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HomeMy WebLinkAbout042-1080-70-000 y ° 3 0 h O ap I (D a 4 m I N 4 ce) N v O co M ~ I ~L Cl) od Lo W N x z o~ y II, LL c ? r- 0 N U it zz C `o N M 3 .I o co w z H z o E; v € 0 z IL m N H u) o I o Z c v v o w FZ- r rn y z v M N .C V c C C L O CL L) C C c O U z F- ~ Z E c N M t6 - I L N N - d CL C) Q l N C M Al) d i O 00 _ c O a N Q O 3 w N N 1 p w O I z ca > vi EL co o o IL IL IL W a ~ I Q N D) W to U o> W O M 0 C14 N m n a> co V N ai U'a I h 'G N QI T (n N ! II ~ ~ ~ 0 I n G co N Or- LL y C O d E 0 0 0) ~O ° u 3 a a d o o CD 0 N C) N C`Vl 't g Co W W W C ! O o O C d' M V O C) C Lo m c a) izz T ~ N N N 00 r y U ^A1 O N 2 N O S.' C U) y d a a tom. ad.~'I d t 0 ` 10 Parcel 042-1080-70-000 06/27/2005 10:24 AM PAGE 1 OF 1 Alt. Parcel 29.29.18.457F 042 - TOWN OF WARREN Current X . ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HEDIN, MARK L L& DANA N MARK L L& DA A N HEDIN 748 107TH ST ROBERTS WI 5402 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 748 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.320 Plat: N/A-NOT AVAILABLE SEC 29 T29N R1 8W 4.32A IN GL 2 LOT 2 & 3 Block/Condo Bldg: CSM VOL 3/899 ORD NKA LOT 6 CSM 11/3146 4.320AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1124/110 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.320 46,500 237,000 283,500 NO Totals for 2005: General Property 4.320 46,500 237,000 283,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.320 46,500 237,000 283,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ mpRk DIN ADDRESS 07 S r SUBDIVISION / CSM# NR LOT # 3 SECTION ,~7 T D 4 N-RI e) W, Town of W AP-R E M ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVER THING WITHIN 100 FEET OF SYSTEM a -Sx 59 Note-- YY AtI6le '15 ovrp 'rap N G~ Is out l'zt t3,~ f ~1 Q 6 ~b10o o p l / ySR C, 0 ip a a3' 3 J C)Room NaYn e A/ IN CATE ORTH ARROW Provide setback and elevation information o rse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: COUW NUA f rip ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W Q,- ts Liquid Capacity: /000 Setback from: Well OVfr S0' House I~ Other a3 Pump: Manufacturer Model# Size - Float seperationGallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length S Number of trenches Distance & Direction to nearest prop, line: Q)UR Setback from: well : OV-eR 5()' House a Other TitN('~ oM I"U)tj ~icaN~l Qa~~ ~H ~l I. Pi IO,VV r1~PR2R (p.-7a 14,PW r a b Fap 4 1 ELEVATIONS two 9,o-7 Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade WeQt 00 a~la~ FoK 1p N(,~.FS rX0 Grza,Nn Sw ~ FAC ~ DATE OF INSTALLATION: -jai tq~, PLUMBER ON JOB: IJ yQ PG LICENSE NUMBER: 3M) INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Numan Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanita 268590 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: HEDIN, MARK & DANA WARREN CST B''"lev.: Insp. BM Elev.: } BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600293 16-'30 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y/ Benchmark Dosing 0 9 i 16 ~i Aeration Bldg. Sewer Holding St/ Inlet 96. TANK SETBACK INFORMATION St/~tt Outlet TANK TO P/ L WELL BLDG. Airlnta to ke ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Heade,"Wo,r. ' 85 g3, Aeration N Dist. Pipe 41 HHoldiaT~ Bot. System ~1s 41 p PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand *1 13.id' -T, P Mod GPM TDH Lift Friction Ft loss e Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length / No. Of Trenches pl No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 5 c9 DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING acturer: INFORMATION Type 0 tit,--C-0011 / CHAM Model Number: l~J7~" O IT System: .6r e$_ >50 11,21 1>60 DISTRIBUTION SYSTEM Header / < Distribution Pipe(s Hole Size x Hole Spacing Vent To Air Intake Length -42-' Dia. Length Dia. T Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst Depth Over Depth Over xx Depth Of _Jlx--Seeded / Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.), 4,4s LOCATION: WARREN.29.29.18W, SW, NE, 107TH ST Plan revision required? ❑ Yes 13.1 o Use other side for additional information. I 0A1 1"9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH P SANITARY PERMIT NUMBER: e Safety and Buildings Division ~~■~~ir,t SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Coaty than 81/2 x 11 inches in size. 04 u 1 Y, N • See reverse side for instructions for completing this application State ScmitioryrPermitu ber The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION P rty Owner Naaf T-1 Property Location _t, h, it ~ = t i C J 1 /411,1 1/4, ST , N, R I o E (or) W Pr9P y Owner's M,Ailir gAclclmss Lot Number Block Number Cifiy; tatt~e t Z 4C1ode t Phone Number Subdivision Name or CSM.lyumaef I- z, V V II. TYPE F BV!LDING: (check one) ❑ State Owned ❑ cityy Nearest R ad ❑ Village i , tt ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF =s I J ~++r 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo (131-1 { , i 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. Q Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12'n Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 I] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate/ a lev. 7. Final Grade e' Re u q ;57' irled (s . ft.) P ( sr] fi) (Gals/ lay/sq: ft.) (Min; /inch) l ~tiollR - ~ ~ • Feet L-Feet VII. TANK Ca in gallo Capacity Total # of site INFORMATION Gallons Tanks Manufacturer's Name Conc ete Con- gFiber- lass Plastic App- Steel New Existin strutted T nks Tanks Septic Tank or Holding Tank 0 0 5 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P4 nrbee's ) (Print) Plu ber'sSigna e: (No Stamp) rPRSW No Business Phone Number::11 rl~ifi'l -.:of.E:e7'~ (.../.'f fof..J Plumoer's ddre3s' eet,.City, State, Zip Code): ; IX. COUNTY / DEPARTMENT USE ONLY it Fee (Includes Groundwater a b ssuPY I ng Agent Signa a (No Stam ps) ❑ Disapproved Sarrry 7T F€€ Surcharge Fee) 4 X Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 'YD-6398.(R. 05/94) DISTRIBUTION:' Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 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 1/2x 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. P., B.L.._6-7 PLOTA 1-111 ROSS 51=~; Ste NAME m_►<. i4, ! L 0 C A 10 nl167 _s~: C E N S E//=. yu a y, t~~ 5 p TMs. t'tar, r a hFr~ ~ 1e4 ij 4-- T ow, Se a Sy em~~ ok S 7 ~o~~ 1~1e11 s rP~?r~ Pitr r - ~ w r• ~ FRESH All, 10W., AND OBSERVAriotj C1tO.~S SECTION Approved Vent Cap Minimum 12'Above Fi na 1 C>J~ eh hod, 4" Cast Iron Above Pipe Venn Pipe To Final Grader- Wisconsin Department of Industry, _S.atx= aid Human Relations SOIL AND SITE EVALUATION REPORT Page 1 of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x ize. Plan must include, but not limited to vertical and horizontal reference point ~i ti f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista o rest roa . 