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HomeMy WebLinkAbout040-1203-10-000 I a o ~ I ~o I ~o a o ° o ° o N h tl C C C o I CM II ~ O I ~ I N Ii U') I L p I U I I N 0) •p 0) L co C q 7 C N 0 € N lei (D a o C ~ N O - Y E Ul y y N N y U CD O d z z° am z c LL L f6 « O C N y {7L C m CO p L = p •c O 3 Q> 3 E a M Cl) Cl) D. 3 I a3i ~ H Z uj z uj I w 0 0 O O O 4.; 00 O ~ O IL m m a co N 3 a M In I I O I O Z C C C V z O y y c p O O ~ ~ E g' E a) M a~ ` 4) N 4) 0) a N CL m CD :3 cc a) CL w co 0) a~ I ayi a I 41 L = o :3 a) ~ a~ ~ I a ~ I ~ c O ~ z° co Z z° m Q z° Z 1 16 p w + N c z C d N Q h H aci N 0 d 2 75 C14 0 CL m tn U') 0 CL cc CL cc c L N y 0 ~ y a N N ~ N d ~i y m~ -0 X 0 0 m p G G d p o C d d _ G G a L N N V~ 3333 o'U 33 n'U _v,3 3 n Z Zoe • N a a a v; a s ii a a a CL m LL > c N ano ano (n 0) a~ °w OOi T N } v } U) J V > 0) 0) > O) 0) CE :z 0) o m o Um (MV C N O (2 O O O_ 00 o rn o = E c~ p w oh = v moo co r CL y c m y rn Z o °y n o V) 4) y y 0 H N N O (O y C co y C ` y y C O ` C O E 0) CO 0 °d o j Y 10, -a) a~ a~i c p ~ 6 api c v a °o °o l M 4. 'E F C N N a C, O y c N y l0 -VO/ c C d c C 5 N C Q O p N C m m C C m N y 0 - d p N O 4. N F- C y 'p v N y v Z CO y 'y0 C N I~ ID ' Q) Lo N Y M Y O O _ 10 Lo Cl) Y N O E co •O O CAM F n N Z 2 2 d~ N Z N 2 H N O Z Z fn r.+ M I~ E a I ~ a I ~ a L IL L CL 4-, L CL 1 v c m 02 rw m 3 O Parcel 040-1203-10-000 12/22/2006 04:43 PAGE 1 OF 1 F 1 Alt. Parcel 35.28.19.937 040 - TOWN OF TROY Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner O - FREEMAN, STEVEN C & DEBRA L STEVEN C & DEBRA L FREEMAN 16 DRY RUN RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 16 DRY RUN RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH lo _ i Legal Description: Acres: 1.210 Plat: 0164-CERNOHOUS ADD SEC 35 T28N R1 9W 1.21A CERNOHOUS ADD LOT Block/Condo Bldg: LOT 01 1 EZ-IE-1208/413 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1208/415 WD 07/23/1997 904/361 07/23/1997 700/135 2006 SUMMARY Bill Fair Market Value: Assessed with: 159311 226,300 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.200 41,200 165,200 206,400 NO Totals for 2006: General Property 1.200 41,200 165,200 206,400 Woodland 0.000 0 0 Totals for 2005: General Property 1.200 41,200 165,200 206,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 104 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 TMINSHIP s, 4AINZSEC.~T,&N, R~W 0. ADDRESS , ST. CROIX ' , WISCONSIN. "3DTVISION LOT___/_LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t -TIC TANK(S) ; ' MFGR. CONCRETE 1--STEEL _ N0. of rings on cover Depth DRY WELL INCHES NO. of width length area no. of lines - width length area~~ depth to top of pipe ei~c 3REGATE ::K RATE J AREA REQUIRED AREA AS BUILT c~ ;claimer: The inspection of this system by St. Croix County does not imply complete j :pliance.with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for Item operation. However, if failure is noted the County will make every effort to -ermine cause of failure. :ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. INSPECTOR DATED r. PLUMBER ON JOB . cam. LICENSE NUMBER t c-t, - t Vtcl-W e5l arcs (e PLB67 State and County State Permit # S Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: Rwr Jclilellu_ B. LOCATION: _5U) % SE" Section T N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~i C_ N L7S I !//'5/nom C. TYPE OF OCCUPANCY: Commercial "Industrial *Other (specify) *Variance Single family_ Duplex No. of Bedrooms -No. of Persons_ D. TYPE OF APPLIANCES: Dishwasher 2<` YES NO Food Waste Grinder YES NO # of Bathrooms. Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY _/00n Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) _ F. EFF U NT DISPOSAL SYSTEM: Percolation Rate 1) _4T2)_/4? 3) Total Absorb Area sq. ft. Nev Addition Replacement *Fill System Seepage Trench: No. Lin . Feet _ Width DepthAW Tile Depth __,Iiip No. of Trenches _j JP Seepage Bed: Length ~ Width _ Depth - 3~,Tile Depth- c=PC,/ No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil T ter, NAME _C.S.T. # -tom' / , nand other information , obtained from (owner/builder). 07, Plumber's Signature -AV/MPRSW fe Phone #TS- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). LjELL 3 f 3 - - mpl~'TfiRn~ t4 _ _ j E r. ~ ~ 7 7 L i i f 7 F II r R ~ h ~ V ~i * } N G~ 4 e _ ~ r _ .`ti, _ - x, _ _ . F ~ ~i ~r ~ . / ~ ~ ~ 1 ,'1 ~ ~4 ~ ~ ~ ` r'~ ~ 1 j t . w,; ~ i ~ E ~ fz rr c,.✓ t N ~.r' Z y REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itatcy Pe,%m.it-~r~ State Septic 5 ~ 6`, NAME Township St. C,%o.ix County Locati.onS& k o6SE%, Secti.oOL T2-A R l~W SEPTIC TANK i Size gattanz. Numb en 96 Campatctmentz ~ Distance Ftcom: wett 6t, 12% on gneate,% ztope Bu.itding <,; , b Gie tands -6t. H.ighwate& 6t. DISPOSAL SYSTEM Distance F&om: Wett 6t. 12% on g,%eate,% .6tope Bu.itd.ing 6t. Wettand6 Ft. H.ighwaxen 6t. FIELD DIMENSIONS: Width ob t&ench 6t. Depth o6 t ock betow t.ite .in. Length o6 each tine 6t. Depth a6 t ock oven t.ite ;Z- .in. Number, of tines ,J Depth o6 tite below gtcaderG.in. Totat .length o6 tines Z6--b 6t. Sto pe of .t&ench ~ n pen 100 6t. Distance between tines_(-, t. Depth to bednack 6(x',7` ~ . Totat abzotbt.ion a&ea'%:"-V- ,jt2 Depth to gnaundwateA 6Z. 2 Requi&ed area 6t PIT DIMENSIONS: Numbe,% o6 pits ~ GAavet anaund p.itd yea no Outb.ide d.iamete ✓ t.. Depth betow .inlet 6t. Tota.t abzonbtion area 6t. 2 Area equitced 6t2 rn INSPECTED BV' IV- %-TITLE APPROVED DATE ` 19 7: REJECTED DATE 197 -EH ~ 11 ~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ML P.O. BOX 309 MADISON, WISCONSIN 53701 ' REPORT ON SOIL BORINGS AND PERCOLATION TES LOCATIONSIL/o, ~/4, Section Tn`A, R gE (or) W, Township or Municipality Lot No. Block No. , - 'L C~ AflolL)s i7 `5/6 County Owner's Name: ,.y~/,k'e y(zAfi< Aj. ; Subdivision Name Mailing Address: Ti~w G~ ~[j (J/2 TYPE OF OCCUPANCY: Residence No. of Bedrooms ,J Other EFFLUENT DISPOSAL SYSTEM: NEW T_ ADDITION REPLACEMENT I AA / 7Q DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 9176 SOIL MAP SHEET L<_! SOIL YPE /L G PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE SINCE LE HOLE A INTERVAL NUM- INCHES THICKNESS IN INCHES BER 1ST WETOTED SWELLINGR IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 tV/IN P-/ Boozoic6 a o "r) P cJID `C It :Irl ok. /X9 161 P a,14 0 a- i SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) r 7• $ n 71, , Jr r_. rr r ~ rr c r y S. / ~ N S.4 V L. - 15- 4,44 L"IAFST 41bS'- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. India a number of square feet of absorption area needed for building type and occupancy. 