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HomeMy WebLinkAbout020-1181-10-000 a o a ° a O 0 d N N r_ c en 4 y H / x O O. U t O t3 ar a v_ b I,s a € I y (y I C O c c Q S? I U) 075 0 p m > C= D > ` C Z E~ a c z C 'Fa IL O.y (D -0 {L 3 N~ .2 .0 'D fp O U f0 ~ 'O L y to in a ~ L 'O C a d N Z 1/1 Z N! a' ~ 8 w 00 z €CD co H Z a m d m 0 0 zv' c m Z a 2 o fn I- r lp d O N Z 0) E E N CL = N N •a d) N N N N (n w d t d L 0 76 O O - Z F- Z Z co z Z- v, I Z w w N a N w ~ E A E CL CL C: w rc crr CL v~ ro rc ra` 0) U) U) Cc :3 o U M ° 3$$ a 3 3 3 n a Z •N `'aaa °IL CL CL CL 0 (a o ~ Lo Lo V/ J V OMi z O W OOi Z 7 0 to = M 0 = O - N D =3 -0 °OO m a I o° m z C in m c v •O w a tT O a O a) a d '0 C m a z cn m a Ul) a , Cl) O ° O C M H C T~ 3 a °E~- M co ° 0' N E tc0 N o ao E o a~ o a~ c c O N M 0 V m Cl) (n U N d 'O M M M .4 i W y L N d ~ N Y M « N V C d • N co 7 U O N O N O N O O U O Sir O N 2 O Z c z N O Z Z rL (n rj 0 R € a € a 0 (D E c c ° c rr~~ ~1 A 0 2 ~U)iU v~U S AND P •O' W I 3707 011. BORING MADISON, ORT ON S TESTS hi~/ IVISIpNN ME. NT OF REp CjO1~T101 g~ Chapter 145) LOT NO : BLK. NO.: SUBD JJ PER FIR 83.091 1 t ~ ~~(~O { r' ' IPALITY: `V~ a J ~S' ,AND UNI Jn(j f1 R ~ TIONS oWN i f"l z L DE TIR TESTS: M,AN RELP' RES^ T N~R * for MAILING AD 710NS E O S IO . 1 / PATES OBSE SV AI NS: AVON /4 Q PRO/F/I~LE p f /4 OWNUER' Y ` /(i~ T ESCRIPTION• Neal ❑Replace BE COMMERCIALD ED EM:loPtional) + NO ~9L,Y(Lme~'_~ SD!' END SYST + USE ~7/ ~ TANK: RECONINI S ~ - stem INF►~LHOLDING©~ Q lGlResidence unablefOr . SYSTEM ® as for system area is ~n the S_ Site suitable IN G©~ U e tested of th elevation RATING NAL: MO' ~U ortion Floodpla'n If anV p EP CONVEwTIQ~ FIOodPlain, indicate XTUFtE' pND D TH O pESIGN RATE: TIONS E v •ON BACK aired DESCIRIc ER OF SOIL WITH TI-IICKN are NOT req PROFILE ERVED ISEE ABBR Tests Indicate: TO BEDROCK IF Ogg If Percolation 0915)lb), INCHES CHA under s.ILHR83. WATER * rL it ~ 1 TO GROUND EST. IGHEST I1 I ( 1 ~ ~ v ~ rb rr ~ G V ED p (1 BORING TO H 1N. ELEVATION DEOSSER - _b l o / 11 Q mQ NUMBER DEPT ( ~j ~J ~ ~ n ~j jS aos~ ~S B- ~ ~ <<(~Is ~ bd e L .v ~ ~ TE MINUTES B- ~j RAPER INCH B ~b~ COLATION TESTS LEVEL-INCHES P R L- 3 PER DROP IN W PEBloc) 2 7 ~ B- TIME PESIOO~t 'G IN HOLE INTERVAL-NIII~. + ~ pEPTH AFTER SWELLING ~ 7 r7 NUMBER INCHES ~ 7 pescribe y,+hat are the hori- P_ ercent cale or distance and the direction end P P- Indicates orin9s P- of suitable sod are face elevation at all b P ensions Show the sur and the dim Ian. t ' P rings the plot P tests, soil b° tion on tion ~ P of Percola d show their Iota - e t locations PLOT PLAN• ShOW reference}POIW4 C~ d vertical elevation~I,N ~L n ~,...._.f e i tal of land slop SYST M ELEVA ~,d tree E a~' ~ . ~cS~e e N P t t p c, Ay p~ i $S~ t ds specified in the Wiscons n ' t~ 6~t progcedures an metho p d ,r ~`.'.w - de by me m accord witk~~ led a and belief. st of N: form were ma the be mY E orted on this correct to TES COMP- T IT . tests rep f the tests are TS W ERE MB koptl all certify that the soil the location o PHONE NU s hereby data recorded and UMB I, the undersigned, nd that the 'j~ CERTIFIA 0 /1 Code ~ a Administrative /l ~d d CST SIG RE' NAME Wr ntl: 6 [ S 4 ADpR S ' f 1 ~ ~ V o v nd Soil Tester. to Local Authority, Property Owner e _ pV ER - Original and one cop" OIST RIgU710N 63951R•~pj83) nILHR-SgD i a~ To ` t- MPS ETO CDmP 01V T- Gc>n iccura F t, )"Oll+' rnpr' t't7 )-639,5 2. The (Ise S0cj.lofT latiorri a, + 2A -vii-Jp rrt.rrr arty -si.. 4• Is'lr;s tether this; , ne,,, r3F ;7acil C3Fi ,F •r'x, col- it-)lete rt ''Pot 'rll'7if?f"ciai U5f Or (-Orr tlr t? Si rued; ``l proJf?C;'3'° 6, PLEASE a S17 In . 