042-1080-80 APPLICANT INFORMATION-PLEASE P LL I FO TI REVIEWED BY DATE PROPERTY OWNER: , Y r ERTY LOCATION Mark Hedin ` LOT SW 1/4 NE 1/4,S29 T29 ,,R 18 {or) W PROPERTY OWNERS MA!I_ING ADDRESS BLOCK # SUBD. NAME OR CSM # 312 7th. St. S = c na csm 3/899 CITY, STATE ZIP CODE `PHONE NLI.~(BER ITY ❑VILLAGE1jfOWN NEAREST ROAD Hudson, WI. 54016 (17,115 `3g1-1 Warren 107th. st. [xj New Construction Use* ] Residential / Number of ` 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 gibed, gpd/ft2~.8__trench, gpolft2 Recommended infiltration surface elevation(s) 100.3 upper 98.2 lower ft (as referred to site plan benchmark) Additional design / site considerations step down trench system 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 for svstem xK1 S ❑ U ❑ S MU I &S ❑ U ia SK ❑ U I ❑ S iaU I ❑ S flu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence IBoindary Roots Bed Trendt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ..1... 1 0-12 10vr3/3 none 1 2msbk mfr 2f .5 .6 mom 2 12-29 7.5yr4/4 none scl 2msbk mfr 9w if .4 .5 Ground 3 29-80 7.5yr4/6 none S Osg mvfr na na .7 .8 elev. 103.6 ft. Depth to limiting factor +80" Remarks: Boring # ::;;<g< 1 0-8 10yr4/3 none sl 2msbk mvfr aw if .6 2 2 8-20 7.5yr4/6 none is Osg mvfr if .7 .8 i~iA~•ii{• 3 20-78 10yr5/4 none co s Osg ml na na .7 .8 Ground elev. 98.2 ft. Depth to limiting factor +78" Remarks: CST Name:-Please Print Phone: Gar L. Steel 715-246-6200 ~ Address: 1554 200th. Ave., N Richmond, WI. 54017 Signature: Date: CST Number: P 4-8-95 cstm 02298 PROPERTY OWNER Mark Hedin SOIL DESCRIPTION REPORT Page2_ot_3_, PARCEL I.D. # 042-1080-80 Depth Dominant Color i Mottles (Texture ( Structure (Consistence JBouIdary I Roots GPD/ft Boring # Horizon in Munsell Ou. Sz. Cont Color Gr. Sz. Sh. I Bed ITrer 1 0-7 10 r4 3 none 1 2m •6 3 I 2 7-18 7.5yr4/6 none is Osg mvfr gw if .7 1.8 i Ground 3 18-78 10yr5/4 none S Osg ml na na .7 j .8 elev. 101.2ft. Depth to limiting factor +78" Remarks: Boring # 1 10-7 10yr4/3 none sl 2fgr mvfr gw if .4 .5 4 2 7-17 7.5yr4/6 none is Osg mvfr gw if .7 .8 3 17-78 7.5yr4/6 none Co S Osg ml na na .7 .8 Ground elev. 103.8 ft. Depth to limiting factor +7811 Remarks: Boring # 1 0-9 10yr2/2 none 1 2msbk mfr gw 2f .5 f .6 5 2 9-35 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 x 3 35-78 7.5yr4/6 none S Osg ml na na .7 .8 Ground. elev. 98.3 ft. Depth to limiting factor +78" Remarks: Boring # Ground elev. ft. Depth to i limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Mark xedin 1554 200th Ave. CSTM2298 SW4NE4 S29-m29N-R18W New Richmond, WI 54017 MPRSW 3254 town of Warren (715) 246-6200 ¢ lot #3 IN 1"=40' BM.=top of 3/4" steel pipe ^ el. 100' Alt. SM.=top of 3/4" steel pipe C el.102.28 1471 ~1 z' a' 3 121 A -B PA Gary L. Steel 4-8-95 IORM 110, 705•A CERTIFIED SURVEY M/`-1.P ;CAL(: IN I I:L:'f WNPLATT FO LANn^ YI11.5 1tin'rum-wnT mrnrTeo 11y - I I I J O I I n to. 111 r: M. r. ln' 0 200 I Moto S W N I I *t GIININING 4:01111. nec011uct, 1.: v„ I,AIl I: III-,II " ' ,UU"11.14(1"1'I 11U V'/ L/^ col:1,4u • /~1. s' sue. oo' cortrrcr( on c7'ION'2J T29NI r, _.SCCI:ION LIN: a III I- o u r ` v I c) in 0 flan 11 coo r - rn _.v) tl nn 4:1'4,1"li 53i;q0' <I EXISTING I" I RUN PIPC n: 111 %%.00.^1 1160.30 tl. ' 0: rnl , 11' lu 7 ? u, o c~ O / 2,1" hOUNO ►I20N DAR 1,502 L (l G C T a 0 I ,n I. C) j -1 n w p -Z.IG AORC in -i ~ n: "cCTION CONNEI2 ocimisEN CA ltl IU I"... iAO N NI - InI n;Go.'00' EXISTING 3/11" II20A1 PIPE to -1 3 N , I-• cu all- 3 110 . n' L 1 N a v' - n.