11,1~ Lt. Indicate scale or, distances. Give horizontal and vertical reference points. In a slope. a o~. f in Cx tN I 1 c ~Z STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~~x lhh~EL X /yA"o l~ a ADDRESS- ~lp 4d p-V 'OC4 !11 ~o aQ ~r'v~4 SUBDIVISION / CSMJ LOT SECTION T N-R_ 1'2(2) Town of T/b y- ST. CROIX COUNTY, WISCONSIN PLAN VIEW e~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ® lJ~~`" i i 0%0~ X5INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: -4t /DO, ew l ALTERNATE BM:~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: ,Or Setback from: Well S(' House Other SD t Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~ l _ Length $S ~ 97 Number of trenches- Distance & Direction to nearest prop. line: Y,S/ Setback from: well: House_2KL2;~ other ELEVATIONS Building Sewer `ST nlet: ST outlet . Q ~ PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade 14~ P,~ 9~.sn g Final grade /,ow 4 __A5 y DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andl-IumanRelations INSPECTION REPORT ST. CROIX Safety and Builydings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268560 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: ANDERSON, DARRELL TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: i lf.[1 TANK INFORMATION EVATION DATA A9600273 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet, TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic y Y s NA Dt Bottom Dosing NA Header/Man. , Aeration NA Dist. Pipe ~r•a 9 a< ? 51 ,y 9a.~s Holding Bot. System 0 7.5' X0.8 PUMP/ SIPHON INFORMATION Final Grade Manufacturer j Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK Moe Numer: INFORMATION TypeO CHAMBER b e{ OR UNIT System: 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 3 Bed / Trench Edges v -33 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY-35.28.19W, SW, SE, DRY RUN ROAD SGcJ~cr.~,.e tsyr. 1 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date sp ¢tor's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH o SANITARY PERMIT NUMBER: ` 4 D~I~HR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code TY (I mommmums STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than _ a 6? S (o p 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION %4.S t/4, S ST T „Z$ N, R l E (oW PROPERTY OWNER'S MAILIN=DDRESS LOT # BLOCK # CITY, STATE ZIP CODE - PHONE NUMBER SUBDIVISION NAME OR Cs~ NUMBER ift'PF4, 1,5jt;M 5_) r-pr o /l o cis If If II. TYPE OF BUILDIE~r G' (Check one) ❑ State Owned ❑ CI LAGE NEAREST ROAD 09"TOWN OF: ❑ Public 2 Fam. Dwelling-# of bedrooms PA RCEL TAX NUMBER( 111. BUILDING USE: (If building type is public, check all that apply) - 1 ❑ Apt/Condo 20 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 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check o y one in line A. Check line B if applicable) A) 1.0 New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 El epage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 e Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 430 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 _5_0 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q 1-a EIV T /Y 4,eA 7~0 750 / O Q b,Fbet YY t CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallo Tanks Concrete structed glass App' Tanks Tan Septic Tank or Holdin Tank IRI Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATE ENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum is Signature: (No Stamps) M MPRSW No.: Business Phone Number: A-4 D 3 S 71.r -7 T?'33 A lumber's Address (Street, City, State, Zip Code): 96 "7 ZZW JV 4;_ 5- Xci Ay IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved SaAtary Permit Fee (Includes Groundwater Date Issued Issuing Agent tamps) pproved ❑ Owner Given Initial I &D Surcharge Fee) Adver a Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety i£ 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 the 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 & 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 1' installed.