7• ulAl<fi A t- SED ( A"I,IM I'0 A F 7 x O-7 s ~C , iTlONS TANK ("rVLY l ILL nH tas ° locations ampleg, 'b7 lrr~ " to scale is sr at Plan I ei?t; Ooi `red A 1 T Si . addresses gr 3 ad arm pfa,° { ra;rnarrerrt; C C? ~ r ; e,"rt a, }Arses not 6tio ter" - t a,yemp, grate=<f your cs as r~ !1U i.tirerl° Ai l'AyS~3F Co,,,JJPLET~sIV, TESTS MU' FILED t~lT!# THE Sr" CER T"'I SOIL TESTERS a a cob 1071hols 8"tOck SS _ Srt,nclstonF= ns. L ,S rrad'=d k H41h Gro(l pater rcolation date ` r{ears !art Ural, Ri mot Ai4(Dt. g i t bVx f;ne P} .fair}-t c T rrrota cOat'se Many, merirUrrt rllStir?cf: 4*ledt Exr- t .ava>>l, `i " v a t e r Rt ; Mark el el `cc, p T® THE OWNER, This soil test report is the first s top of this soil sevtagc sysTe test in p in sec uring a sarritar obtain a m and a permit the tietd prior to y per t mit, The eou permi , The sanitary application rnus permit issuance. ntY or the De permit t be submitte A complete Department Obtained set may request d aria appropriate local of plans for the posted prior to the al authority in Private start of any construction order to . 1 SANITARY PERMIT APPLICATION couNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than [:1 /Ylifrilinto3rpre5vrous 8% x 11 inches in size. clheapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER biliqtl PROPERTY LOCATION ) rd U 11 C' L° Ij'/aS F S 0? T , N, R E (Or) PRQ W OWNER'S MAIj G AD RESS LOT # BLOC C/ (0 I 3- C TY, TATE 1[l~ J ZI ODE PHONE NUMBER SUBDIVISION NAM OR C M N~MBFRR ~~~t656n . W/ to S ...l.L-- II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD t~ ) ❑ State Owned ❑ VILLAGE : Sa PQ =N QF: ❑ Public ] 1 or 2 Fam. Dwelling-# of bedrooms I_ 'PARCEL XNU E ( ) 111. BUILDING USE: (If building type is public, check all that apply) 1`If l; 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 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 El Mound 300 Specify Type 41 El Holding Tank 12 ® Seepage Trench 220 In-Ground 42 ❑ 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals//~y/sq. ft.) (Min./inch) ~f 5 '3-J~ E EVATION zoo v 0 ! a 4 3Se Feet qt y ~eet VII. TANK CAPACITY Prefab. Site Fiber- Exper. in gallons Total # of Manufacturer's Name Con- Steel glass Plastic App INFORMATION New xistin Gallons Tanks Concrete structed Tanks Tanks Septic Tank or Holdin Tank /~V T Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. F Plu er's Name (Print): Plu Signature: (No Stamps) MP/MP Business Phone Number: ~ ~S 1~ -6 1 & L4 f Plumber's Address (Street, City, State, Zip Codej: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved ba itary Permit Fee (Includesrcharge Fee) Groundwater a e ssue Issuin Agent Signatu No Stamps) ❑ Oner Given Initial / *pproved Su 0O Adverse D rmi tion X. ONDITIONS OF APPROVAL/REA S FOR DISAPPROVAL: SBD-6398 (formerly Plb-87) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber v 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 (SED 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, usualty 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 3% 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 cqn 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) i I e 14W h /4-tt4a Are E ~I TO 9l9 -3,93 gel I f fors-e~ ~ren4t<,- or D S z,~t►c. eD ~ 6a • e 