~ r-r EXISTING FCNCL ; ILI I1, tJ o 1 l~ ; i i to U r- j I r! o N.} Iry in to . ~",0 2.IG /1C1:L5 o It- Cj 1- 0 _-7 N ~i(1/.0G 1t x.(10 .0 0, ' „ • I7~° 1)2',511 0rn i5 0 4___U 1J 'J47.OG' 00 51 0, ~5. `cam rj ynn n •p•. GG' PERMANENT l A ~l'M(tl~l'f - - t 0 .~ti _ •l4CU's (.Y~9 V u ii I'.ct4►,,, o/ UNk[(L GOV I. LOT 2 r , , v; .rr( ?ii 1.1 J\j p F.) 1) 0 •.1 : A 141' M I 9 / I 1 J./~ ~ r.~y 0• IIADIUs LCKGrll= : G 7.00' : rv/ I ,Il l i CCNTIIA1. A11GLI-- 5G°rl':)U" .,r. CROIX COUP ITY .1r1.•!t,~ 1'ANGI'rlr, IICMIIIIG=N2°24'51 1-))/ . ' . cQMP,IuIfN51vf: PAIY, i:P[ANNIAfG ~~Iyf. }ll I onurl ' /'1) AM) ;:U1dING Col,,,' M11 • / IL i„ ,OV.,q or nn' .1svc~l: h11•.r,.,... r .;1<<rt~~{ S'TC - 1115 SE191C'1'ANK MAINTE'NANCF, AGREFNI FNT St. Croix Coullo, O~'1'NI;R/1 Jl'I?IZ ._---__1."4------31__~~!°tN MAILING ADDRI'sSS a~l 72' S~, PROPERTY ADDRESS (077**"` S l-- 122oA2e-r-'s (location of septic system) Please obtain from the Planning Dept. CITY/STATI, f kAnSf; " L,)L_ PROI'F,RTY LOCA'T'ION SW 1/4, A't*--" 1/4, Section _aj___, _`N, TOWN OF S'T'. CROIX COUN'T'Y, \VI SUBDIVISION LOT NUMBER 3 CERTIFIED SURVEY MAI) VOLUME Z , I'AG E _ LOT NUMBER 3 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/\\'c, 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 lolling O,Veer within 30 days of the three year cxpira ion date til(;NIM I)nrl: ~-~~"S tit Clorx l orlnty /,oning Oflier ( icwl'.I IIIIU'lll 't'nlel 1101 ('arnllcharl Road Ilud.;oll. \":I V1010 11/93 T C i©a 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: issold and submitted to this office with the appropriate deed recording. - owner of property M,~21C t-hcp I ILO D ty n gin/ Location of property 5w 1/4~_l/4, Section ;Lt , T Z9 N-R W Township WAp- 400 Mailingaddress 31'2r sorj, 1A 1 1LA0KZ - Address of site__1ff tc;t`` Rz~oerh-~ Wk 5 Lt0 , S Subdivision name Lot no. Other homes on property? YesX No Previous owner of property Total size of property Total size of parcel 'z - ~ e- CoMdIN6n wlzrF l vT ~Z i u E Date parcel was created ,Z Are all corners and lot lines identifiable? ( Yes No Is this property being developed for (spec house)? Yes No Volume ia-t3-7 )and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND 'PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if, available, would be helpful so as to avoid delays of the reviewing process. If the deed description -references to a Certified Survey .'Map', the -Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify` that all statements' on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property 'described in this information form, by virtue of a warranty deed recorded n~,t a office of the County Register of Deeds as Document No and that I (we) presently own the proposedsite 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. ature of plicant Co- xcant IAW A2 - (p Date of Signature Date of Signature . - a7w9J~Q ftft ftr of Wioonsin Forst 2 - rm WARRANTY OW" REGISTER'S Of ` DOCUMENT NO. $LCRCrf C~ , ' ~ Asc~d Ivr Ps. ~ MAY 3 ~ 1995 r bV at I goo P. RegWw of Deeft on" rind ea WM W*= NWrM MR MC01006 DATA NAM! AND AITW" ADDRNe Ott ~iow'itt ~Crrbei net iltwe i ___.--1~- Y ~4MIa o1'RipomiR'' } •T ft" at OPMV eltit 'tot 2 of Beet f a~ 29 TbwDdffq 29 th ice.,., Cka t~ ~pa' de •ibed'as foOHOW. Lot 2'Of la%e IC iCittifled uv~ay I"h, ZPQe 14, 3D I Doc. No. 3791. 