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HomeMy WebLinkAbout020-1301-10-000 M ~ O o o ' 0 N O ti i i d O V ~ N N O ~ C Z 7 (0 LL c O 3 ~ I Q 3 Cl) N Z O) U = O Z a m 0 O Z a~i z v 2 U H O N z c E a ~ N co N O C O N y N • a L 00 a 0 0 O O N Q w o N z m z z y d C N (mil w ~ R 1~ d to C ' y > O H N.9 1 % y O CD o O c a m Z- Co U) 0) :3 Q (L a co 0 •N oaaa CL _ ) O N 2 rn rn y to U a) rn rn } Q O N Q N O O O co O C q N O 00 p d Q } Cn 2c6 m 1~1 O O O 0) 0 0 00 O O O C '7 j rn 0 co 3 T i r O E c u d 'y G 'O y. F- W O C Q ~O N O Cl) N N U w 'a In (D ICI O N O O L • N 7 O N O w N /6 U cO O 2 U N O Z c ~2 N CO dt a € a L a 4-, E v c c 7 Q t A a~ CO) IO) I► f r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Rrh" oi~ ! IL ADDRESS PrwL F- V) f 1,J uo SUBDIVISION / CSM# LOT # I~ SECTION T Z)q N-R19 W, Town of ~At4JD OP ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM MANHOlt ove r, 0"Titt 6a ~ e 3 Btrwoom Aor(t l 7' / Ig' yd' 3 3s Re u - - - - I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f BENCHMARK: G UMV17 IUQ-Y ~O S W S'1 P ( = U` O ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W ttS Liquid Capacity: Setback from: We116V V50 House 13-Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~a Length 3 Number of trenches Distance & Direction to nearest prop. line: Setback from: well:01)0'50 House-33 , Other NZ,fi. xIL v - U4 &'G 4 N h Wy. 38 3$ ELEVATIONS Cod P(1 Building Sewer ST Inlet. 0(0. o~ 1 ST outlet U( . PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Sow, Final grade ~U7. Q DATE OF INSTALLATION: / S- J 1 rn ~l~ i~ cC fi 11 PLUMBER ON JOB: LICENSE NUMBER: 1 y INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labbr,And 14, r►r'an Relations ST. CROIX Safety, and Buiidings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: COULTER, AMY I Hild-gon 1k CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark /00 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet /0(,,3-/ TANK SETBACK INFORMATION St/Ht Outlet Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic > J /7' >as7 NA Dt Bottom Dosing NA Header/ Man. 7, p Aeration NA Dist. Pipe .7,/17 Holding Bot. System P.63 /03,-c7`,/ PUMP / SIPHON INFORMATION Final Grade 3 _ ati ~ OQ, SI Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3~' / DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: ~cS0 A/ ~ OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over k xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Trench Center Bed /Trench Edges ~ 0 6 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.17.29.19W, SW, SW, Lot 140, Brookwood Drive 9(/0 I,3 7v9 7,09 Plan revision required? ❑ Yes dNo Use other side for additional information. SBD-6710 (R 05/91) Date ns is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I = SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 6 ,X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~ a 831 6 8% X 11 inches in size. Check if revision t previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORM ION,. I PRO ERTY OWN P TY LOCATION '/4s 0 '/4, S / ` Tc~ N, R E (or PROPERkY OWNER'S MAILING ADDRESS LOT # BLOCK # f CITY STA E ZIP CODE PHONE NUMBER DIVISION NAME OR CSM NUMBER J / 60 A) - c V Eo4a&J 6i " /011 II. TYPE OF BUILDING: (Check one) CITY NEWEST RgAD k.. k ❑ State Owned ❑ VILLAGE: I D. .0 4OWNOF: PARCEL TAX NUMBEH(S) ❑ Public t91 or 2 Fam. Dwelling-# of bedroom ~~IL5rn Dr III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo v 2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable) A) 1. RNew 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.E] 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 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 614 `48 ' r` Q o~ ..101. Feet V ~tFeet o VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank I 0 b U t 31 S Lift Pump Tank/Si hon Chamber 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) MP/MPRSW No.: Business Phone Number: ou Q - 0 7fE 3S ' WU Plumber's Address (Street, City, tats, Zip Code AA _ l ~ a x`11 ~ a tJ Iv bSO~ S 5 0 , IX. COUNTY/DEPARTMENT USE ONLY E] Disapproved Sanitary,Permit Fee (Includes Groundwater a e Issued I ing Agent Signature (No Stamps) Surcharge Fee) )OU v Approved El Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a 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 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 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) P B, L E 7 PLOT' A 1-111 c., 0 . 51-U ~ ~ I - - _ _ • P I~~~ n ~1 ~L fir(" ~ N AMC M Cou tti N...M E T(m LIC ENS FL 0 A ID 4y` . o -i&Q(p p~ R) r,A►Qy aT r io0~ 10 s9pt o°' f-~.~y.~ ay 1 3 ~nRoo rY, . dad N to SW fad COXMn >e . sfi4)<4 Q' QAGklhs~ Plus ARCi~ft~' ~1z are J by se E + sy sir r•, • ~ ~ N oe " ~ROO W00 , FRES11 All' If,L[:'1';i -A~1D OBSERVATION PI.PE C11OSS SECTION Approved Vent Cap Minimum 12" Above I»A.) (Z-OAa).p Final Gr-afle Job 1, I 7 - . Above Pipe Cast Iron ~ Ve~~~ Pipe To Final Gracie • Marsh Hay Or -Synthetic Covcri.ilg i Min. 2" Aggr.c(j1.1t _ I . Over Pipe Dis l-ribu lion Pipe Tee I Aggregate V1_ Pei f. orated Pipe Bel' fC~ .~a Dcncath Pipe -_Coupling Te minad.ng' r Ro't~ar~ p r . . Aot tom. of Sys tem- Industry, SOIL AND SITE EVALUATION REPORT Page Wisconsin Human Rela Department oftions Labor and of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUN Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PR PERTY OWNER: PROPERTY LOCATION T ~0 GOVT. LOT S 1/4 5 u/ 1/4,S /7T 2 °I N,R E (or~ LL ler PROPE OWNER':S MAIL G ADDRESS LOT # BLOCK # BD. NAME OR CSM # ///D u e 16, ;fir' C ST TE ZIP CODE PHONE NUMBER ❑CITY ❑VI LAGE OWN NEAREST ROAD I/ / J'Oew Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building A) L ] Replacement ` [ ] Public or commercial describe It! '4 Code derived daily flow J D gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required ,q -3 bed, ft2 trench, ft2 Maximum design to ding rate -gybed, gpd/ft 2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 102-, IF L.jaSlleferred to site plan benchmark) Additional design / site considerations .6,4 -51( Sy Grob ISw,w,, ,n•~ Flood plain elevation, if applicable ft Parent material &_,o S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system AYS ❑ U IBS ❑ U MS ❑ U I~FKI ❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerich l' T 77,T7 c7 .S . j 0=1o Z au S 1 r~+ S~lr m Z 0-1-5, /O 3/7- 5/ /,W 5~L oo,, c ca bqr Ground 3 S- y! r" X / S 1 /m G eJ l/J! , 7 elev. /,9 ~V4141 LOJ*7 q,? Al/ 1.7 1 Depth to limiting factor o A, Remarks: Boring # S D_ G.. n K z s s~ C~ . l 6 y / S t'` rYi /w' 9' Ground .3 9 - 37 /o m/z / ( , g elev. o 5, 'ow 01$t S . 