• J 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 in 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 in #1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of Labor and Human Relations Division of Safety & Buildings in accord with ILH R 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 S 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. 3:5-. 'q a • 19 • 3~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION R~~G GOVT.LOT 114S)5 114,S35TZ N,R /9 4W) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STAT ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 017OWN NEAREST ROAD r Utz V R014 204 Lj- syoaa c?1.Sryd6 S95 [ ] New Construction Use (4 Residential I Number of bedrooms 3 Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow q50 gpd Q S42 1*. Recommended design loading rate _ bed, gpol111:2. ej&-trench, gpd/ft2 Absorption area required CIM_ bed, ft2 2 SO trench, ft2 Maximum des!' n loading rate - 7 bed, gpd/ft2. 2_trench, gpd/ft2 Recommended infiltration surface elevation(sCoixe r q%,t( lo,ver 90• It (as referred to site plan benchmark) bcyA Cc. I,S) Additional design / site considers' ns e )c)Q L o•(- 5 *-l Parent material Flood plain elevation, if applicable ft U SYSTEM IN FILL HOLDING TANK S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE 1:1 U S ❑ U R S ❑ U ❑ S SU ❑ S o i l =Unsuitable fors stem ®S C3 U 5Z S .R SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botx>dary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tench C3 1/-,20 a t m d sti, C S 3 S .11 .5 a o- s -S// i s I 1Z m :56k 9' e -S i v F. 74 Ground 3 24) ?-:51 / S1. m sbk M CS - . s • elevq ft 4/ S O m s L GIs - 8 Depth to ,-5 7- 93 ,5 m 5 VF mvff• 105 limiting • , • 'S factor - )O • 7/;Z 5 F ryv- mv-Fr e52 Remarks: CT) Wf'Q 'n1 tt+ 10 Boring # l C S 3- S _ 1 6 -oZI IU ~2 f S~ ~ S k S a 2.. a -40 e s icl 02 sbk m~'' cS 111r .5 3 s s 51 4, S 1, M sb k M -~R S I Y-F :5- Ground elev 5'82 l o 4l~ 9~ft• ,y s 5 -43 7.S O VF m mo ~4S Depth to limiting C9 VP Mu PC .5 factor eg7.1 Remarks: t 'k'je-- IN ° CST Name.-Please Prin Phone: p~ -03441 66~rt ~/S 7 Address: Signature: Date: ~~/9/ CSC um e PROPERTY OWNER SOIL DESCRIPTION REPORT Page ot, PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo rrlary Roots GPD/ftin. Munsell Ou. Sz. Con t. Color Gr. Sz. Sh. Bed rends 1 0- 0 :;?jI Si L m L CS 3F 5 >t a t i o >D 3l .511 r~► ~bk m FR CS -F "5 Ground S -32 R l C rn In ~r, C S .s elev e m S~ F12 Cy 1 Y`F , a. 3 ft. 32- Id c Depthto - ,rte S L m S U 171 Fe C S J-P .5 limiting factors, (Q V012 GJ.3 S 0 m rvl L - 7 - - Q .S V,e ~o Y14, S gL loyp Remarks: I IS r) Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # m1 5~°_. C'F_ Y1 S Ground 1 elev. ft. a a S r Depth to . r limiting ` t factor Evan-r Remarks: Boring # F M .`M Ground elev. ft Depth to limiting factor -T-F-L] Remarks: SBD-8330(R.05/92) 0 Z/V~.f..vv I LA-~ K loo - -11v ~ 0 9 !a s S9O 1 NI V b ~ he z 3 o Z ~o p 6N 6 o Wisconsin Department of Industry, SOIL AND SITE E V ON REPORT Page _ of Labor and Human Relations Division of Safety & Buildings in accord With Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 ny sin s ,e P y~ in u~ but S not limited to vertical and horizontal reference point (BM), ire ion andof s ale r PARCEL I.D. # dimensioned, north arrow, and location and distance to n r ad.v~, 3s..~ a 9. 