900,~L~J W7v D g3 ~0 Vic, ~a by i L ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1 " u""u ■ u w "ir"b ST. CROIX COUNTY GOVERNMENT CENTER • 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 9, 1995 Derrick Construction P.O. Box A New Richmond, Wisconsin 54017 ATTN: Ron Martinson RE: Septic Inspection for Bernard Jilek Address: 735 Aldro Road, Hudson, Wisconsin Dear Mr. Martinson: An inspection of the septic system for the above address was conducted on May 31, 1995. This property is located in the NW; of the SE; of Section 28, T29N-R19W, Lot 39, Cedar Hills Estates II, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please feel free to contact this office. Sincerel , Mary Jenkins Assistant Zoning Administrator mz STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _~~~D~m~, (p ADDRESS SUBDIVISION / CSM# p~ 4(,11i LOT SECTION_sQE_Tc277q N-R~'9~ W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D ` / J ;y ZZ INDICATE NORTH ARROW I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. c BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /Qnt5 Setback from: Well~ga House Pa Other Pump: Manufacturer y Model# Size Float seperation - Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: o? / Length r Number ofy~sZ, . D( Distance & Direction to nearest prop. line: ~ (~✓'s,~ Setback from: well:'/" House 3_ Other ELEVATIONS Building Sewer ST Inlet. 7, IoS ST outlet /07, PC inlet PC bottom Pump Off Header/Manifold Bottom of system / d Z i Existing Grade Final grade ~b b DATE OF INSTALLATION: a - PLUMBER ON JOB: LICENSE NUMBER: 5Fj 3 INSPECTOR: 3/93:jt F Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andlTumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Pla JILEK, BERNARD X CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: lQ D U , A9500026 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i~. Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 07.5p TANK SETBACK INFORMATION St/Ht Outlet 61V /07.2/ Vent TANKTO P/L WELL BLDG. A irIto ntake ROAD D et Air Septic yaSl as a ' NA Dt Botto Dosing NA Header if Man.g ~Q Aeration NA Dist. Pipe F olding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. Towel SOIL ABSORPTION SYSTEM BED / TRENCH Width h Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /°I DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type o Moe Number: System: c r' o AJJA " 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 cI Depth Over 1 !r xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 0 Bed /Trench Edges a V _ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Huds~n.28.29.19W, ~ SE, Lot 39, Aldro Road /64~ F6 ce ft,Xtlan revision required? ❑ Yes ❑ No r - /Us e other side for additional information. f JSBD-6710 (R 05/91) Date Ifispeckor'; Signature Cert. No. , { ADDITIONAL COMMENTS AND SKETCH F . SANITARY PERMIT NUMBER: i i SANITARY PERMIT APPLICATION 4 ►ILFIR COUNTY In accord with ILHR 83.05, Wis. Adm. Code 57. G N o t X STATE SANITA Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than as S33d, 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 q J?e in r, & M /Vk) % %,S IK TX/,N,R / 4Dr)W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 171 DI rc 1`"1 i~ A CITY, STATE I-ZIP CODE P;ONUMBER . SUBDIVISION ~V`A~M~ R CSM NUMBER 45 S 4/8 1235' C.er! II. TYPE OF B L ING: (Check one CITY NEAREST ROAD Q ❑ State Owned VILLAGE : u O n A Id ❑ Public X 1 or 2 Fam. Dwelling-# of bedrooms t- PAR EL TAX NUMBER(S) „u 111. BUILDING USE: (If building type is public, check T11 that apply) 1 ❑ Apt/Condo 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 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.XNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Inrsting System B) El A Sanitary Permit was previously issued. Permit## 141 23~ 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 C REQUIIR/ED(sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 77.7-0 wD( T..7 CC;: " • 7 /403a A Feet A04.