7 naft. Depth to limiting fcor~ Remarks: CST Name:-Please Print Phone: 3$G Address: o S/~ Soy. S O~~ Signatu Date: i S. CSC©~ enD l l~J Z 7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2-of PARCEL I.D. # ' Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench "k? Z CZ / S ,t o-1S' L s / /0 Ye Ground L3-33 D ,C /5 S - Xl C w Depth to limiting factor >'Z" 3 I T-1 Remarks: / Boring # J z S S6~ C ~i/p~ S ov- % • p' /Oy/ 57 12 Ground elev. Depth to limiting i factor Remarks: Boring # Q S Ground / Jl~!! elev. 36 ` g2'' 0 S ✓ 6~~5 Depth to limiting factor 1>S3 Remarks: Boring # y: i\ Ground elev. ft. Depth to limiting > factor Remarks: BD-8330(8.05/92) 3 err 3 Wdak w0oy s, b,- CL=/ ° 65 © ~$L s _ 51 Yy ° s yy, ra 1 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER jjj ` - t J,' MAILING ADDRESS 14( 0 S QXJ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~AU 25, tA.PROPERTY LOCATION 1/4, Section ~ 7 , T d N-R__~9_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION 2;F "Dffar0j j LOT NUMBER./ CERTIFIED SURVEY MAP , VOLUME 1-1 PAGE , LOT NUM 3ERZ410 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: l- old Z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 `!'his 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. "wn,_ r of property ~Q CJ f~ f.c - ./l Location of property5(,j_)l/4 ` w 1/4, Section Z ~y ~LN-R~W Township jtWSpt'l i;aiiing address Z2 a/7 _ 57. A d :3 r e s of site Subdivision name IL/~ h Lot no. Other homes on property? --yes No Previous owner of property Total size of parcel 4f AC( Date parcel was created lsre all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes A_"No ',,olume00~ and page Number of Deeds.~00 as recorded with the Register INCI,I_,DE WITH THIS APPLICATION THE FOLLOWING: WAPRAN'T'Y DIED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE, SEAL OF THE REGIS'T'ER 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 OWNKIZ CERTIFICATION ('we) certify that all statements on this form are true to the hest of my (our) knowledge that I am t.~;e (we) (are) the owner(s) of property described in this information form, by virtue of a '-arianty deed recorded in the office of the County Register of as Document the proposed _ -7 and that I (we) presently site for the sewage disposal system or I (we) c:.,tained an easement, to run the above described property, for t:h- construction of said system, and the same has been duly recorded in the office of Count Re No. Y gistor of deeds as Document S~9natur of applicant Co-applicant Date of Signature - Date of Signature ii 00GUMRNT NO. N ARRANTY DEED. THIS SPACE RESERVED FOR RECORDING DATA ttPW STATE BAt- ' F_. LSC I .aa,FORM 2 - 1982,1 V4 1 Fb'3€~~1~ ~i REGISTERS 'OFFICE i 7.:._'.. s;. Mix cam., wrs, rDaYr4pl E. Wert and Beverly A; Wert, husband.,and Reed. for Record this 3rd • , Jan. wl fe sitir ivic wally and each •~.n their own ri . t day of A.D. 19_95 y 3 . at 9:30, "J. Ooulter conveys and warrants to - ?wt T C." 49tNer e P ~r ~sv r - ; _ RaiR1r1'& Wei imer, S.C. 430 Second St. P. 0. Bo)( 106 - - Hudson, Ali - ,16 the fallowing described real estate in ...st_.