3? APPLICANT INFORMATION-PLEASE PRINT ALL ' 6' ~ C) REVIEWED BY DATE PROPERTY OWNER: PR R ION R~~GL r GOVT. 114Sf7l' 1l4,S3STZ ,N,R /qr)W PROPERTY OWNER':S MAILING ADS ESS O X# SUBD. NAME OR CSM # CITY,, STA ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®fOWN NEAREST ROAD '§W-2a (2/574Q15"-SW i r DRY R014 RC)At% [ ] New Construction Use [xJ Residential / Number of bedrooms [ j Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 'I50 gpd U Se Recommended design loading rate . S bed, gpd/ft2,trench, gpolft2 Absorption area required CIM bed, ft2 7 .SO trench, ft2"' ~Maximum design loading rate . 7 bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s)( Vr }r°&y: `11,7llower c. It (as referred to site plan benchmark) ( I,S~ Additional design / site consider a' ns back c:,4 S Parent material - O Flood plain elevation, if applicable ft 163 OVVCJ'. S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem cgs ❑ U 5JS ❑ U .4 S❑ U R S ❑ U ❑ S BU ❑ S RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bolxidary Roots GPD/ft renal Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. a +Bd si, C S 3 Vo -3 2 1, r a s. is m s6 k el" CS IWF AA Ground 3 2-W v,,e A/ S'L m sbk I~1 ~R 5 i, e195-q ft 642 614, S 0 m s ML Q's - 7 9 Depth to ,_5' - 8 O 5 V F (Y A c, .S a , s 93 4 limiting factor 40 qj- tp 74Z 5 P ry\ md-Fr , - S Remarks: rnints+ "t ° r o Boring # C S 3 s Z 4a a 6[_ o s 10-1 02 msbk rn-Ci cS Ivf .5 ~'rv"trly~ 3 V0-4s- 5 e. 514 -5, M sbk vn ~7R (L S I yf Ground S O rr P)1, A S • el v9 ft. 5 ~82 10 4-14, Depth to _ 57 q3 4 limiting op (~)v PC .5 fac22 It Remarks: t Vert `i- r k) W ' ' s Xjj CST Name: Please Prin L Phone: - _ (3 hert Address: Signature: Dateo7y`9CO CSC um e PROPERTY OWNER SOIL DESCRIPTION REPORT Page _ of At 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 Tmrxh 1 c~- 0 all S/ L m 56L Ds CS 3F S 1 ►b 3~ S~ oZ m~5b~ m FR CS S Ground 3 (k-32- o p- SI C oZ to rn ~P► C S I F ,s elevb ft C 1 M 51L FYI Ft2 C Y 01F Depthto Jr .~`f ,5 S L m S k (Yl F ~ 5 limiting factor - S d (0%3 S 0 m n'1 L P ~ S- 1104e YA, F C) YF h1 J 2 - S Remarks: t LS r~ L, we+ Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # tiY w 'Peen M ~w se re- n s ;t;:;.:,.:a Ground elev. l ft a S~ r l Depth to © C r limiting factor t~ / ~•vGl/Y1 40 Remarks: r' Boring # } \ti Ys Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) r 0 1 1 C~ W 9 t ~ D D iI tai- • I , *'V m ` j LA i \ Pt- I ic> ~oQ~+1V1 A ~ ~ o~ g 0 n~ ilo~I ` JJ ' j y' ~ S9o t 1 IN- 1 p fan L.. m to Z o 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 z i~ L A'A"- ci' f! 4~ Location of property_~1/4 1/4, Section_ TgrN-R W Township Mailing address Address of site r44 A CA III n Subdivision name 60?- e' Lot no. Other homes on property? Yes No Previous owner of property Y Total size of property 02 / GEC; r-,,o S Total size of parcel Date parcel was created LAW Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes P No and Page Number 36 as recorded with the Register Volume !