4ation 29, lban bJP 29 &Wth lKlee 1s ~'0~c;. ' ek~c~ibed as fol2cssa` Lot-3'a~ f~,tff~e~fiii~ • . ~ ~l~E•Cer~t ~Sr iarveys No. 36i7~t a'°t i Iwo . eet iO ft"ments, Z"ts*etlms and rights-of-mV of record, if atty. . - anted ~ ~ - ~ ~ a ~ • l~Z/ ittA7tL11fy~~faCt (SEAL) AU"UH lCATM ACRNOwLtOGMSM tF , St. « rrols _ owiaeiaM016it dy d - • ewe 6edre toe tUi~ bft*I ""a WKmMSTAnIARorwwcoN= ant oohed bf, j7ftI W ft ) ee ste ' ;~"oexWm d Oe TtMfi POTMAWAT MINIS cowTm my + VWS"nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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 t e 042-1080-70 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRI`f PROPERTY OWNER: ERTY LOCATION Mark Hedin F ,aY 4 LOT SW 114 NE 1/4,S29 T 29 N,R 18 ft(or) W PROPERTY OWNER':S MA!i_ING ADDRESS BLOCK # SUBD. NAME OR CSM # 312 7th. St. S. na csm 3/899 CITY, STATE ZIP CODE f?I ON 0' (:)VILLAGE DOWN NEAREST ROAD Hudson, WI. 54016(7 ) -1421' Warren 107th. st. WIN k0ew Construction UseU Residential / Nu 9 [ ] Addition to existing building j ] Replacement [ ] Public or commercial Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/1112 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) 95.22 ft (as referred to site plan benchmark) Additional design / site considerations alt. site step down trenches 3' below surface el. 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 for svstem 191 S ❑ U ❑ S M I ®S ❑ U I )QS ❑ U ❑ S )MU ❑ Sx4mU SOIL DESCRIPTION REPORT Boring# Horizon) Depth Dominant Color Mottles Texture I Structure ConsistencelBourxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend) 1 0-8 10ry3/3 none 1 2msbk mfr gw 2f .5 .6 2 8-27 10yr4/4 none sil 2ms'ok mfr gw if .5 .6 Ground 3 27-90 10yr5/4 none co s Osg ml na na .7 .8 elev. 99.02 ft. Depth to limiting factor +90" Remarks: Boring # 1 0-9 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 << 2 9-29 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 3 29-88 10yr5/4 none cos Osg ml na na .7 .8 Ground elev. 99.22 ft. Depth to limiting factor +88" Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1554 200t . ave., New Ri hmond, WI. 54017 Signature: Date: CST Number: 4-8-95 cstm 02298 PROPERTY OWNER Mark Hedin SOIL DESCRIPTION REPORT Page 2' of PARCEL I.D. # 042-1080-70 Boring # Horizon Depth Dominant Color i Mottles Texture I Structure ConsistenceJBorndary I Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench 1 0-9 10yr4/3 none sl 2msbk mvfr 9w 2f .5 ; .6 3 2 9-27 7.5yr4/6 none sl 2msbk mvfr gw if .5 ~.6 Ground 3 27-8 10yr5/4 none Co S Osg ml na na .7 ` .8 elev. l 97.92 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-6 10yr4/3 none sl 2mgr mvfr gw 2f .5 .6 4 2 6-14 7.5yr4/6 none is Osg mvfr 9w 1f .7 1.8 3 14-76 10yr5/4 none Co S Osg ml na na .7 .8 Ground elev. 91.72 ft. Depth to limiting factor +76" Remarks: - Boring # 0-14 10yr4/3 none sl 2mgr mvfr gw 2f .5 ~.6 52 14-2 7.5yr4/6 none is Osg mvfr gw if .7 .8 3 20-7 10yr5/4 none Co S Osg ml na na .7 .8 Ground elev. 91.62 ft. Depth to limiting +74 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Mark xedin 1554 200th Ave. CSTM2298 SW4NEq S29-T29N-x18W New Richmond, WI 54017 MPRSW 3254 town of Warren (715) 246-6200 k lot #2 N 1"=40' BM.=top of 1" steel pipe @el. 100, Alt. BM.=nail in pine tree C e1.100.30 l~' 2 D~ i3.3 \VA ~5 (o pG- ~ b c 'Q ASS ~ 2®(0 °(,pn aL2 Gary L. Steel 4-8-95