a E c~° •►v ) a a a z a ~ 7 O V1 U rn a) N U w rn rn } U _ d O\ r.: N a) 0 0 N CO O O O i M 0 N N O O j W (p N .L.. d L 0) O l inv to N ¢>v) m m C O C') N C O CC O M c c E co N m m 0 Y ° o ° n a Q -o 0 O 0 O O 0 0 O C`/\ N N N N N pj N 30 N CO W (O N m _ co L L - 00 (p W b,y O N O O) y F" E O y, O~ F (n N O N~~ :n v at n d a CL ~w E rr~~ O R O `~1 A 0 a III O w 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS n?S a A4- A i`,j 1 a i►/~ SUBDIVISION / CSM ~~a vGd~ S' JQ tr O ~tJ LOT Jt-Q SECTION 4_~d T N-R Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~Q v h n INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: sdCyy= d S l ALTERNATE BM: 49; i+ Ste; SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /,2d'1S Setback from: Well ~Q 7-- House Other Pump: Manufacturer. Z e cry- Model#_ Size loG C~a~T Float seperation Gallons/cycle: Alarm Location 66 .SOIL ABSORPTION SYSTEM Width: 5- Length Number of trenches Distance & Direction to nearest prop. line: 1. ' Setback from: well: Si5 4- House ~ Y4' 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: c LICENSE NUMBER: INSPECTOR: 3/93:jt Safety and Buildings Division Bureau of Building Water Systems v■~r■r■ SANITARY PERMIT APPLICATION 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number as9~IF7 The information you provide may be used by other government agency programs heck it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro ertyOwnerName f Property /,g- 1 /4 S P A T- , N, R j g E (or) Property Owner's Mailing Addres /C~/v 'C. Lot Number Block Number ~ S ~ 7 i JYt -5`r City, State Zip Code Phone Number Subdivision me or CSM Number r II. TYPE F BUILDING: (check one) ❑ State Owned ❑ !ty Nearest Road ❑ Vll age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF .So(,~ eke A25E, G 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0xo ---S 0-660 1 E] 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) 1.9 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 121®,Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-ln-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 CIO Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Q Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- ` Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank Z d!~ L Lift Pump Tank /Siphon Chamber l 1 j#7 ! Lv'G ~ 1:1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( Stamps) / PRSW No.: Business Phone Number: 4) 7 /-,s Plumber's Address (Street, City, State, Zip Code): ,c -25- Aar e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag ntSignature (No m - Surcharge Fee) 71-3,1076 proved ❑ Owner Given initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One Copy To: Sufety & Buildings Division, Owner, Plumber 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. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate -efix (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 'akes; 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. ftsconsin Giepartment of Industry, Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sa n ita ry Perm it No.: Permit Holder's Name: ❑ -City El Village ❑ Town of: State PIS SINGH, RANJIT R X CST BM Elev.: , Ins p- BM Elev/.~ , B Description: ~ Parcel Tax No.: . GD !