~W-j 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. H 7 COD 7 , and that I (we) presently own the proposed site for the ewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant Date o ignature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER lJ q r e~ MAILING ADDRESS D F- Al fi Q PROPERTY ADDRESS 1 ~'~15 ZV` (location of septic system) Please obtain from the Planning Dept. CITY/STATE l U.F_ --Ax L / PROPERTY LOCATION S 114,s J5 1/4, Section, T_2~_LN-R_L? _W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~'Ne o u s lC o LOT NUMBER CERTIFIED SURVEY MAP -,VOLUME Aff, 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 returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: A~6 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: l/ 4, S 1/4, Sec. 5-, T_,z -N, RW, Town of 7-1,0 Y Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced % 9 9 Did flow back occur from absorption system? Yes d No (if no, skip next line) Approximate volume or length of time: allons minutes Capacity: `Od0 241 Construction: Prefab Concrete Steel Other Manufacurer (if known) : V 1Q .-FS E J- 19 Q~ o Age of Tank (if known) : l4~ 0 IA& &~9~ 29 I~F b 4 Ajk- C 'k V f, (Signatur ) (Name) Please Print o-w-r►1a © 3 ~ 8 (Title) qq (License Number) _ L~ (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name CA V iFj4 gnature f AL&7 MP/MPRS m 3 ~g 5/88 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-AM THOU 81..CE RESERVED FOR RECORDING DATA WARRANTY DEED ;i 470007 I; VOL 904 IPA!,-; .361 REGISTER'S OFFICE This Deed, made between Lauren, 9.,..-Bo .uer and-_-.__. D., Marian E... Borner- husband and.wi.f a ST. CROIX Recd for ReC&d , (~aator. "'.s 1991 and Darrell L. Anders-on.and Barbara.-J. Anderson at husband and wife, as..survivorship marital ~4C XX property 6rar► of 0"& tee, i Witnesseth, That the said Grantor, for a valuable oonsideraoro i~~ ]NQ , canoe s to Grantee the fullawing described rest estate in S t.. Croix County State of Wisconsin: 219 North Main P0• Bay 138_,' Siva F&114 Wisoonsia )4023 ~}~c,~rl Lot Une (1) of Cernohous Addition to the Town of Troy, being Lot One (1) of Certified Tax Parcel No: . Survey Map in Volume Three (3) of Certifieda Survey Map, Page 624. , W.NSM KB This homestead property. (is) (is not) Togaher with all and singular the hereditaments and appurtesLurees thereunto belonging; And . Lauren R_. Borner..and .yariau . E. - Darner warrants that the title is good, indefeasib.e in fee simple and free and clear of encumbrances except easements, restrictions, and rights-cf-way of record, if any, and will warrant and defend the same. Dated this day of L~ R c/ 19.91 _ (SEAL) (SEAL) • Lauren R ...Borner... . . _ (SEAL) 4Z-&-- 2:--- 'e*CA(-(SEAL) . Marian E. Borner _ . a 33 M. ACKNOW LODGMENT Signature(s) AS°'1 Y~ is t STATE OF WtIC&M. T . 4e • e C•lunty. - .WAt"W wMed the _A F!%4t -1....., 19-1! rerson lly came be' or# me this ~!dt...day of • i~_`~ 19...91. the above named 10% ---Lauren R. Borner etrd_ 4S P' • TI E: ME3I$ER STR'It~•'$llT•OF WISCONSIN (If not. authorized by 1 706.06, Wis. Stats. )C~Cl to ~ down to be the person .who executed the L O VN M'. SS + C! 1 Y~ . forearms instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY C_ L. Gavlord. Attorney _ r~;\ ST. CROIX COUNTY f.~ WISCONSIN ZONING OFFICE M Y N M N N N N M rrrrf ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Ft 77- Hudson, WI 54016-7710 - (715) 386-4680 September 12, 1996 Darrell and Barb Anderson 16 Dry Run Road River Falls, Wisconsin 54022 Re: Septic Inspection for Property Located at 16 Dry Run Road, River Falls, Wisconsin: Dear Mr. and Mrs. Anderson: An inspection of the septic system installed to serve the above described residence was conducted on August 7, 1996. This property is located in the SW-,, of the SE k of Section 35, T28N-R19W, Lot 1 of the Cernohous Addition, Town of Troy, St. Croix County, Wisconsin. At the time of installation, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, CAssistant Zoning Administrator pe