-_Croix ...County, State"of Wisconsip: Tax Parcel No: 020- 1301-10 Lot 140, Park View Estates Sixth Addition to the TOwn of Hudson. a This . .lsnOt__._-__.__ homestead property. (:k) (is not) Exception to warranties WIETHER WITH AND SUBJECT TO any other easements, . covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend anv such other recorded encumbrances beyond the term established by law therefor. Ei~~FN December 94 Dated this day of . l aL) ia~rrel E. Wert SEAL isf'AL) ' `bier y A t . . „ F ~i iii AUTHZNTICATION ACKNOWLEDGMENT' fe•and STATE OF WISCONSIN' _ ~i Pam Ea_'..................................... del aMBX ss. nt authen th' ; -da f.:_'_~ 19 Personally Personally came Cbefore me this day of Yt - Wert - 19 the above named ou . ,l Gwin • TITt : UEMBER STATE BAR OF WISCONSIN not, atithorized by § 706:06,rWis. Stats.) to me known to be the person . who executed the foregoing instrument and acknowledge the sauce. ~•11TIlVBTRUMENT WAS DRAFTED BY • Atty. Hum H. Mn - nd, St. , laudson, WI 54016 4362 . - Notary Public county, Wis. (Bid iI i ureamay be authenticated or acknowledged. Both My Commission is permanent. (IF„not, state expiration . are rip necesaary) date: 12 - ) •N;moa of peYaatis sisaina in any capacity should be typed or printed below their signatures. - - 9- - - - f h. n WAggAmTt IMED STATE BAR OF JVISCONSM Wisconsin Legal (31ank Co.. Inc. FORM 'io. 2- 1U82 Milwaukee.'Wsconsin i ir• r ~ 1 h' r ` 3 ~I it LOCKIt:i/ lhi?,lIJI 01 IIIC N`JI/1 IN PAM OF ME SWIM OF fIJL III` SLII/ IIJ f,tJ; f (OF ME NEI/•1 Of 111E SIVI/•I, ALE. IN SECTION U. 1,29a, (JI'JI'~„ AJJD Iii FAIO AF :fIJE SI:1/i OF 1'(It StYI/-1, J OF NUDSOti, $I; CkOJX COUN'IY~ MISCONSIU. ~ yYw... w.,, t.<•.w r' a>•1 relif•," euxu • • / 1 , rl~~{ili i~ r ICJ' r . TM.r• a. N ixtr„1aa.u... ~ +Y • I• •wa •..w• - " ' . a►jtcll••[NIMif N ril r~• Sa. YR y 11elf,ll• IK, IN we" 11611(11"t(11 Wi> Sim.. M .i •.•icerwr .au,c yaf•a r111.11R/s o(A. y ~a NSt. AJNi• C•Je N pa.LkJ by S. _ Wrr r. OIM 0 .ttiK .ppa- 11e 11 (e1. W4 e1M> • '^Sw A f• t• a•' Y• r0•,W[xt{o UM IN 611.1m ii. rcer ~}.:~-ter.. ~ i C•nie,Jlw j.~l i.y or _ Nu•a •x•aau•aa • I to iu. n I . u.., r : IPal • n..«.I. n••..•• 1 ~ w... .f • My~ s, T,W A C~ 1~ • •'.W vu•NI UNMxr i.a. aniii . i ;•:.q •.:p••, :au I: .a• 4Y•O /1014110• J;sizs>~ t0^Y• c\t•{1.1,111 I•• •n/ OI Ncrq 11 ••I Ir N••M'MY ` - Y•'»'>•y Iv co^,rM tf p Jl _ t"- N Ifilf tWeaA { t0. , wit •N •Y . R 1"IAP . ►e,N~~ 5I' CE9TlflI:O PRAY IRV ET Y4! 4W _E I. PncI ie2 I •s Lre••_ rrwr (D" NQ 32HU) I 1 M:•ri q••1 Nf 00' • I LOT 134 S °)l5A I.1 Krtf i LwTcwii " 8R 105 ,•N N n 1¢~ I I I ! • i LOT 135 op•• r r ~ f ~a:.t woa•1 +1 iiA.4 w it see 9, ?V w O 411 A -I y • •1 M fl of M1 u~ri i •,r;,. ♦ LOT 132 i LOT 13..0 ZII ~y 1 m IN K•' +'1 I pp fts ~1 ZI \ .A" N II ~~iN N /t f IQ6 z1 . '1 Y a LO' 136 I 1 , 4jI I I g ~1 Q •N••a'.wy.