/i9~/l GfJ tiYy~nQ as TANK INFORMATION ELEVATION DATA 46 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4, /ZG6 Benchmark Dosing 4, r'Y1, o~ • Sa ~S. < Aeration Bldg. Sewer Ob Holdi St/ FX Inlet i 1. ''3 ~W/', TANK SETBACK INFORMATION St/ Outlet O Verit TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic > 5 Id NA Dt Bottom i Dosing NA Header/ `3 s ~a Ile 7 d2 iq. Aeratio NA Dist. Pipe8•(Z' I 3. Hol Bot. System /a, 7/ PUMP) INFORMATION Final Grade Manufacturer Demand Model Number ! GPM TDH Lift 51" I Friction._- System TDH~j}~Ft Forcemain Length / Dia. F-i Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length / No. Of Trenches PIT No. Of Pits Insi Liquid Depth DIMENSIONS 5 -2 DI SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA Manu acturer SETBACK INFORMATION Typeo ne~da,e CHAMBER System: ~,jµ- 15J. /,0 , Mo a Num er: /1/-4 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) u x Hole Size x Hole S g Vent To Air ke Length 11L Dia. / Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-G a Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Top ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.), LOCATION: TROY.16.28.19W, SW, NE, SOUTHERN PACIFIC ~C Y'1 ~.t 7"~ ~1-~!!~ ~,l:-t~j~~C~ t'`k_`_ ~!t'~ - ✓'~.~'~l.,,i s i'iy~Il !l ~r ~!;?c.~I', ~~~•e..li'~'H~`t'~ ~~:1ccx "Q.~- /✓~JYI~J ~~KLr.✓1 LLe-f Q.,, L1'~ lan revision required? ~s r~ EY%:~ ~F__7 [I 1 1 t 2 Use other side for additional information. .3/ . L, SBD-6710 (R 05/91) Date Inspector's Signature Cert. No 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: PAGE GF PUMP CHAMBER CROSS SECTION AUD SPECIFICATIMS VC JT CAP `I"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKING Z5' FROM DOOR, JUNCTION BOX MAMHOLE COVER WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I `1" MIU. I8"miAI. COIJDUIT IDLET PROVIDE I AIRTIGHT SEAL I / * A I I~~ I III I I I ALARM a I II. I I *APPROVED I ow JOINTS WITH I I ELEV_ FT. APPROVED PIPE I 3' ONTO PUMP ` OFF D SOLID SOIL L CONCRETE BLOCK RISER EXIT PERM17ED OIJLH IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOILIS DOSE TANKS MANUFACTURER: WMBER OF DOSES: PER DAH TAUK SIZE: ~SQ GALLOUS DOSE VOLUME ALARM MANUFACTURER: c-o e{Cs,-Al IMCLUDING BACKFLOW: 1511* 94;-7 GALLONS MODEL UUMBEK: CAPACITIES: A= IMCHES OR L(~ GALLOWS SWITCH TYPE: ift ev B=INCHES OR 37 GALLONS PUMP MADUFAC.TURIiR: Ldall-a- ' C=FIWCHES OR ~>P GALLONS MODEL DUMBER: -z,,7 r D= ergs INCHES OR !1d_ GALLONS SWITCH TYPE: hla-y e- MOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE RATE -6PM INSTALLED OD SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIAJIMUM NETWORK SUPPLY PRESSURE , . , , . . , , , - , FEET + FEET OF FORCE MAIM X -?A9 Floo FtFRICTIOU FACTOR.- Il7 FEET TOTAL Dy1JAMIC. HEAD = ALL FEET IMTERKJAL DIMEMSIOMS OF TAUK: LEMGTH ;WIDTH ;LIQUID DEPTH SIGUED:~~" LICENSE AJUMBER: W4J j DATE.' Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau 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 .0 Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number g63;;Y17 The information you provide may be used by other government agency programs ❑ Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number. 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ,t r 1/4 11- 1/4, S Tarr' , N, R Ir E (0069 -006 ffW Property Owner's Mailing Address Lot Number Block Number 7 City, State Zip Code Phone Number Sub i ision Name or CSM Number II. TYPE BUILDING: (check one) ❑ State Owned ❑ Itia Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ° Town of wo ~rcf"h aY,cl x+ c III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo C'I'V d 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- aNew 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 RSeepage 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/day/sq. ft.) (Min./inch) Elevation 6 d Feet Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel Plastic p New Exist in structed glass App. Tanks Tanks Septic Tank or Holding Tank ~z .add I( t°GrLt l~ ® El ❑ ❑ ❑ El Lift Pump Tank /Siphon Chamber ❑ ❑ ~ ~ El El 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 /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater Date Issued Issuing Ag t Signature (No S m A roved E] Surcharge Fee) Pp Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One ropy To: Safety B 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: 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. 