#_5 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ~e to 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. Business Phone Plumber's Name (Print): Plumber's Signatur Stamps) eIFMPRSW No.: Number: Ca1~~~ ~s~ V ay6 sus Plumber's Address (Street, City, Stat , Zip Code): LL&nd lcJ D/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Per it Fee (Includes Groundwater ate Issued ing Agent Sign ure No Stamps) rtA Approved I ❑ Owner Given Initial Surcharge Fee) Adverse Determination ln~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber IF INSTRUCTIONS h 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 subraAed 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, 608-266-381.5. 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 inst4led. 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) (3erfidV'~ ruw , SEy S~Ca Taoro-R J%J 1 701 G, v-cle. *jj * -ms's 5gas oajoo, N~ItsE.ff 76ujri1 N O C6`c~ra• ` O 3 7 ~--1 , I i ~ J 3~ } .15 lc~ 8~ 6a bf ri Haws..Q .bP 4414PV L i a, j~/ ~Qc recuS A O -^c.,4 /r24 hk N4I) A PoP)a"-• 'w- E~ I ate/ t#lt m nf4.P ~s,er -f ia9, 6 Dom- ~ ~ s}-i~ e 1- ~?n~cda~ ?4 /03• $ w CO r M t~-t i'-o + 3 j ,r ~ a ~ ~ , ♦ i ~ 5 L' F 1 i ~ ♦ i, ♦ w III r F~ • ~ ~ f "•5 V• r. ~ 1 ~ • +~F 1. ~ a t L . . , - r w - R ~ ,b v 5 , y, .i ~J ♦ f 1 ~e~ Crv S S cI IOr f, 0,4' A Str, S, 6 S,2,y l9td Ile Vy~* w6a l b~ W1 r,\ G Fr11h A" Intet► And ODlerrollon PIp/ f J Illn)mum Cop /1~~9 /eJ,,.w l/I ['(~"1Y ADDre•)d Vrnl 12~ Aoore flnel Crade 20. 420 Above Plpp _ 4• Cool Iron To /Ih,i a,,d, Veha PIP, u.rrh Ira, Or SrnlMlk C• glny I'll 2' 004 Plp~lrepel, 01Ur1►.Ilon PIPe o o ° Tee e V Atlrelate aeneal► Pipe ° PerlorUee PIP, Behr ° -C;'pllnl Terenln,Jin1 At Colleen 01 tfel,re Pilopo)tD PIne,l 9~f.cl SOIL FILL 0ISTKIBUTIO1.1 PIPE Y a APPROVED S` p-ICTIC COVE 2~oF 11GGf{~G111E ---fir r ~'11A7ERil~t- OR 9" OF STRAW ?'~Yw OR MARSH ELEV, of/ ~E Y`M,oY 1.".OPIA-2l/~ AGGREGATE wO OtSTRIp~rJTIrJ1J PIFE T ' , AUU AT LEAS7t0 IIJCNCS BUT 1,10 hoR U y2EuCNCS OELOW F11~AL GRADE ' L GRADE tuxtmuM DaPrH OF F-XCAVAT100 ROM OR 16N L I11N1r1t1t~ p~PTli of ExcAv A ~A~~ WILL 6E IlJCHES ATIO" rROt\ gt6I1AL 6ROE WILL INCNC S SIGUCD: LIC E jSC UUMBE It: DATE: _ " 9J 110 Wisconsin 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 St. Croix Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), dir and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to tipar"t 020-1180-10 APPLICANT INFORMATION-PLEASE PRlptt ALL INFOR REVIEWED BY DATE PROPERTY OWNER: PERTY LOCATION Bernard R. Jilek LOT NW 1/4 SE 1/4,S28 T 29 N,R 19 1(or) W PROPERTY OWNERS MAILING ADDRESS « BLOCK # SUED. NAME OR CSM # 1701 Century Circle, #118 na Cedar Hills Estates II CITY, STATE ZIP CODE PHONE NUMBS df [:]VILLAGE MOWN NEAREST ROAD Woodbury, NIN. 55125 1612)735-04 Hudson Aldro Rd. New Construction Use (xj Residential I Number of bedrQoi [ j Addition to existing building (j Replacement [ j Public or commercial