•OOJ •1' >I' ` LOT 131 ees9e'W I 149 O LOT 137 Jee :,:••_r:1L_ c, f~~~Y-• =nN:- - - - W Ki/f - g~ ~ . rf ~',Ir1 \ Ncaw a Nrarwl, ut..l•r = Pe L•OoTcl,ii6 LOT 146 31 lw'N.n•'Lr'3°L u.t» wn p ~\.IQ. / t u.wi ••n H ' \ ,j, It •ty . /mss ~V•° `v\~ LOT 145 .d X11\ 44 1. //~e •i w ~ 0 ~ \N.w! N n 4♦+ ~ ~ i~ LOT 139 LOT 147 It11 LOT 142 , 1 r r 1NKn> \v\I •r,•I• N •t I LOT 141 1 ( q, i li1' i>a♦,ewit t LOT 144 ♦A no 4. ♦ LOT 143 NIt Y~r ~Yil ♦0~ Y, ~1 r1' w 1•r. f 1 / t ee 1/ a 1 I .1• OUTfOT z t ae /1J ' I M V•N1 • ,1 In YI Nrr{yN.- / M. ~ Ma••A'0••L , 1996.♦0•%/' _ _ ON 83 I ~ ilYl:i' ' ~ ~ 8!GC~E ~ ~ ~ fad I 1 I ~ o~ _ • r. l•.1.' ~ lfl r 1 Iw'. ,vl .I Ma•., Y. IY l1 •\4 SI~IIf//J1F' _ r ~.,.•ri..,.,.s-Yttr 1-....1 r'...,r•T.,r ~ ~ ~ i z?i~j g 31 P7- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of ' Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 57' ~Q1' Y, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 02 a, f O f •/D• ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. t" Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner p Q Property Location -TA/ ` 9 r(A^ EA) ~C X ME 4/ZZ Govt. Lot NA) 1 /4 Al~- 1.14 S ` 7 T Z N R l (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSMj# C: 1! r. D 1J/T V 4/11 /,3,f 00X&) 0.0 4? PA P-4A~VI,8 10 City State Zip Code Phone Number ❑ City ❑ Village 0 ToWri, st Road ff VP-V/t) 411 sclml, 3F/- Zf3o ,yv/~so,✓ aRo~~rwoov Ale ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material 5,41yq D yr w /f SA Flood Plain elevation if applicable ft. General comments _ and recommendations: Salt ~'aif 104-j]" Q/•r ? / 94(5114,76- -5Yr - sD:/s lv,"'y ele Ge'~T ~,r>r~c/ ~v~u.~? •eP • ~S~ v ~ ,f3 vl/ 114 /vim • -Boring # ❑ Boring C'G• Z Z Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1P.`0 313 2 g•/e /oyR SL ,c CS . <o 41•// /Dye s~ s ,e .7- A Z CJr nmul Boring # ❑ Boring 2' pit Ground surface elev. 93 > ' 7 Z ft. Depth to limiting factor //D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / 10-7 /0 ye 3 S/L //ZYf / C S -F Z -3 2 • Ito /e Y/Q S L S c w /7c . <; - 2-G /O Y R s/ S //1;1 ~.e ,57 Z •//0 ,0 R S ~ .S. -r ~P,e • 7 2. Effluent #1 = BODY > 30 < 220 mg/L and TSS >30 150 mg/L " Effluent #2 = BODY < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number 2oBEP- r u1bet'c c,i ~ZM4 W-V~ Zz~3~s Address Date Evaluation Conducted Telephone Number 13 - "61 -7IS- 3,P6 • E/d's Ulbricht private Sewage ConsultantO 655 O'Neil Rd. Hudson, Wis. 54016 fl fT Gi0 Bit/ SET ~ ~ idrtJ E' C k ~ << sir 0 7- 115" / / L U dZO•/3v/'~O• Property Owner vh / 3 Parcel ID # ~ Page Z of i Boring # Boring [0 2.- 1 Z > BI ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o•« roYle 313 SiL z .e WA cS 2 -f- . z .3 z /d •L3 IVYR,31el S~ / ~C cS /f 3 3 "3 ~o SL /f ~SLi c'S • 6 • 1/S ~oYR Al - cr- ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t Boring # ❑ `Boring Pit Ground surface elev. ft. Depth to limiting factor ❑ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider 4nd employer. 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