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. T1 rz,JT1 T S ;,~ayh 3 Y ti d v -7f W4 Konsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY sY' ctx Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCELI.D. # not limited to vertical and horizontal reference point (BM), direction and %of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVfEWEO BY DATE PROPERTY OWNER: PROPERTY LOCATION 0-.M - B`f e b1-4N ~S SCl{U t- 2, GOVT. LOT SL4.1 1/4 ►JE 1/4,S Jb T -?-FS .,N,R l9 E (oe PROPERTY OWNER`--S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 710 1~1. Rl0`l 9T- S r-.) - &X-rj 1LR slam J 3 H 4 Wt~D t~ D N CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD ~u~,z Pit LS w 1 s ~o zz (71S) (4 z s C / o sovTrtt PRc lr-/ C j>d New Construction Use p(J Residential / Number of bedrooms `1 Additkn to existing building j) Replacement [ ] Public or commercial describe Code derived daily flow b")O gpd Recommended design loading rate - bed, gpolft2 ° • 9 trench, gpdtft2 Absorption area required % S $ bed, ft2 SO trench, ft2 Maximum design loading rate o •-1 bed, gpd/ft2 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) Selff PhK E 3 It (as referred to site plan benchmark) Additional design / site considerations S Lre >voR Zo rti sTfVL1-<EP_ w,-1 Q ~ 3 Parent material SebV "ter OULE S" sr GZ&Q Flood plain elevation, if applicable N ft S = Suitable for system CONVENTIONAL MOUND • IN-GROUND PRESSURE AT-GRADE SYSTBI FLFILL HOLDING TANK I I F U=Unsuitable for stem ®S ❑ U ® S ❑ U IN ❑ U 0S ❑ U 0S ❑ U ❑ S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistenloe Bo,,,e y Roots G P D/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rent - 51 I 2 `FS ~~12 VAi' L` S Zv O S o~~ ] O -L~ 1b `12 3 13 It-(-z8 ~o`t fly - s Z`FSbk fm c S lug °.S o.~ Ground 3 zg-gf 1b42 -~5/b Sl sblt M'C-t_ cS - o•S ~•6 elev. ft. y yl -6~ low R 3 S/b s I• f 3 'F sd►c ►`n f i,- - - Depth to limiting factor, ~l W Sov OF S'f s - pksf S tr)kj?'j A3 ~Ir LftiV. Remarks: Boring # 5 O - Z~Sb1z ~n cS -Zvi o.S0.6 Z z 10/-L0 ~04R 3J6 S1 \oS\0k mvi>r cs o-Y ° S 3 6o-q9 L°`1 R Yl6 - S v Sg m 1 Ground elev. \0k.10 ft Depth to limiting factor 9 rr Remarks: T Nazne.-Please Print Phone: 715-425-0165 Arthur L. We erer egi3rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Q 3- C/~f Date: S - 6 -R3 CST Number: M00576 PROPERTYOWNER~"e- SC!{ uITZ SOIL DESCRIPTION REPORT Page of 3 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 t=~3 1 O-a ~,0~.2 313 - si 1 ~,'F sbk r~'F~. c S z~~- o•s ~,6 5:><;::::;< 2 f8 t Opt 2 y!y - s I.1 Z Sbk Y►~'~l^ c S t f o- S 4-L Ground 3 1~-~1O I.vYR VA S eIG~. " S5 elev. q9-Zft. y qt)-)t)3 1 1~' `tP- Yl6 - S Sg ►'YI I - D-7 o•$ Depth to limiting ota3" Remarks: Boring # - , "'v : 1 0 -•7 ~b`1 lZ 3!3 - S 1~ Z'~ S btic Ln C°_ S 2 U * S' o 2 ►'c Vn ~ `Fh G S Z v `F o• y n_ S Ground 3 ~lp•lb tlS4V? L,llf, elev. as-q ft. Depth to limiting factor ~ioya Remarks: Boring # 00 wt>. 1 0 -9 1 Ll`1 LZ 3 3 S 1) 2'FS b►c hv1 f^ c~ S 2 u~ u S :01 S LOUR 3!6 S11 -LTSdk cS l~f u.Siu•L Ground 3 Zy SyR y/6 GM `S ~cSbk W) v c S - c~- S a- L elev. y y6_gq l 11 R- Y! - S O Say w►) - o 10 > 103.6 ft. Depth to limiting factor „ 799 Remarks: Boring # O, S f Z S-Sl> `iR L/b s) ) C- Sbk ~~b• c S 1u~- o.~(i p. S 3 s~_io loy2 y!y _ S v sg wt 1 U.