desdi Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 hnch, gpdtft2 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) 103.20 bed It (as referred to site plan benchmark) Additional design/ site considerations 104.14-101.70- trenches-alt. area 99.50-98.60 trenches Parent material outwash Flood plain elevation, if applicable na It S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench 1 0-10 10 r3/3 none sl lfgr mvfr gw if .4 .5 1 2 10-21 10yr4/4 none is Osg mvfr gw if .7 .8 Ground 3 21-94 10yr5/4 none co s Osg ml na na .7 .8 elev. 107.64ft. Depth to limiting factor +941, Remarks: Boring # 1 0-10 10yr3/2 none sl lfgr mvfr 9w if .4 ? .5 2 2 10-22 10yr4/4 none is Osg mvfr gw if .7 .8 3 22-94 10yr4/4 none co s Osg ml na na .7 .8 Ground elev. 107.4'644t. Depth to limiting factor +941, Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 2 t . Ave., Ne w ichmond, . WI. 54017 Signature: o~ Date: CST Number: 2-23-95 cstm 02298 16- PROPERTYOWNER Bernard Jilek SOIL DESCRIPTION REPORT Page? of 3 PARCELI.D.# 020-1181-10 Boring# Horizon Depth Dominant Color Mottles (Texture Structure Consistence Boundary Roots GPDJft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed !Tn& 1 -14 10yr3/3 none si 1fgr mvfr gw if .4 .5 3 2 4-28 10yr4/4 none is Osg mvfr gw if .7 i .8 Ground 3 8-84 10yr5/4 none co s Osg ml na na .7 .8 elev. i 107.64 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-11 10yr3/3 none sl lfgr mvfr 9w if 1.4 .5 4 2 11-25 10yr4/4 none sl 2msbk mvfr GW if .5 .6 3 25-80 7.5yr4/6 none co s Osg ml na na .7 .8 I Ground' elev. 101.60. Depth to ~l limiting factor Remarks: Boring # .>v 1 0-10 10yr3/3 none sl 2msbk mfr gw if .5 .6 5 2 10-19 10yr4/4 none sl 2msbk mfr gw if .5 .6 3 19-33 7.5yr4/6 none is Osg mvfr Ow if .7 .8 Ground elev. 4 33-80 7.5yr4/6 none co s Osg ml na na .7 .8 102.30. Depth to limiting factor +8011 Remarks: Boring # 3 M•4:•i?: ii:? Ground elev. j ft. I Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Bernard R. Jilek 1554 200th Ave. CSTM2298 NW4SEQ S28-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #39-Cedar Hills Estates II I N 1"=40' BM.=nail in Poplar tree at el. 100, Alt. BM.= nail in Cedar tree at el. 109.60' &0 ~.5 So` L 0 80 3 or`5' 25 ~ ~~~a Z. r3$ f Gary L. Steel; 2-23-95 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~-1_44,AS-2-4 Z_ V_X% ' a1 _~t LE k MAILING ADDRESS V10 t 6etq -!A! N Lt Rc-ue *-l b; ~oor~ a rr, ML) PROPERTY ADDRESS ~1 ~t-O~°ZO Pao (location of septic system) Please obtain from the Planning Dept. CITY/STATE 41-A O Sot- . \PJ I C--;- 4 81 b PROPERTY LOCATION R\^/ 1/4, '5l= 1/4, Section 23 , T _7~9 N-R _t9 W TOWN OF I,M 10 Sc N ST. CROIX COUNTY, WI SUBDIVISION t4t "151 ,l LOT NUMBER 3 CERTIFIED SURVEY 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 returned to the St. Croix County Zoning. Officer within 30 days of the three ar expiration date. SIGNED: DATE: -A St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 1 I STC-loo This application form is to be completed in full ~the owner(s and signed ) of the property being. developed, .Anyinadequacies will only result ~ h delays of the pormit igsuance development be intended for resale by owner/cohtr chtor,( i s hec house), then 1a second form should*be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. I-------------- Owner of property -~taz,~1~ Location of • property lw-1/4 JG 1/4, Section "2OC) ~r Township L~Uns' N Mailing address 7 ''moo , /Vt I Address of site AL-Deo • Asau \ I 5 4c) l b , Subdivision name. -non, U,.L,5 - ~ Lot no. Other homes on property? ves x No Previous owner of property \A/1, -V4E-~._M A Total size of parcel 144 A, j1 AE Date parcel-wags created - I Z - q .!'Are all corners and lot lines identifiable? & .Yes No Is this property Oeing developed for (spec house)?,••`Yes .2S_No Volume ll_ 11006 and. Page Number A& 91 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 & TIIE SEAL OF THE REGISTER OF DE' certified survey, if available, would be helpful ~I o asd oioavoid 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 ail statements on this form are true to the best of my (our) knowledge that I (we) am the property described in this information form, tb a owner(s) of warranty deed recorded in the office of the county Registez~•of Deeds as Document No. 15 _S 13 own the , and that I (we) presently proposed site for the sewage disposal system or I (we obtained an easement, to run the above described the construction of said system, and the-same hasopbeen, ) duly recorded, in the office of county Register of deeds as Document No. SZS 13~b iignaturee of appl ant 4Z4Uplica t 'Z- 2` Date of -615• Signature Date of Signature. FEB-13-.'95 MON 08:13 ID: TEL NO : #00? P02 't..i i~Aii 1leiinrae ►ew hcioeDtN• e•Th oOCUMCNT NO. WARRANTY 0560 STATE DAR OF WISCONOIN FORM 2-1942 525138 VOL j108►A,Fr4899 gE01STM5S MCI ST. CROIX CO., IM ftiggald Pre! . w~~i~!~?!. ll.ad for P.e.ra ........h'.4 ? ~ JAN 12 1995 4 c ....s soht ee R 1i 1ek4.. E,...t~37?S, at zt s0 P M conveys and warrants to .....haabstd.,and.wife. An. feint-tenanta 't. fA4L of Dg Ni URN TO Sir. Craar• ..............county, -=r-.......~ tho following described real state in state of Wiamnsin: Taz Pared No: 0 4: }~S$}-}e0-0QQ riot 39, Cedax Hills Estates II in the '.gown of litadean, sc. L=X OOUnty, Wisconsin. 9XEMPT the r This deed is given in full fttiefacta.Cn of a ontract vdlullx~ lOt 9ZnPa 598 dated August 25, 1994 and re=cad Auqul t 26, as nocuant No. 520671 in the office of the F8gi8ter Of Deeds for St. Croix y O=ty, WifaO=I*in. This Y1flt heu,estvad Property. 451 (is not) Exception to warrantieat TOGETHM WITH AND suBjz= TO any Other easeiaants, COVamtst resexvati= or restrictions of record, if any, but this shall not be deeitted t,O extard Any such other reoutded er .,brar~cas beyorr5 the term est&lished by law therefor. r$ day of .......17MUM IS 95 Listed thin . . (BEAL) (S>0AL) . !R(.. E. Wichellrr,ll k+..r.........(SEAL) . ...................................................................(SEAL) thid`~. 4ticha3al AUTHENTICATION AOHNOWXjXVQ dZNT 8iirtaturep) 3y1CC73%~.k+'...19;n1,alrnan. STATE Or W13CONSIN 1 . (u. 4 ....lid ,T. RIM County. authY ea ay ot..... l rv 1S.K. Personally came bufore me this ................day of r 19........ the above named .1.... . H....... I I • TITLE., MEMBER STATE BAR OF WISCONSIN (If nu to me known to be the pcraou who executed the Authorized by 1 106.05, Wig. Stats.) foreSolnc instrument and seknowkdga the san.,o• THIS INSTRUMENT WAY OnA/TED BY y r~.~.................................................. ........f7~`i tS Jt..10 1.k!..RL.QNtj! WI 54019 • 4$0 2nd St„ Fluri......, Notary Public ...County, is. (Signatures may be authenticated or acknowledged. th My Commission is permanent (I1 not, state expiation Ho are not nmesaery.) date: to.........) ~s ima of albino Agniae en in0 aD,a:ty .nou:a bo tyrgl cr nrtnwe h.lew N.r:r •Un•evrer