~ n-$ Ground elev. Yo4 - ft. Depth to limiting factor ?LUZ Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 ~ s sz,ut6'~o4F_ ~T SO sc~L~ 1 = L4 i1o•0p' 11p0~~ ~ 6wVL~' IZd -SID tyoT~ `Iv 1N51'At l l~R t~.grnt~ 150 ~~niLytt~ f~T qF S'wt0e: -r7LL~c4eT Cy lit) w►v G 'R~~ c4rv'~ov R `we'nt ~ `ti7i ~ ~ u ~T~1-$~ R2~F s 1-W'ti~? p~.rtrl C30YR11''1 OF 't't2~vC4~~S 11J "'['t}~ SF7~P 1`'K11?\~_. Sth w vrS 1--pvrvD RT D tEPof S OF 4 D« 70 6C-'`_ -Vyf ultdC-', mN)cNKUWl 14"2!' eDULR OUER TOG DtS'n2IVJ17O1V V-I II .S, J _ ~w~ s~S~~c _~i.. ev ~r~ o~ ~ av~ N G ccw ~~ro ~ , o ~ n~ r 0 0 ,3 7 0 r ~o 0 23 P-P y I ~ I•~ Z o ~ 1 I ° L I I I rs soa I : ; U 1 >f . oe. ee, ~o s - Ell I I W I I li co I z 3 1 LD I 1 a U) c>7 I I I CLJ m co ~w 11 I I Ln t rni i I I cv cu I . i I N m Q ~ .sz•ree . I J oil x .oe.ed,to s I U a 1 1"I T LL' I I' cmv u a) CU CX) I II I cu r, in I . z I III In I W rn rn l I=IW I N N col N I 1 . oor oo aw I ; of I N .oe.eh,[o s ZI l o \ of 1 I t o I ~I ~ a ' U vi . OZ - -E - z I a ~I ~ rn I I rn Ln 1 l C) co cm 1 N N I I N m OfS I I H , Op I • • 0 • P.- 10 . AA OT ui .107 A4 9A, z 1 1 1 ~ 'f! g~ ~~byN J O &04 I ' 1N U) U 1 I w N ah3sY~ i m LO 1 I I \ I/ 60 .g c !2 ¢ v j rn <O / M O l~l r cu \ I 9p t0 z r, I U cn •2g.sg ....il I fZ S or 00 m to I Q 1 I n c I ( I I© l0 Ob N\L N N 1 I o m V p / U_wxcn CD cy) m .60'etb I -~I- m m a .01 ed, [0 cc ° I (r) s zum I ~ frfl ~ \ ~ N I.- - I m co Q1 m n ♦ .9 N N .09 / I i OP I I o I 3-23-1996 2:46PM FROM CUDD BROTHERS CONST 715 425 8053 P.1 STC-1.05 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Add~2i ,r S': '.1;9 h , mAU.aNG ADDREss 7 hZzex Lg -1&4, PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~~dsy PROPERTY LOCATION ,f~4) I14, /_jZ_ 1/4, Section T 2 rN-R_ l ~7 W TOWN OF '~'V ST. CROIX COUNTY, WI SUBDIVISION 'S Je.Y LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME , PAGE , 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 re d t roix County Zoning Officer within 30 days of the three year expi SIGNED: DATE: !cS' l9 9~ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 3-23-1996 2:14PM FROM CUDD BROTHERS CONST 715 425 8053 P.2 8TC- 200 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 DPI ,d_r , T S'INQ~ Location of property. ,:J 1/4 1/4, Section 14< , T.4 N-R_ Z,~7' W Township Mailing address 5~~?? ki° Z c Address of site 35'41 50 6 Subdivision name ; -A) l Lot no. other homes on property? Yes_tL_No Previous owner of property Total size of property Total size of parcels Date parcel was created Are all corners and lot lines identifiable? _L~1(_Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number > 7 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. , 0 -J1 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. Sig u e of licant Co-Applicant Date of Signatu a Date of Signature 540440 \\.\RRA%* IN' MIA) CUCuMENV NO. 17'i ST. 11.:_ t F-; - - - MAR 5 ii.o ,:,[I%C, Ind In t.i 10 Ran Li t in 9 10 ra ,he IUI;oNlrty, dC,crllxd R:.. i .,at, - 1t ~)t.ttc of \Cs.on rr. Lot 50, Glover Station Third Addition in -.cwn of Troy. $~T E _ flits _ l s n O t itomest:ad x,nem MIX c_,t1 Ewepttonto warranees'. Easements, restrictions riZhts-of-way of record, if any. Dated this day of _ :iarch_ .-\D P4 G5_ `,oody s, Inc. LC~!cu•- s --'~a'c' - .Sf.\Ll SEAL) By 3ober ~ H. `Moody, '3c, , Secretary SEAL) SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Boberr h. Moudy, -s-- State of V isconsin, _ - t fd - rc - authennrued this day of M a r ch 96 ay .d - - Me j; Kristina Ogiand - TI FLE MEMBER SLATE BAR OF ISCONSIN - - - - Of liot• - - ~..:.,d authorized by §706 00. Wis. Scats) net,, n THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland w~~ r